Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. Search terms included (...) “moral injury” and “moral distress,” identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs. (shrink)

This article explores the way the distinction between enhancement and therapy has been used in Catholic bioethics to assess the moral character of technologies that developments in genetics and neuroscience have made possible. The purpose of drawing lines between therapy and enhancement is typically to claim that the former is always ethically justified and the latter is morally suspect, if not altogether impermissible. The author connects the enhancement versus therapy distinction to concepts of human nature that ground it and examines (...) the function of the distinction in these theological anthropologies. She argues that the distinction is insufficient for making decisions regarding use of neurotechnologies. Catholic ethicists thus need to explore alternative methods to begin the essential project of developing neuroethics. National Catholic Bioethics Quarterly 15.1 : 63–72. (shrink)

This book is unique in presenting evidence on development across the lifespan across multiple levels of description. The authors use a well-defined disorder - Williams syndrome, to explore the impact of genes, brain development, behaviour, as well as the individual's environment on development.

The sociologist Fred Davis (1979) was the first to propose that nostalgic reverie plays a role in connecting temporally distinct aspects of the self. His proposal has stood the test of time. Yet, t...

While knowledge represents a valuable commodity, not all forms of knowledge are afforded equal status. The politics of knowledge, which entails the privileging of particular ways of knowing through linkages between the producers of knowledge and other bearers of authority or influence, represents a powerful force driving knowledge development. Within the health research and practice community, biomedical knowledge (i.e. knowledge pertaining to the biological factors influencing health) has been afforded a privileged position, shaping the health research and practice community's view (...) of health, illness and appropriate intervention. The aim of this study is to spark critical reflection and dialogue surrounding the ways in which the politics of knowledge have constrained progress in addressing mental health and illness, one of today's leading public health issues. I argue that the hegemony of biological knowledge represents an ethical issue as it limits the breadth of knowledge available to support practitioners to ‘do good’ in terms of addressing mental illness. Given the power and influence inherent within the nursing community, I propose that nurses ought to engage in critical reflection and action in an effort to better situate the health research and practice community to effectively address the mental health of populations. (shrink)

Though better recognized for its immediate endeavors in human embryo research, the Carnegie Department of Embryology also employed a breeding colony of rhesus macaques for the purposes of studying human reproduction. This essay follows the course of the first enterprise in maintaining a primate colony for laboratory research and the overlapping scientific, social, and political circumstances that tolerated and cultivated the colony’s continued operation from 1925 until 1971. Despite a new-found priority for reproductive sciences in the United States, by the (...) early 1920s an unfertilized human ovum had not yet been seen and even the timing of ovulation remained unresolved. Progress would require an organized research approach that could extend beyond the limitations of working with scant and inherently restrictive human subjects or with common lab mammals like mice. In response, the Department of Embryology, under the Carnegie Institution of Washington, instituted a novel methodology using a particular primate species as a surrogate in studying normal human reproductive physiology. Over more than 40 years the monkey colony followed an unpremeditated trajectory that would contribute fundamentally to discoveries in human reproduction, early embryo development, reliable birth control methods, and to the establishment of the rhesus macaque as a common model organism. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Surprised by DisabilityEmily K. MichaelToday I am meeting Diana, one of my young blind students, for coffee. Soon she will enroll in our summer program that teaches blind teenagers independent living skills and self–advocacy. Her teachers explain that she has prepared questions for me.“So,” Diana begins, as we follow the uneven sidewalk toward the restaurant. “What would you do if you wanted to go outside without your sunglasses?”I can (...) guess why she poses this question, but I conceal my theory for now. Instead, I smile and adjust the large, dark sunglasses that fit over my regular glasses. “Why would I want to do that?”“I don’t know... Just say, you wanted to,” she finishes diffidently. She walks slightly in front of me, the familiar sound of her white cane scraping and tapping against the bricks laid in the sidewalk. I rarely travel with other blind people, so the sound of her cane comforts me.“I’m so sensitive to light that I’d be miserable without my shades,” I explain. I’m careful with my tone here. Like me, Diana is unable to read facial expressions—she listens attentively to vocal cues. She is a smart 13–year–old, and she will notice if I start to sound preachy. [End Page 207]“Okay, so what if you wanted to go out without your cane?”I’m ready for this one: “Diana, my cane keeps me safe. I’m happy to have it with me.” The cane alerts me to vital environmental changes, like the textural difference between sidewalks and streets. Unexpected curbs, sudden stairs, perilous sign-posts, and wayward children become apparent to me through the white cane. It is as if the cane helps sketch the boundaries around me; its contact with objects creates a vivid spatial awareness.I sense that my responses fill Diana with a mixture of defeat and frustration. I have not validated her reticence to use the shades or cane. Nor have I handed her a rhetorical placebo, a catchy phrase she can pull out whenever she feels uncomfortable with her disability. Resisting her white cane and dark glasses, she loathes the idea of looking different. Though neither of us can see others staring, we feel the judgment and pity—and the occasional sense of wonder from those for whom we’re still a novelty, the ones who want to point and exclaim, “Look Ma, a real blind girl!”Both Diana and I carry emblems of blindness that are easily recognized from a distance—visible signs of disability. Other disabled people can “pass” as nondisabled. If they don’t use wheelchairs, crutches, canes, dogs, or braces, no one will know that they have disabilities. Hence, the disabilities that don’t require visible accessories are called “invisible disabilities”—a term that strengthens the connection between disability and appearance.Diana doesn’t want to “look” blind. She wants me to give her an out, to divulge the strategies I’ve devised for leaving the house without my cane and shades. Underneath her casual questions lies the prevailing obsession, “What’s the secret to looking normal?” As a successful blind woman, I must have it figured out. The secret, Diana, is easy to articulate and difficult to enforce. I can write it more readily than I can live it.The secret begins with a very broad spectrum of acceptance. First, I must accept myself as a blind woman who needs a cane and dark glasses to travel in safety and confidence. Then I must accept that these mobility aids are uncommon and highly visible—which means that, almost every time I go out, people will approach me. And lastly, I must accept that the attitudes of others do not determine who I am, that their idea of blindness does not define my experience of it.The white cane was not always easy for me to carry. Though I have been legally blind from birth, I did not use the white cane in my daily life until high school. Before my freshman year, I could pass as nondisabled. At high school, I found myself on a large, crowded campus with only six minutes... (shrink)

