Moral distress names a widely discussed and concerning clinician experience. Yet the precise nature of the distress and the appropriate practical response to it remain unclear. Clinicians speak of their moral distress in terms of guilt, regret, anger, or other distressing emotions, and they often invoke them interchangeably. But these emotions are distinct, and they are not all equally fitting in the same circumstances. This indicates a problematic ambiguity in the moral distress concept that obscures its distinctiveness, its relevant circumstances, (...) and how individual clinicians and the medical community should practically respond to it. We argue that, in a range of situations that are said to be morally distressing, the characteristic emotion can be well‐understood in terms of what Bernard Williams calls “agent‐regret.” We show what can thereby be gained in terms of a less ambiguous concept and a more adequate ethical response to this distinctive and complex clinician experience. (shrink)

Kirk Lougheed argues that active euthanasia (here ‘euthanasia’) is impermissible for people who are extremely sick and cannot exercise their vital forcei because (1) exercising vital force does not require volition but only being an object of caring relationships and (2) African philosophy entails other-regarding deontological duties to stay alive.1 In this commentary, we point out an implication of Lougheed’s view that is morally problematic and offer a revision that avoids this implication. We also argue for an additional advantage of (...) this revision. Lougheed’s view implies that a person who is the object of very few relationships has a much weaker duty to stay alive than a person who is well-loved and the object of many relationships. This is because he seems to think that duties to stay alive are derived entirely from one’s relationship with other people. While he is clear that a person, even if terminally ill or permanently unconscious, has a duty to stay alive so that they could remain the object of harmonious relationships, he is silent on whether duties to stay alive could be grounded in reasons that have to do with oneself. Plausibly, on this view, the strength of one’s duty to stay alive depends solely …. (shrink)

This paper defends the idea that phenomenological approaches to self-consciousness can enrich the current analytic philosophy of perception, by showing how phenomenological discussions of minimal self-consciousness can enhance our understanding of the phenomenology of conscious perceptual experiences. As a case study, I investigate the nature of the relationship between naïve realism, a contemporary Anglophone theory of perception, and experiential minimalism (or, the ‘minimal self’ view), a pre-reflective model of self-consciousness originated in the Phenomenological tradition. I argue that naïve realism is (...) not only compatible with, but can be supplemented with experiential minimalism in a novel way. The suggestion is that there are reasons to combine naïve realism and experiential minimalism. My focus here will be on drawing a connection between the notion of minimal self and two core theoretical commitments of naïve realism, relationalism and transparency. (shrink)

Moral distress is complex and has received varied definitions, and its distinctiveness is consequently often unclear when placed alongside related concepts like moral injury or moral stress. Buchbi...

How can we have a sense of the presence of ordinary three-dimensional objects (e.g., an apple on my desk, a partially occluded cat behind a picket fence) when we are only presented with some parts of objects perceived from a particular egocentric viewpoint (e.g., the facing side of the apple, the unoccluded parts of the cat)? This paper presents and defends a novel answer to this question by incorporating insights from two prominent contemporary theories of perception, naïve realism and sensorimotor (...) theory. Naïve realism is the view that perception is fundamentally a matter of obtaining a relation of ‘acquaintance’ with some mind-independent entities (e.g., objects, properties, events). Sensorimotor theory holds that perception involves implicit practical understanding or ‘anticipation’ of the covariance between movements and sensory changes. I argue that perceptual presence is best accounted for in terms of the combination of our direct ‘acquaintance’ with some parts of perceived objects and sensorimotor ‘anticipations’ of how the objects would look different depending on some movements and actions. (shrink)

The majority of workplace incivility research has focused on implications of such acts for victims and observers. We extend this work in meaningful ways by proposing that, due to its norm-violating nature, incivility may have important implications for perpetrators as well. Integrating social norms theory and research on guilt with the behavioral concordance model, we take an actor-centric approach to argue that enacted incivility will lead to feelings of guilt, particularly for prosocially-motivated employees. In addition, given the interpersonally burdensome _as (...) well as_ the reparative nature of guilt, we submit that incivility-induced guilt will be associated with complex behavioral outcomes for the actor across both home and work domains. Through an experience sampling study (Study 1) and two experiments (Studies 2a and 2b), we found that enacting incivility led to increased feelings of guilt, especially for those higher in prosocial motivation (Studies 1 and 2a). In addition, supporting our expectations, Study 1 revealed that enacted incivility—via guilt—led to increased venting to one’s spouse that evening at home, increased performance the next day at work, as well as decreased enacted incivility the next day at work. Our findings demonstrate that enacted incivility has complex effects for actors that span the home and work domains. We discuss the theoretical and practical implications of our results. (shrink)

In this chapter, I will consider Miller’s reading of Augustine on the emotions that should arise in a person who, in pursuing justifiable ends, causes morally undesirable eventualities. Drawing on Miller’s article “Augustine, Moral Luck, and the Ethics of Regret and Shame,” I focus on the concept of what he calls “intrapsychic luck” and argue that it offers a new, further humanizing insight into discourses on moral distress in modern medicine. Moral distress, which was first coined in the nursing literature (...) in 1984, has since gained traction in the wider medical literature, with some now hypothesizing it as a root cause of clinician burnout. I will briefly review this development and re-describe moral distress as a feeling of agent-regret that aptly arises in circumstances of what Miller calls “extrapsychic luck.” On this picture, intrapsychic luck clarifies an added source of moral distress that attends to the self’s anarchic desires. I illustrate this point in terms of the pervasive threats of self-interested careerism and commercialism in modern health care and the clinician’s struggle against self-alienation. I show that this struggle further elucidates moral distress as a deeper problem of professional identity and conclude by considering some practical implications of that insight. (shrink)

The Council on Ethical and Judicial Affairs of the American Medical Association examines physicians’ professional ethical responsibility in the event that the security of patients’ electronic records is breached.

