Objective Moral distress is a complex phenomenon experienced by healthcare professionals. This study examined the relationships between key dimensions of Organizational Culture in Healthcare (OCHC)—perceived psychological safety, ethical climate, patient safety—and healthcare professionals’ perception of moral distress.Design Cross-sectional surveySetting Pediatric and adult critical care medicine, and adult hospital medicine healthcare professionals in the United States.Participants Physicians (n = 260), nurses (n = 256), and advanced practice providers (n = 110) participated in the study.Main outcome measures Three dimensions of OCHC were (...) measured using validated questionnaires: Olson’s Hospital Ethical Climate Survey, Agency for Healthcare Research and Quality’s Patient Safety Culture Survey, and Edmondson’s Team Psychological Safety Survey. The perception of moral distress was measured using the Moral Distress Amidst a Pandemic Survey. The hypothesized relationships between various dimensions were tested with structural equation modeling (SEM).Results Adequate model fit was achieved in the SEM: a root-mean-square error of approximation =0.072 (90% CI 0.069 to 0.075), standardized root mean square residual = 0.056, and comparative fit index =0.926. Perceived psychological safety (β= −0.357, p <.001) and patient safety culture (β = −0.428, p<.001) were negatively related to moral distress experience. There was no significant association between ethical climate and moral distress (β = 0.106, p = 0.319). Ethical Climate, however, was highly correlated with Patient Safety Culture (factor correlation= 0.82).Conclusions We used structural equation model to test a theoretical model of multi-dimensional organizational culture and healthcare climate (OCHC) and moral distress.Significant associations were found, supporting mitigating strategies to optimize psychological safety and patient safety culture to address moral distress among healthcare professionals. Future initiatives and studies should account for key dimensions of OCHC with multi-pronged targets to preserve the moral well-being of individuals, teams, and organizations. (shrink)

Moral distress is one of the core topics of clinical ethics. Although there is a large and growing empirical literature on the psychological aspects of moral distress, scholars, and empirical investigators of moral distress have recently called for greater conceptual clarity. To meet this recognized need, we provide a philosophical taxonomy of the categories of what we call ethically significant moral distress: the judgment that one is not able, to differing degrees, to act on one’s moral knowledge about what one (...) ought to do. We begin by unpacking the philosophical components of Andrew Jameton’s original formulation from his landmark 1984 work and identify two key respects in which that formulation remains unclear: the origins of moral knowledge and impediments to acting on that moral knowledge. We then selectively review subsequent literature that shows that there is more than one concept of moral distress and that explores the origin of the values implicated in moral distress and impediments to acting on those values. This review sets the stage for identifying the elements of a philosophical taxonomy of ethically significant moral distress. The taxonomy uses these elements to create six categories of ethically significant moral distress: challenges to, threats to, and violations of professional integrity; and challenges to, threats to, and violations of individual integrity. We close with suggestions about how the proposed philosophical taxonomy of ethically significant moral distress sheds light on the concepts of moral residue and crescendo effect of moral distress and how the proposed taxonomy might usefully guide prevention of and future qualitative and quantitative empirical research on ethically significant moral distress. (shrink)

In this commentary on Carse and Rushton’s call for reorientation of moral distress, we state agreement with the authors that the discourse of moral distress should refocus on the moral components of integrity. We then explain how our philosophical taxonomy of moral distress, mentioned by the authors, appeals to moral integrity. In this process, we clarify our taxonomy’s appeal to Aristotle’s concept of akrasia. We conclude by offering support of Carse and Rushton’s challenge to organizations to strengthen moral integrity by (...) fostering resilience. (shrink)

There has been an ongoing appeal in the bioethics literature for a broader understanding and conceptual clarity of the phenomenon of moral distress. Several authors argue that greater conceptual cl...

