Presents a plethora of approaches to developing human potential in areas not conventionally addressed. Organized in two parts, this international collection of essays provides viable educational alternatives to those currently holding sway in an era of high-stakes accountability.

Background: The Voluntary Assisted Dying Act 2017 passed into law in Victoria, Australia, on the 29 November 2017. Internationally, nurses have been shown to be intimately involved in patient care throughout the voluntary assisted dying process. However, there is a paucity of research exploring Australian nurses’ perspectives on voluntary assisted dying and, in particular, how Victorian nurses anticipate the implementation of this ethically controversial legislation will impact their professional lives. Objectives: To explore Victorian nurses’ expectations of the ethical and practical (...) impacts the voluntary assisted dying legislation will have on their professional lives. Research design: This qualitative study analysed nurses’ free text responses collected as part of a larger mixed methods online survey investigating staff views on the Voluntary Assisted Dying Act. Data were collected during the period between the passing of the voluntary assisted dying legislation and the start date and were analysed using inductive content analysis. Participants and research context: Free text survey responses were analysed from 1873 nurses employed across seven Victorian health services located in both metropolitan and regional areas of the state. Ethical considerations: The study obtained research ethics approval and all participants were informed of the voluntary and anonymous nature of their participation. Findings: This study identified three broad areas of Victorian nurses’ professional lives that they expected to be impacted by the implementation of voluntary assisted dying: professional identity, career development and workplace relationships. Conclusion: Participants anticipate diverse and nursing-specific impacts of the implementation of voluntary assisted dying in Victoria. Their insights can inform health services in jurisdictions considering or already implementing voluntary assisted dying, to develop policies, procedures and staff training programmes that safeguard the well-being and legal rights of their nursing staff. (shrink)

It has been said that pragmatism's "merely instrumental" truths fail to motivate radical change whereas absolute ideals make excellent guiding and driving forces for justice. However, in Radical Equations: Math Literacy and Civil Rights, Robert Moses speaks of the radical success of pragmatic principles, used in the Civil Rights Movement, that are continued today in the Algebra Project. This paper applies Dewey's claims about education and community to Moses's own arguments as a means of depicting the role that pragmatic ideals (...) play in achieving radical social change. (shrink)

In a crisis, societal needs take precedence over a patient’s best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. (...) But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When “triaging” or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies. (shrink)

This paper raises a worry about the non-identity intuition. As one part of the non-identity problem, the non-identity intuition tells us that when choosing between bringing a person with a good life into existence and bringing a person with a great life into existence, we have moral reason to bring the person with a great life into existence. But there is a worry to be had about the non-identity intuition. Because the non-identity intuition compares future persons exclusively in regard to (...) their well-being, the non-identity intuition values future persons solely for the well-being enjoyed by each of them. Therefore, or so the worry goes, the non-identity intuition fails to be compatible with what it means to value persons for their own sake. (shrink)

Although pride has been central to philosophical and religious discussions of emotion for thousands of years, it has largely been neglected by psychologists. However, in the past decade a growing body of psychological research on pride has emerged; new theory and findings suggest that pride is a psychologically important and evolutionarily adaptive emotion. In this article we review this accumulated body of research and argue for a naturalist account of pride, which presumes that pride emerged by way of natural selection. (...) In this view, pride is prevalent in human life because of the functional and adaptive role it has played in the attainment, maintenance, and communication of social status throughout our evolutionary history. (shrink)

The COVID-19 pandemic has presented a global threat to physical and mental health worldwide. Research has highlighted adverse impacts of COVID-19 on wellbeing but has yet to offer insights as to how wellbeing may be protected. Inspired by developments in wellbeing science and guided by our own theoretical framework, we examined the role of various potentially protective factors in a sample of 138 participants from the United Kingdom. Protective factors included physical activity, tragic optimism, gratitude, social support, and nature connectedness. (...) Initial analysis involved the application of one-sample t-tests, which confirmed that wellbeing in the current sample was significantly lower compared to previous samples. Protective factors were observed to account for up to 50% of variance in wellbeing in a hierarchical linear regression that controlled for a range of sociostructural factors including age, gender, and subjective social status, which impact on wellbeing but lie beyond individual control. Gratitude and tragic optimism emerged as significant contributors to the model. Our results identify key psychological attributes that may be harnessed through various positive psychology strategies to mitigate the adverse impacts of hardship and suffering, consistent with an existential positive psychology of suffering. (shrink)

