While the phenomenon of ‘moral distress’ has been of interest to the nursing community since Jameton first described it in 1984, moral distress is now understood to effect healthcare professionals...

Within this paper, we discuss Moral Distress Reflective Debriefs as a promising approach to address and mitigate moral distress experienced by healthcare professionals. We briefly review the empirical and theoretical literature on critical incident stress debriefing and psychological debriefing to highlight the potential benefits of this modality. We then describe the approach that we take to facilitating reflective group discussions in response to morally distressing patient cases (“Moral Distress Reflective Debriefs”). We discuss how the debriefing literature and other clinical ethics (...) activities influenced the development of our approach. In particular, we focus on the role of the clinical ethicist as a facilitator with particular emphasis on encouraging perspective-taking and nurturing ethical attunement in a supportive manner. We suggest that this approach reduces the narrowing effects of frustration and anger that are often reported when individuals experience moral-constraint distress. Finally, we provide an example of Moral Distress Reflective Debriefs, elucidating how this supportive process complements ethics consultation and can mitigate the negative effects of moral distress. (shrink)

Nathaniel Hone’s three portraits of Sir John Fielding establish a public image for the magistrate and a visual language for representing his blindness. Fielding is represented in 1757 as a family man, in 1762 as a sociable member of the Republic of Letters, and finally in 1773 as the embodiment of Justice. The movement across the portraits from empiricism to allegory not only conveys his increasing social status and celebrity, but also the mingling of philosophical and poetic ideas about blindness (...) in Enlightenment thinking. This paper argues that Hone’s construction of Fielding’s vision impairment in the latter two portraits reflects changing attitudes to blindness resulting from Lockean sensationalism and the widespread success of cataract operations. The more academically ambitious final portrait, however, also draws on iconographic tropes of blind justice, casting Fielding in allegorical guise that confers upon him heightened powers of reason and impartiality. For Hone, Fielding’s blindness is a crucial part of his status and identity, but it also provides opportunities to push portraiture beyond its association with the imitation of the visible and into the realm of invention. (shrink)

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving (...) the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work. (shrink)

Do states have the right to prevent potential immigrants from crossing their borders, or should people have the freedom to migrate and settle wherever they wish? Christopher Heath Wellman and Phillip Cole develop and defend opposing answers to this timely and important question.

This paper examines how young peoples’ lived experiences with personal technologies can be used to teach engineering ethics in a way which facilitates greater engagement with the subject. Engineering ethics can be challenging to teach: as a form of practical ethics, it is framed around future workplace experience in a professional setting which students are assumed to have no prior experience of. Yet the current generations of engineering students, who have been described as ‘digital natives’, do however have immersive personal (...) experience with digital technologies; and experiential learning theory describes how students learn ethics more successfully when they can draw on personal experience which give context and meaning to abstract theories. This paper reviews current teaching practices in engineering ethics; and examines young people’s engagement with technologies including cell phones, social networking sites, digital music and computer games to identify social and ethical elements of these practices which have relevance for the engineering ethics curricula. From this analysis three case studies are developed to illustrate how facets of the use of these technologies can be drawn on to teach topics including group work and communication; risk and safety; and engineering as social experimentation. Means for bridging personal experience and professional ethics when teaching these cases are discussed. The paper contributes to research and curriculum development in engineering ethics education, and to wider education research about methods of teaching ‘the net generation’. (shrink)

This essay considers the ancient antecedents to the “new field” of the ethics of philanthropy, arguing that key questions such as “to whom should we give our money?” have already been explored by ancient authors and that the answers they give to these questions can be quite different to the answers given by contemporary scholars. By analysing the treatment of giving in Aristotle’s Nicomachean Ethics, Cicero’s De Officiis, and Seneca’s De Beneficiis, I argue that the focus of ancient thinkers upon (...) giving within one’s own community can be viewed as a possible response to a number of issues that have been raised by modern scholars, including the “problem of acting at a distance” and the “problem of accountability.” Moreover, these ancient thinkers have additional, positive reasons for thinking that philanthropy should take place within one’s own community, based upon their ideas of man’s natural duty to his political community, and the social benefits that can be derived from local philanthropy. The integration of ancient perspectives, then, into these modern debates, can serve to complement and broaden research in this emerging field. (shrink)

