Conventional management strategies for anti-corporate anger involve its negative construal as an inappropriate irrationality in need of containment. An alternative account is offered in which such anger comprises a healthy and health-sustaining component of care-based moral agency directed not only toward the affiliative advancement of connection among community members, but also toward the (political) resistance to violation, injustice, and carelessness through which disconnection from responsive community relationships occurs. The role of anger in care-based moral agency is (...) demonstrated through discussion of the classic case of environmental and human health crisis at Love Canal, New York. (shrink)

Research in moral psychology has recently raised questions about the impact of context and the environment on the way the human mind works. In a 2012 call to action, Paley wrote: “If some of the conclusions arrived at by moral psychologists are true, they are directly relevant to the way nurses think about moral problems, and present serious challenges to favoured concepts in nursing ethics, such as the ethics of care, virtue, and the unity of the person” (...) (p. 80). He urges nurse ethicists and scholars to evaluate the impact these findings may have for moral theory.In this paper, I review some of Paley's (Nursing Philosophy, 13, 2012, 80) critique, focusing on the argument that theories of nursing ethics have failed to account for the role of context; both in terms of its impact on the way nurses make moral judgements and in terms of the environment's influence on the way the mind works. I then examine nursing literature on moral agency, and focus on the role of the environment and context play within existing theory. I argue that theories of moral agency have often accounted for the role of context on the way nurses make decisions; however, less attention has been paid to its impact on the mind. With this background, I use insights from the fields of moral philosophy and moral psychology to refine the conceptualization of nurse moral agency in a way that is reflective of current cognitive, philosophical and nursing practice‐based science. (shrink)

This paper articulates and defends a noncognitive, care-based view of identification, of what privileged psychic subset provides the source of self-determination in actions and attitudes. The author provides an extended analysis of "caring," and then applies it to debates between Frankfurtians, on the one hand, and Watsonians, on the other, about the nature of identification, then defends the view against objections.

This paper investigates the process of moral agency development as a community-supported process. Based on a multimethod qualitative inquiry, including diaries, focus groups, and documentary analysis, we analyze the experiences of middle managers in two Norwegian hospitals during the first year of the COVID-19 pandemic. We find that moral agency is developed through a community-embedded value inquiry, emerging in three partially overlapping steps. The first step is marked by moral reflex, an intuitive, value-driven, pre-reflective response (...) to a crisis situation. In the second step, the managers involved the community in value calibration, a collective-ethical sensemaking. In the third step, they took active stances to translate values into actions, with an increased awareness of values and an ability to explain and justify their actions. We label the steps, respectively: value inquiry-in-action, value inquiry-on-action and reflective enactment of value. An analysis of the process reveals two aspects critical for moral agency development: it happens through confrontation with uncertainty, and it is relational, that is, embedded in a community. While uncertainty forces an intuitive moral response, dialogical reflection in the community develops value awareness and relationships of mutual care and support. (shrink)

We argue that a command and control system can undermine a commander’s moral agency if it causes him/her to process information in a purely syntactic manner, or if it precludes him/her from ascertaining the truth of that information. Our case is based on the resemblance between a commander’s circumstances and the protagonist in Searle’s Chinese Room, together with a careful reading of Aristotle’s notions of ‘compulsory’ and ‘ignorance’. We further substantiate our case by considering the Vincennes Incident, when (...) the crew of a warship mistakenly shot down a civilian airliner. To support a combat commander’s moral agency, designers should strive for systems that help commanders and command teams to think and manipulate information at the level of meaning. ‘Down conversions’ of information from meaning to symbols must be adequately recovered by ‘up conversions’, and commanders must be able to check that their sensors are working and are being used correctly. Meanwhile ethicists should establish a mechanism that tracks the potential moral implications of choices in a system’s design and intended operation. Finally we highlight a gap in normative ethics, in that we have ways to deny moral agency, but not to affirm it. (shrink)

A moral agent is an individual who is capable of choosing and acting in accordance with judgments about what is right, wrong, good, bad, worthy, or unworthy. Such individuals are thought to be free and hence responsible for what they do. The obstacles to freedom and responsibility raise philosophical problems in regard to moral agency.

This essay examines the goals of care and the exercise of guardianship authority in the long-term care of persons with Alzheimer's disease and other forms of chronic, progressive dementia. It counters philosophical views that deny both agency and personhood to individuals with Alzheimer's on definitional or analytic conceptual grounds. It develops a specific conception of the quality of life and offers a critique of hedonic conceptions of quality of life and models of guardianship that are based on a hedonic (...) legal standard of “best interests.” As an alternative, it proposes a conception of quality of life based on the notions of “semantic agency” and “memorial personhood.”. (shrink)

While concepts of care and caring have a long history, the terms have become especially prominent in recent times. Care and caring, I argue, have emerged as what philosopher Charles Taylor calls ‘moral sources,’ uber-concepts that allow for moral deliberation, the prioritization of preferences, and our identity formation as persons. Linking the current salience of care to a growing awareness of the dynamics of a crisis- and catastrophe-ridden world, I consider care within the context of university students’ declining (...) mental health. Acknowledging role differentiation within universities and the contributions of Well-being units with specialist knowledge, I contend that frontline tutors without such knowledge have an important role to play in developing alternatives to an increasingly pervasive medicalised conception of care, one that constitutes students as passive patients. Drawing on Martha Nussbaum and Amartya Zen’s capabilities approach to human flourishing, I suggest that there is considerable scope, within the civil society environments of the university sector, for life skills-oriented practices of care that are profoundly agential, and, through this, curative, protective, and liberating. I illustrate the relevance of the theoretical propositions through a case study of a collaborative performance of the ‘Shout at Cancer Choir’ (aka ‘Laryngectomy Choir’) at the University of Lincoln, UK, in 2023. The aim is to show how particular forms of community engagement, within or beyond the formal curriculum, create capabilities-based conditions for students’ flourishing. (shrink)