Fertility preservation has become more common for various populations, including oncology patients, transgender individuals, and women who are concerned about age-related infertility. Little attention has been paid to fertility preservation for patients with differences/disorders of sex development (DSD). Our goal in this article is to address specific ethical considerations that are unique to this patient population. To this end, we present a hypothetical DSD case. We then explore ethical considerations related to patient’s age, risk of cancer, concern about genetic transmission (...) of a DSD condition to children, co-occurring gender dysphoria, and access to experimental fertility preservation procedures. Given the limitations of current technologies, we recommend offering fertility preservation to individuals living with DSD using an informed decision-making approach that instills realistic expectations and minimizes the potential for false hope. Finally, we conclude with practical recommendations for this case based on the ethical considerations. (shrink)

Though better recognized for its immediate endeavors in human embryo research, the Carnegie Department of Embryology also employed a breeding colony of rhesus macaques for the purposes of studying human reproduction. This essay follows the course of the first enterprise in maintaining a primate colony for laboratory research and the overlapping scientific, social, and political circumstances that tolerated and cultivated the colony's continued operation from 1925 until 1971. Despite a new-found priority for reproductive sciences in the United States, by the (...) early 1920s an unfertilized human ovum had not yet been seen and even the timing of ovulation remained unresolved. Progress would require an organized research approach that could extend beyond the limitations of working with scant and inherently restrictive human subjects or with common lab mammals like mice. In response, the Department of Embryology, under the Carnegie Institution of Washington (CIW), instituted a novel methodology using a particular primate species as a surrogate in studying normal human reproductive physiology. Over more than 40 years the monkey colony followed an unpremeditated trajectory that would contribute fundamentally to discoveries in human reproduction, early embryo development, reliable birth control methods, and to the establishment of the rhesus macaque as a common model organism. (shrink)

Human cooperation is highly unusual. We live in large groups composed mostly of non-relatives. Evolutionists have proposed a number of explanations for this pattern, including cultural group selection and extensions of more general processes such as reciprocity, kin selection, and multi-level selection acting on genes. Evolutionary processes are consilient; they affect several different empirical domains, such as patterns of behavior and the proximal drivers of that behavior. In this target article, we sketch the evidence from five domains that bear on (...) the explanatory adequacy of cultural group selection and competing hypotheses to explain human cooperation. Does cultural transmission constitute an inheritance system that can evolve in a Darwinian fashion? Are the norms that underpin institutions among the cultural traits so transmitted? Do we observe sufficient variation at the level of groups of considerable size for group selection to be a plausible process? Do human groups compete, and do success and failure in competition depend upon cultural variation? Do we observe adaptations for cooperation in humans that most plausibly arose by cultural group selection? If the answer to one of these questions is “no,” then we must look to other hypotheses. We present evidence, including quantitative evidence, that the answer to all of the questions is “yes” and argue that we must take the cultural group selection hypothesis seriously. If culturally transmitted systems of rules that limit individual deviance organize cooperation in human societies, then it is not clear that any extant alternative to cultural group selection can be a complete explanation. (shrink)