Wittgenstein explores learning through practice in the Philosophical Investigations by means of an extended analogy with games. However, does this concern with learning also necessarily extend to education, in our institutional understanding of the word? While Wittgenstein's examples of language learning and use are always shared or social, he does not discuss formal educational institutions as such. He does not wish to found a ‘school of thought’, and is suspicious of philosophy acting as a theory that can be applied to (...) other areas of life. While Wittgenstein's focus on developing independent thinking was neither individualistic nor anti-institutional, it did, however, focus on developing the thinking of his students rather than theorising about how this could be applied on a large scale. An analysis of Hermann Hesse's novel, The Glass Bead Game will help us to pick up where Wittgenstein deliberately left off—thinking about how (or if) one can institutionalise learning methods that encourage thinking for oneself. These differences in the writers’ treatment of education will become evident in the differences between their game analogies. While language-games combat our ‘craving for generality’ in Philosophical Investigations, the Glass Bead Game represents this craving, and how it manifests itself throughout history in disciplines other than logic and philosophy of language. It also represents the potential for institutions to become insular, exclusive communities. (shrink)

Austerity, by its very nature, imposes constraints by limiting the options for action available to us because certain courses of action are too costly or insufficiently cost effective. In the context of healthcare, the constraints imposed by austerity come in various forms; ranging from the availability of certain treatments being reduced or withdrawn completely, to reductions in staffing that mean healthcare professionals must ration the time they make available to each patient. As austerity has taken hold, across the United Kingdom (...) and Europe, it is important to consider the wider effects of the constraints that it imposes in healthcare. Within this paper, we focus specifically on one theorised effect—moral distress. We differentiate between avoidable and unavoidable ethical challenges within healthcare and argue that austerity creates additional avoidable ethical problems that exacerbate clinicians’ moral distress. We suggest that moral resilience is a suitable response to clinician moral distress caused by unavoidable ethical challenges but additional responses are required to address those that are created due to austerity. We encourage clinicians to engage in critical resilience and activism to address problems created by austerity and we highlight the responsibility of institutions to support healthcare professionals in such challenging times. (shrink)

Reproduction is broadly recognised as fundamental to human flourishing. The presumptive priority of reproductive freedom forms the predominant position in the literature, translating in the non-sexual reproductive realm as an almost inviolable right to access assisted reproductive technology (ART). This position largely condemns refusal or restriction of ART by clinicians or the state as discriminatory. In this paper, I critically analyse the moral rights individuals assert in reproductive pursuit to explore whether reproductive rights entitle hopeful parents to ART. I demonstrate (...) that none of the protected actions performed, or entitlements generated are sui generis ‘reproductive’ rights, leading to the claim that there is no such thing as a right to reproduce. Under scrutiny, the reproductive right is a far narrower and weaker rights assertion than is recognised in the literature. I argue that the predominant position is grounded in a fundamental misunderstanding of the scope and strength of reproductive claims.I also highlight a significant conceptual inconsistency in the literature. On one hand, there is broad consensus that reproductive rights are predominantly negative, yet access to fertility treatment is framed as a component of the right. This wrongly contorts the negative nature of reproductive rights into a positive claim-right to ART. I conclude that this mistakenly frames ART access as sitting within the scope of reproductive freedom. I offer a revised conceptual paradigm of reproductive rights that has important clinical and policy implications for the provision and regulation of ART. (shrink)

