Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley’s Moral Distress Scale and Olson’s Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely (...) correlated with perceptions of ethical climate. Each of the HECS factors (peers, patients, managers, hospitals and physicians) was found to be significantly correlated with moral distress. Based on these findings, we highlight insights for practice and future research that are needed to enhance the development of strategies aimed at improving the ethical climate of nurses’ workplaces for the benefit of both nurses and patients. (shrink)

Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and other health care practitioners (...) have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care. (shrink)

The limitations of rational models of ethical decision making and the importance of nurses’ human involvement as moral agents is increasingly being emphasized in the nursing literature. However, little is known about how nurses involve themselves in ethical decision making and action or about educational processes that support such practice. A recent study that examined the meaning and enactment of ethical nursing practice for three groups of nurses (nurses in direct care positions, student nurses, and nurses in advanced practice positions) (...) highlighted that humanly involved ethical nursing practice is also simultaneously a personal process and a socially mediated one. Of particular significance was the way in which differing role expectations and contexts shaped the nurses’ ethical practice. The study findings pointed to types of educative experiences that may help nurses to develop the knowledge and ability to live in and navigate their way through the complex, ambiguous and shifting terrain of ethical nursing practice. (shrink)

In the previous four papers in this series, individual versus structural or contextual factors have informed various understandings of moral distress. In this final paper, we summarize some of the key tensions raised in previous papers and use these tensions as springboards to identify directions for action among practitioners, educators, researchers, policymakers and others. In particular, we recognize the need to more explicitly politicize the concept of moral distress in order to understand how such distress arises from competing values within (...) power dynamics across multiple interrelated contexts from interpersonal to international. We propose that the same socio-political values that tend to individualize and blame people for poor health without regard for social conditions in which health inequities proliferate, hold responsible, individualize and even blame health care providers for the problem of moral distress. Grounded in a critical theoretical perspective of context, definitions of moral distress are re-examined and refined. Finally, recommendations for action that emerge from a re-conceptualized understanding of moral distress are provided. (shrink)

Zusammenfassung In diesem Aufsatz wird erstens der Frage nach den gesellschaftlichen Umgangsweisen von europäischen Gesellschaften der Neuzeit mit religiös gerahmter, weiblicher Nahrungsabstinenz nachgegangen. Zweitens werden Überlegungen dahingehend angestellt, welche Bedingungen und Faktoren für die Persistenz dieser relativ marginalisierten Praxis im untersuchten Zeitraum ausgemacht werden können. Dabei wird in der Argumentation für einen wissensgeschichtlichen Ansatz plädiert. Mit diesem Instrumentarium können u. a. auch hybride Erklärungsweisen der historischen Akteure rekonstruiert werden, die nicht einfach den Kategorien „natürlich“ bzw. „übernatürlich“ zugeordnet werden können. Der (...) Gegenstand der Fallstudie sind nahrungsabstinente Katholikinnen Westeuropas im Zeitraum von 1780 bis 1980. Nahrungsabstinenz hat dabei auf der objektsprachlichen Ebene sowohl die Bedeutung von Nicht-essen können oder wollen bis hin zur völligen Abwesenheit des Bedürfnisses nach „irdischer“ Nahrung. (shrink)

Research on moral distress has paid limited attention to nurses’ responses and actions. In a survey of nurses’ perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and (...) distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an “inability to act due to institutional constraints” or a “failure to pursue a right course of action.” Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change. (shrink)

Summary With regard to the dynamics of human experience and behavior, Gestalt theoretical psychotherapy (GTP) relies mainly on Kurt Lewin’s dynamic field theory of personality. GTP is carried out by including a re-interpretation of Lewin’s theory in some aspects of psychotherapeutic practice in relation to critical realism. Human experience and behavior are understood to be functions of the person and the environment (including the other individuals therein) in a psychic field (life space), which encompasses both of these mutually dependent factors. (...) The anthropological model of this approach is, therefore, not mono-personal but, a priori, structural and relational in nature. It does not one-sidedly focus on the “inner components” of a person, but on the interrelation of the individual and a given environment, which affects experience and behavior. After a brief introduction of these basic concepts, this lecture will focus especially on Lewin’s concept of tension-systems, which may be considered as the Gestalt theoretical counterpart of Freud’s drive theory. Further, we define the basic assumptions which underlie GTP and explain how the person moves through her/his life experience in terms of Gestalt psychology. (shrink)