Parkinson's disease patients receiving dopaminergic treatment may experience bursts of creativity. Although this phenomenon is sometimes recognized among patients and their clinicians, the association between dopamine replacement therapy in PD patients and creativity remains underexplored. It is unclear, for instance, whether DRT affects creativity through convergent or divergent thinking, idea generation, or a general lack of inhibition. It is also unclear whether DRT only augments pre-existing creative attributes or generates creativity de novo. Here, we tested a group of PD patients (...) when “on” and “off” dopaminergic treatment on a series of tests of creative problem-solving, and related their performance to a group of matched healthy controls as well as to their pre-PD creative skills and measures of inhibition/impulsivity. Results did not provide strong evidence that DRT improved creative thinking in PD patients. Rather, PD patients “on” medication showed less flexibility in divergent thinking, generated fewer ideas via insight, and showed worse performance in convergent thinking overall than healthy controls. Pre-PD creative skills predicted enhanced flexibility and fluency in divergent thinking when PD patients were “on” medication. However, results on convergent thinking were mixed. Finally, PD patients who exhibited deficits in a measure of inhibitory control showed weaker convergent thinking while “on” medication, supporting previous evidence on the importance of inhibitory control in creative problem-solving. Altogether, results do not support the hypothesis that DRT promotes creative thinking in PD. We speculate that bursts of artistic production in PD are perhaps conflated with creativity due to lay conceptions of creativity. (shrink)

Coregulation refers to the process by which relationship partners form a dyadic emotional system involving an oscillating pattern of affective arousal and dampening that dynamically maintains an optimal emotional state. Coregulation may represent an important form of interpersonal emotion regulation, but confusion exists in the literature due to a lack of precision in the usage of the term. We propose an operational definition for coregulation as a bidirectional linkage of oscillating emotional channels between partners, which contributes to emotional stability for (...) both partners. We propose several distinctions and raise unanswered questions that will need to be addressed in order to understand the relevance of coregulation for well-being in adulthood. (shrink)

Children bring intuitive arithmetic knowledge to the classroom before formal instruction in mathematics begins. For example, children can use their number sense to add, subtract, compare ratios, and even perform scaling operations that increase or decrease a set of dots by a factor of 2 or 4. However, it is currently unknown whether children can engage in a true division operation before formal mathematical instruction. Here we examined the ability of 6- to 9-year-old children and college students to perform symbolic (...) and non-symbolic approximate division. Subjects were presented with non-symbolic or symbolic dividends ranging from 32 to 185, and non-symbolic divisors ranging from 2 to 8. Subjects compared their imagined quotient to a visible target quantity. Both children and adults were successful at the approximate division tasks in both dots and numeral formats. This was true even among the subset of children that could not recognize the division symbol or solve simple division equations, suggesting intuitive division ability precedes formal division instruction. For both children and adults, the ability to divide non-symbolically mediated the relation between Approximate Number System acuity and symbolic math performance, suggesting that the ability to calculate non-symbolically may be a mechanism of the relation between ANS acuity and symbolic math. Our findings highlight the intuitive arithmetic abilities children possess before formal math instruction. (shrink)

People in an emotional exchange form a temporal interpersonal emotion system (TIES), in which their emotions are interconnected over time (Butler, 2011). These systems can be in various states, defined by the pattern of emotional interconnections. We have defined coregulation as one such state involving coupled dampened oscillations between partners’ emotions that converge on a stable level. Coregulation could be distinguished from other states, such as stress buffering, by comparing statistical models that represent the theoretical distinctions between states. Optimal data (...) for such modeling includes assessments of both partners’ emotions over time and a contrast between securely attached partners, strangers, and being alone. Research of this sort is needed to uncover the mechanisms by which emotional interdependence promotes well-being. (shrink)

Some individuals facing dementia contemplate hastening their own death: weighing the possibility of living longer with dementia against the alternative of dying sooner but avoiding the later stages of cognitive and functional impairment. This weighing resonates with an ethical and legal consensus in the United States that individuals can voluntarily choose to forgo life‐sustaining interventions and also that medical professionals can support these choices even when they will result in an earlier death. For these reasons, whether and how a terminally (...) ill individual can choose to control the timing of their death is a topic that cannot be avoided when considering the dementia trajectory. With a focus on the U.S. context, this landscape review considers the status of provisions that would legally permit people facing dementia to hasten death with appropriate support from medical professionals. This review can be used to plan and guide clinical and legal practitioner discussion and policy development concerning evolving questions not fully covered by existing medical decision‐making provisions. (shrink)