Goals for adding philosophy to the school curriculum centre on the perceived need to improve the general quality of critical thinking found in society. School philosophy also provides a means for asking questions of value and purpose about curriculum content across and between subjects, and, furthermore, it affirms the capability of children to think philosophically. Two main routes suggested are the introduction of philosophy as a subject, and processes of facilitating philosophical discussions as a way of establishing classroom ‘communities of (...) inquiry’. This article analyses the place of philosophy in the school curriculum, drawing on three relevant examples of school curriculum reform: social studies, philosophy of science and Kura Kaupapa Māori. (shrink)

The predominant position in the reproductive rights literature argues that access to assisted reproductive technologies (ART) forms part of an individual’s right to reproduce. On this reasoning, refusal of treatment by clinicians (via provision) violates a hopeful parent’s reproductive right and discriminates against the infertile. I reject these views and suggest they wrongly contort what reproductive freedom entitles individuals to do and demand of others. I suggest these views find their origin, at least in part, in the way we define (...) “reproduction” itself. This paper critically analyses two widely accepted definitions of human reproduction and demonstrates that both are fundamentally flawed. While the process of reproduction includes the biological acts of begetting and bearing a child, I argue that it does not extend to include rearing. This reworked definition has little impact in the realm of sexual reproduction. However, it has significant ethical implications for the formulation and assignment of reproductive rights and responsibilities in the non-sexual realm in two important ways. First, a claim to access ART where one has an intention to rear a child (but does not beget or bear) cannot be grounded in reproductive rights. Second, lacking an intention to rear does not extinguish the reproductive rights and responsibilities for those who collaborate in the process. I conclude that clinicians collaborate in non-sexual reproduction at the point of triggering conception (begetting) and therefore have the right to refuse to be involved in non-sexual reproduction, in some instances, as do all reproductive collaborators. (shrink)

Studies of implicit learning have shown that individuals exposed to a rule-governed environment often learn to exploit 'rules' which describe the structural relationship between environmental events. While some authors have interpreted such demonstrations as evidence for functionally separate implicit learning systems, others have argued that the observed changes in performance result from explicit knowledge which has been inadequately assessed. In this paper we illustrate this issue by considering one commonly used implicit learning task, the Serial reaction time task, and outline (...) what we see as an important problem associated with each of the commonly used methods used to assess explicit knowledge. This is that each measure requires a form of response which is dependent on the subjects having some knowledge of the serial-order of the sequence. We argue that such methods, or more specifically their analyses, seriously underestimate other sources of knowledge, which may be available to subjects during their performance of the SRT task. In support of this argument we demonstrate that subjects' serial-order knowledge can, in principle, be independent of subjects' knowledge of the statistical structure of the sequence, and we propose an alternative method for analysing performance on the Generate task which avoids this problem. (shrink)

This paper comments on the process of re-development of the Maori-medium Science (Pūtaiao) curriculum, as part of overall curriculum development in Aotearoa New Zealand. A significant difference from the English Science curriculum was the addition of an ‘extra strand’ covering the history and philosophy of science. It is recommended that this strand be taught by means of narratives (i.e. using ‘narrative pedagogy’) in order to avoid a superficial didacticism that succumbs to the traditional notion of science curriculum content as ‘merely (...) factual’ in nature. An argument is presented for the ethical necessity of including this extra material in Māori science education. (shrink)

Fertility clinicians participate in non-sexual reproductive projects by providing assisted reproductive technology (ART) to those hoping to reproduce, in support of their reproductive goals. In most countries where ART is available, the state regulates ART as a form of medical treatment. The predominant position in the reproductive rights literature frames the clinician’s role as medical technician, and the state as a third party with limited rights to interfere. These roles broadly align with established functions of clinician and state in Western (...) liberal democracies, where doctors have duties to provide safe, beneficial and legal healthcare to all who seek it. Recognised state responsibilities include safeguarding equitable access to medical services and protecting and promoting reproductive liberty.I argue against this normative moral framing of clinician and state involvement in non-sexual reproduction, suggesting that clinician and state join the non-sexual reproductive project at the point of triggering conception. Begetting a child is more than just the provision and regulation of healthcare; it generates rights and confers responsibilities on all who join this morally significant project. All who collaborate have the right to join or refuse to join the project. I suggest this is intuitively understood in the sexual realm, but not in the non-sexual realm. My key substantive claim is that non-sexual reproduction is a pluralist pursuit that morally implicates more than the genetic and gestational contributors. I find that while the moral basis of a clinician or the state’s right to refuse to join the ART project is the same as for those providing gestational or genetic input, the reasons that morally underpin their refusal differs. (shrink)

