Le Poidevin has recently presented an argument that gives rise to a serious problem for relationist theories of space. It appeals to the simple geometrical fact that if A, B and C are three points lying in a straight line, then AB and BC together entail AC. He suggests that an ontological relationship of supervenience must be appealed to to explain this entailment. Given this thesis of supervenience, relationism is implausible. I argue that the problem that Le Poidevin raises for (...) relationism should be rejected, because the thesis of supervenience is false. The latter rests upon what Le Poidevin refers to as ‘The explanatory principle', a principle which he claims to be a natural extension of the truthmaker principle. Contrary to this, I argue that given any plausible theory of truthmaking, the explanatory principle is false. With the rejection of this principle, Le Poidevin's argument against relationism collapses. (shrink)

Given Kim’s principle of explanatory exclusion (EE), it follows that in addition to the problem of mental causation, dualism faces a problem of mental explanation. However, the plausibility of EE rests upon the acceptance of a further principle concerning the individuation of explanation (EI). The two methods of defending EI—either by combining an internal account of the individuation of explanation with a semantical account of properties or by accepting an external account of the individuation of explanation—are both metaphysically implausible. This (...) is not, however, to reject the problem of mental explanation, for EE can be replaced with a far weaker principle, which does not require the acceptance of EI, but which generates a similar problem for dualism. (shrink)

Proponents of the subset account of property realization commonly make the assumption that the summing of properties entails the summing of their forward-looking causal features. This paper seeks to establish that this assumption is false. Moreover, it aims to demonstrate that without this assumption the fact that the subset account captures an entailment relation—which it must if it is to be of any use to non-reductive physicalism—becomes questionable.

I defend a dualist model of psychophysical causal relevance, according to which mental events are not causes in the physical domain, but are causally relevant in this domain because they enable — or, in other words, provide the appropriate structure for — physical events to be caused. More specifically, I defend the claim that mental events are ‘double preventers’ within the physical domain, where double preventers are a type of enabling event. The distinction that I make between causes and enabling (...) events and the dualist model of psychophysical causal relevance that I defend has emerged from my acceptance of the powers theory of causation. In this paper, I explore how this dualist model of psychophysical causal relevance offers a response to Papineau’s defence of the causal completeness principle via the conservation laws. (shrink)

According to one popular criterion of property identity, where X and Y are properties, X is identical with Y if and only if X and Y bestow the same conditional powers on their bearers. In this paper, I argue that this causal criterion of property identity is unsatisfactory, because it fails to provide a sufficient condition for the identification of properties. My argument for this claim is based on the observation that the summing of properties does not entail the summing (...) of the conditional powers that they bestow on an object, but, rather, in some cases their subtraction. If so, the following causal structure seems possible: There are two properties, A and B. Each bestows a different set of conditional powers on its bearer, but the conjunctive property A-and-B bestows exactly the same set of conditional powers as either A or B. If this causal structure is possible, then it creates a serious problem for the causal criterion of property identity. (shrink)

The Mind in Nature has two central aims. First, that of defending a ‘basic ontology’. Second, having advanced a plausible ontological framework, to appeal to it to cast light on the status of intentionality and the nature of consciousness, paying particular attention to the question of what distinguishes conscious systems from those that are vegetative.Central to Martin's basic ontology is his acceptance of a realist conception of dispositionality. Contrary to the view of David Lewis and others, talk about a thing's (...) dispositions cannot be analysed as talk about a thing's behaviour in a set of counterfactual circumstances . The account of dispositions that emerges from Martin's discussion is one according to which a specific disposition is either actual or it is not. To be actual a disposition need not be manifesting any manifestation. Unmanifesting dispositions are not, therefore, unactualized possibilia – a description which, he observes, is more fitting of unmanifested manifestations . In advancing a realist conception of dispositionality, Martin also opposes those who maintain that dispositional properties reduce to …. (shrink)

Recently, the European Union decreed that European countries should use disclosures of brand placement in programs and movies on television to guarantee fair communication. However, an understanding of the effects of disclosing brand placement is lacking. The present study is the first to test the impact of the new TV sponsorship regulations regarding disclosure of brand placement. In an experiment, we examine viewers’ opinions about disclosures along with the effects of disclosure timings. Analyses show that brand memory increases when a (...) disclosure is shown. In addition, brand memory is significantly higher when the disclosure is shown during the placement than when it is shown after the placement. Disclosures do not seem to activate critical attitudes. Respondents confronted with a disclosure, regardless of the timing, were not more skeptical towards brand placement than respondents who were not exposed to a disclosure. These findings have important implications for theory and public policy regarding brand placement disclosures. (shrink)