It is often said that consequentialism violates the separateness of persons. But what does this mean? Existing interpretations are often unclear, or let consequentialism off easy: because they target amendable parts of the consequentialist framework, they can be sidestepped by more subtle versions of the theory. Consequentialism's opponents, however, might hope for a stronger interpretation––one which suggests that the separateness of persons objection presses a distinct and powerful charge against consequentialist theory. This paper proposes such an interpretation. It starts from (...) the fact that, unlike other moral theories, consequentialism determines how to act by looking at features such as states of affairs or outcomes. Yet, crucially, states of affairs or outcomes often make reference to, or extend across, more than one person. Thus, they implicitly and necessarily group together different individuals. In the proposal of this paper, it is this part of consequentialism which violates the separateness of persons. (shrink)

Common-sense morality seems to tell us that a rescuer who can save either one individual or five other individuals from death has a duty to save the greater number. But contractualism, a moral theory on which principles must be justifiable to individuals, seems to imply that it is permissible to save the one. This is because a commitment to individual justification blocks the possibility of appealing to the aggregate amount of lives saved. Does contractualism really have this implication? If so, (...) should we side with the common-sense approach, or is there any reason to side with the contractualist? In this paper, I first examine a new argument from Jay Wallace which claims to reconcile contractualism with a duty to save the greater number. I find the argument to be unsuccessful. I then suggest that common-sense morality doesn't support a duty to save the greater number as straightforwardly as it might initially seem as it might initially seem. I introduce two mundane cases in which the permissibility of saving either the lesser or greater number is intuitively plausible, and I offer some reasons to think that the permissibility of saving the lesser number coheres with our value judgements more generally. (shrink)

The United States, along with other nations and international organizations, has developed an elaborate system of ethical norms and legal rules to govern biomedical research using human subjects. These policies govern research that might provide direct health benefits to participants and research in which there is no prospect for participant health benefits. There has been little discussion, however, about how well these rules would apply to research designed to improve participants’ capabilities or characteristics beyond the goal of good health. When (...) mentioned at all in the literature, this so-called enhancement research, as opposed to research aimed at diagnosing, preventing, curing, or treating illnesses or medical conditions, is usually dismissed without explanation. (shrink)

Williams and DeSteno (2010) and Gladkova (2010) question the validity, utility, and theoretical support for the bifurcation of pride into hubristic and authentic facets. Though these commentators highlight unanswered questions and important directions for future research, we argue that the broad, evolutionarily informed framework for the two facets, presented in our target article nonetheless provides the best fit and explanation for the existing pattern of evidence. We offer several empirical suggestions for future studies addressing the questions raised by the commentators, (...) and emphasize the need for emotion researchers to hew closely to empirical data in developing theoretical accounts. (shrink)

Emerging adult newlywed couples often experience many demands on their time, and three common problems may surface as couples try to balance these demands—problems related to finances, sleep, and sex. We used two waves of dyadic data from 1,001 emerging adult newlywed couples to identify four dyadic latent profiles from husbands’ and wives’ financial management behaviors, sexual satisfaction, and sleep quality: Flounderers, Financially Challenged Lovers, Drowsy Budgeters, and Flourishers. We then examined how husbands’ and wives’ marital satisfaction, in relation to (...) profile membership, varied at a later wave. We found that Financially Challenged Lovers and Flourishers had significantly higher marital satisfaction than Drowsy Budgeters and Flounderers. Whereas, Financially Challenged Lovers and Flourishers did not differ in terms of marital satisfaction, Drowsy Budgeters seemed to have slightly higher marital satisfaction than Flounderers for wives only. However, we did not find evidence that these connections meaningfully differed by sex. Implications for the efforts of clinicians and educators are discussed. (shrink)

