What Science Leaves Unsaid: A Reconsideration in 2 Voices.

Background Health care professionals find themselves participating in insignificant events in human existence such as birth, pain, and death which is a privilege but also poses challenges as this participation involves decisions that can be life-changing and having an effect on everyone involved. The study aimed to explore moral distress within the context of Saudi Arabia. Methodology A simple qualitative design was used with a research paradigm of constructivism. Data collection included in-depth interviews with five critical care nurses who were purposively sampled. The setting for the study was the critical care units at King Abdul- Aziz Medical City- Jeddah. Data analysis included content analysis. Principles of academic rigor were followed. Findings Two themes emerged from this study with various subthemes. Theme 1: Turning away from nursing obligations: hands are tied, the burden of workload, no voice, not honoring oath; Theme 2: Bad practice: hierarchy in practice and feeling guilty. Conclusions This study highlights that moral distress within critical care units is a real problem that impacts on critical care nurses' physical and psychological stress. Health care institutions should mobilize resources to reduce these effects on critical care nurses and other health care professionals.

Being a healthcare professional in both paediatric and adult hospitals will mean being exposed to human tragedies and stressful events involving conflict, misunderstanding, and moral distress. There are a number of different structured approaches to reflection and discussion designed to support healthcare professionals process and make sense of their feelings and experiences and to mitigate against direct and vicarious trauma. In this paper, we draw from our experience in a large children's hospital and more broadly from the literature to identify and analyse four established approaches to facilitated reflective discussions. Each of the four approaches seeks to acknowledge the stressful nature of health professional work and to support clinicians from all healthcare professions to develop sustainable skills so they continue to grow and thrive as health professionals. Each approach also has the potential to open up feelings of uncertainty, frustration, sorrow, anguish, and moral distress for participants. We argue, therefore, that in order to avoid unintentionally causing harm, a facilitator should have specific skills required to safely lead the discussion and be able to explain the nature, scope, safe application, and limits of each approach. With reference to a hypothetical but realistic clinical case scenario, we discuss the application and key features of each approach, including the goals, underpinning theory, and methods of facilitation.

There are three main conceptualizations of nurses' stress: occupational stress, moral distress, and traumatization (compassion fatigue, secondary traumatic stress, vicarious trauma). Although we have learned a great deal from these fields, some of them lack important contextual aspects of nurses' practice, such as the gendered nature of the workforce and the nature of the work, including bodily caring. The purpose of this study was to reformulate the nature of stress in nursing, with attention to important contextual aspects of nurses' practice. Smith's sociological frame of institutional ethnography was used to explicate the social organization of nurses' stress. Data collection methods included in-depth interviews, participant observation, and focus groups with pediatric intensive care nurses. Data analysis focused on the social organization of nurses' stress, including negotiating power-based hierarchies and articulating the patient to the system. The article concludes with recommendations for addressing nurses' stress through a more critical and contextual analysis.

As healthcare accelerates into an era defined by artificial intelligence, precision medicine, and advanced technologies, nursing leadership faces a critical inflection point. This article argues that the most essential leadership capability for nursing now and in the decade ahead is heart-centred leadership: the intentional integration of compassion, ethical integrity, relational awareness and strategic competence. Far from being sentimental, heart-centred leadership is positioned as a practical and evidence-based response to escalating burnout, moral distress, and the erosion of nursing's professional identity-challenges intensified by the COVID-19 pandemic and ongoing workforce shortages. Drawing on nursing theory and contemporary leadership research, the article demonstrates how leadership grounded in psychological safety, moral resilience and authentic human connection strengthens patient outcomes, supports workforce sustainability and enables learning in complex healthcare systems. It highlights how heart-centred leaders approach error, technology adoption and performance measurement in ways that protect the nurse-patient relationship while maintaining organisational accountability. Attention is also given to the role of women leaders, equity and social justice and the necessity of leader wellbeing as a foundation for compassionate cultures. The article concludes that as healthcare becomes increasingly technologically sophisticated, nursing leadership must become more intentionally human-centred. Leading with heart ensures that innovation serves healing rather than eclipsing it, safeguarding nursing's core purpose of alleviating suffering and promoting human flourishing.