Place, practice and status have played significant and interacting roles in the complex history of primatology during the early to mid-twentieth century. This paper demonstrates that, within the emerging discipline of primatology, the field was understood as an essential supplement to laboratory work. Founders argued that only in the field could primates be studied in interaction with their natural social group and environment. Such field studies of primate behavior required the development of existing and new field techniques. The practices and (...) sites developed by American primatologist Clarence Ray Carpenter were used to demonstrate that scientific standards could be successfully applied to the study of primates in the field. In an environment in which many field biologists fought for higher scientific status, Carpenter gradually adopted increasingly interventionist techniques. These techniques raised epistemological problems for studies whose value rested on the naturalness of the behaviors observed. Thus, issues of status shaped field practices and subsequently altered Carpenter's criteria for what constituted natural primate behavior. (shrink)

After twelve years as the inaugural Director of the Caroline Chisholm Centre for Health Ethics, leading Melbourne bioethicist Dr Norman M Ford has resigned his position. Instead of contemplating retirement however, the tireless septuagenarian, who is also a philosopher, author, Honorary Research Fellow in the School of Philosophy and Bioethics at Monash University and Catholic Salesiah priest, has his sights set on tackling even more controversial biomedical issues as an independent research scholar and author. Georgina Hall gets an insight (...) into his life’s work. (shrink)

Stephen Cole Kleene was one of the greatest logicians of the twentieth century and this book is the influential textbook he wrote to teach the subject to the next generation. It was first published in 1952, some twenty years after the publication of Godel's paper on the incompleteness of arithmetic, which marked, if not the beginning of modern logic. The 1930s was a time of creativity and ferment in the subject, when the notion of computable moved from the realm (...) of philosophical speculation to the realm of science. This was accomplished by the work of Kurt Gode1, Alan Turing, and Alonzo Church, who gave three apparently different precise definitions of computable. When they all turned out to be equivalent, there was a collective realization that this was indeed the right notion. Kleene played a key role in this process. One could say that he was there at the beginning of modern logic. He showed the equivalence of lambda calculus with Turing machines and with Godel's recursion equations, and developed the modern machinery of partial recursive functions. This textbook played an invaluable part in educating the logicians of the present. It played an important role in their own logical education.". (shrink)

Aims:The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress.Background:Moral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon.Design:Systematic literature review and narrative synthesis (November (...) 2015–March 2016).Data sources:Ovid MEDLINE®In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO®1967–Present, CINAHL®Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education Abstracts.Review methods:Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis.Results:In all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity.Conclusion:We suggest the combination of (1) the experience of a moral event, (2) the experience of ‘psychological distress’ and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress. (shrink)