In Clark’s thoughtful analysis of the evolution of the two facets of pride, he suggests that the concurrent existence of hubristic and authentic pride in humans represents a “persistence problem,” wherein the vestigial trait (hubristic pride) continues to exist alongside the derived trait (authentic pride). In our view, evidence for the two facets does not pose a persistence problem; rather, hubristic and authentic pride both likely evolved as higher-order cognitive emotions that solve uniquely human—but distinct— evolutionary problems. Instead of being (...) conceptualized as serial homologues, with one the vestigial form of the other, we argue that hubristic and authentic pride are both derived homologues of a vestigial proto-pride emotion that existed in our shared ancestry with other primates. (shrink)

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

The dual-code proposal of number representation put forward by Cohen Kadosh & Walsh (CK&W) accounts for only a fraction of the many modes of numerical abstraction. Contrary to their proposal, robust data from human infants and nonhuman animals indicate that abstract numerical representations are psychologically primitive. Additionally, much of the behavioral and neural data cited to support CK&W's proposal is, in fact, neutral on the issue of numerical abstraction.

This research examines the contribution of W.J.T. Mitchell, especially on the philosophy of image. Image has been so long treated as an object. W.J.T. Mitchell located image as a subject that produced self-reflection, even capable to create a theory about themselves. The contributions of Mitchell on philosophy of image are manifested on his concepts: pictorial turn, the distinction of image and picture, mixed media, meta-picture, and bio-picture.

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances of intentional wrongdoing, by males in nonacademic medical settings, with oversight problems and a selfish motive such as financial gain or sex. More than half of cases involved a wrongdoer with a suspected (...) personality disorder or substance use disorder. Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions. (shrink)

How can mental properties bring about physical effects, as they seem to do, given that the physical realizers of the mental goings-on are already sufficient to cause these effects? This question gives rise to the problem of mental causation (MC) and its associated threats of causal overdetermination, mental causal exclusion, and mental causal irrelevance. Some (e.g., Cynthia and Graham Macdonald, and Stephen Yablo) have suggested that understanding mental-physical realization in terms of the determinable/determinate relation (henceforth, 'determination') provides the key to (...) solving the problem of MC: if mental properties are determinables of their physical realizers, then (since determinables and determinates are distinct, yet don't causally compete) all three threats may be avoided. Not everyone agrees that determination can do this good work, however. Some (e.g., Douglas Ehring, Eric Funkhauser, and Sven Walter) object that mental-physical realization can't be determination, since such realization lacks one or other characteristic feature of determination. I argue that on a proper understanding of the features of determination key to solving the problem of MC these arguments can be resisted. (shrink)

Fallibilists claim that one can know a proposition on the basis of evidence that supports it even if the evidence doesn't guarantee its truth. Jessica Brown offers a compelling defence of this view against infallibilists, who claim that it is contradictory to claim to know and yet to admit the possibility of error.

Although task-unrelated thinking has been increasingly investigated in recent years, the content and correlates of everyday off-task thought in clinical d...