FigureThe COVID-19 pandemic brought unforeseen, unprecedented challenges to healthcare staff well-being. It also elicited compassion, a sense of community and belonging, and strong interdisciplinary collaboration at NYC Health + Hospitals/Kings County. Kings County is a Level I trauma center, one of the 11 acute care facilities of New York City Health + Hospitals. Designated a Center of Excellence for stroke, diabetes, perinatal care, AIDS, Parkinson disease, behavioral health, and Sexual Assault Forensic Examiner (SAFE), the facility houses 624 certified beds, employs more than 5,000 people, and serves 2.6 million residents of Brooklyn. In pursuit of nursing excellence, Kings County implemented a creative and evidence-based wellness program that supports the health and well-being of its most valuable asset—the staff—especially during the COVID-19 pandemic.1,2 The innovative program, in alignment with the Pathway to Excellence® framework, helped sustain a positive practice environment for all of its stakeholders. Problem statement and process At the wellness program's inception in 2018, the initial aim was to address: the acute reaction to unanticipated and adverse work-related events; stress; secondary, vicarious, complex, and collective trauma; compassion fatigue; and burnout. The goal was to provide staff with the opportunity to discuss difficult experiences they encounter daily, allowing them to bring their entire selves to work and feel comfortable doing so.1 From the onset of COVID-19 pandemic in 2020, the interdisciplinary well-being steering committee recognized a need to provide real-time identification and response to staff exhibiting signs of stress, burnout, and exhaustion. With nurses at the forefront, the committee decided to expand the capacity of existing well-being program services to meet a wider range of needs.3,4 We implemented a more holistic approach embracing other aspects of well-being, including physical, psychological, socioeconomic, spiritual, and cultural.5 Engagement and collaboration with other disciplines was critical. We welcomed the help of everyone—licensed therapists, psychologists, psychiatrists, RNs, peer counselors, creative arts therapists, dance/art/drama/yoga/meditation instructors, and even finance personnel. This ready-to-respond team provided psychological first aid and education on grief, trauma, stress management, substance use disorder, and healthy coping strategies applicable at work and at home. They facilitated connection to resources such as the employee-assistance program (EAP), mental health services, pastoral care, child mental health support services, and domestic violence assistance.6 With the increasing demand for support, the well-being team met with staff throughout the facility to acknowledge their challenges and provide assistance in building their inner strength and resilience. The team began each day with a meditation to center and prepare themselves for challenging situations. Debriefs and meditations helped the well-being team to let go, feel refreshed, and continue their work the next day. Implementation of initiatives Kings County leadership and nursing teams implemented sustainable interventions and strategies to support staff well-being. Wellness rooms were enhanced with soothing music, gratitude cards, comfort snacks, water, and aromatherapy, provided 24/7. Volunteers were available to provide debriefs and informational resources to staff members. In response to the unfortunate passing of colleagues, wellness rooms were expanded to include mourning and remembrance spaces where staff could go at any time to leave photographs and notes on the board, write their name and thoughts in the guest book, light electronic candles, and spend quiet contemplative moments in comfortable chairs. Other implemented well-being initiatives are detailed below. Meditation hours: Held every Tuesday afternoon in a wellness room, staff can participate in 10-minute meditation sessions facilitated by hospital pastoral staff in collaboration with the well-being steering committee. Stress, trauma, and resiliency training: Rolled out by nurse trainers, this initiative provided education that leaders and staff could use to address their personal challenges or help support their colleagues and family members. There were 133 participants in the training series.2,7 Wellness rounds: Conducted on units, these check-ins with individuals (1:1) or groups foster ongoing dialogue on wellness and help identify burnout, exhaustion, stress, trauma, and moral distress. Rounds could transition to much-needed debriefs (group or individual). One-to-one or group debriefs: These impromptu or scheduled conversations (1:1 or groups) with a trained wellness supporter hold a safe space for reflection and processing. During these debriefs, facilitators share informational and therapeutic resources and schedule follow-ups. Compassion carts: The well-being team rounded with carts to deliver healthy snacks, beverages, and hygiene kits to various areas where staff couldn't leave the unit. Rounding with the compassion cart opened opportunities to engage staff in on-the-go debriefs or check-ins and offer support, resources, and follow-up visits. There were also nourishment stands located outside the units where staff could get a cup of coffee or tea and decompress. We-Time Wednesdays: These offerings involve creative relaxation and self-care activities for groups in common areas or on the units. Through We-Time, employees from nursing and other disciplines can engage in mindfulness/meditative activities such as beading, painting, coloring, listening to relaxing music, and box breathing. Dance, movement, and stretch: This is a weekly event with a volunteer artist-in-residence who promotes physical well-being by reducing body tension and exhaustion, as well as inspiring staff to feel mentally, emotionally, and psychologically rejuvenated through movement. Creative arts sessions: Sessions include beading, knitting, painting, and planting to support compassion fatigue. Evidence suggests art-based interventions are effective in reducing adverse physiologic and psychological outcomes.8 Schwartz Rounds: As a member of The Schwartz Center for Compassionate Healthcare, Kings County conducts Schwartz Rounds sessions for teams that experienced an adverse event at work. Participants listen in a nonjudgmental way to each other's stories about a specific emotionally traumatic case, recognizing similarities and differences across job roles, departments, cultures, religions, and individual beliefs. This fosters and supports empathy, collaboration, and compassion for self and others.9 Boxing COVID-19: Staff can release frustration, anxiety, anger, or fear by "boxing" a cardboard wall. Memorial services: Memorial services are held in open air spaces within the campus where coworkers and bereaved family members come together to share testimonies, honor, and celebrate the lives of those lost to COVID-19. Transcendental meditation (TM): This is a simple, natural technique that allows the active-thinking mind to experience quiet levels of thought, promotes deep relaxation, and reduces stress levels. TM can be practiced for 20 minutes on one's own time, twice daily, when sitting comfortably with eyes closed.10 A formal