When health professionals experience moral distress during routine clinical practice, they are challenged to maintain integrity through conscientious practice guided by ethical principles and virtues that promote the dignity of all human beings who need care. Their integrity also needs preservation during a crisis like the COVID-19 pandemic, especially when faced with triage protocols that allocate scarce resources. Although a crisis may change our ability to provide life-saving treatment to all who need it, a crisis should not change the (...) ethical values that should always be guiding clinical care. Enduring ethical commitments should encourage clinicians to base treatment decisions on the medical needs of individual patients. This approach contrasts with utilitarian attempts to maximize selected aggregate outcomes by using scoring systems that use short-term and possibly long-term prognostic estimates to discriminate between patients and thereby treat them unequally in terms of their eligibility for life-sustaining treatment. During times of crisis and calm, moral communication allows clinicians to exercise moral agency and advocate for their individual patients, thereby demonstrating conscientious practice and resisting influences that may contribute to compartmentalization, moral injury, and burnout. (shrink)

Moral resilience is an emerging concept that has not been fully acknowledged. The aim of this study is to explain lived experiences of moral resilience in intensive care units nurses. This is a qualitative study with a content analysis approach guided by the method of Elo and Kyngäs and based on the theoretical framework of Defilippis et al. Data were collected through 17 in‐depth, individual, and semi‐structured interviews with 17 nurses, who were selected by purposeful sampling. The results (...) of the present study support the theory of Defilippis et al. while adding another category to it. Three categories of self‐awareness, harmonized connection, and moral well‐being, which are consistent with the result of Defilippis et al. were extracted deductively, while the category of moral agency was also extracted inductively from the data. The explanatory theory resulting from Defilippis et al.'s study can be used as a guide to cultivate and improve the moral resilience of nurses working in intensive care units. Moral resilience is fostered in nurses by nurturing and improving their capacities, such as self‐awareness, self‐efficacy, self‐confidence, and self‐reflection. These traits can help maintain and promote moral agency while establishing harmonized connections. Acquiring moral resilience skills can lead to positive outcomes and reduced moral distress. (shrink)

The ethics of care and Confucian care ethics are both characterised by relations-based moral reasoning and decision-making. Acknowledging this similarity, this article compares and contrasts these two ethics, highlighting Western and Eastern moral concerns. One of the main differences between the two ethical theories is their different focus on vulnerability and inequality as factors in achieving equality in the ethics of care; another is the reciprocity, rather than equality, dimension in Confucian ethics. Both theories enshrine the view that (...) the characteristics of care offer scope for developing the capacity for judgement. However, a fundamental difference is revealed when considering that Confucian ethics emphasises care as a virtue in the cultivation of one's moral agency, whereas the ethics of care sees care as both a disposition and practice, and the caring relationship to be a primary means of moral evaluation. For the care ethicists, the practice of care embraces communicative morality, within fluid, dynamic interpersonal relationships - in sharp contrast to Confucian care practices, which are constructed within formal standards and fixed, role-based relationships. (shrink)

For nursing, the idea of bearing witness is of utmost importance. Nurses are present with persons who experience changes in their health and quality of life and who live intense and profound moments of struggling, questioning, and finding meaning. Nurses are also with persons from moment to moment as their lives unfold, and when joy, serenity, contentment, vulnerability, sadness, fear, and suffering are experienced. In this paper, it is proposed that bearing witness is a moral way of engaging in (...) the nurse–person relationship. Based on Levinas’s ethics of the face, it is claimed that bearing witness is enacting one’s moral responsibility, which arises from the encounter with the other. Drawing on Parse’s human becoming theory, ways of witnessing and bearing witness are defined and discussed. It is suggested that bearing witness is a human‐to‐human way of being‐relating, a mode of human coexistence. Bearing witness is being present and attentive to the truth of another’s experiences. Moreover, in this paper, the ways nurses enact their moral agency and bear witness to others placed in their care, or turn away, are explored. Nurses’ moral agency is located in the constrained moral space of contemporary health care. Hence, the creation of a moral space, which allows nurses to enact their moral responsibility of bearing witness to other persons’ experiences of health and quality of life, is called for. In doing so, it is suggested that the act of bearing witness needs a specific nursing knowledge base and a recognition that being present and being with another is a valuable nursing practice that is utterly meaningful for persons who are living through difficult times. (shrink)

Empirical evidence indicates that much of human behavior is unconscious and automatic. This has led some philosophers to be skeptical of responsible agency or personhood in the moral sense. I present two arguments defending agency from these skeptical concerns. My first argument, the “margin of error” argument, is that the empirical evidence is consistent with the possibility that our automatic behavior deviates only slightly from what we would do if we were in full conscious control. Responsible (...) class='Hi'>agency requires only that our actions more or less express our conscious goals and values. My second argument is a non-realist defense of moral agency. If we are willing to reject metaethical realism about agents, then there may be good reasons why we should retain the concept of agency in our moralizing, even if automaticity undermines the belief that we are really in conscious control of our behavior. We can do this by adopting a “reactive attitudes” approach to moral responsibility. On this view, agency is determined not by actual features of human psychology but by the attitudes and practices that we ought to adopt in response to the actions and motivations of individuals. (shrink)

This paper discusses the philosophical issues pertaining to Kantian moral agency and artificial intelligence. Here, our objective is to offer a comprehensive analysis of Kantian ethics to elucidate the non-feasibility of Kantian machines. Meanwhile, the possibility of Kantian machines seems to contend with the genuine human Kantian agency. We argue that in machine morality, ‘duty’ should be performed with ‘freedom of will’ and ‘happiness’ because Kant narrated the human tendency of evaluating our ‘natural necessity’ through ‘happiness’ as (...) the end. Lastly, we argue that the Kantian ‘freedom of will’ and ‘faculty of choice’ do not belong to any deterministic model of ‘agency’ as these are sacrosanct systems. The conclusion narrates the non-feasibility of Kantian AI agents from the genuine Kantian ethical outset, offering a utility-based Kantian ethical performer instead. (shrink)