A mass problem is a set of Turing oracles. If P and Q are mass problems, we say that P is weakly reducible to Q if for all Y ∈ Q there exists X ∈ P such that X is Turing reducible to Y. A weak degree is an equivalence class of mass problems under mutual weak reducibility. Let [Formula: see text] be the lattice of weak degrees of mass problems associated with nonempty [Formula: see text] subsets of the Cantor (...) space. The lattice [Formula: see text] has been studied in previous publications. The purpose of this paper is to show that [Formula: see text] partakes of hyperarithmeticity. We exhibit a family of specific, natural degrees in [Formula: see text] which are indexed by the ordinal numbers less than [Formula: see text] and which correspond to the hyperarithmetical hierarchy. Namely, for each [Formula: see text], let hα be the weak degree of 0, the αth Turing jump of 0. If p is the weak degree of any mass problem P, let p* be the weak degree of the mass problem P* = {Y | ∃X ⊆ BLR )} where BLR is the set of functions which are boundedly limit recursive in X. Let 1 be the top degree in [Formula: see text]. We prove that all of the weak degrees [Formula: see text], [Formula: see text], are distinct and belong to [Formula: see text]. In addition, we prove that certain index sets associated with [Formula: see text] are [Formula: see text] complete. (shrink)

I discuss a puzzle that shows there is a need to develop a new metaphysical interpretation of mathematical theories, because all well-known interpretations conflict with important aspects of mathematical activities. The new interpretation, I argue, must authenticate the ontological commitments of mathematical theories without curtailing mathematicians' freedom and authority to creatively introduce mathematical ontology during mathematical problem-solving. Further, I argue that these two constraints are best met by a metaphysical interpretation of mathematics that takes mathematical entities to be constitutively constructed (...) by human activity in a manner similar to the constitutive construction of the US Supreme Court by certain legal and political activities. Finally, I outline some of the philosophical merits of metaphysical interpretations of mathematical theories of this type. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Going Polyphonic I: With Namita Goswami et al.Alyson Cole and Kyoo LeeThis time around, we go polyphonic.The articles in the next two issues, Vol. 13 and Vol. 14, explore critical questions, paradigm-shifting idseas, and fresh connections arising from the intimately networked fields of intersectional, decolonial, and trans studies today. “Polyphonia,” a term we borrowed from music, is meant to characterize ways in which each piece as in a (...) “note” remains distinctly their own while dialogically and dynamically connected to an evolving ecosystem of ideas and visions in the making. As an umbrella term, it is meant to shelter resonances from each article that speaks directly not only of, but to, theory today by doing it in their own way.In this issue, we are presenting “A Forum on Namita Goswami’s Subjects That Matter.” It consists of seven responses to Goswami’s pioneering work on intersectionality as exemplified by her recent book, Subjects That Matter: Philosophy, Feminism, and Postcolonial Theory (SUNY Press, 2019) as well as the earlier co-edited volume, Why Race and Gender Still Matter: An Intersectional Approach (Routledge, 2014, co-edited by Maeve M. O’Donovan, Namita Goswami, and Lisa Yount). What is polyphonic about this assemblage is its interlocutory structure and orientation: each scholar—Al Frankowski, Falguni Sheth, Jennifer Scuro, Lauren Guilmette, Luce deLire, Russell Ford, and Tyler M. Williams, all coming from different angles, perspectives, and positions—discusses their reading of Goswami on intersectionality while showing how and where their own scholarship meets hers. Goswami, in turn, responds to each response while providing a synthesized account of what she gleans from this choral interaction, what she finds inspiring, as well as challenging. The articles in the next issue, [End Page 1] Vol. 14, following the forum, will virtually continue the music, although not in direct response to Goswami’s work.We hope you will join us in this somewhat experimental virtual symposium that is not even on Zoom. We hope you will join us in thinking that this more literalized model of a “scholarly conversation,” actual and virtual, vitally embodies the very spirit of interdisciplinary, intergenerational, intercontinental intersectionality as a conversation, ongoing intellectual encounters among many of us in various “sub-fields,” for the lack of a better word, that, again literally, cannot be neatly contained in any disciplinary terms, boxes, or territories.The tranScripts section in this issue consists of two entries, the first of which is the fourth installment of Mieke Bal’s Moments of Meaning-Making, J–L. Then we have Margaret Carson’s translation of Juliana González on Remedios Varo.Again, this issue has been a labor of collective love. We would like to thank all the brilliant authors and extraordinarily generous and helpful peer reviewers for this issue, not to mention the ever so resourceful and skillful editorial staff at the press we constantly rely on for expert guidance and feedback, all of whom have been inspirations for us editors. [End Page 2]Copyright © 2024 State University of New York... (shrink)