TM training session by a trained instructor is provided to all new participants. Recognition events: Kings County sees recognition as an essential element of a positive practice environment and joy at work. Many recognition events take place throughout the year. For example, each year the organization hosts a volunteer recognition event where nursing staff who render volunteer and community work are recognized, honored, and given the opportunity to share their personal stories and experiences. Nursing leaders' wellness retreats: These events create the environment to build meaningful connections, strengthen relationships among leaders, and model a culture of wellness. We conduct separate retreats for nurse leaders (directors of nursing and assistant directors of nursing) and for nurse managers/assistant nurse managers. Topics include work-life balance, understanding a culture of wellness in the healthcare community, how gratitude improves overall well-being, identifying and addressing stressors, modeling self-care, showing how vulnerability and emotional availability are strengths that benefit patients and staff, and bringing more meaning and personal value to work. Nurse leaders also support their staff to take time off or use their annual leave days to rest and rejuvenate or spend more time with their families. Outcomes and ongoing interventions The latest research underscores the need for, and the success of, well-being interventions. The World Health Organization defined burnout as "a disease of the 21st century" and the Occupational Safety and Health Administration declared stress a workplace hazard.11-13 From 2021 through 2022, the demand for Kings County's well-being support services continued to grow and strategies evolved. Our focus continued to prioritize addressing burnout, compassion fatigue, emotional pain, trauma, moral injury, and distress.14 Nurse supervisors and unit managers showed sensitivity to the well-being needs of their staff. They generated the largest number of referrals for both 1:1 peer support and group debrief sessions in the past 2 years. Managers allowed staff to attend group well-being events by arranging coverage on the units, even if it was only for 15 minutes. According to staff, this is often enough for them to feel rejuvenated and able to reset. It's vital to regularly evaluate our wellness initiatives for their value and usefulness to staff, and based on the findings, initiatives are revised to meet current staff needs. Some feedback and evaluation findings on select well-being initiatives are included below. Dance, movement, and stretch: We've learned that brief sessions (intervals of 10 to 15 minutes) are more realistic for busy nurses working on the units; therefore, sessions would turn over every 15 minutes. Participants articulated that the activity greatly reduced their stress levels. Schwartz Rounds: Some comments in postactivity surveys included: "I have a new appreciation of my colleagues from other disciplines." "I feel more compassion toward patients and families." "I was on the unit during this event which I don't think I will ever forget. I am very appreciative that this space was created to speak about/process this." "I feel greater support for my efforts to provide care in difficult emotional and social situations." "I have better sense of belonging to a team." Figure 1:: ANCC Pathway to Excellence® Framework for Positive Practice EnvironmentsWe-Time Wednesday creative arts sessions: Participants expressed relief from stress after the activity stating: "It's okay to take time for yourself." "This activity reminds me that no matter how busy we are, we still have time for ourselves to unwind and be creative. I enjoyed the activity and look forward to more of this." Support group sessions: A team member wrote: "Staff are able to move from fear, helplessness, anger, and perceived defeat, to celebrating their strength, unity, positive impact, and successes," and "I had an over-an-hour long group processing session with four nurses who are recovering from COVID themselves, grieving for the loss of their patients/colleagues/personal relations, and coping with changes in their workplace—people felt comfortable enough to shed tears in front of me and one another, and through the group they are beginning to rely on each other as their support system." TM: Based on survey feedback from those who received the training, 100% reported, "I have experienced a greater clarity of mind," and 83% reported, "I have less fatigue." A participant commented, "It has taught me more patience and compassion. I have more empathy for others and listen more attentively to what others tell me. Instead of reacting immediately, I learned to just listen and acknowledge what they say." Mostly from what proved to be effective and appreciated interventions during the pandemic, together with other evidence-based approaches, we've developed a tool kit that's now ingrained into what we do every day to support staff well-being as a Pathway to Excellence-designated organization. Table 1 shows support programs and strategies provided as part of the well-being tool kit. Table 1: - Well-being support programs and strategies Well-being focus Initiative/offering Physical Nourishment stands Dance, movement, and stretch Fitness center Walking groups Yoga Movement therapy and mindfulness Massage chairs Psychological Recognition events Schwartz Rounds Transcendental Meditation Stress, Trauma, and Resiliency Training Group debriefs One-to-one sessions Wellness rounds Referrals to Behavioral Health services and the EAP Socioeconomic Child mental health services Domestic violence assistance Financial personnel support Wellness retreat Relationship-building Spiritual Meditation hours with pastoral staff Meditation bus Memorial services Pastoral care services Meditative yoga Cultural Creative arts sessions Support for cultural groups affected by disasters Pathway to Excellence Nursing Volunteer Appreciation Day (honoring volunteer services provided within cultures and communities) Pathway to Excellence Kings County achieved Pathway to Excellence designation in October 2022. The Pathway standards of shared decision-making, leadership, and well-being are evident and instrumental to the culture and success of the initiatives referenced in this article. Through shared decision-making, the well-being steering committee members plan and implement initiatives. Organizational leaders are provided tools and training to prepare them to support their teams for their well-being needs. A positive practice environment In keeping with Pathway to Excellence standards, Kings County integrates employee well-being and resilience into our organization's strategic and operations plan. Senior and nursing leadership serve as educators, coaches, and role models for well-being. Led by a nurse, our multidisciplinary steering committee team spearheads and collaborates with the hospital community to implement and evaluate well-being initiatives. With the Pathway to Excellence Program, Kings County is committed to creating and supporting a positive practice environment: an environment in which nurses are empowered, their values are validated, interprofessional collaboration is a norm, and worker health and well-being are prioritized.