Because health care professions exist to provide a good for society, ethical questions are inherently part of them. Such professions and their members can be assessed based on how effective they are in developing knowledge and enacting practices that further the health and well‐being of individuals and society. The complexity of contemporary health care environments makes it important to prepare clinicians who can anticipate, recognize, and address problems that arise in practice or that prevent a profession from fulfilling its service (...) goals and obligations. Different health care professions have evolved distinct perspectives about appropriate goals for, and the purposes of, their clinicians, even when the goal of improving health and well‐being for society is shared across professions. While medicine and nursing goals are shared in principle, they differ in the particulars. Given the centrality to nursing of ethical questions, the profession has a collective responsibility to help clinicians at all levels of practice become ethically savvy and to reinforce their moral agency as needed. Both knowledge of nursing ethics and knowledge of the interdisciplinary field of bioethics are critical to nursing work. (shrink)

Background: Legislative changes are resulting in assisted death as an option for people at the end of life. Although nurses’ experiences and perspectives are underrepresented within broader ethical discourses about assisted death, there is a small but significant body of literature examining nurses’ experiences of caring for people who request this option. Aim: To synthesize what has been learned about nurses’ experiences of caring for patients who request assisted death and to highlight what is morally at stake for nurses who (...) undertake this type of care. Design: Qualitative meta-synthesis. Methods: Six databases were searched: CINAHL, Medline, EMBASE, Joanna Briggs Institute, PsycINFO, and Web of Science. The search was completed on 22 October 2014 and updated in February 2016. Of 879 articles identified from the database searches, 16 articles were deemed relevant based on inclusion criteria. Following quality appraisal, 14 studies were retained for analysis and synthesis. Results: The moral experience of the nurse is (1) defined by a profound sense of responsibility, (2) shaped by contextual forces that nurses navigate in everyday end-of-life care practice, and (3) sustained by intra-team moral and emotional support. Discussion: The findings of this synthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The findings further demonstrate that to fully appreciate the ethics of assisted death from a nursing standpoint, it is necessary to understand the broader constraints on nurses’ moral agency that operate in everyday end-of-life care. Ethical considerations: Research ethics board approval was not required for this synthesis of previously published literature. Conclusion: In order to understand how to enact ethical practice in the area of assisted death, the moral experiences of nurses should be investigated and foregrounded. (shrink)

(2001). The Care-Based Ethic of Nazi Medicine and the Moral Importance of What We Care About. The American Journal of Bioethics: Vol. 1, No. 1, pp. 64-74.

In Huckleberry Finn, a thirteen-year old white boy in antebellum Missouri escapes from his abusive father and befriends a runaway slave named Jim. On a familiar reading of the novel, both Huck and Jim are, in their own ways, morally impressive, transcending the unjust circumstances in which they find themselves in to treat each other as equals. Huck saves Jim’s life from two men looking for runaway slaves, and later Jim risks his chance at freedom to save Huck’s friend Tom. (...) I want to complicate the idea that Huck and Jim are morally commendable for what they do. More generally, I want to explore how oppression undermines the moral agency of the oppressed, and to some degree, the oppressor. In §1 I take a careful look at Jim’s choice, arguing that his enslavement compromises his moral agency. In §2 I show how Jim’s oppression also shapes the extent to which Huck can be praiseworthy for his action. In §3, I consider the consequences for thinking about the moral agency of the oppressed, and in §4 I explore the limitations of the concept of moral worth for theorizing in cases of oppression. (shrink)

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals (...) of the nursing profession, CERN sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

This paper discusses Confucian notions of moral autonomy and moral agency that do not follow strict and ideal notions of autonomy that one can find in many Western theories of moral philosophy. In Kantian deontology, for example, one's autonomy, specifically one's rational will to follow universal moral rules, is a necessary condition of moral agency and moral responsibility. In Confucian moral philosophy, however, this type of strict moral autonomy is rarely (...) observed. A Confucian moral agent is often depicted as a partially heteronomous individual who often accepts and follows others' moral authority and considers external contingencies in her moral deliberations. Yet active moral agency is maintained in Confucian philosophy. In this paper, I will explain and analyze a partially heteronomous but active form of moral agency in Confucian moral philosophy. First, I will survey different notions of moral autonomy and explore philosophical theories of partial autonomy and heteronomy. Second, I will discuss, on the basis of interactive, responsive, and situated notions of the self, how Confucian moral agency can be explained without strict standards of autonomy. In Confucianism, morality or virtuosity reflects the relational, responsive, and situated nature of human being that resonates with other human beings and their environmental contingencies. Mencius, for example, acknowledges and discusses interactive or relational nature of moral action and the dependency of the moral self on external conditions of life without giving up active moral effort and full moral responsibility. Third, based on my analysis of moral autonomy and responsibility in early Confucian philosophy, I will argue that Confucian moral philosophy provides a unique way of understanding moral agency, not through self-enclosed independency but through relational and interactive interdependency of communal agency. (shrink)

Moral distress has been covered extensively in the nursing literature and increasingly in the literature of other health professions. Cases that cause nurses’ moral distress that are mentioned most frequently are those concerned with prolonging the dying process. Given the standard of aggressive treatment that is typical in intensive care units (ICUs), much of the existing moral distress research focuses on the experiences of critical care nurses. However, moral distress does not automatically occur in all end-of-life (...) circumstances, nor does every critical care nurse suffer its damaging effects. What are the practices of these nurses? What specifically do they do to navigate around or through the distressing situations? The nursing literature is lacking an answer to these questions. This article reports a study that used narrative analysis to explore the reported practices of experienced critical care nurses who are skilled at and comfortable working with families and physicians regarding the withdrawal of aggressive treatment. A major finding was that these nurses did not report experiencing the dam-Moral Agency, Moral Imagination, and Moral Community: Antidotes to Moral Distress Terri Traudt, Joan Liaschenko, and Cynthia Peden-McAlpine Terri Traudt, MBC, MA, is a Communications Consultant specializing in bioethics at the Center for Bioethics at the University of Minnesota, in Minneapolis. trau0116@umn.edu Joan Liaschenko, PhD, RN, FAAN, is a Professor at the Center for Bioethics and Nursing at the University of Minnesota. Cynthia Peden-McAlpine, PhD, ACNS, BC, is an Associate Professor in the School of Nursing at the University of Minnesota. © 2016 by The Journal of Clinical Ethics. All rights reserved. aging effects of moral distress as described in the nursing literature. The verbal communication and stated practices relevant to this finding are organized under three major themes: (1) moral agency, (2) moral imagination, and (3) moral community. Further, a total of eight subthemes are identified. The practices that constitute these themes and subthemes are further detailed and discussed in this article. Understanding these practices can help mitigate critical care nurses’ moral distress. (shrink)