Family members do not have an official position in the practice of euthanasia and physician assisted suicide in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could serve as a starting point (...) for further empirical and ethical inquiry. A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families’ experiences and grief after EAS. 4) Family and ‘the good euthanasia death’ according to Dutch physicians. Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making. (shrink)

Approaches to business ethics can be roughly divided into two streams: ‹codes of behavior’ and ‹forms of subjectification’, with code-oriented approaches clearly dominating the field. Through an elaboration of poststructuralist approaches to moral philosophy, this paper questions the emphasis on codes of behaviour and, thus, the conceptions of the moral and responsible subject that are inherent in rule-based approaches. As a consequence of this critique, the concept of a practice-based ‹ethics of responsiveness’ in which ethics is never final but rather (...) always ‹to come’, is investigated. In such an approach the ethical self is understood as being continuously constituted within power/knowledge relations. Following this line, we ask how one can become a responsible subject while also acknowledging certain limits of full responsibility. We thereby explore responsibility as a considered but unconditional openness in response to the other. (shrink)

L’itinéraire de Jeanne Kœhler-Lumière l’a conduite de la philanthropie à la collaboration avec les pouvoirs publics pour la réalisation d’une politique sociale à Lyon après la Première Guerre mondiale. Fille et sœur d’industriels, elle participe aux œuvres mises en place pour le personnel de l’usine familiale, puis élargit son action en faveur de l’enfance à l’échelle de la ville. Cependant, l’ancrage de la famille Lumière dans le camp de la République laïque isole Jeanne Kœhler-Lumière des milieux traditionnels de la philanthropie (...) conservatrice et catholique. La guerre constitue un tournant durant lequel elle s’engage dans les services de santé, travaillant avec des sommités du monde médical lyonnais. Son expérience et sa notabilité lui valent dans les années 1920 d’être sollicitée par la municipalité radicale en quête de compétences pour impulser une politique sociale. Dame d’œuvres puis ambassadrice du social, Jeanne Kœhler-Lumière illustre une forme originale de participation des femmes à la vie politique. (shrink)

Conspiracy Theories The term “conspiracy theory” refers to a theory or explanation that features a conspiracy among a group of agents as a central ingredient. Popular examples are the theory that the first moon landing was a hoax staged by NASA, or the theory that the 9/11 attacks on the World Trade Center were not … Continue reading Conspiracy Theories →.

Multinational corporations are operating in complex business environments. They are confronted with contradictory institutional demands that often represent mutually incompatible expectations of various audiences. Managing these demands poses new organizational challenges for the corporation. Conducting an empirical case study at the sportswear manufacturer Puma, we explore how multinational corporations respond to institutional complexity and what legitimacy strategies they employ to maintain their license to operate. We draw on the literature on institutional theory, contingency theory, and organizational paradoxes. The results of (...) our qualitative longitudinal study show that managing corporate legitimacy is a dynamic process in which corporations adapt organizational capacities, structures, and procedures. (shrink)

In many countries grappling with the politics of equal recognition, the experiences, beliefs and reasons for action of people who identify as non-binary are starting to be seen as valid and intelligible.1 And, despite some gender clinics still responding cautiously to requests for non-standard medical interventions, their treatment needs are now recognised in major clinical guidelines. This is the current social context in which Notini and colleagues outline the case of ‘Phoenix’, an 18-year-old birth-assigned woman, who has requested the indefinite (...) continuation of puberty suppression, a treatment that was initiated when the client was 11 years old to mitigate their intense distress at the onset of puberty. Drawing on a conception of health as overall well-being, the authors conclude that OPS is ‘consistent with the proper goals of medicine’, and that there are ‘equity-based reasons’ for offering OPS to adults as a group. They concede that the physical risks are greater for OPS than for hormonal interventions generally provided to people with a binary gender identity. They also acknowledge the need for ‘a fine-grained ethical evaluation of Phoenix’s particular situation’ to assess whether the potential benefits of OPS outweigh the potential harms for this individual. Here I respectfully raise three points to amplify the authors’ discussion. First, there seem to be significant ethical issues of a general, not a particular, kind arising from the type of individual evaluation they call for. Following initial screening for significant mental distress and other major vulnerabilities, the key undertaking …. (shrink)