Contemporary healthcare finds itself at a crossroads. While technological advances have revolutionized our capacity to diagnose and treat disease, something essential seems missing from the healing encounter. Patients report feeling like numbers rather than persons, while healthcare providers experience unprecedented levels of burnout and moral distress (1,2). This disconnect suggests that our current paradigms, rooted in scientific reductionism and Cartesian dualism, may inadvertently fragment the very human experiences they seek to heal. This essay proposes an integrative framework that honors both scientific rigor and the sacred dimensions of healing. Rather than abandoning evidence-based medicine, we argue for expanding our understanding of what constitutes evidence to include the profound ways that meaning, relationship, and transcendence influence health outcomes. Drawing from diverse fields—neuroscience, medical anthropology, trauma research, and theological scholarship—we outline twelve interconnected themes that could transform healthcare practice while maintaining its scientific foundation. The framework we present here emerged from years of clinical practice working with patients whose suffering exceeded the boundaries of conventional diagnostic categories. Time and again, we encountered individuals whose healing required not just medical intervention but restoration of meaning, connection, and hope. These encounters forced us to grapple with fundamental questions: What does it mean to heal? How do we honor both the biological and spiritual dimensions of human suffering? Can medicine embrace mystery without abandoning rigor?

Background and Purpose: With demand for aged care growing rapidly in Australia and globally, there is a concomitant growth in demand for an aged care workforce. The Australian Royal Commission’s into Aged Care Quality and Safety handed down its final report in February and found significant issues in aged care, and many of the recommendations contained in the final report represent a failure of leadership. The issues identified by the Royal Commission require well-trained and insightful leaders to deal with the funding system’s economic constraints, workforce shortages, safety and quality issues with the care delivered, and the system’s ability to meet consumers’ expectations. For these reasons, it is critical to understand what makes an effective aged care leader through their followers’ eyes at all levels. Design Methodology and Approach: This mixed-methods study sought to answer questions relating to leadership style and the constructs of organisational identification (OID) and job satisfaction (JS) to determine any associations between leadership style and the strategies deployed to increase OID and JS. Study 1 was quantitative in approach and examined differences in responses between the Leaders who self-rated and those who rated them in the quantitative study labelled as Raters in this study. The online questionnaire contained three prior validated tools of the MLQ5X[Short] (Bass & Avolio, 1993), the Identification with a Psychological Group Scale (Mael & Tetrick, 1992) that measured OID and the Measure of JS (Traynor & Wade, 1993). Study 2 employed the qualitative method of Interpretive Phenomenological Analysis (IPA) to better understand the Leaders and Raters’ lived experiences from transcripts of semi-structured interviews of semi-structured interviews designed around the areas of difference found in study 1 and provided a more granular understanding of the identified differences and why they occur. Results and Findings: There were six areas of significant difference between the two groups that informed the semi-structured interview agenda. The study found that OID was not evident among the participants in both groups who were attracted to aged care because it was the type of work rather than the attractiveness of the employing organisation. Leadership style was not associated with promoting or inhibiting OID. Leadership style, however, did have a significant effect on JS and a greater depth of understanding of why this occurred. Participants demonstrated significant moral distress, role stress, and disengagement that the literature suggests can lead to job burnout resulting in increased workforce turnover and exacerbating workforce shortages and issues relating to the quality and safety of the care provided. The research also identified a disparity between leaders’ intentions in their leadership role and follower expectations. The research concluded that the personal behaviours of leaders (PBoLs) that relate to self-development, developing positive interpersonal behaviours, developing authentic and ethical leadership practices, and developing others are required. These PBoLs were central to leaders exhibiting the influencing functions of leaders (IFoLs) and informed the conceptual model developed to guide leadership training programs and performance assessment frameworks for aged care leaders. Implications: The research contributes to developing training programs and performance assessment strategies for aged care leaders to narrow the intention-experience disparity. It will assist in improving the working lives of aged care employees, reduce staff turnover intentions and improve the quality and safety of care for elderly Australians. The research outcomes may also assist in making aged care more attractive as a career alternative for those considering entering employment and retaining those already working in aged care.