From roughly 1965 to 1995, Columbia University's Department of Sociology was a leading center for social study of science, both nationally and internationally. It was often referred to as the Merton School or Columbia School, and four scholars paved its way : Robert K. Merton, Harriet Zuckerman, Stephen Cole, and Jonathan Cole. The goal of the Columbia School was to create and legitimate a new sociological specialty focusing on the scientific community and the growth of scientific knowledge and (...) they did this by exploring the norms, values, and structure of science. The core values of the scientific and university system and the norms attached to them consisted of deeply held beliefs as well as principles that determined how individuals would act. They were organizing principles designed to support the institution in meeting its goals and mission. They influenced the types of social structures that developed to carry out the activities of scientists. Edited by Jonathan R. Cole, this collection of individually and co-authored papers and essays by Cole represents some of the work produced by Cole and his close collaborators over the past 50 years. the essays are contextualized with an introduction by Cole. The pieces in this volume represent the major concerns on the Columbia School, whose focus of attention was not on the production of individual pieces of knowledge, but on the social systems that made that production possible. (shrink)

The Covid‐19 pandemic has highlighted many of the difficult ethical issues that health care professionals confront in caring for patients and families. The decisions such workers face on the front lines are fraught with uncertainty for all stakeholders. Our focus is on the implications for nurses, who are the largest global health care workforce but whose perspectives are not always fully considered. This essay discusses three overarching ethical issues that create a myriad of concerns and will likely affect nurses globally (...) in unique ways: the safety of nurses, patients, colleagues, and families; the allocation of scarce resources; and the changing nature of nurses’ relationships with patients and families. We urge policy‐makers to ensure that nurses’ voices and perspectives are integrated into both local and global decision‐making so as to minimize the structural injustices many nurses have faced to date. Finally, we urge nurses to seek sources of support throughout this pandemic. (shrink)

This book explores the importance of compassion and empathy within educational contexts. While compassion and empathy are widely recognised as key to living a happy and healthy life, there is little written about how these qualities can be taught to children and young people, or how teachers can model these traits in their own practice. This book shares several models of compassion and empathy that can be implemented in schooling contexts, also examining how these qualities are presented in children’s picture (...) books, films and games. The editors and contributors share personal insights and practical approaches to improve both awareness and use of compassionate and empathetic approaches to others. This book will be of interest and value to all those interested in promoting compassion and empathy within education. (shrink)

Empathy is sometimes so hard to achieve that one may wonder if it is a virtue for caregivers at all. Perhaps a caregiver cannot always know how a patient feels, and perhaps that knowledge is sometimes too painful to possess. A nuanced understanding of what empathy entails and of the conditions for attaining it can help ground its possibility.

Place, practice and status have played significant and interacting roles in the complex history of primatology during the early to mid-twentieth century. This paper demonstrates that, within the emerging discipline of primatology, the field was understood as an essential supplement to laboratory work. Founders argued that only in the field could primates be studied in interaction with their natural social group and environment. Such field studies of primate behavior required the development of existing and new field techniques. The practices and (...) sites developed by American primatologist Clarence Ray Carpenter were used to demonstrate that scientific standards could be successfully applied to the study of primates in the field. In an environment in which many field biologists fought for higher scientific status, Carpenter gradually adopted increasingly interventionist techniques. These techniques raised epistemological problems for studies whose value rested on the naturalness of the behaviors observed. Thus, issues of status shaped field practices and subsequently altered Carpenter's criteria for what constituted natural primate behavior. (shrink)

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood as well as the (...) academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context. (shrink)