The subject of this article is moral agency in nursing, studied by the use of an applied philosophical method. It draws upon nurses’ accounts of how they see intrinsic value in their work and believe that they make a difference to patients in terms that leave their patients feeling better. The analysis is based on the philosophy of Iris Murdoch to reveal how nurses’ accounts demonstrated that they hold a view of themselves and their professional practice that is (...) intrinsically linked to, and dependent upon, their capacity to see good in the work they do. (shrink)

BackgroundAlthough nurses are crucial to ensure patients’ peaceful death in hospitals, many nurses experience various ethical conflicts during end-of-life care. Therefore, research on nurses’ entire ethical decision-making process is required to improve nurses’ ethical decision-making in end-of-life care. This study aimed to identify Korean nurses’ ethical decision-making process based on their moral sensitivity to end-of-life patients.MethodsIn total, 171 nurses caring for terminal patients responded to the survey questionnaire. To measure the participants’ moral sensitivity and ethical decision-making process, we (...) used the Korean version of the Moral Sensitivity Questionnaire and Nurses’ Ethical Decision-Making around End of Life Care Scale. Finally, multiple linear regression analysis was used to investigate the effect of moral sensitivity on nurses’ ethical decision-making.ResultsThe mean of moral sensitivity was 4.8 ± 0.5 (out of 7), and that of ethical decision-making was 4.6 ± 0.5 (out of 6). Among the sub-dimensions of ethical decision-making, the highest score was in perceived professional accountability (5.2 ± 0.5), and the lowest in moral reasoning and moral agency (3.9 ± 0.6); the score of moral practice was 4.4 ± 0.7. In the multiple linear regression model, moral sensitivity (β = 0.852, p <.001), clinical department (β = − 7.018, p =.035), ethics education (β = 20.450, p <.001), job satisfaction (β = 5.273, p <.001), and ethical conflict (β = − 2.260, p = 0.031) were influential ethical decision-making factors.ConclusionsThis study revealed a gap between nurses’ thoughts and practices through the ethical decision-making process. They failed to lead their thought to moral practice. It also implies that moral sensitivity could positively affect nurses’ ethical decision-making. To make nurses morally sensitive, exposing them to various clinical cases would be helpful. Additionally, ethics education and clinical ethics supporting services are valuable for improving nurses’ ethical decision-making. If nurses improved their ethical decision-making regarding end-of-life care, their patients could experience a better quality of death. (shrink)

Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs’ perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants’ moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work (...) environment. We used quantitative instruments and explored participants’ perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses. (shrink)

Moral distress is a phenomenon that has been receiving increasing attention in nursing and other health care disciplines. Moral distress is a concept that entered the nursing literature – and subsequently the health care ethics lexicon – in 1984 as a result of the work done by American philosopher and bioethicist Andrew Jameton. Over the past decade, research into moral distress has extended beyond the profession of nursing as other health care disciplines have come to question the (...) impact of moral constraint on individual practitioners, professional practice, and patient outcomes. Along with increased interest in the phenomenon of moral distress have come increasing critiques – critiques that in their essence point to a serious lack of conceptual clarity in the definition, study, and application of the concept. Foundational to gaining conceptual clarity in moral distress in order to develop strategies to prevent and ameliorate the experience is a careful revisiting of the epistemological assumptions underpinning our knowledge and use of the concept of moral distress. It is our contention that the conceptual challenges reveal flaws in the original understanding of moral distress that are based on an epistemological stance that holds a linear conception of cause and effect coupled with a simplistic perspective of ‘constraint’ and ‘agency’. We need a more nuanced approach to our study of moral distress such that our ontological and epistemological stances help us to better appreciate the complexity of moral agents acting in organizational contexts. We believe that critical realism offers such a nuanced approach. (shrink)

The connection between ethics and theological vision has become increasingly important for ethics as we better appreciate how the moral agent is embedded in a framework that affectively and intellectually shapes her moral reasoning. Moral reasoning is always reasoning within (that is, within a moral framework, a religious worldview, and/or a set of ideological commitments). A similar framing occurs in literature, which I refer to as its “horizon.” A literary text's horizon comprises the theological and metaphysical (...) commitments that are implied by the text and that the reader relies on to make sense of it. I suggest that there is a parallel between how moral frameworks and literary horizons operate in that both shape moral judgment. I argue that in using literature as a resource for ethics, the same contemporary currents that have led us to appreciate the embeddedness of moral reasoning should also encourage us to give more careful attention to the theological or metaphysical vision implied by a text. Such a “theo-ethical” reading of literature provides a richer understanding of particular moral goods and the interplay between those goods and ethical themes like agency, hope, and redemption. I substantiate this claim with a reading of William Blake's Jerusalem: The Emanation of the Giant Albion. (shrink)

Background:Moving into the last phase of life comprises a developmental transition with specific needs and risks. Facilitating transitions is an important component of the work of nurses. When curative interventions are no longer helpful, nurses enact key roles in caring for patients and families.Aim:The aim of this study was to examine the experiences of registered nurses in acute care settings as they worked with patients and families to facilitate transition to comfort-focused care.Research design:Sampling, data collection, and data analysis were guided (...) by constructivist grounded theory, chosen because of its strength in identifying and explicating social processes.Participants and context:A purposeful sample of 26 registered nurses working in acute care hospitals in one community in the northeastern United States participated in this study through semi-structured interviews.Ethical considerations:The study received approval from the university’s Institutional Review Board for the Protection of Human Subjects. Participants provided informed consent.Findings:Nurses facilitated transition to comfort-focused care by enacting their moral commitments to patients and families. They focused on building relationships, honoring patient self-determination, and maintaining respect for personhood. In this context, they discerned a need for transition, opened a discussion, and used diverse strategies to facilitate achieving consensus on the part of patients, family members, and care providers. Regardless of how the process unfolded, nurses offered support throughout.Discussion:Achievement of consensus by all stakeholders is critical in the transition to comfort-focused care. This study deepens our understanding of how nurses as moral agents utilize specific strategies to assist progress toward consensus. It also offers an example of recognizing the moral agency of nurses through listening to their voices.Conclusion:Increased understanding of effective nursing strategies for facilitating transition to comfort-focused care is essential for developing needed evidence for excellent care and strengthening end-of-life nursing education. (shrink)