Advances in the understanding of Ras oncoprotein function suggest novel points for anti‐tumor intervention. First, upstream‐acting guanine nucleotide exchange factors and SH2/SH3 domain‐containing adaptor proteins that link Ras with growth factor receptor tyrosine kinases have recently been characterized. Second, work on downstream‐acting Ras effector functions including the Ras GTPase‐activating protein (p120GAP) and the Raf kinase has revealed direct biochemical interactions that are functionally required for oncogenic Ras signalling. We summarize progress in these areas and discuss the potential for novel applications (...) to anti‐cancer chemotherapy. (shrink)

BackgroundRelatives have no formal position in the practice of euthanasia and physician-assisted suicide (EAS) according to Dutch legislation. However, research shows that physicians often involve relatives in EAS decision-making. It remains unclear why physicians do (not) want to involve relatives. Therefore, we examined how many physicians in the Netherlands involve relatives in EAS decision-making and explored reasons for (not) involving relatives and what involvement entails.MethodsIn a mixed-methods study, 746 physicians (33% response rate) completed a questionnaire, and 20 were interviewed. The (...) questionnaire included two statements on relatives’ involvement in EAS decision-making. Descriptive statistics were used, and multivariable logistic regression analyses to explore characteristics associated with involving relatives. In subsequent interviews, we explored physicians’ views on involving relatives in EAS decision-making. Interviews were thematically analysed.ResultsThe majority of physicians want to know relatives’ opinions about an EAS request (80%); a smaller group also takes these opinions into account in EAS decision-making (35%). Physicians who had ever received an explicit EAS request were more likely to want to know opinions and clinical specialists and elderly care physicians were more likely to take these opinions into account. In interviews, physicians mentioned several reasons for involving relatives: e.g. to give relatives space and help them in their acceptance, to tailor support, to be able to perform EAS in harmony, and to mediate in case of conflicting views. Furthermore, physicians explained that relatives’ opinions can influence the decision-making process but cannot be a decisive factor. If relatives oppose the EAS request, physicians find the process more difficult and try to mediate between patients and relatives by investigating relatives’ objections and providing appropriate information. Reasons for not taking relatives’ opinions into account include not wanting to undermine patient autonomy and protecting relatives from a potential burdensome decision.ConclusionsAlthough physicians know that relatives have no formal role, involving relatives in EAS decision-making is common practice in the Netherlands. Physicians consider this important as relatives need to continue with their lives and may need bereavement support. Additionally, physicians want to perform EAS in harmony with everyone involved. However, relatives’ opinions are not decisive. (shrink)

The Routledge Handbook of Emergence is an outstanding reference source and exploration of the concept of emergence, and is the first collection of its kind.

Power and authority in terms of the Ten Commandments (TCs) are discussed. The paper reviews the TCs in Christianity, Judaism, and Islam. The treatment and basis for power and authority in each religion are clarified. Implications of power and authority using the perspective of the TCs are provided. The paper suggests that in today's business environment people tend to be selective in identifying only with certain elements of the TCs that fit their interest and that the TCs should be viewed (...) as general moral guidelines. (shrink)

The current debate on “free agency” seems to highlight the romantic aspects of free agent and considers it a genuine response to changing economic conditions (e.g., high-unemployment rate, importance of knowledge in the labor market, the eclipse of organizational loyalty, and self pride). Little attention, if any, has been given to the religious root of the free agency concept and its persistent existence across history. In this paper, the current discourse on free agency and the conditions that have led to (...) its emergence are briefly discussed. The paper focuses on the theological perspectives of Judaism, Christianity, and Islam on the concept. Implications for management and business organizations are provided. (shrink)