There is a perpetrator historiography of the Holocaust and a Jewish historiography of the Holocaust. The former has received the lion’s share of attention in bioethics, particularly in the form of warnings about medicine’s potential for complicity in human atrocity. However, stories of Jewish physicians during the Holocaust are instructive for positive bioethics, one that moves beyond warnings about what not to do. In exercising both explicit and introspective forms of resistance, the heroic work of Jewish physicians in the ghettos and concentration camps tells us a great deal about the virtues and values of medicine. In this article, we frame the stories of four of these Jewish physicians in ways that are instructive for contemporary medicine. By far, the most widely recognized and discussed figure is Viktor Frankl, whose work on hope and the meaning of suffering remains essential insofar as medicine inherently confronts disease and death. Less discussed in bioethics and medical humanities are the cases of Mark Dworzecki, Karel Fleischmann, and Gisella Perl. Dworzecki’s efforts to encourage others in the Vilna Ghetto to document their experiences illustrates the power of narrative for the human experience and the notion of ethics as narrative in the face of suffering. Fleischmann’s art underscores not only the importance of reflective practices for professionals as a form of simultaneous introspection and testimonial, but illuminates hope amid sheer hopelessness. This hope, which was comparatively implicit in much of Fleishmann’s art, is explicated as a method by Frankl, becoming a form of therapy for both physicians wrestling with their professional work, and patients wrestling with their illnesses and diseases. Finally, Perl’s resistance to Mengele’s orders highlights the importance of moral action, not just reflective reaction. The experiences of each of these figures, while certainly located in the unique horrors of Holocaust Germany, portends lessons for today’s physicians faced with moral distress and ethical dilemma in the face of suffering, interpersonal relationships, and socio-political conflicts that increasingly test the professed ideals of medicine. In this article we briefly tell the story of each of these physicians and connect the lessons therein to contemporary medical practice.