Alongside clinical practice, medical schools now confront mounting reasons to examine nontraditional approaches to ethics. Increasing awareness of systems of oppression and their effects on the experiences of trainees, patients, professionals, and generally on medical care, is pushing medical curriculum into an unfamiliar territory. While there is room throughout medical school to take up these concerns, ethics curricula are well-positioned to explore new pedagogical approaches. Feminist ethics has long addressed systems of oppression and broader structures of power. Some of its (...) established concepts can offer distinct value as medical climates change and adapt in response to increased awareness of the experiences of marginalized individuals and populations. In this essay, we offer a set of concepts from feminist ethics that have a fundamental role to play in medical school curriculum: relationality, relational autonomy, and epistemic justice. Though these concepts are not exhaustive, they can be taught in tandem with the concepts that have historically grounded ethics education in medical school, such as autonomy and beneficence. Ultimately, we contend that these concepts hold particular value in ethics curriculum insofar as they diversify mainstream ethical approaches, directly address the pervasiveness of systems of oppression in medicine, and recognize the voices and concerns that may be marginalized in standard approaches. (shrink)

BackgroundThe phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice.Research aimTo explore the concept of moral (...) distress in nursing both empirically and conceptually.MethodologyFeminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis.Ethical considerationsThe study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom.FindingsThe empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas.DiscussionWe suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress.ConclusionThe empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’. (shrink)

Victims of oppression are often called to let go of their anger in order to facilitate better discussion to bring about the end of their oppression. According to Amia Srinivasan, this constitutes an affective injustice. In this paper, we use research on emotion regulation to shed light on the nature of affective injustice. By drawing on the literature on emotion regulation, we illustrate specifically what kind of work is put upon people who are experiencing affective injustice and why it is (...) damaging. We begin by explaining affective injustice and how it can amount to a call for emotion regulation. Then we explain the various techniques that can be used to regulate emotions and explain how each might be harmful here. In the penultimate section of the paper, we explain how the upshot of this is that victims of affective injustice are left with a dilemma. Either they try to regulate their anger in a way that involves ignoring the fact of their oppression or they regulate it in a way that is likely to be harmful for them. Finally, we consider whether there are any good solutions to this dilemma, and how this issue opens up the possibility for further research into emotion regulation and moral philosophy. (shrink)

There has been increasing debate in recent years about the conceptualization of moral distress. Broadly speaking, two groups of scholars have emerged: those who agree with Jameton’s ‘narrow definition’ that focuses on constraint and those who argue that Jameton’s definition is insufficient and needs to be broadened. Using feminist empirical bioethics, we interviewed critical care nurses in the United Kingdom about their experiences and conceptualizations of moral distress. We provide our broader definition of moral distress and examples of data that (...) both challenge and support our conceptualization. We pre‐empt and overcome three key challenges that could be levelled at our account and argue that there are good reasons to adopt our broader definition of moral distress when exploring prevalence of, and management strategies for, moral distress. (shrink)

Clinical ethics committees aim to resolve conflict, facilitate communication and ease moral distress in health care. Dialogue in committee discussions is complex and involves a balance between implicitly and explicitly expressed values of patients, families and professionals. Evaluating effectiveness and concrete outcomes is challenging and most studies focus on broad benefits such as quality of care and reduction of unnecessary or unwanted treatments. In this paper we propose ‘physician satisfaction’ as a valuable outcome. We refer to the clinical ethics approach (...) followed at one large paediatric hospital in Australia, propose reasons for the often-expressed feeling of satisfaction and discuss why this feeling matters. We conclude that physician satisfaction is a valid measure of an effective ethics consultation because it implies the person has been listened to and respected by others, and has perhaps developed greater understanding of and insights into their own work and values, and those of others. (shrink)