" Façonner le monde atome par atome " : tel est l'objectif incroyablement ambitieux affiché par les promoteurs américains de la " National Nanoinitiative ", lancée en 1999. Un projet global de " convergence des sciences ", visant à " initier une nouvelle Renaissance, incorporant une conception holiste de la technologie fondée sur [..] une analyse causale du monde physique, unifiée depuis l'échelle nano jusqu'à l'échelle planétaire. " Ce projet démiurgique est aujourd'hui au coeur de ce qu'on appelle la " (...) technoscience ", étendard pour certains, repoussoir pour d'autres. En précisant dans ce livre la signification de ce concept, pour sortir enfin du sempiternel conflit entre technophiles et technophobes, son auteur propose d'abord une sorte d'archéologie du terme " technoscience ". Loin d'être un simple renversement de hiérarchie entre science et technique, il s'agit d'un changement de régime de la connaissance scientifique, ayant désormais intégré la logique entrepreneuriale du monde des affaires et mobilisant des moyens considérables. Surtout, Bernadette Bensaude-Vincent montre que le brouillage de la frontière entre science et technique n'est que la manifestation d'un tremblement plus général, marqué par l'effacement progressif des distinctions traditionnelles : nature/artifice, inerte/vivant, matière/esprit, homme/machine, etc. Alors que nos sociétés sont silencieusement reconfigurées par les nanotechnologies, Internet, le génie génétique ou les OGM, ce livre montre l'importance de faire enfin pleinement entrer les questions de choix technologiques et scientifiques dans la sphère du politique et dans l'arène publique. Car la technoscience est un processus historique qui engage la nature en la refaçonnant et qui implique la société dans son ensemble. (shrink)

All articles in May 2019’s special issue of Bioethics offer profound insights into the issue of “being a burden to others” in relation to wishes to die, which are highly relevant for ethical debates about end‐of‐life care and physician‐assisted dying. In this reply, we wish to stress the importance of acknowledging and analyzing the sociopolitical context of the phenomenon “being a burden” in relation to wishes to die and we will show how this analysis could benefit from a care ethical (...) approach. As discussions in care ethics have made clear, caring practices are both social and political practices. An empirical and ethical analysis of “being a burden” therefore needs to take institutional and societal norms and structures into account, in addition to first‐person experiences and concepts such as caring needs, relational autonomy, and interdependency. Besides the relevance of the sociopolitical context for the phenomenon “being a burden” as such, the sociopolitical context also seems relevant for the investigation of the phenomenon, which we will illustrate by reflecting on “being a burden” in relation to the practice of physician‐assisted dying in the Netherlands. (shrink)

The current empirical research and normative arguments on physician-assisted dying in the Netherlands seem insufficient to provide ethical guidance to general practitioners in the practice of PAD, due to a gap between the evidence and arguments on the one hand and the uncertainties and complexities as found in everyday practice on the other. This paper addresses the problems of current ethical arguments and empirical research and how both seem to be profoundly influenced by the Dutch legislative framework on PAD and (...) a certain view on ethics. Furthermore, the paper elaborates on how other approaches to empirical research in bioethics, such as found in the broad field of narrative research, could supplement the empirical and ethical evaluation of PAD in the Netherlands. This paper also addresses the challenging question of how empirical data—in this case narratives—relate to normativity. The paper is written in the form of a personal narrative of the author, a young Dutch general practitioner and researcher in bioethics. This style is intentionally chosen, to illustrate how work context and professional background influence the observations one makes and the questions one may ask about the topic of PAD. In addition, by using this style, this paper not only gives a different perspective on a much-contested bioethical issue, but also on the challenges faced when a physician–bioethicist has to navigate different disciplinary fields and epistemological paradigms, especially since the ‘empirical turn’ in bioethics. (shrink)

