Although moral distress is now a well-recognized phenomenon among all of the healthcare professions, few evidence-based strategies have been published to address it. In morally distressing situations, the “presenting problem” may be a particular patient situation, but most often signals a deeper unit- or system-centered issue. This article describes one institution’s ongoing effort to address moral distress in its providers. We discuss the development and evaluation of the Moral Distress Consultation Service, an interprofessional, unit/system-oriented approach to addressing and ameliorating moral (...) distress. (shrink)

The notion of virtue in general, and courage in particular, has had a hard time integrating itself into the everyday lexicon of bioethics. Following the lead of enlightenment moral philosophy, which concentrates on the theory of right action as opposed to the ancient Greeks' emphasis on the development of good character, bioethics, with some notable exceptions, has tended to relegate consideration of the virtues to the sidelines of moral argument. Recently, however, there have been calls for the necessity of “moral (...) courage” in the context of clinical ethics. As nurses, physicians, and other health care professionals confront a variety of moral contexts in which the virtue of courage is invoked to "do the right thing," stand up for patients' rights, and uphold the ethical standards of their professions, they are increasingly reminded of their moral duty to exhibit courage in the face of institutional obstacles to the proper care of their patients. For example, a nurse's hesitation to approach a physician to request increased sedation for an agitated patient out of fear of retaliation is represented in one article as a lack of courage.In this paper we offer a critical assessment of such invocations of courage. While we find courage to be an indispensable virtue in some challenging contexts, in other settings we find invocations of courage to be both an unfortunate endorsement of an oppressive status quo that can divert attention from the real problems and an undesirable and potentially destructive strategy within health care institutions whose goal is medically excellent and morally good clinical practice. As we shall argue, a call to virtuousness is not always virtuous. (shrink)

Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective (...) ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings. (shrink)

Ethics raises questions about what kind of society we ought to be, questions that are at the heart of this case. Increasingly, inequalities in healthcare fueled by lack of access, inadequate insurance coverage, and rising costs are creating dilemmas in the proper distribution of healthcare resources. Questions of distributing scarce and valuable resources are fundamentally questions of justice. The classic definition of justice is the duty to give to each person what they deserve and can legitimately claim so that justice (...) is understood as a moral obligation to help persons exercise their rights. Distributive justice, i.e., what distribution of resources is fair, equitable, and appropriate, thus turns on the concept of rights. One of the key questions in this case is whether and to what extent this patient has a right to treatment for his heart disease. In the classic understanding of justice, he must assert and we as a society must agree that he has a right to treatment for his heart condition before we are morally obligated to provide this care. Are there limits to this patient's right to healthcare? If so, what are they? The differing principles of distributive justice use different criteria to rank or weight decisions regarding the proper and just distribution of healthcare services. In this case, at least two competing but ethically valid principles can be identified: the humanitarian principle and the libertarian principle. (shrink)

Abstract Studying a concept as complex as moral distress is an ongoing challenge for those engaged in empirical ethics research. Qualitative studies of nurses have illuminated the experience of moral distress and widened the contours of the concept, particularly in the area of root causes. This work has led to the current understanding that moral distress can arise from clinical situations, factors internal to the individual professional, and factors present in unit cultures, the institution, and the larger health care environment. (...) Corley et al. ( 2001 ) was the first to publish a quantitative measure of moral distress, and her scale has been adapted for use by others, including studies of other disciplines (Hamric and Blackhall 2007 ; Schwenzer and Wang 2006 ). Other scholars have proposed variations on Jameton’s core definition (Sporrong et al. 2006 , 2007 ), developing measures for related concepts such as moral sensitivity (Lutzen et al. 2006 ), ethics stress (Raines 2000 ), and stress of conscience (Glasberg et al. 2006 ). The lack of consistency and consensus on the definition of moral distress considerably complicates efforts to study it. Increased attention by researchers in disciplines other than nursing has taken different forms, some problematic. Cultural differences in the role of the nurse and understanding of actions that represent threats to moral integrity also challenge efforts to build a cohesive research-based understanding of the concept. In this paper, research efforts to date are reviewed. The importance of capturing root causes of moral distress in instruments, particularly those at unit and system levels, to allow for interventions to be appropriately targeted is highlighted. In addition, the issue of studying moral distress and interaction over time with moral residue is discussed. Promising recent work is described along with the potential these approaches open for research that can lead to interventions to decrease moral distress. Finally, opportunities for future research and study are identified, and recommendations for moving the research agenda forward are offered. Content Type Journal Article Pages 1-11 DOI 10.1007/s10730-012-9177-x Authors Ann B. Hamric, School of Nursing, Virginia Commonwealth University, P.O. Box 980567, Richmond, VA 23298-0567, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

Moral distress is a phenomenon increasingly recognized in healthcare that occurs when a clinician is unable to act in a manner consistent with his or her moral requirements due to external constraints. We contend that some experiences of moral distress are self-inflicted due to one’s under-assertion of professional authority, and these are potentially avoidable. In this article we outline causes of self-inflicted moral distress and offer recommendations for mitigation.