The practical phenomenon of moral diversity is a central feature of many contemporary societies and poses a distinct problem to moral theory building. Because of its goal to settle the moral question fully and exclusively and/or to provide better understanding of moral disagreement, traditional first-order moral theory often does not provide sufficient guidance to address this phenomenon and moral agency in deeply morally diverse societies. In this article, I move beyond traditional first-order (...) class='Hi'>moral theorizing and, based on multilevel social contract theory (Moehler 2018, 2020a), develop a practically sound notion of moral agency for morally diverse societies. The interrelational and dynamic notion of integrated moral agency developed in this article demands that agents actively exercise their rational and affective capacities, are receptive to the capacities of others, and are aware of the type of moral interaction in which they engage with others. The notion of integrated moral agency helps agents to reconcile conflicting first-order moral directives and to maximally protect agents’ autonomy in morally diverse societies. (shrink)

Arguably, one of the most exciting recent advances in moral philosophy is the ongoing scientific naturalization of normative ethics and metaethics, in particular moral psychology. A relatively neglected area in these improvements that is centrally important for developing a scientifically based naturalistic metaethics concerns the nature and acquisition of successful moral agency. In this paper I lay out two examples of how empirically based findings help us to understand and explain some cases of successful moral (...) agency. These are research in moral internalization and aggression management. Using these examples, I sketch some lessons for investigating successful moral learning and moral action. My proposal reflects a common theme in scientifically based philosophy generally: the shift from the armchair methods of analyzing concepts and finding a priori foundations, the enterprise of first philosophy, to an effort to study the phenomena themselves, using empirical findings and theories to answer philosophical questions about these phenomena, an endeavor recently characterized as second philosophy. (shrink)

Considerations of nonhuman animal moral agency typically base their reasoning and (very often negative) verdict on a capacity‐focused approach to moral agency. According to this approach, an entity is a moral agent if it has certain intrapersonal features or capacities, typically in terms of conscious reflection and deliberation. According to a practice‐focused notion of moral agency, however, an entity is a moral agent in virtue of being a participant of a moral (...) responsibility practice (MRP). I argue that a practice‐focused approach to moral agency, combined with empirical evidence from research on canid social play and cognition, with support from The Function Argument, makes the notion of nonhuman animal moral agency more likely than usually indicated. However, the support is not absolute, as the practice‐focused approach itself may be put into question. I describe how this objection prompts us to critically assess any empirical, metaethical, or normative assumptions on these matters. These questions, in turn, raise a number of further questions of how we should conceive of, use, and evaluate whatever standards of moral agency we adopt. (shrink)

Psychopaths have long been of interest to moral philosophers, since a careful examination of their peculiar deficiencies may reveal what features are normally critical to the development of moral agency. What underlies the psychopath's amoralism? A common and plausible answer to this question is that the psychopath lacks empathy. Lack of empathy is also claimed to be a critical impairment in autism, yet it is not at all clear that autistic individuals share the psychopath's amoralism. How is (...) empathy characterized in the literature, and how crucial is empathy, so described, to moral understanding and agency? I argue that an examination of moral thinking in high-functioning autistic people supports a Kantian rather than a Humean account of moral agency. (shrink)

This paper argues that what interests Locke most is not whether we are free to suspend desire but the nature of the liberty that suspension grants us, and that Lockean liberty is essentially about deliberation that takes place in what has nowadays come to be called the space of reasons. This allows me to offer a novel and balanced account that carefully designates both causal and rational elements of Locke’s theory of moral agency: after having reached judgment concerning (...) the best course of action, we are to take measures, if need be, so that this cognitive achievement raises the corresponding conative element, namely an uneasiness that determines our will. Locke’s ambitious theory intends to incorporate two strong philosophical intuitions widely held incompatible: that our will is free and that impulses have an effect on our choices. The present interpretation thus throws new light on the development of Western moral thought. (shrink)

As the quality movement in health care now enters its fourth decade, the language of quality is ubiquitous. Practitioners, organizations, and government agencies alike vociferously testify their commitments to quality and accept numerous forms of governance aimed at improving quality of care. Remarkably, the powerful phrase ‘‘quality of care’’ is rarely defined in the health care literature. Instead it operates as an accepted and assumed goal worth pursuing. The status of evidence-based medicine, for instance, hinges on its ability to improve (...) quality of care, and efforts are made by both proponents and detractors to unpack the contents and outcomes of evidence-based practice while the contents of ‘‘quality of care’’ are presumed to be understood. Because the goals of medicine are far from obvious, this paper investigates the neglected term, ‘‘quality of care,’’ in an effort to understand what it is that health care practices are so uncritically assumed to be striving for. Finding lack of consensus on the terminology in the quality literature, I propose that the term operates rhetorically by way of persuasive appeal (and lack of descriptive meaning). Unsatisfied that ‘‘quality of care’’ operates as a mere buzzword in morally contentious debates over resource allocation and duties of care, I implore health care communities to go beyond mere commitments to quality and, instead, to focus attention on the difficult task of specifying what counts as quality care within an economically constrained health care system. (shrink)

Much attention has been paid to the role of the nurse in recognizing and addressing ethical dilemmas. There has been less emphasis, however, on the issue of whether or not nurses understand the ethical nature of everyday practice. Awareness of the inherently ethical nature of practice is a component of nurse ethical sensitivity, which has been identified as a component of ethical decision-making. Ethical sensitivity is generally accepted as a necessary precursor to moral agency, in that recognition of (...) the ethical content of practice is necessary before consistent action on behalf of patient interests can take place. This awareness is also compulsory in ensuring patient good by recognizing the unique interests and wishes of individuals, in line with an ethic of care. Scholarly and research literature are used to argue that bolstering ethical awareness and ensuring that nurses understand the ethical nature of the role are an obligation of the profession. Based on this line of reasoning, recommendations for education and practice, along with directions for future research, are suggested. (shrink)

