Write a PREreview

Clinical moral disengagement scaffolding produces neurobiologically mediated escalation suppression through authority displacement, signal suppression, institutional gaslighting, organizational deviance conditioning, and moral adaptation. This framework integrates Continuity Risk Framework (CRF) audit indicators with neuroscience, trauma science, and epigenetics to demonstrate how organizational designs impair threat detection, moral reasoning, and decision latency. The comprehensive governance matrix maps these mechanisms to patient harm, workforce injury, and CRF failures, establishing failure‑to‑rescue as an engineered outcome rather than an individual lapse. Leadership accountability metrics, including weighted ISO 45003/HSE‑aligned audit instruments, enable mechanism identification and governance realignment. The model advances safety science by unifying CRF methodology, safety culture analysis, and biologic adaptation evidence, transforming leadership accountability from outcome review to mechanism elimination.