In their article “A Broader Understanding of Moral Distress,” Campbell, Ulrich, and Grady (2016) correctly assert that moral distress is well established in the nursing literature and is gaining at...

An exploration of modern society and the critical value of popular culture.

Dans la genese de sa constitution, la philosophie n'a pu faire l'economie d'une confrontation avec la musique qui fournissait aux anciens Grecs les schemes fondamentaux de la culture. De cette confrontation Platon est le temoin. Scindant la musique, il privilegie l'Harmonique, qui en est la partie theorique, sans toutefois lui reconnaitre la titre de science supreme. Correlativement, il condamne comme dysharmonie, tumulte fracassant et perturbateur de l'ordre cosmique, l'harmonie chromaticiste dont il s'emploie, non sans paradoxe, a decrire le detail. Par (...) cette lecture en filigrane des Dialogues de Platon, l'auteur se propose de reconstruire la pensee qui procede de l'harmonie chromaticiste et de montrer son importance dans l'elaboration de la philosophie fondatrice. Au carrefour des disciplines du savoir antique, ce livre s'adresse non seulement aux philosophes, mais aussi a tous ceux qui, musiciens ou stylisticiens, s'interessent a la forme musicale. (shrink)

Sudden, broad-scale shifts in public opinion about social problems are relatively rare. Until recently, social scientists were forced to conduct post-hoc case studies of such unusual events that ignore the broader universe of possible shifts in public opinion that do not materialize. The vast amount of data that has recently become available via social media sites such as Facebook and Twitter—as well as the mass-digitization of qualitative archives provide an unprecedented opportunity for scholars to avoid such selection on the dependent (...) variable. Yet the sheer scale of these new data creates a new set of methodological challenges. Conventional linear models, for example, minimize the influence of rare events as “outliers”—especially within analyses of large samples. While more advanced regression models exist to analyze outliers, they suffer from an even more daunting challenge: equifinality, or the likelihood that rare events may occur via different causal pathways. I discuss a variety of possible solutions to these problems—including recent advances in fuzzy set theory and machine learning—but ultimately advocate an ecumenical approach that combines multiple techniques in iterative fashion. (shrink)

Investigating the theoretical and empirical relationships between transparency and trust in the context of surveillance, this volume argues that neither transparency nor trust provides a simple and self-evident path for mitigating the negative political and social consequences of state surveillance practices. Dominant in both the scholarly literature and public debate is the conviction that transparency can promote better-informed decisions, greater oversight, and restore trust damaged by the secrecy of surveillance. The contributions to this volume challenge this conventional wisdom by considering (...) how relations of trust and policies of transparency are modulated by underlying power asymmetries, socio-historical legacies, economic structures, and institutional constraints. They study trust and transparency as embedded in specific socio-political contexts to show how, under certain conditions, transparency can become a tool of social control that erodes trust, while mistrust-rather than trust-can sometimes offer the most promising approach to safeguarding rights and freedom in an age of surveillance. The first book addressing the inter-relationship of trust, transparency, and surveillance practices, this volume will be of interest to scholars and students of surveillance studies as well as appeal to an interdisciplinary audience given the contributions come from political science, sociology, philosophy, law, and civil society. (shrink)

This essay explores the lasting theoretical value of Marcuse’s “repressive desublimation” via the psychoanalytic concepts of Žižek and Lacan. It argues that Marcuse’s theory should be adapted to include Lacanian notions of death drive and enjoyment, but also that it remains particularly suitable to structurally define consumer capitalist ideologies that incorporate both drive and immediate gratification to reinforce institutional patriarchy. Combining the theories then reveals a paradoxical demand to “enjoy responsibly,” which engenders various indirect rationalizations of Marcuse’s “performance principle.” This (...) interpretation also points to various positive ideological beliefs with critical significance that exceeds Marcuse’s focus on their “higher unification.”. (shrink)