BackgroundInvolvement of adolescent girls in biomedical HIV research is essential to better understand efficacy and safety of new prevention interventions in this key population at high risk of HIV infection. However, there are many ethical issues to consider prior to engaging them in pivotal biomedical research. In Uganda, 16–17-year-old adolescents can access sexual and reproductive health services including for HIV or other sexually transmitted infections, contraception, and antenatal care without parental consent. In contrast, participation in HIV prevention research involving investigational (...) new drugs requires adolescents to have parental or guardian consent. Thus, privacy and confidentiality concerns may deter adolescent participation. We describe community perspectives on ethical considerations for involving adolescent girls in the MTN 034 study in Uganda.MethodsFrom August 2017 to March 2018, we held five stakeholder engagement meetings in preparation for the MTN 034 study in Kampala, Uganda (NCT03593655): two with 140 community representatives, two with 125 adolescents, and one with 50 adolescents and parents. Discussions were moderated by the study team. Proceedings were documented by notetakers. Summary notes described community perspectives of adolescent participation in HIV research including convergent, divergent or minority views, challenges, and proposed solutions.ResultsMost community members perceived parental or guardian consent as a principal barrier to study participation due to concerns about adolescent disclosure of pre-marital sex, which is a cultural taboo. Of 125 adolescent participants, 119 (95%) feared inadvertent disclosure of sexual activity to their parents. Community stakeholders identified the following critical considerations for ethical involvement of adolescents in HIV biomedical research: (1) involving key stakeholders in recruitment, (2) ensuring confidentiality of sensitive information about adolescent sexual activity, (3) informing adolescents about information to be disclosed to parents or guardians, (4) offering youth friendly services by appropriately trained staff, and (5) partnering with community youth organizations to maximize recruitment and retention.ConclusionsStakeholder engagement with diverse community representatives prior to conducting adolescent HIV prevention research is critical to collectively shaping the research agenda, successfully recruiting and retaining adolescents in HIV clinical trials and identifying practical strategies to ensure high ethical standards during trial implementation. (shrink)

The conservation laws do not establish the central premise within the argument from causal overdetermination – the causal completeness of the physical domain. Contrary to David Papineau, this is true even if there is no non-physical energy. The combination of the conservation laws with the claim that there is no non-physical energy would establish the causal completeness principle only if, at the very least, two further causal claims were accepted. First, the claim that the only way that something non-physical could (...) affect a physical system is by affecting the amount of energy or momentum within it, or redistributing the energy and momentum within it. Second, the claim that redistribution of energy and momentum cannot be brought about without supplying energy or momentum. Both of these claims, however, are exceedingly difficult to defend in the context of the argument. (shrink)

Mental causation has been a hotly disputed topic in recent years, with reductive and non-reductive physicalists vying with each other and with dualists over how to accommodate, or else to challenge, two widely accepted metaphysical principles—the principle of the causal closure of the physical domain and the principle of causal non-overdetermination—which together appear to support reductive physicalism, despite the latter’s lack of intuitive appeal. Current debate about these matters appears to have reached something of an impasse, prompting the question of (...) why this should be so. One possibility well worth exploring is that, while this debate makes extensive use of ontological vocabulary—by talking, for instance, of substances, events, states, properties, powers, and relations—relatively little attempt has been made within the debate itself to achieve either clarity or agreement about what, precisely, such terms should be taken to mean. Hence, the debate has become somewhat detached from broader developments in metaphysics and ontology, which have lately been proceeding apace, providing us with an increasingly rich and refined set of ontological categories upon which to draw, as well as a much deeper understanding of how they are related to one another. In preparing this volume, the editors invited leading metaphysicians and philosophers of mind to reflect afresh upon the problem of mental causation in the light of some of these recent developments, with a view to making new headway with one of the most challenging and seemingly intractable issues in contemporary philosophy. (shrink)

Despite the fact that Davidson's theory of the causal relata is crucial to his response to the problem of mental causation - that of anomalous monism - it is commonly overlooked within discussions of his position. Anomalous monism is accused of entailing property epiphenomenalism, but given Davidson's understanding of the causal relata, such accusations are wholly misguided. There are, I suggest, two different forms of property epiphenomenalism. The first understands the term 'property' in an ontological sense, the second in a (...) linguistic sense. Anomalous monism cannot plausibly be accused of either. The first cannot legitimately be applied to anomalous monism as it is incompatible with Davidson's ontology. And accusations of predicate epiphenomenalism, although consistent with Davidson's ontology, are ungrounded regarding Davidson's anomalous monism. Philosophers of mind have mislocated the problem with Davidson's anomalous monism, which in fact lies with the implausible theory of the causal relata upon which it rests. (shrink)

In the contemporary mental causation debate, two dualist models of psychophysical causal relevance have been proposed which entail that although mental events are causally relevant in the physical domain, this is not in virtue of them causing any physical event. It is widely assumed that the principle of the causal completeness of the physical domain provides a general argument against interactive dualism. But, whether the completeness principle presents a problem for these alternative forms of interactive dualism is questionable. In this (...) paper, focusing on the popular no-gap argument for the completeness principle, I explore one reason why. (shrink)

According to the partial identity account of resemblance, exact resemblance is complete identity and inexact resemblance is partial identity. In this paper, I examine Arda Denkel's (1998) argument that this account of resemblance is logically incoherent as it results in a vicious regress. I claim that although Denkel's argument does not succeed, a modified version of it leads to the conclusion that the partial identity account is plausible only if the constituents of every determinate property are ultimately quantitative in nature.