Contract cheating – outsourcing student assignments for a fee – presents a growing threat to the integrity of higher education. As contract cheating is based on students purchasing assignments that are original, traditional plagiarism detection tools remain insufficient to detect contract cheating. Part of the problem is that proving contract cheating is difficult. As a result, instructors may find it hard to prosecute students. To help address the problem, this conceptual paper builds upon extant scholarship on contract cheating and argues (...) that a novel evidence-based approach is needed. Such an approach should allow instructors to detect and prosecute cases of contract cheating effectively and efficiently. The paper then presents an outline of such an approach and calls it the “Doping Test” approach as it mimics some aspects of doping testing in professional sport. (shrink)

La notion de médiation culturelle s'est institutionnalisée dans le monde culturel et dans le monde universitaire. Son analyse concerne la situation de médiation et le système de médiations comme répertoire d'actions, ce qui engage deux dimensions: la dimension historique et la dimension politique. Il est donc nécessaire, tant dans la recherche que dans les formations, de maintenir une distance critique envers certaines conceptions mythiques de la notion.The concept of cultural mediation has become an institutionalized part of the worlds of both (...) culture and the university. Analysis of the concept covers the context of mediation and the general system of mediations, understood as a repertoire of actions. This brings into play two dimensions, historical and political. It is therefore necessary to maintain a critical distance from certain mythologizing versions of this notion, as much in research as in education and training. (shrink)

Les événements culturels internationaux constituent-ils un système symbolique indépendant des médias? Le propos de cet article s'inscrit dans une théorie générale de la trivialité, c'est-à-dire de la circulation des concepts entre la sphère de la production culturelle et celle des médias. Sans remettre en cause l'apport fondamental de Davidson à la théorie de l'événement - à savoir qu'un événement existe indépendamment de toute reconstruction ultérieure notamment par les médias - et, au contraire, en soulignant les apports d'une sémantique de l'histoire (...) pour comprendre une production culturelle, il cherche à mettre en évidence les interactions entre ces deux sphères, notamment les rôles du dispositif et du répertoire d'actions dans la pré-construction de l'information et l'incorporation de certains éléments du débat mené dans les médias par la sphère culturelle. S'il ne peut pas proposer une définition arrêtée de l'événement culturel international, en revanche, le chercheur peut observer le travail permanent de reconfiguration que couvre la catégorisation de ces événements.The international cultural events they are a symbolic system independent media? The purpose of this article is part of a general theory of triviality, that is to say, the circulation of concepts between the sphere of cultural production and the media. Without jeopardizing the fundamental contribution of Davidson's theory of the event - ie an event exists independently of any subsequent reconstruction by the media - and, instead, highlighting the contributions of the semantics history to understand cultural production, it seeks to highlight the interactions between these two spheres, including the roles of the device and directory actions in the pre-construction information and the incorporation of some elements of the debate conducted in the media by the cultural sphere. If they can not provide a conclusive definition of the international cultural event, however, the researcher can observe the work of permanent reconfiguration covers the categorization of these events. (shrink)

The feminist sex wars have been characterized by debates between radical feminists and sex radical feminists about women's experiences of empowerment versus oppression in the sex industry. Based on a qualitative study of the experiences of exotic dancers, this article introduces a new theoretical paradigm to the feminist sex wars that values the contributions of both sex radicals and radical feminists. It articulates a twofold temporal dimension of sex workers' experiences: how women's feelings of pleasure and empowerment gradually decline over (...) time and how good and bad experiences rapidly transform into their opposites over the course of a single evening, making the strip bar a volatile and unsettling space for performers. (shrink)

„On 23rd February 2022, when the editors had worked out topical issues of dispute relating to politics, ethics, technology and religion for a Hans Jonas Centre conference on responsibility for the future and discourse ethics, it was suddenly foreseeable that Russia would invade the core area of Ukraine the next night. We immediately informed our Ukrainian colleagues that we would allow them asylum, if desired, and invite them to the conference in Bad Kissingen as keynote speakers. In no time at (...) all, the new programme for the confer-ence was ready: After commemorating Hans Jonas' honorary doctorate in Berlin under the motto ‘Fatalism would be a mortal sin’ exactly 30 years ago, we now focus on ‘Discourse despite war’. After that, we discuss digitalisation as well as theology, philosophy and commitment". With contributions by Prof. Dr. Claus Altmayer; Harald Asel, M.A.; Dorothee Bär, MdB; Dr. Thomas Bausch; Prof. Dr. Dietrich Böhler; Prof. Dr. Michael Bongardt; Wolfgang Freese; Bernadette Herrmann, M.A.; Sebastian Höpfl; Bischof em. Prof. Dr. Dr. h.c. mult. Wolfgang Huber; Dr. Grigori Katsakoulis; Pfarrer Wolfgang Klein; Wolfgang Korb; Dr. Lena Kornyeyeva; Prof. Dr. Dr. h.c. Klaus Leisinger; Prof. Dr. Dr. h.c. Hans Lenk; Prof. Dr. Ulf Liedke; Prof. Dr. Alfons Matheis; Dr. Olaf Meyer; Dr. Jürgen Naeher-Zeiffer; Stephanie von Dallwitz; Dr. Marianne Rabe; Dr. Manuela Rottmann, MdB; PD Dr. Dr. Thomas Rusche; Prof. Dr. Johann Michael Schmidt; Dr. Eva-Maria Schwickert; Maritta Strasser, M.A.; OB Dr. Dirk Vogel and Prof. Dr. Anatoliy Yermolenko. (shrink)