In this paper we examine ethical issues relevant to conducting mental health research with refugees and immigrant communities that have cultural orientations and social organisation that are substantially different to those of the broader Australian community, and we relate these issues to NH&MRC Guidelines. We describe the development and conduct of a mental health research project carried out recently in Melbourne with the Somali community, focusing on ethical principles involved, and relating these to the NH&MRC National Statement on Ethical Conduct (...) in Research Involving Humans, and the NH&MRC document Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research.The experience of conducting mental health research with the Somali community highlights the fact that the principles of inclusion and benefit enunciated in the NH&MRC document Values and Ethics are particularly pertinent when conducting research with refugees and immigrant communities that are culturally distant to those of the broader Australian community. These principles inform issues of research design and consent, as well as guiding respectful engagement with the participating community and communication of the research findings. (shrink)

We observe that approaches to intersubjectivity, involving mirror neurons and involving emulation and prediction, have eclipsed discussion of those same mechanisms for achieving coordination between the two hemispheres of the human brain. We explore some of the implications of the suggestion that the mutual modelling of the two situated hemispheres is a productive place to start in understanding the phylogenetic and ontogenetic development of cognition and of intersubjectivity.

Pionnière dans la pénalisation du viol en 1980, la France a été en eurocrime qu’aurait entraîné l’unanimité dans l’acceptation de la nouvelle définition proposée par la Commission européenne. L’absence de consentement devient finalement pour tous le critère principal, et de nombreux pays ont aligné récemment leur législation avec la directive européenne. Sur le droit à l’avortement, la convergence est moins sensible, plusieurs pays mettent d’importantes restrictions. La constitutionnalisation de la liberté d’avorter et de sa garantie en France va peut-être conduire (...) à son inscription dans les droits humains. (shrink)

The meaning of life and man's alienation from himself and his natural environment is examined in brief selections, illustrated with photographs, from the works of Albert Schweitzer.

Was passiert, wenn die Bevölkerung die Möglichkeit erhält, sich ungeschminkt und ungefiltert zu bioethischen Problemstellungen zu äußern?

It is commonly accepted – not only in the philosophical literature but also in daily life – that ignorance is a failure of some sort. As a result, a desideratum of any ontological account of ignorance is that it must be able to explain why there is something wrong with being ignorant of a true proposition. This article shows two things. First, two influential accounts of ignorance – the Knowledge Account and the True Belief Account – do not satisfy this (...) requirement. They fail to provide a satisfying normative account of the badness of ignorance. Second, this article suggests an alternative explanation of what makes ignorance a bad cognitive state. In a nutshell, ignorance is bad because it is the manifestation of a vice, namely, of what Cassam calls “epistemic insouciance”. (shrink)

This long-awaited two-volume set constitutes the definitive presentation of the system of classifying moral judgment built up by Lawrence Kohlberg and his associates over a period of twenty years. Researchers in child development and education around the world, many of whom have worked with interim versions of the system, indeed, all those seriously interested in understanding the problem of moral judgment, will find it an indispensable resource. Volume I reviews Kohlberg's stage theory, and the by-now large body of research on (...) the significance and utility of his moral stages. Issues of reliability and validity are addressed. The volume ends with detailed instructions for using the forms in Volume 2. Volume 2, in a specially-designed, user-friendly format, includes three alternative functionally-equivalent forms of the scoring system. (shrink)

In this paper, I take a critical look at Sartorio’s book Causation and Free Will (2016). Sartorio offers a rich defence of an actual-sequence view of freedom, which pays close attention to issues in the philosophy of causation and how they relate to freedom. I argue that although this focus on causation is illuminating, Sartorio’s project nevertheless runs into some serious difficulties. Perhaps most worrying amongst them is whether the agent-based reason-sensitivity account, offered by Sartorio, is consistent with Frankfurt-style cases (...) – the very cases which are provided as the sole reason to endorse an actual-sequence view of freedom. I suggest that given that powers and causation are so intimately bound together, the debate is skewed somewhat by thinking of these as rivals. (shrink)

WINNER BEST SOCIAL PHILOSOPHY BOOK IN 2021 / NASSP BOOK AWARD 2022 -/- Together we can often achieve things that are impossible to do on our own. We can prevent something bad from happening or we can produce something good, even if none of us could do it by herself. But when are we morally required to do something of moral importance together with others? This book develops an original theory of collective moral obligations. These are obligations that individual moral (...) agents hold jointly, but not as unified collective agents. To think of some of our obligations as joint or collective is the best way of making sense of our intuitions regarding collective moral action problems. Where we have reason to believe that our efforts are most efficient as part of a collective endeavor we may incur collective obligations together with others who are similarly placed as long as we are able to establish compossible individual contributory strategies towards that goal. The book concludes with a discussion of “massively shared obligations” to large-scale moral problems such as global poverty. (shrink)