Closure is the central premise in one of the best arguments for physicalism—the argument from causal overdetermination. According to Closure, at every time at which a physical event has a sufficient cause, it has a sufficient physical cause. This principle is standardly defended by appealing to the fact that it enjoys empirical support from numerous confirming cases (and no disconfirming cases) in physics. However, in recent literature on mental causation, attempts have been made to provide a stronger argument for it. (...) This essay argues that, insofar as these attempts are successful, they actually establish a far stronger closure principle. Worryingly, the acceptance of this stronger principle presents a new problem for the most popular form of physicalism, that of nonreductive physicalism. The problem shall be referred to as the 'Problem of Strong Closure.'. (shrink)

Emergence is often described as the idea that the whole is greater than the sum of the parts: interactions among the components of a system lead to distinctive novel properties. It has been invoked to describe the flocking of birds, the phases of matter and human consciousness, along with many other phenomena. Since the nineteenth century, the notion of emergence has been widely applied in philosophy, particularly in contemporary philosophy of mind, philosophy of science and metaphysics. It has more recently (...) become central to scientists' understanding of phenomena across physics, chemistry, complexity and systems theory, biology and the social sciences. The Routledge Handbook of Emergence is an outstanding reference source and exploration of the concept of emergence, and is the first collection of its kind. Thirty-two chapters by an international team of contributors are organised into four parts: Foundations of emergence Emergence and mind Emergence and physics Emergence and the special sciences Within these sections important topics and problems in emergence are explained, including the British Emergentists; weak vs. strong emergence; emergence and downward causation; dependence, complexity and mechanisms; mental causation, consciousness and dualism; quantum mechanics, soft matter and chemistry; and evolution, cognitive science and social sciences. Essential reading for students and researchers in philosophy of mind, philosophy of science and metaphysics, The Routledge Handbook of Emergence will also be of interest to those studying foundational issues in biology, chemistry, physics and psychology. (shrink)

This book explores a range of traditional and contemporary metaphysical themes that figure in the writings of E. J. Lowe, whose powerful and influential work was still developing at the time of his death in 2015. Leading philosophers present new essays on topics to do with ontology, necessity, existence, and mental causation.

This paper serves two purposes: first, the proposition of an ethical fiduciary theory that substantiates the often-cited assertion that the patient–physician relationship is fiduciary in nature; and second, the application of this theory to the case of informed consent. Patients’ decision-making preferences vary significantly. While some seek fully autonomous decision-making, others prefer to delegate parts of their decision. Therefore, we propose an ethical fiduciary theory that allows physician and patient to jointly determine the physician’s role on a spectrum from fiduciary (...) as advisor to fiduciary as agent. Drawing on legal concepts of the fiduciary relationship and on phenomenological accounts of obligation by Lévinas and Løgstrup, our theory relies on the key attributes of trust, vulnerability and otherness. Finally, practical implications of this theory for the informed consent process are developed: we propose a preassessment of patients’ risk and value profiles as well as a restructuring of the oral consent interview and the written consent materials. (shrink)

This book presents engaging and informative analysis of three interrelated notions, namely: selfhood, the first person pronoun ‘I’ and the first person perspective. Philosophers have long debated about these notions on non-empirical grounds often focusing on the question of whether the first person pronoun ‘I’, beyond its role as a grammatical term, has an underlying implication for the ontology of selfhood. Philosophers continuously grapple with whether the first person pronoun ‘I’ is a referring expression and if it is, what its (...) referent is or could be. To give an adequate treatment of such questions, philosophers have begun working across the relevant disciplines. This book highlights some excellent examples of the complex nature of the first person thoughts as they figure in linguistics, autism, thought insertion in schizophrenia and the phenomenon of mental autonomy. In Selfhood, Autism and Thought Insertion, many of the leading philosophers working on this issue, as well as a few emerging scholars, have written 12 new essays addressing questions besetting the ontology of selfhood. The essays address topics as diverse as reflections on E. J. Lowe’s non-Cartesian substance dualism, physical determinism, the metaphysics and anti-metaphysics of the self, animalism, neo-Lockean persons, rationality and the first-person, whether the first person is essentially a linguistic concept, first-person and third-person perspectives and autism, consciousness, first person perspective and neuroimaging, thought insertion and mental autonomy. The contributors to this volume do not agree in all of the details associated with the notion of selfhood, yet they all have a common conviction that the central questions besetting it must be taken seriously. (shrink)