Pets often factor in older adults’ health behaviors and decisions. However, the degree to which issues related to pet ownership are encountered or addressed by professionals working with this population remains unknown. The aim of this study was to identify specific issues stemming from pet ownership professionals had encountered in their work with older adults, people living with dementia, and care partners. An interdisciplinary sample completed an online survey addressing pet ownership issues encountered in their work. Descriptive statistics, t-tests, and (...) repeated measures ANOVAs were used to analyze quantitative data. A conventional content analysis was used to analyze open-ended responses to an item asking about “other” issues encountered in their work with these populations. The professionals estimated 46.29% of clients had been pet owners, 41.23% regularly asked about pets, and 79.22% had encountered issues related to pet ownership. Specific issues raised to the professionals varied by type of client. The professionals reported older adults most often raised getting pet items into the home and concerns about their pets’ health. The issues most often raised by people living with dementia to the professionals were planning for the pet due to a housing transition and basic pet care. Care partners focused on basic pet care and planning for the pet due to a housing transition. The professionals themselves most often raised the issues of basic pet care, concerns about falling, and the pets’ behavior. Professionals who entered clients’ homes were more likely to raise issues stemming from pet ownership compared to those who reported they did not enter clients’ homes in their current job, t = 5.59, p < 0.00001. The eleven new issues identified by the content analysis underscored how the health and wellbeing of people and their pets are linked. The results of this study provide strong evidence that professionals do encounter issues related to pet ownership. Including issues stemming from pet ownership into procedures, policies, and programs is likely to have positive impacts on those served by and working in the geriatric workforce. (shrink)

At the forefront of international concerns about global legislation and regulation, a host of noted environmentalists and business ethicists examine ethical issues in consumption from the points of view of environmental sustainability, economic development, and free enterprise.

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

"Der Text ist ein Wald, in dem der Leser der Jäger ist" notierte Benjamin für sein Passagen-Projekt. Das Buch erschließt Benjamins Arbeitsweise erstmals ausgehend von seiner eigenen Lektürepraxis. Als lesender Jäger und Sammler durchforstete Benjamin Texte von Goethe, Marx, Kafka, Freud und vielen weiteren Autoren. Angesichts der Heterogenität seiner Quellen ist erstaunlich, dass sich in der Art seiner Lektüre methodische Eigenheiten wiederholen. Burkhardt Lindner hat diesen Zugriff auf andere Autoren als Entwendung beschrieben, mit der Benjamin "den fremden Text sich anverwandelt (...) oder abstößt und damit in die eigenen Denkerfahrungen einsenkt". Der Band erkundet verschiedene Dimensionen dieses Verfahrens und schärft den Begriff der Entwendung durch Einzelanalysen. So werden Denk- und Schreibweisen sichtbar, die bislang nicht als ein von Benjamin werkübergreifend angewendetes Verfahren aufgearbeitet wurden. "The reader is the hunter in the forest of the text" (Benjamin, Arcades Project). As a reading hunter Benjamin trawled through texts by Marx, Kafka, Freud, and many more. For the first time, the volume Entwendungen. Walter Benjamin und seine Quellen scrutinizes Benjamin ́s method based on his particular reading practice. The volume investigates the various angles of this practice, sharpens the notion of "Entwendung" by means of single case studies. It uncovers ways of thinking and writing that have not been identified as a method traversing the entirety of Benjamin ́s oeuvre. (shrink)

Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need (...) to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent. (shrink)

Hierarchical cognitive mechanisms underlie sophisticated behaviors, including language, music, mathematics, tool-use, and theory of mind. The origins of hierarchical logical reasoning have long been, and continue to be, an important puzzle for cognitive science. Prior approaches to hierarchical logical reasoning have often failed to distinguish between observable hierarchical behavior and unobservable hierarchical cognitive mechanisms. Furthermore, past research has been largely methodologically restricted to passive recognition tasks as compared to active generation tasks that are stronger tests of hierarchical rules. We argue (...) that it is necessary to implement learning studies in humans, non-human species, and machines that are analyzed with formal models comparing the contribution of different cognitive mechanisms implicated in the generation of hierarchical behavior. These studies are critical to advance theories in the domains of recursion, rule-learning, symbolic reasoning, and the potentially uniquely human cognitive origins of hierarchical logical reasoning. (shrink)