Some commentators have condemned Kant’s moral project from a feminist perspective based on Kant’s apparently dim view of women as being innately morally deficient. Here I will argue that although his remarks concerning women are unsettling at first glance, a more detailed and closer examination shows that Kant’s view of women is actually far more complex and less unsettling than that attributed to him by various feminist critics. My argument, then, undercuts the justification for the severe feminist critique of (...) Kant’s moral project. (shrink)

In this paper, I present a general profile of individuals with psychopathy, autism, and acquired sociopathy as well as look specifically at the abilities of these individuals with respect to the moral domain. These individuals are individually and collectively interesting because of their significant affective and social impairments. I argue that none of these individuals should be considered full moral agents based on a proposed account of moral agency consisting of the following two necessary conditions: the (...) capacity for moral judgment and the capacity for moral motivation. Since each of these groups of individuals fails to satisfy the criteria in a different way, these arguments help to distinguish three primary ways in which emotion contributes to moral motivation. I conclude with a suggested general implication of this discussion for related debates in moral theory. (shrink)

Contemporary literature includes a wide variety of definitions of empathy. At the same time, the revival of sentimentalism has proposed that empathy serves as a necessary criterion of moral agency. The paper explores four common definitions in order to map out which of them best serves such agency. Historical figures are used as the backdrop against which contemporary literature is analysed. David Hume’s philosophy is linked to contemporary notions of affective and cognitive empathy, Adam Smith’s philosophy to (...) projective empathy, and Max Scheler’s account to embodied empathy. Whereas cognitive and projective empathy suffer from detachment and atomism, thereby providing poor support for the type of other-directedness and openness entailed by moral agency, embodied and affective empathy intrinsically facilitate these factors, and hence are viewed as fruitful candidates. However, the theory of affective empathy struggles to explain why the experience of empathy includes more than pure affective mimicry, whilst embodied empathy fails to take into account forms of empathy that do not include contextual, narrative information. In order to navigate through these difficulties, Edith Stein’s take on non-primordial experience is used as a base upon which a definition of affective empathy, inclusive of an embodied dimension, and founded on a movement between resonation and response, is sketched. It is argued that, of the four candidates, this new definition best facilitates moral agency. (shrink)

Although we theorize that nurses ‘make a difference’ to patient outcomes and speculate that this happens because nurses ‘care’, there is so far little evidence to support this nebulous claim. Efforts to promote care as the defining characteristic of nursing, and an ‘ethic of care’ as the ethical basis of nursing, have sparked debate within the discipline. This debate has resulted in a polarization that has effectively stalled productive discourse on the issues. Moreover, the focus on care has been at (...) the expense of understanding the true nature of the relationship between caring and the broader base of ethical knowledge that underpins nursing and that must underpin nursing if it is a viable practice profession. This paper used the framework of philosophical argument to explore the moral and ethical foundations of nursing from the perspective of personal and public morals, and responsive nurse–patient relationships as the reflection of ethical nursing knowledge. The foundation of ethical nursing knowledge is the personal moral sense that resides within the individual and that nurses hold in common with others. Personal moral knowledge is transformed into disciplinary ethical knowledge specific to nursing through disciplinary consensus. Responsive relationships are conceptualized in the nursing literature as founded on three essential elements: respect, trust, and mutuality. These three elements are grounded in ethical nursing knowledge; therefore responsive nurse–patient relationships reflect both personal moral knowledge and disciplinary ethical knowledge. By facilitating the articulation of ethical nursing knowledge in practice, responsive relationships connect theory, ethical knowledge, and clinical outcomes. (shrink)

This thesis aims to elucidate an apparent paradox about the role of emotion in moral agency. A number of lines of concern suggest emotion may have serious negative impact on moral agency. On the other hand, there are considerations that suggest emotion also plays a crucial role in motivating, informing and even constituting moral agency. Significantly, there is a strong connection between participant reactive attitudes and ascription of moral status as agent or subject. (...) Nonemotional agents could not hold such attitudes. Also, removing participant reactive attitudes imposes a peculiar and incoherent form of solipsism about moral agency. Given this necessary role for emotion, can we give an account of emotion that will also meet the worries? I examine, as crucial examples, three recurrent lines of concern about emotion - that it threatens our capacities for objectivity, rationality, and autonomy - to tease out the descriptive assumptions about emotion, and the normative assumptions about moral agency, that these objections are based on. I then offer three lines of argument towards resolving these worries. The first addresses the worries directly, and the other two shift blame off emotion. First, then, I argue that the normative concerns can largely be met by a descriptive account that views emotion as cognitive. However, “judgementalist” cognitive accounts that assimilate emotion to belief may make emotion metaethically respectable at the cost of making it meta-ethically redundant. Also, such accounts are descriptively less than plausible. A better approach, I argue, is to allow that belief may play a significant role in emotion but to also allow at least a quasicognitive role to the distinctively affective element in emotion: feeling. I also argue for a hrther revision of cognitive accounts to emphasise that emotions reflect features of those who feel them. If we were different, our emotions would be different. So, secondly, I argue that a number of the features that power worries about emotions have their sources in what those who feel them are like, rather than in emotions as such. However, both human nature and emotion are capable of significant plasticity and diversity. We are also capable of a considerable - but not infinite - degree of self-determination both about what we are like and what our emotions are like. Finally, I argue that the normative assumptions that power the objections to emotion are themselves in need of revision - and in some tension with each other. This leads to a McGufin-theory of emotion in moral agency: Problems with emotion’s place in moral agency serve as indicators of unresolved tensions in our thinking about moral agency, rather than just indicators of problems with emotion as such. In view of this, I also argue for caution in any attempts to change emotion to fit particular ideals of moral agency. (shrink)