ABSTRACT:Clinical ethics consultants bear witness to the direct harms of intersecting axes of oppression—such as racism and classism—as they impinge on elucidating and resolving ethical dilemmas in health care. Health Care Ethics Consultation (HCEC) professional guidance supports recognizing and analyzing power dynamics and social-structural obstacles to good care. However, the most relied upon bioethical principles in clinical ethics have been criticized for insufficiency in this regard. While individual ethics consultants have found ways to expand their approaches, they do so in (...) an ad hoc way without frameworks to guide consistency. Motivated by the practical expertise of clinical ethicists, this essay offers a new framework to support openness to analyzing power imbalances and respecting marginalized voices and values. This framework is grounded in transformative justice, where the aim is to take responsibility for oppression by centering and responding to moral perspectives and value systems that are all too often silenced. (shrink)

The present study endeavors to give a description of a famous case of sexual harass- ment at the workplace and critique it in terms of its embedment of an intertwined relationship between two pervasive ideologies prevalent in our society: patriarchy and consumerism. By focusing on the favorable conditions, ways of resolution, and outcomes of the lawsuit, this essay approaches the organization- al culture of Mitsubishi Motor Manufacturing of America through the lens of critical theory. Selective literature review on sexual harassment, (...) as well as general coverage of the event by the media and the parties involved demonstrate the validity of the claim that this study has made. (shrink)

Embora a ideia de que os processos orgânicos se equilibrassem entre dois processos opostos, um construtivo e um destrutivo, fosse lugar-comum entre as especulações biológicas do século XIX, a semelhança entre a proposta de um instinto de morte, introduzida por Élie Metchnikoff em sua obra de 1903, Etudes sur la Nature Humaine, e a pulsão de morte, proposta por Freud em 1920, justifica não somente essa breve exposição sobre algumas das reflexões de Metchnikoff, como traz novamente à cena a ideia (...) – detectada por meio do mecanismo da apoptose - de que forças de morte atuam na própria constituição da matéria orgânica. (shrink)

El Vaticano II fue una experiencia vivencial de militantes cristianos que se comprometieron durante su realización y posterior implantación. Como en la liturgia, se recorrió un camino nuevo y vivo pasando de una Iglesia “de espaldas” al pueblo a una Iglesia “vuelta” para el pueblo. Novedad generosa y valiente enriquecida por la esperanza que, con fracasos, dudas, luchas se insertó en los grupos marginados. Desde allí siguieron buscándose nuevos caminos y surgieron nuevas esperanzas. Actitudes que crearon la fuerza de una (...) comunión inspirada en el amor y el sacrificio de Jesús en busca de una humanidad mejor. Novedades y cambios que provocaron conflictos eclesiológicos y mostraron la vida y dinamismo de nacientes comunidades que apostaron por la renovación del Espíritu. Los conflictos fueron anuncio contra el silencio que se quería imponer y confesión de fe de los que creyeron en el Dios de la vida. En nuestras limitadas y condicionadas voluntades, la Ruah divina que fecundó el Concilio, sigue soplando para mejorar la historia. Queriéndolo o no, las estructuras eclesiales se mueven aunque sean como una brisa suave. - DOI: 10.5752/P.2175-5841.2011v9n24p1325. (shrink)

Hildegard of Bingen’s mystical and cognitive experience uniquely combines the visual and auditory dimensions of the knowledge, in her own account, revealed to her by divine wisdom. According to Hildegard, the hidden meaning of her visions was communicated to her by a voice from the sky; thus the auditio allows her to understand the uisio, while the uisio allows her to remember the message of the auditio. Moreover, as we shall see, the Rhenish magistra apparently finds pleasure in the knowledge (...) of the natural world, an intellectual pleasure about which she does not speak directly but which is clearly shown in her works. In this paper, on the basis of Hildegard’s definition of scientia, I will try to determine what she understands by ‘knowledge’ and use her notion of praescientia Dei as a measure for the analysis of the distinct visions of the universe set out in two of her works, the Sciuias and the Liber diuinorum operum. There we can see that, despite the divine inspiration to which she attributes her wo... (shrink)