Horgan (1993) proposed that "superdupervenience" - supervenience preserving physicalistic acceptability - is a matter of robust explanation. I argued against him (1999) that (as nearly all physicalist and emergentist accounts reflect) superdupervenience is a matter of Condition on Causal Powers (CCP): every causal power bestowed by the supervenient property is identical with a causal power bestowed by its base property. Here I show that CCP is, as it stands, unsatisfactory,for on the usual understandings of causal power bestowal, it is trivially (...) satisfied or falsified. I offer a revision of CCP which incorporates the evident fact that causal powers are grounded in fundamental forces. (shrink)

The capacity to generate recursive sequences is a marker of rich, algorithmic cognition, and perhaps unique to humans. Yet, the precise processes driving recursive sequence generation remain mysterious. We investigated three potential cognitive mechanisms underlying recursive pattern processing: hierarchical reasoning, ordinal reasoning, and associative chaining. We developed a Bayesian mixture model to quantify the extent to which these three cognitive mechanisms contribute to adult humans’ performance in a sequence generation task. We further tested whether recursive rule discovery depends upon relational (...) information, either perceptual or semantic. We found that the presence of relational information facilitates hierarchical reasoning and drives the generation of recursive sequences across novel depths of center embedding. In the absence of relational information, the use of ordinal reasoning predominates. Our results suggest that hierarchical reasoning is an important cognitive mechanism underlying recursive pattern processing and can be deployed across embedding depths and relational domains. (shrink)

Scientists have long counseled against interpreting animal behavior in terms of human emotions, warning that such anthropomorphizing limits our ability to understand animals as they really are. Yet what are we to make of a female gorilla in a German zoo who spent days mourning the death of her baby? Or a wild female elephant who cared for a younger one after she was injured by a rambunctious teenage male? Or a rat who refused to push a lever for food (...) when he saw that doing so caused another rat to be shocked? Aren’t these clear signs that animals have recognizable emotions and moral intelligence? With _Wild Justice_ Marc Bekoff and Jessica Pierce unequivocally answer yes. Marrying years of behavioral and cognitive research with compelling and moving anecdotes, Bekoff and Pierce reveal that animals exhibit a broad repertoire of moral behaviors, including fairness, empathy, trust, and reciprocity. Underlying these behaviors is a complex and nuanced range of emotions, backed by a high degree of intelligence and surprising behavioral flexibility. Animals, in short, are incredibly adept social beings, relying on rules of conduct to navigate intricate social networks that are essential to their survival. Ultimately, Bekoff and Pierce draw the astonishing conclusion that there is no moral gap between humans and other species: morality is an evolved trait that we unquestionably share with other social mammals. Sure to be controversial, _Wild Justice_ offers not just cutting-edge science, but a provocative call to rethink our relationship with—and our responsibilities toward—our fellow animals. (shrink)

In this essay, I argue that prescription drug laws violate patients' rights to self-medication. Patients have rights to self-medication for the same reasons they have rights to refuse medical treatment according to the doctrine of informed consent (DIC). Since we should accept the DIC, we ought to reject paternalistic prohibitions of prescription drugs and respect the right of self-medication. In section 1, I frame the puzzle of self-medication; why don't the same considerations that tell in favour of informed consent also (...) justify a right of self-medication? In section 2, I show that the prescription drug system was historically motivated by paternalism. In section 3, I outline the justifications for the DIC in more detail. I show that consequentialist, epistemic, and deontic considerations justify the DIC. In sections 4–6, I argue that these considerations also justify rights of self-medication. I then propose that rights of self-medication require non-prohibitive prescription policies in section 7. I consider two objections in sections 8 and 9: that patients ought not to make medically risky or deadly decisions, and that unrestricted access to prescription-grade pharmaceuticals would result in widespread misuse and abuse. Section 10 concludes. (shrink)