Reductionists about agency maintain that an agent’s causing something is reducible to states and events involving the agent causing something. Some worry that reductionism cannot accommodate robust forms of agency, such as self-determination. One reductionist answer to this worry, which I call ‘identification reductionism,’ contends that self-governing agents are identified with certain attitudes, and so these attitudes’ causing a decision count as the agent’s self-determining the decision. I argue that a prominent species of identification reductionism developed by Harry (...) Frankfurt, Agnieszka Jaworska, Jeffrey Seidman, and David Shoemaker—according to which an agent is identified with his (deepest) cares—is inadequate. (shrink)

It may be the case that the most challenging moral problem of the twenty‐first century will be the relationship between the individual moral agent and the practices and institutions in which the moral agent is embedded. In this paper, we continue the efforts that one of us, Joan Liaschenko, first called for in 1993, that of using feminist ethics as a lens for viewing the relationship between individual nurses as moral agents and the highly complex institutions (...) in which they do the work of nursing. Feminist ethics, with its emphasis on the inextricable relationship between ethics and politics, provides a useful lens to understand the work of nurses in context. Using Margaret Urban Walker's and Hilde Lindemann's concepts of identity, relationships, values, and moral agency, we argue that health care institutions can be moral communities and profoundly affect the work and identity and, therefore, the moral agency of all who work within those structures, including nurses. Nurses are not only shaped by these organizations but also have the power to shape them. Because moral agency is intimately connected to one's identity, moral identity work is essential for nurses to exercise their moral agency and to foster moral community in health care organizations. We first provide a brief history of nursing's morally problematic relationship with institutions and examine the impact institutional master narratives and corporatism exert today on nurses’ moral identities and agency. We close by emphasizing the significance of ongoing dialogue in creating and sustaining moral communities, repairing moral identities, and strengthening moral agency. (shrink)

Based upon research into small community-based organisations, Information and Communication Technologies (ICTs) can be interpreted as a technology that emerges from complex environments of support, teaching, and community development. While the ICTs investigated are commonplace and relatively simple systems (personal computers, Internet), they are part of complex and extended systems of action, knowledge, information, and support that reach into local communities. This basket of processes and skills, oriented around social justice principles, can be conceived of as ‘technologies of care’, strongly (...) influenced by the values and work activity primarily concerned with supporting people in need. Furthermore, prior research has tended to take a dystopic view about the use of technology by women, who are the major workforce in such environments, but a more nuanced approach is taken her, demonstrating that while workers are competent with ICTs, they is only one element in a process which relies upon communicative and interpretive independence. This understanding of the place of ICTs in human services work has important implications for those implementing or designing ICTs, though clarifying workers’ tacit understandings is a research challenge. Based on more recent research, suggestions are also made about the limitations of the study and the need to take into account other ways of articulating tacit, practical knowledge about ICT relationships through methods such as CO-MAP. (shrink)

Technology is pervasive and overwhelming in the intensive care setting. It has the power to inform and direct the nursing care of critically ill patients. Technology changes the moral and social dynamics within nurse—patient encounters. Nurses use technology as the main reference point to interpret and evaluate clinical patient outcomes. This shapes nurses’ understanding and the kind of care provided. Technology inserts itself between patients and nurses, thus distancing nurses from patients. This situates nurses into positions of power, granting (...) them epistemic authority, which constrains them as moral agents. Technology serves to categorize and marginalize patients’ illness experience. In this article, moral agency is examined within the technologically-mediated context of the intensive care unit. Uncritical use of technology has a negative impact on patient care and nurses’ view of patients, thus limiting moral agency. Through examination of technology as it frames cardiac patients, it is demonstrated how technology changes the way nurses understand and conceptualize moral agency. This article offers a new perspective on the ethical discussion of technology and its impact on nurses’ moral agency. Employing reflective analysis using the technique of embodied reflection may help to ensure that patients remain at the centre of nurses’ moral practice. Embodied reflection invites nurses critically to examine how technology has reshaped conceptualization, understanding, and the underlying motivation governing nurses’ moral agency. (shrink)

An important question for a naturalized philosophical psychology is what constitutes moral agency (MA). The two prominent scientific theories to which such a philosophical approach might appeal, those of cognitive developmental theory (CDT) and social learning theory (SLT), currently face an investigative dilemma: The better theories of the acquisition of beliefs and the performance of action based on them, the SLTs, seem to be irrelevant to the phenomenon of MA and the theories that seem to be relevant, the (...) CDTs, are unsatisfactory in their accounts of acquisition and action. In this paper I take up the cause of SLT accounts of MA. Critics of SLT accounts of MA can be interpreted as arguing that they are irrelevant to MA because they lack one or more of five functional criteria that require MA to be integral morally motivated cognitive agency. I argue that SLT accounts of MA, and specifically Bandura's social cognitive theory, (SCT), when applied to issues of MA, meet these criteria. Assuming the merits of SLT explanations of both the acquisition of beliefs and the performance of actions based on them, I conclude that SLTs generally, and specifically Bandura's SCT, are promising candidates for explaining MA. If so, they merit the attention of naturalistic philosophical psychologists. (shrink)

There is a striking similarity between the philosophy of Martin Heidegger and Harry G. Frankfurt: they both argue that the temporal nature of human existence and agency is due to the fact that humans care about things. Even though Heidegger’s concept of care and Frankfurt’s concept of caring are very different, they are worth comparing because they play a similar role and have similar significance in their thinking. This comparison also offers an opportunity for a desired dialog between philosophers (...) working in those two different traditions. I argue that the two views can complement each other: Though Frankfurt provides a detailed psychological description of caring, his concept of caring is too mentalistic and leads to solipsism. Thus, his theory can be enriched with the help of Heidegger’s view based on the concept of Being-in-the-world. (shrink)

In her book Experience Embodied Anik Waldow devotes a chapter to “Locke’s Experimental Persons.” Her chapter aims to show how Locke’s views on persons, personal identity, and moral agency in his Essay concerning Human Understanding build on his esteem-based approach to education that he develops in Some Thoughts concerning Education. After outlining main contributions that Waldow makes in her chapter, I turn to three issues that in my view deserve further consideration. First, I draw attention to the question (...) of how Locke’s esteem-based education can be reconciled with his moral views in the Essay. I propose that the question of how children become persons or moral agents who see their actions bound by divine law is worth examining with more detail. Second, I contrast Waldow’s interpretation of what a Lockean action is with an alternative interpretation and show that this has implications for how we understand the role of consciousness in Locke’s account of persons and personal identity. Third, I take a closer look at Waldow’s view that consciousness has an epistemic function in Locke’s account of persons and personal identity and highlight advantages of also acknowledging a metaphysical function of consciousness. (shrink)