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...) describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. (shrink)

The critique to which Blumenthal-Barby et al. (2022), respond—that philosophy has little left to do in bioethics—reflects a common assumption that normative theorizing first generates general moral...

Philosophically, practical wisdom has been discussed within the context of virtue ethics as a deliberative process or one dependent on a constellation of other virtues. The context of virtue ethics provides additional relevant concepts to consider when defining and measuring practical wisdom. Broadening the psychological perspective to consider the practice of deliberation within decision-making or to examine the contributions of other virtues will advance the understanding of the nuances related to doing the right thing, at the right time, for the (...) right reason toward a moral end. At the same time, with a more developed biological perspective, there can be advancements in the complexity and completeness of the biological model underlying the psychological processes of practical wisdom. Importantly, with a well-developed science of practical wisdom, one can foster behavioral changes in a professional agent conducive to making professionally wise choices. The aim of this collection of essays by experts in the field of practical wisdom is to bring together these multidisciplinary perspectives on the conceptualization of practical wisdom to guide a meaningful integration of concepts of competence and character with care into the education and support of medical professionals. (shrink)

Enck and Condley (2025) draw welcome attention to clinician experiences of “agent-regret.” They define agent-regret broadly as a person’s regret over their “harmful but not wrongful actions,” that...

The majority of workplace incivility research has focused on implications of such acts for victims and observers. We extend this work in meaningful ways by proposing that, due to its norm-violating nature, incivility may have important implications for perpetrators as well. Integrating social norms theory and research on guilt with the behavioral concordance model, we take an actor-centric approach to argue that enacted incivility will lead to feelings of guilt, particularly for prosocially-motivated employees. In addition, given the interpersonally burdensome as (...) well as the reparative nature of guilt, we submit that incivility-induced guilt will be associated with complex behavioral outcomes for the actor across both home and work domains. Through an experience sampling study (Study 1) and two experiments (Studies 2a and 2b), we found that enacting incivility led to increased feelings of guilt, especially for those higher in prosocial motivation (Studies 1 and 2a). In addition, supporting our expectations, Study 1 revealed that enacted incivility—via guilt—led to increased venting to one’s spouse that evening at home, increased performance the next day at work, as well as decreased enacted incivility the next day at work. Our findings demonstrate that enacted incivility has complex effects for actors that span the home and work domains. We discuss the theoretical and practical implications of our results. (shrink)

This thesis is about perceptual experience, its subjective character, and how it is essentially structured. It focuses specifically on how the nature of perception is shaped not only by our acquaintance with the world but also by the very structure of experience itself. My central claim is that perceptual consciousness incorporates different aspects, some of which constitute the very way in which experiences are organized, sustained, and structured. Over the course of this thesis, I develop and defend an original account (...) of the nature of perceptual experience by integrating naïve realism, a prominent contemporary Anglophone theory of perception, with insights and ideas from the Phenomenological tradition. In particular, I argue that there are fruitful grounds for combining naïve realism and a phenomenologically grounded account of the essential structural features of experience (‘minimal self’, ‘temporality’, ‘anticipation’). Naïve realism holds that perception is fundamentally a matter of being in direct contact with some mind-independent entities. Proponents of naïve realism often emphasize the ‘object-dependent’ nature of perception. The appeal to the structural features of experience offers us a promising way to delineate the oft-overlooked ‘subject-dependent’ nature of perception and capture the phenomenological richness of our conscious experiential life. This thesis offers a rich, phenomenologically informed account of the nature of perception which in turn places us in a better position to understand the nature of hallucination. The integration of naïve realism and the structural approach to consciousness I develop in this thesis yields a novel solution to the problem of hallucination: structural disjunctivism. According to this view, the ‘partially overlapping’ psychological nature of perception and hallucination is accounted for in terms of their structural similarities and differences. I seek to show how detailed analyses and reflections on the structures of perceptual experience pave the way to reconceive the phenomenological basis of naïve realism. (shrink)

The last decade has seen an explosion of interest in the health and welfare of marginalized communities around the world. In one striking indicator, public and private development assistance for health programs increased from $8.65 billion in 1998 to $21.79 billion in 2007 [1]. There has been emergent academic interest as well, with growing ranks of undergraduate and graduate students and professionals adopting the field as their specialty. Despite the burgeoning interest, however, much about the field remains unclear. Reimagining Global (...) Health is an important contribution to this budding field for two reasons: it proposes a cohesive introductory text for a field in desperate need of one, and it seeks to “reimagine” some key concepts in global health in an effort to provide a bold new direction for the field. Its stated aim is to move global health from a mere “collection of problems” into an identifiable discipline .As a textbook, the work succeeds admirably. The book .. (shrink)