In this essay an ‘objective’ account of intrinsic value is proposed and partly defended. It is claimed that a kind of value exists which is, or may reasonably be supposed to be, a property of certain objects. The presence of such value is not to be wholly accounted for as the ‘projection’ of certain human feelings elicited by the object thought to be of value, nor by the object's meeting certain operative human conventions prescribing what is to be admired, nor (...) by its being conformable, in some way, to human needs or desires. Hume, of course, would have none of this. It is hoped to show that if one adopts Hume's account, then his attempt to show that there nevertheless will be convergence in the long run as to what is of aesthetic value is forced and unsuccessful. By contrast, on the ‘objective’ account convergence is to be expected. This, of course, only shows the superiority of the ‘objective’ account so long as there is an expectation of long-term convergence. This is not an expectation of most contemporary value ‘subjectivists’, and therefore the argument will not be directly relevant to their positions. (shrink)

In recent decades, the term ‘ legitimacy ’ has featured heavily in debates about international law and international institutions. Yet the concept of legitimacy, mercurial as it is, has remained under-scrutinized, leading to confusion and misuse. Rather than advancing a particular conception of what may make international law legitimate, this article seeks to clarify and complicate how international lawyers understand and use legitimacy as a concept. To begin, the article distinguishes between legal, moral and social legitimacy. It highlights the different (...) ways in which these three approaches to legitimacy have been used in international law scholarship, while drawing attention to some of their more problematic tendencies. From there, it breaks the concept of legitimacy down into three major elements: its object, subject and basis. It argues that the tendency to blur these elements has led to much of the uncertainty and obfuscation in legitimacy debates. Finally, the article stresses the importance of distinguishing legitimacy from other grounds for compliance, including coercion, self-interest and habit. Ultimately, it argues that if treated with sufficient rigour, legitimacy provides a useful analytical concept for international lawyers. In doing so, it aims to encourage and facilitate the participation of international lawyers in broader inter-disciplinary debates about legitimacy. (shrink)

If the world were wholly just, the following inductive definition would exhaustively cover the subject of justice in holdings.1. A person who acquires a holding in accordance with the principle of justice in acquisition is entitled to that holding.2. A person who acquires a holding in accordance with the principle of justice in transfer, from someone else entitled to the holding, is entitled to the holding.3. No one is entitled to a holding except by applications of i and 2.The complete (...) principle of distributive justice would say simply that a distribution is just if everyone is entitled to the holdings they possess under the distribution. (shrink)

It first needs to be shown that this question raises a problem, for many people think it is answered, or at least dissolved, in the following way. There are two independent ways of answering the question “Why should I do X?”; one ultimately in terms of what I want to do, the other ultimately in terms of what I morally ought to do. Thus showing that I morally ought to do something is a final justification of a course of action. (...) No answer can be given to the further question “Given that X is what I morally ought to do, why ought I to do X?”. No further moral reasons can be given as ex hypothese the final moral reasons have already been given. As it is denied that moral reasons can be reduced to reasons in terms of what I want to do, the only other possible kind of reason has been ruled out also. This, however, is said net to matter, because moral reasons are not in need cf any further justification. Moral considerations simply are reasons for action just as much as wanting to do something simply is a reason for doing it. (shrink)

This series of three articles describes the history of land law shared by the British and American legal systems, and how and why these legal traditions have diverged from each other in modern times. This Article - part 1 in this series - describes the emerging customs and laws regarding land rights among early inhabitants of Britain, and how succeeding invasions and occupation by Celtic, Roman, Germanic, and Norman peoples altered these customs and laws. The Article details the profound changes (...) in land law worked by massive economic changes in early British society, including sociological occurrences such as the Black Death, and the adoption of laws, such as the Statute of Uses in 1536. (shrink)

This is the first study to recognise the broad impact of opera in early-modern French culture._Downing A. Thomas considers the use of operatic spectacle and music by Louis XIV as a vehicle for absolutism; the resistance of music to the aesthetic and political agendas of the time; and the long-term development of opera in eighteenth-century humanist culture. He argues that French opera moved away from the politics of the absolute monarchy in which it originated to address Enlightenment concerns with sensibility (...) and feeling. The book combines close readings of significant seventeenth-century and eighteenth-century operatic works, circumstantial writings and theoretical works on theatre and opera, together with a measure of reception history. Thomas examines key works by Lully, Rameau, and Charpentier, among others, and extends his reach from the late seventeenth century to the end of the eighteenth. (shrink)

The history of the Euclidean Steiner tree problem, which is the problem of constructing a shortest possible network interconnecting a set of given points in the Euclidean plane, goes back to Gergonne in the early nineteenth century. We present a detailed account of the mathematical contributions of some of the earliest papers on the Euclidean Steiner tree problem. Furthermore, we link these initial contributions with results from the recent literature on the problem.