Theological understandings of children’s moral agency can benefit from attention to Lev Vygotsky’s dialectical, sociocultural theory of child development. Viewing development as a series of transformations resulting from scaffolded learning in response to new challenges, rather than as an additive process, it anticipates uneven, diverse, and nonlinear processes of growth. It connects moral reasoning with moral agency without using verbal moral reasoning as a proxy for moral ability. This universal process of active, mentored (...) growth yields diversity rather than uniformity in moral practice on all scales from the cultural to the individual. It suggests that Christian moral education should not sequester children from the world or focus on teaching moral principles but mentor them in virtue. Children must encounter challenges; they must have the precursor virtues and concepts to meet those challenges with mentoring; and they must have caring mentors. (shrink)

ABSTRACTZhi is an important Chinese notion that conveys among other things human capacity to set aims, to determine a course of action, or to persist in a resolve. The term naturally turns up in Chinese contributions to Western Free Will debate. In this paper, I explain zhi by working out a comparison that goes from East to West. I do a three-fold textual analysis of zhi focusing on the Mencius. I outline different usages found in the text, examine a nuanced, (...) dominant meaning suggested in 2A.2, and discuss notional features based on language patterns. My analysis yields a more homegrown understanding of zhi which I shall compare with Western expressions of moral agency. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Acting Person and Christian Moral Life by Darlene Fozard WeaverSameer YadavThe Acting Person and Christian Moral Life By Darlene Fozard Weaver WASHINGTON, DC: GEORGETOWN UNIVERSITY PRESS, 2011. 215 PP. $32.95In this carefully argued and theologically subtle study of human moral agency, Darlene Fozard Weaver describes a large-scale shift in theological ethics away from an “act-centered” approach and toward a more “person-centered” approach. She (...) catalogues the shift via recent debates between those with “traditionalist” and “revisionist” attitudes toward the moral status of particular actions in Roman Catholic ethics. Whereas the traditionalist position claims that the intrinsic evil of particular acts is determinative of the moral blameworthiness of the acting person, revisionists hold that the moral status of any act is more fundamentally determined by the orientation of the person to his or her act. This revisionist movement toward a person-centric analysis reflects a wider trend that also includes Protestant ethics, particularly in the twentieth-century resurgence of virtue ethics prompted by MacIntyre and Hauerwas. [End Page 210]Against this backdrop, Weaver wishes to side neither with those traditional act-centric models that culminated in the regulation of personal acts found in pre–Vatican II penitential manuals nor with the more recent person-centric models that privilege the moral interiority of the acting person. Each, she argues, has its gains and losses. The traditional picture rightly gives our particular actions their own fundamental moral significance, but at the expense of tending toward a kind of Pelagianism. The revisionist picture recognizes the irreducibility of our subjective orientation to particular acts, but it leaves the moral significance of personal actions and our resources for navigating moral dilemmas problematically open-ended. Crucially, both pictures, with their narrow fixation on moral culpability, restrict the moral significance of personal actions.Weaver’s contribution is to sketch an account acknowledging the irreducibility of the fundamental orientation of the acting person to his or her acts, while attending to the way that particular actions retain their power for determining that orientation. She builds a picture of this reflexive relation between person and act by way of its instantiation in the relation of sin to particular sins; intimacy with God as bound up in our actual relations to self and others; fidelity to God as a matter not primarily of moral culpability but of moral responsibility in negotiating the particular demands that others place on us; truthfulness before God as the kind of naming of our actions required by the vision of fidelity shared by our community; and reconciliation with God as realized in the healing enabled by acts of forgiveness for our breaches of fidelity. Each moment in this development of her overall picture carefully builds upon the moment preceding it to produce a rich and compelling picture of human moral economy as an outworking of (rather than meriting of) divine grace.Throughout the book, Weaver’s theological interests in moral theorizing are stressed over the philosophical ones, and this may disappoint readers wondering how a theology of human action supervenes on issues such as (in) compatibilism about free will or the metaphysics of agent causation. Although Weaver’s refocusing of our attention on the significance of particular actions is salutary, her criticism of virtue-based approaches as incomplete is attenuated by her dependence upon the Hauerwasian conception of virtue to explicate the very notion of reflexivity that she defends. Such worries notwithstanding, Weaver has given us an extraordinarily fruitful framework for Christian moral theology. Moreover, it is expressed lucidly and makes excellent use of literary sources and current events to illustrate her analysis. Given its depth and accessibility, the book not only is required reading for Christian moral theologians but also deserves a wider readership from anyone interested in making theological sense of human agency. [End Page 211]Sameer YadavIndiana Wesleyan UniversityCopyright © 2015 Society of Christian Ethics... (shrink)

How and why could some stories be construed as sacred in organizations, and what functions does the sacred have in organizational values work? Research has shown how values can be made formative of a range of organizational purposes and forms but has underscored their performative, situated, and agentic nature. We address that void by studying the sacred as a potentially salient yet under-researched realm of values work. Drawing on an ethnographic case study of a faith-based health care organization and the (...) ethical philosophy of Paul Ricoeur, we describe how the sacred is figured in two sets of tales that were lived and told with surprising intensity and consistency: the parable of the Good Samaritan and the tale of the legacy bestowed by the organization’s founder. We theorize how this figuring of the sacred in story and in action recasts values work from a centralized and unitary process to a two-way learning dialectic between the ongoing creative imitation of action and narrative. Values in the shape of stories of the sacred do not achieve their meaning as unchangeable cores or sanctioned beliefs. Rather, they come to life in a process of ongoing moral inquiry that co-evolves with moral agencies. In the latter regard, the sacred primarily becomes manifest in everyday work in the form of questioning and creative acts of care. People become moral agents when they feel and respond to the sacred in the call of the other. (shrink)