Disciplinary boundaries become increasingly unclear when grappling with “wicked problems,” which present a complex set of policy, cultural, technological, and scientific dimensions. “T-shaped” professionals, i.e. individuals with a depth and breadth of expertise, are being called upon to play a critical role in complex problem-solving. This paper unpacks the notion of the “T-shaped expert” and seeks to situate it within the broader academic literature on expertise, integration, and developmental learning. A component of this project includes an exploratory study, which is (...) aimed at evaluating the emergent attributes of T-shaped expertise in two different educational programs completed between January and May in 2015. The two programs build disciplinary knowledge in science, technology engineering, and mathematics fields at the core, while expanding the students’ awareness and comprehension of other expertise. The courses introduced science and engineering students to case study topics focusing around complex human-technological-ecological systems in a nanotechnology and society course; and the governance of genetically modified organisms in a science, technology, and society course. We analyze pre- and post-test data from this pilot project before presenting findings that pertain to student learning, as well as variants in the methodology and reflect on the utility of the selected methodology for evaluating expertise as it evolves over time. The paper closes with a discussion of a theory of acquisition with implications for delineating early attributes and characteristics of T-shaped expertise. (shrink)

When subjects violate epistemic standards or norms, we sometimes judge them blameworthy rather than blameless. For instance, we might judge a subject blameworthy for dogmatically continuing to believe a claim even after receiving evidence which undermines it. Indeed, the idea that one may be blameworthy for belief is appealed to throughout the contemporary epistemic literature. In some cases, a subject seems blameworthy for believing as she does even though it seems prima facie implausible that she is morally blameworthy or professionally (...) blameworthy. Such cases raise the question of whether one can be blameworthy for a belief in a specifically epistemic sense rather than in some already recognised sense, such as being morally or professionally blameworthy. A number of authors have recently argued that there is a moral or social sense in which one ought to conform one’s beliefs to the evidence. In this paper, I argue that even while accepting that there are moral and social norms governing belief, there are cases in which a subject is blameworthy for a belief but isn’t plausibly morally or socially blameworthy. If this latter view is correct, then we may need to develop a new account of blame which can be applied to beliefs which are not morally or socially blameworthy. (shrink)

Following Burge, many anti-individualists suppose that a subject can possess a concept even if she incompletely understands it. While agreeing that this is possible, I argue that there is a limit on the extent to which a subject can incompletely understand the set of concepts she thinks with. This limit derives from our conception of our ability to reflectively evaluate our own thoughts or, as Burge puts it, our ability to engage in critical reasoning. The paper extends Burge’s own work (...) on critical reasoning. He argued that critical reasoning imposes a limit on the extent to which we can be mistaken about what thoughts we are having; in general, we can know non-empirically what we are thinking . He does not explicitly consider whether critical reasoning also imposes a limit on incomplete understanding of thoughts. (shrink)

Moral distress among nurses is well researched and well documented, but there is limited research on the moral distress experienced by care leaders, who serve as intermediaries between patient care nurses and higher levels of administration. Healthcare professionals experience moral distress daily in the context of older adult care. The aim of this scoping review was to evaluate recent literature on moral distress in older adult care with the goal of revealing how care leaders’ experiences of moral distress in older (...) adult care have been conceptualized in earlier studies. The research questions were: How is the concept of moral distress as experienced by care leaders in older adult care defined in the existing literature? How is the concept of moral distress conceptualized in the literature? The research has been conducted in accordance with the guidelines set forth by the Finnish National Advisory Board on Research Ethics TENK. We saw that consensus on how moral distress is defined is lacking. Care leaders in older adult care experience substantial moral distress, which could be linked to the duality of their leadership role. Moral distress can be caused by a complex interplay of individual and structural factors and the challenging complex moral issues inherent to older adult care. Moral distress could impact care leaders’ emotional health, job performance, overall job satisfaction and result in higher turnover rates, absenteeism, decreased quality of patient care, and increased organizational costs. Addressing moral distress on the individual, team, and organizational levels is crucial for enhancing care leaders’ well-being and improving the overall quality of care for older adults. A focus on the identification of strategies whereby care leaders can be supported, exploration of the long-term effects of moral distress on healthcare professionals in general, and the organizational outcomes associated with moral distress should be included in future research. (shrink)