The rise of modern medicine and the extension of its explanatory powers over so many areas of human experience coincided with the increasing cultural authority of imaginative literature as a record and exploration of everyday life. Both literature and medicine addressed central questions about moral, social, and physical distress and drew from the same cultural presuppositions that they in turn confirmed or helped to shape. Although the relations between doctors and patients were rarely a subject for fictional treatment, the discourse of medicine and the methodology of medical science entered into imaginative treatments of psychic distress and of the social problems arising from urbanization and an industrial economy. Literary scholarship on the relations between medicine and literature has flourished since the 1980s, as a result of the wide acceptance of interdisciplinary research and of the influence of Michel Foucault's work on the disciplinary force of medical discourse.

Background: The cost of caring for patients and their families in the midst of interconnected resource, ethical, moral, legal and practical considerations compromises a physician's emotional and physical well-being and therefore patient care. Whilst the cost of caring is historically best associated with compassion fatigue, data has suggested that this may extend to other related concepts, such as vicarious trauma, secondary traumatic stress and burnout. In particular, palliative care physicians are especially vulnerable as they witness and encounter more cases of death and dying. Methods: This study aims to provide a more clinically relevant notion of the cost of caring amongst palliative care physicians in Malaysia. 11 physicians underwent semi-structured interviews as part of the Systematic Evidence-Based Approach (SEBA) for prospective studies. Results: Analysis of the interview transcripts revealed the following domains: (1) conceiving the costs of caring; (2) risk factors; and (3) support mechanisms. Conclusion: This SEBA-guided study into the cost of caring amongst Malaysian palliative care physicians suggests that the costs of caring extend beyond encapsulating moral distress, compassion fatigue, vicarious trauma, secondary traumatic stress and burnout. Rather, the data suggests a personalized notion that varies with individual and contextual factors which are in flux and change over time. A longitudinal, personalized and holistic mentoring program is therefore proposed to counter this cost.

BackgroundDemands upon surgeons are increasing, especially in the care of the terminally ill. Fronting patient care, supporting families and guiding multi-disciplinary care teams facing the loss of patients see surgeons experiencing moral distress, compassion fatigue, vicarious trauma and secondary traumatic stress with the blurring of professional and personal boundaries. The full extent of these ‘costs of caring’ upon a surgeon remains unclear despite evidence of their compromises to patient care. To understand the costs of caring, semi-structured interviews are proposed to achieve the primary aim of understanding ‘What is known about the costs of caring on surgeons in Singapore?’ and the secondary aim, ‘What is the impact of the costs of caring on a surgeon’s professional identity?’.MethodsTwelve surgeons of various subspecialties from a tertiary cancer centre in Singapore were interviewed between 21st June 2022 and 18th December 2023. Transcripts were analysed using Krishna’s Systematic Evidence-Based Approach.ResultsThe key domains identified were: (1) motives for surgical career; (2) forms of emotional distress experienced; (3) impact of challenging experiences on personhood; and (4) buffer mechanisms.ConclusionsThe costs of caring impact surgeons’ professional identities; shape their ‘internal compasses’ or the way they deliberate and assess their responsibilities; and influence patient safety and family support. The costs of caring and the ‘internal compass’ are moulded by the surgeon’s traits, maturing competencies, growing insights, clinical experience and sociocultural context. Without holistic, longitudinal and personalised support in both the personal and professional spheres, the costs of caring compromise surgeons’ confidence and professional identities.

There is no cure without care.

Embracing a living ethics stance involves recognizing moral reasoning as a continuous, everyday practice inherent in personal and professional interactions. Ethics is not confined to academic experts or ethics committees but is a fundamental, evolving aspect of human experience. Despite this, professional ethics is often taught as a static set of principles, overlooking its dynamic nature. While familiarity with ethical theories does not eliminate moral doubt, ethics is frequently portrayed as rule-based, leading professionals to interpret uncertainty as a sign of failure or moral incompetence. This perception can inhibit open dialogue and contribute to moral distress. Pragmatist ethics, grounded in the work of Dewey, underscores the evolving and experiential character of ethics, positioning doubt and moral inquiry as essential to growth and development. From this perspective, doubt functions not as a deficiency but as a stimulus for deeper moral reflection. This chapter presents a pragmatist approach to living ethics and examines its relevance for moral reasoning in professional contexts such as health care and research. It outlines key elements of a pragmatist approach to professional ethics and demonstrates how this perspective can inform ethics education and enhance moral reasoning in practice.

Legal Authority and Competence: The May-Can Disconnect According to Barbara Safriet