Together we can achieve things that we could never do on our own. In fact, there are sheer endless opportunities for producing morally desirable outcomes together with others. Unsurprisingly, scholars have been finding the idea of collective moral obligations intriguing. Yet, there is little agreement among scholars on the nature of such obligations and on the extent to which their existence might force us to adjust existing theories of moral obligation. What interests me in this paper is the perspective of (...) the moral deliberating agent who faces a collective action problem, i.e. the type of reasoning she employs when deciding how to act. I hope to show that agents have collective obligations precisely when they are required to employ ‘we-reasoning’, a type of reasoning that differs from I-mode, best response reasoning, as I shall explain below. More precisely, two (or more) individual agents have a collective moral obligation to do x if x is an option for action that is only collectively available (more on that later) and each has sufficient reason to rank x highest out of the options available to them. (shrink)

_A portion of the revenue from this book’s sales will be donated to Doctors Without Borders to assist the humanitarian work of nurses, doctors, and other health care providers in the fight against COVID-19 and beyond._ _Concepts and Cases in Nursing Ethics_ is an introduction to contemporary ethical issues in health care, designed especially for Canadian audiences. The book is organized around six key concepts: beneficence, autonomy, truth-telling, confidentiality, justice, and integrity. Each of these concepts is explained and discussed with (...) reference to professional and legal norms. The discussion is then supplemented by case studies that exemplify the relevant concepts and show how each applies in health care and nursing practice. This new fourth edition includes an added chapter on end-of-life issues, and it is revised throughout to reflect the latest developments on topics such as global health ethics, cultural competence, social media, and palliative sedation, as well as ethical issues relating to COVID-19. (shrink)

Moral duties concerning climate change mitigation are – for good reasons – conventionally construed as duties of institutional agents, usually states. Yet, in both scholarly debate and political discourse, it has occasionally been argued that the moral duties lie not only with states and institutional agents, but also with individual citizens. This argument has been made with regard to mitigation efforts, especially those reducing greenhouse gases. This paper focuses on the question of whether individuals in industrialized countries have duties to (...) reduce their individual carbon footprint. To this end it will examine three kinds of arguments that have been brought forward against individuals having such duties: the view that individual emissions cause no harm; the view that individual mitigation efforts would have no morally significant effect; and the view that lifestyle changes would be overly-demanding. The paper shows how all three arguments fail to convince. While collective endeavours may be most efficient and effective in bringing about significant changes, there are still good reasons to contribute individually to reducing emission. After all, for most people the choice is between reducing one’s individual emissions and not doing anything. The author hopes this paper shows that one should not opt for the latter. (shrink)

Humans are prone to producing morally suboptimal and even disastrous outcomes out of ignorance. Ignorance is generally thought to excuse agents from wrongdoing, but little attention has been paid to group-based ignorance as the reason for some of our collective failings. I distinguish between different types of first-order and higher order group-based ignorance and examine how these can variously lead to problematic inaction. I will make two suggestions regarding our epistemic obligations vis-a-vis collective (in)action problems: (1) that our epistemic obligations (...) concern not just our own knowledge and beliefs but those of others, too and (2) that our epistemic obligations can be held collectively where the epistemic tasks cannot be performed by individuals acting in isolation, for example, when we are required to produce joint epistemic goods. (shrink)

The essence of religion was once widely thought to be a unique form of experience that could not be explained in neurological, psychological, or sociological terms. In recent decades scholars have questioned the privileging of the idea of religious experience in the study of religion, an approach that effectively isolated the study of religion from the social and natural sciences. Religious Experience Reconsidered lays out a framework for research into religious phenomena that reclaims experience as a central concept while bridging (...) the divide between religious studies and the sciences. Ann Taves shifts the focus from "religious experience," conceived as a fixed and stable thing, to an examination of the processes by which people attribute meaning to their experiences. She proposes a new approach that unites the study of religion with fields as diverse as neuroscience, anthropology, sociology, and psychology to better understand how these processes are incorporated into the broader cultural formations we think of as religious or spiritual. Taves addresses a series of key questions: how can we set up studies without obscuring contestations over meaning and value? What is the relationship between experience and consciousness? How can research into consciousness help us access and interpret the experiences of others? Why do people individually or collectively explain their experiences in religious terms? How can we set up studies that allow us to compare experiences across times and cultures? Religious Experience Reconsidered demonstrates how methods from the sciences can be combined with those from the humanities to advance a naturalistic understanding of the experiences that people deem religious. (shrink)