Women who participate in outdoor recreational activities reap many physical and emotional benefits from their experiences. However, gender-related feelings of objectification, vulnerability, and fear in this space limit women’s participation. In this study, the authors investigate how women pursue their enjoyment of urban outdoor recreation at South Mountain Park in Phoenix, Arizona, despite their perceptions and experiences related to fear of violence. Through surveys and interviews with women who recreate at South Mountain, the authors look at the ways the women (...) cope with their fear using various strategies. This study reveals the gender-related conflicts that persist for participants, who grapple with their appreciation of uncompromised nature and their need to feel safe in this environment. Ultimately, they illustrate how an ongoing negotiation exists for the women as the authors balance choices and concerns related to their outdoor recreation and what aspects of surveillance and control they consider, reject, or accept. (shrink)

Women who are abused by their male intimate partners incur many costs, ranging in severity from fleeting physical pain to death. Previous research has linked the presence of children sired by a woman’s previous partner to increased risk of woman abuse and to increased risk of femicide. The current research extends this work by securing data from samples of 111 unabused women, 111 less severely abused women, 128 more severely abused women, and 26 victims of intimate partner femicide from the (...) Chicago Women’s Health Risk Study to document an ordinal trend in the risk of experiencing more severe forms of violence for women who have children in the household sired by a previous partner. The discussion addresses two potential explanations for this trend and highlights directions for future research. (shrink)

Theories of the genetics underlying punctuated equilibrium (PE) have been vague to date. Here the developmental gene hypothesis is proposed, which states that: 1) developmental regulatory (DevReg) genes are responsible for the orchestration of metazoan morphogenesis and their extreme conservation and mutation intolerance generates the equilibrium or stasis present throughout much of the fossil record and 2) the accumulation of regulatory elements and recombination within these same genes—often derived from transposable elements—drives punctuated bursts of morphological divergence and speciation across metazoa. (...) This two‐part hypothesis helps to explain the features that characterize PE, providing a theoretical genetic basis for the once‐controversial theory. Also see the video abstract here https://youtu.be/C-fu-ks5yDs. (shrink)

The target article suggests inter-individual variability is a weakness of microbiota-gut-brain research, but we discuss why it is actually a strength. We comment on how accounting for individual differences can help researchers systematically understand the observed variance in microbiota composition, interpret null findings, and potentially improve the efficacy of therapeutic treatments in future clinical microbiome research.

Using medical advances to enhance human athletic, aesthetic, and cognitive performance, rather than to treat disease, has been controversial. Little is known about physicians? experiences, views, and attitudes in this regard. We surveyed a national sample of physicians to determine how often they prescribe enhancements, their views on using medicine for enhancement, and whether they would be willing to prescribe a series of potential interventions that might be considered enhancements. We find that many physicians occasionally prescribe enhancements, but doctors hold (...) nuanced and ambiguous views of these issues. Most express concerns about the potential effects of enhancements on social equity, yet many also believe specific enhancements that are safe and effective should be available but not covered by insurance. These apparently contradictory views might reflect inherent tensions between the values of equity and liberty, which could make crafting coherent social policies on medical enhancements challenging. [Supplementary materials are available for this article. Go to the publisher's online edition of American Journal of Bioethics for the following free supplemental resource(s): An additional table (Table 5) referred to on p. 5]. (shrink)

Since the early 1980’s, with the clinical advent of in vitro fertilization resulting in so-called “test tube babies,” a wide array of ethical considerations and concerns regarding artificial womb technology (AWT) have been described. Recent breakthroughs in the development of extracorporeal neonatal life support by means of AWT have reinitiated ethical interest about this topic with a sense of urgency. Most of the recent ethical literature on the topic, however, pertains not to the more imminent scenario of a physiologically improved (...) method of neonatal care through AWT, but instead to the remote scenario of “complete ectogenesis” that imagines human gestation occurring entirely outside of the womb. This scoping review of the ethical literature on AWT spans from more abstract concerns about complete ectogenesis to more immediate concerns about the soon-to-be-expected clinical life support of what we term the fetal neonate or fetonate. Within an organizing framework of different stages of human gestational development, from conception to the viable premature infant, we discuss both already identified and newly emerging ethical considerations and concerns regarding AWT and the care of the fetonate. (shrink)

Recruiting research participants based on genetic information generated about them in a prior study is a potentially powerful way to study the functional significance of human genetic variation, but it also presents ethical challenges. To inform policy development on this issue, we conducted a survey of U.S. institutional review board chairs concerning the acceptability of recontacting genetic research participants about additional research and their views on the disclosure of individual genetic results as part of recruitment. Our findings suggest there is (...) unlikely to be a “one-size-fits-all” solution, but rather several ethically acceptable approaches to genotype-driven recruitment, depending on context. Disclosures made during the consent process for the original study and the clinical validity of the results are key considerations. Researchers must be prepared to communicate and answer questions in clear lay language about what is known and not known regarding the role of genetics in their proposed area of research. (shrink)