The British Medical Association has published a new report on health and human rights in immigration detention in the UK. Locked up, locked out outlines how aspects of current detention policies and practices are detrimental to the health of those detained and the challenges doctors face in providing healthcare in the immigration detention setting. It makes a number of recommendations aimed at addressing policy and practice which impact on health and well-being, including calling for an end to the routine use (...) of detention as a means of monitoring those facing removal from the UK and for the introduction of a time limit on the length of time individuals can be detained. It also provides guidance for doctors working in these settings on some of the common ethical and professional dilemmas they may face. The report can be accessed and downloaded at www.bma.org.uk/immigrationdetention. The Government has announced its intention to review mental health legislation for England and, in relation to non-devolved issues, for Wales.1 The Government states that it is ‘committed to delivering parity of esteem between mental and physical health’, although it does not clarify the meaning of ‘parity of esteem’. Similarly, the Government states that it wants to ensure that people with mental health problems ‘are treated with dignity, and that their liberty and autonomy is respected as far as possible’. Again, the Government has not indicated the meaning of ‘as far as possible’. Although not directly mentioned in the review’s terms of reference, it must be set against the background of changing legal and ethical expectations in relation to the rights of those with mental or cognitive disorders and disabilities. The UK is a signatory to the United Nations Convention on the Rights of People with …. (shrink)

Erdoğan intensifies assault on Turkish civil society Deeply worrying reports from the Turkish Medical Association suggest that the Turkish President Recep Erdoğan is hardening his attack on civil society in Turkey, using the legitimate activities of the TTB as the flimsiest of pretexts. In January 2018, the TTB issued a short statement raising concerns about the impact on public health of Turkey’s military operation in the Kurdish-controlled region of northern Syria. It denounced the operation saying ‘No to war, peace immediately’. (...) In response to the Association’s press release, the Turkish president publicly accused the 83 000 strong TTB of being terrorist sympathisers. ‘This institution has nothing to do with Turkishness and nothing about them is worthy of the notion of Turkishness’, he said. 1 Eleven of its senior doctors, including the Association’s chairman, were later detained following an order from a Turkish prosecutor. President Erdoğan made it... (shrink)

In February 2014, the Belgian Parliament passed legislation allowing euthanasia for terminally ill children of all ages by 86 votes to 44, with 12 abstentions. The Bill became law in early March after being signed by the King, making Belgium the first country in the world to abolish age restrictions for euthanasia. Previously, the youngest age at which euthanasia was permitted was 12 years old in The Netherlands.1Euthanasia was legalised in Belgium in 2002, and the new legislation introduces amendments to (...) the law extending euthanasia to minors in certain circumstances. Euthanasia is now permissible for children of all ages where the child has a “terminal and incurable illness”, experiences “constant and unbearable physical suffering”, and death is expected to occur within a “brief period”. The child must be deemed capable of making the decision, and have the agreement of their parents.Belgian law sets no timetable for euthanasia from the point at which the patient first expresses a wish to die. As with adults seeking euthanasia, any request must be made in writing. A physician and “outsider” brought in to give a second opinion must agree upon the diagnosis and prognosis, and a paediatric psychiatrist or psychologist must certify in writing that the child possesses “the capacity of discernment”. Following this, the child's physician must meet with the parents to inform them of the outcome of the consultation and ensure they are in agreement with the child's request. The child and the family must receive psychological care and support if so desired.The move provoked heated debate and divided the medical, legal and political professions in Belgium. A group of 160 of the country's paediatricians opposed a change in the law, citing concerns about the largely subjective assessment of the “capacity of discernment”, and drawing attention to advances in …. (shrink)

Animal and plant species exhibit an astonishing diversity of sexual systems, including environmental and genetic determinants of sex, with the latter including genetic material in the mitochondrial genome. In several hermaphroditic plants for example, sex is determined by an interaction between mitochondrial cytoplasmic male sterility (CMS) genes and nuclear restorer genes. Specifically, CMS involves aberrant mitochondrial genes that prevent pollen development and specific nuclear genes that restore it, leading to a mixture of female (male‐sterile) and hermaphroditic individuals in the population (...) (gynodioecy). Such a mitochondrial‐nuclear sex determination system is thought to be rare outside plants. Here, we present one possible case of CMS in animals. We hypothesize that the only exception to the strict maternal mtDNA inheritance in animals, the doubly uniparental inheritance (DUI) system in bivalves, might have originated as a mitochondrial‐nuclear sex‐determination system. We document and explore similarities that exist between DUI and CMS, and we propose various ways to test our hypothesis. (shrink)

