The Cost of Care
Exploring the Moral Side of Paradox Among Primary Medicine Doctors
Bibliographic Data
| ID | 22413828 |
|---|---|
| Authors | James Greenslade-Yeats (0000-0003-2589-623X, Auckland University of Technology, corresponding author), Tago L Mharapara (Auckland University of Technology) |
| Year | 2026 |
| Publication date | 2026-07-14 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Journal of Business Ethics (JOURNAL) |
| Journal identifiers | ISSN: 0167-4544 • E-ISSN: 1573-0697 |
| Publisher | Springer Science and Business Media LLC (PUBLISHER) |
| DOI | 10.1007/s10551-026-06399-1 |
| OpenAlex | W7168293195 |
| Language | EN |
| References cited | 52 |
Organizational paradoxes are traditionally viewed as problems that defy logic, yet they may also challenge individuals’ moral beliefs and values. Drawing on interviews with primary medicine doctors in the United States (N = 24) and New Zealand (N = 26), our study focuses on the understudied moral side of paradox and how it relates to power relations. Specifically, we explore how power relations influence doctors’ experiences of a “morally asymmetrical” paradox—namely, an underlying tension between cost and care imperatives—where one pole (care) is seen as morally important while the other (cost) holds largely instrumental value. We find the cost-care tension is generative for doctors when they can engage both poles on their own terms, but triggers moral distress when structural power imbalances prevent doctors from engaging morally important care imperatives. We also show how doctors respond to such distress using three “moral boundary management approaches”— Moral self-differentiation, Moral dissociation , and Moral dissociation combined with extra-role moral engagement —whereby doctors’ (re)position their personal moral responsibilities in relation to their roles in the healthcare system. Altogether, our study advances understanding of the important yet understudied links among paradox, power, and morality.
Business ethics · Distress · Ethics of care · Generative grammar · Health care · Moral disengagement · Moral responsibility · Quality of Life Research · Ethics in medical practice · Healthcare cost, quality, practices · Management and Organizational Studies
Toward a Theory of Paradox
A Paradox Perspective on Corporate Sustainability
Microfoundations of Organizational Paradox
Dynamic Decision Making
Qualitative Research and the Academy of Management Journal
Short on Time
Constrained Morality in the Professional Work of Corporate Lawyers
Why are Men More Likely to Morally Disengage Under Job Stress than Women? Evidence from Resting-state fMRI
Stages of Corporate Sustainability
A Dynamic Theory of Moral Distress in Child Welfare Workers
The self-importance of moral identity
Theorizing morality in context
Objectification, standardization, and commodification in health care
Inequality Regimes
| Highly cited | No |
|---|