Humans grasp discrete infinities within several cognitive domains, such as in language, thought, social cognition and tool-making. It is sometimes suggested that any such generative ability is based on a computational system processing hierarchical and recursive mental representations. One view concerning such generativity has been that each of the mind’s modules defining a cognitive domain implements its own recursive computational system. In this paper recent evidence to the contrary is reviewed and it is proposed that there is only one supramodal (...) computational system with recursion in the human mind. A recursion thesis is defined, according to which the hominin cognitive evolution is constituted by a recent punctuated genetic mutation that installed the general, supramodal capacity for recursion into the human nervous system on top of the existing, evolutionarily older cognitive structures, and it is argued on the basis of empirical evidence and theoretical considerations that the recursion thesis constitutes a plausible research program for cognitive science. (shrink)

Stakeholder theory provides a framework for investigating the relationship between corporate social performance (CSP) and corporate financial performance. This relationship is investigated by examining how change in CSP is related to change in financial accounting measures. The findings provide some support for a tenet in stakeholder theory which asserts that the dominant stakeholder group, shareholders, financially benefit when management meets the demands of multiple stakeholders. Specifically, change in CSP was positively associated with growth in sales for the current and subsequent (...) year. This indicates that there are short-term benefits from improving CSP. Return on sales was significantly positively related to change in CSP for the third financial period, indicating that long-term financial benefits may exist when CSP is improved. (shrink)

Danišová, Nikola, 2021. Marginálie k figúre šibala v arcinaratívoch (Tematologicko-kultúrne súvislosti). Nitra: Univerzita Konštantína Filozofa v Nitre. ISBN 978-80-558-1807-8.

The Codification of Islamic Criminal Law in the Sudan: Penal Codes and Supreme Court Case Law under Numayrī and al-Bashīr. By Olaf Köndgen. Studies in Islamic Law and Society, vol. 43. Leiden: Brill, 2018. Pp. xii + 480. $171, €149.

A study examined the journalistic codes of ethics from 23 countries involved in the Conference on Security and Cooperation in Europe (CSCE), using descriptive and interpretative content analysis. The contents of the 24 codes from the 23 countries were divided into explicit categories on the basis of a 17-part classification scheme, including: "truth, ""acquisition of facts, ""professional secrecy, ""freedom of information, ""professional integrity, ""human rights," and "values." Results indicated that: (1) the most important principle in all the codes was represented (...) by truth; (2) the general rule on acquisition and checking of facts was that journalists should use open and honest means to acquire information; (3) confidentiality of sources must be maintained; and (4) freedom of information figures prominently in nearly all of the codes. Findings suggest the development among the CSCE countries of some sort of basic, universal model of journalistic codes where the accent is on truth, freedom of information, and protection of the individual. Studies like this one point to the increasing urgency for research on the "new Europe" and its rapidly changing cultural landscape. (Twenty-one references, a list of the codes of ethics examined, and a list of publications in English and Swedish of the Department of Journalism and Mass Communication of the University of Tampere are attached.) (RS). (shrink)

Danišová, Nikola, 2021. Marginálie k figúre šibala v arcinaratívoch (Tematologicko-kultúrne súvislosti). Nitra: Univerzita Konštantína Filozofa v Nitre. ISBN 978-80-558-1807-8.