Doctors and medical students in the UK have voted in support of the decriminalisation of abortion for women who self-administer abortions and healthcare professionals who provide abortions within the context of their clinical practice. Abortion should be treated as a medical issue rather than a criminal one. ### Background to the vote The vote took place at the end of June during the British Medical Association’s Annual Representative Meeting, where representatives of doctors and medical students from across the British Isles (...) gathered to set BMA policy through democratic procedures. Representatives considered the issue of decriminalisation during a 2-hour debate, where diverse and opposing viewpoints were heard. The debate was informed by a neutral discussion paper that was published by the BMA in February, which provided a guide to some of the key legal and ethical issues raised by the debate around decriminalisation.1 The BMA’s new policy only relates to whether abortion should or should not be a criminal offence; the policy does not address the broader issue of when and how abortion should be available. The BMA has established policy on these issues which remains unchanged.2 ### The law on abortion Induced abortion is currently a crime throughout the British Isles. There are, however, a range of exceptions to the crime laid out in statute and/or common law, for example, in England, Scotland and Wales, under the Abortion Act 1967. Any healthcare professionals operating within those defined exceptions, which include grounds for authorising an abortion and procedural requirements, can lawfully carry out an abortion as a clinical procedure. Outside these defined exceptions, the criminal offences potentially apply both to those who participate in carrying out abortions for others, including doctors, nurses and midwives, and to women who carry out abortions on themselves. For example, healthcare professionals who do not follow procedural requirements can attract criminal sanctions …. (shrink)

Essex University, in association with Johns Hopkins Center for Public Health and Human Rights, has brought out a timely report highlighting the increasing global criminalisation of the provision of healthcare.1 The report, with a foreword by Professor Dainius Puras, United Nations Special Rapporteur on the right to health, explores the pressures on medical impartiality arising in large part from both global and national responses to the threat of terrorism. Both international humanitarian law, human rights law and long-established principles of medical (...) ethics—as set out in various declarations of the World Medical Association—establish an absolute principle that all people, regardless of their beliefs, affiliation or status, have rights of access to appropriate healthcare. And this right extends to wounded and sick combatants, as well as civilians, during times of armed conflict. One of the challenges in this area is that in recent years, many conflicts have become ‘asymmetric’. Contemporary conflicts seldom involve opposing state armies. Instead, they increasingly involve irregular combatants, often labelled ‘terrorists’ or ‘insurgents’ by the states they are opposing. In response to these threats, many states have developed sometimes draconian legislation outlawing terrorist groups and those offering support. The danger, outlined in some detail in the report, is that the vital distinction between the impartial provision of medical care and the criminal offence of materially aiding terrorism is lost. In 2016, largely in response to the deliberate targeting of healthcare personnel and facilities in the conflicts disfiguring the greater Middle …. (shrink)

In June 2021, the BMA published its report on moral distress and moral injury in UK doctors.1 The report includes definitions of the terms ‘moral distress’ and ‘moral injury’ as well as a summary of how the concepts have developed over time. There is also an analysis of the BMA’s pan-profession survey of moral distress and moral injury of doctors in the UK, the first of its kind. The impact of COVID-19 and recommendations for tackling moral distress also feature. Many (...) may be unfamiliar with the concepts of ‘moral distress’ and ‘moral injury’. These terms are relatively new, and debate is ongoing in academic circles on the best way to understand them.2 Some use the terms interchangeably. The BMA defines moral distress as the psychological unease generated where professionals identify an ethically correct action to take but are constrained in their ability to take that action. Even without an understanding of the morally correct action, moral distress can arise from the sense of a moral transgression. More simply, it is the feeling of unease stemming from situations where institutionally required behaviour does not align with moral principles. This can be as a result of a lack of power or agency, or structural limitations, such as insufficient staff, resources, training or time. The individual suffering from moral distress need not be the one who has acted or failed to act; moral distress can be caused by witnessing moral transgressions by others. Moral injury can arise where sustained moral distress leads to impaired function or longer-term psychological harm. Moral injury can produce profound guilt and shame, and in some cases also a sense of betrayal, anger and profound ‘moral disorientation’. It has also been linked to severe mental health issues. There is increasing recognition across the UK of the problem …. (shrink)