We expand Chater & Loewenstein's discussion of barriers to s-frames by highlighting moral psychological mechanisms. Systemic aspects of moralized social issues can be neglected because of (a) the individualistic frame through which we perceive moral transgressions; (b) the desire to punish elicited by moral emotions; and (c) the motivation to attribute agency and moral responsibility to transgressors.

While the cancellation of a number of high-profile loans because of corruption concerns has made headline news, the World Bank's principal approach to poorly governed countries is lending in order to support reforms. Although designed to be an apolitical technocratic development financier, increasingly the Bank has focused its attention and resources on promoting good governance in its borrowers. Bank lawyers and presidents have attempted to hive of apolitical aspects of governance by arguing a distinction between the rule of law and (...) the political character of government, but this distinction is illusory. The Bank's inability to address the political embeddedness of poor governance in neo-patrimonial governments skews risk assessments and impedes the formation of effective strategies. Reform of the charter would not eliminate the Bank's bureaucratic and political constraints. (shrink)

Focusing on the body as a visual and discursive platform across public space, this book explores marginalization as a sociocultural practice and hegemonic schema. The chapters center upon physical contexts, discursive spaces, and philosophical arenas to deconstruct seemingly intrinsic connections between body and behavior, whiteness, and normativity.

It has been claimed that decisions reached democratically have the consent of those subject to them. It will be shown that arguments for this view rest on either a Kantian or a utilitarian conception of consent. When the distinct nature of these arguments is kept clearly in mind, it becomes apparent that little remains of any of them. Nothing remains of the argument based on the Kantian conception, at least in so far as it is used to support the view (...) that democratic government rests on the consent of the governed. Though something remains of the arguments based on the utilitarian conception, what remains is not what they often are thought to establish. The spurious plausibility of consent arguments for democracy is due to switches between the Kantian conception of consent and the utilitarian. (shrink)

The commandment to “love your neighbor as yourself” is central to Christian discipleship. How does the concrete way that we express love enhance or diminish our ability to love? This paper brings Karl Rahner’s theology of neighbor love into dialogue with a description of altruism and compassion provided by social psychologist, C. Daniel Batson, and neuroscientists Tania Singer and Olga Klimecki. For Rahner, grace enables and sustains love. In addition, a mutually reciprocal relationship of unity exists between human love for (...) God, neighbor, and self. Furthermore, Rahner contends prayer as one way to cultivate compassion for another. The scientific research presented here examines aspects of the relationship between self and other known as empathy and compassion. The research of Batson, Singer, and Klimecki shed light on the role of self-love in compassion as well as the ways our capacity to empathize conditions our potential for altruism. (shrink)

The issue addressed in this thesis is one in the absolute idealism of Spinoza. It is one of specifying an interpretation of substance-attribute identity as a solution to the problem of reconciling it with the diversity of the attributes and the oneness of substance. As a testing ground for any proposed solution, a list of questions is generated. Given the countable diversity of the attributes, can we conceive of the identity of each of them with the one substance? Why, if (...) I am identical to a mode of each of infinite attributes, do I perceive only a body? What is the rational explanation for the infinite countable diversity of the attributes and our being directly acquainted with only two? In what manner can we reconcile the divisibility of substance with the activity of thought? How does one reconcile the order of extension seeming to be one of external relations with the essentially internal order of any finite thinking thing? How does one reconcile the independent being of modes of extension with the truth-functionality of ideas? In what manner is it possible to understand the appearance of the uniqueness of the one thing conceived under the idea of the body and the one-among-severalness of the same thing conceived under the idea of the individual's mind? In what manner can it be said that substance, consisting of infinite attributes, is accurately and completely conceived through any one of them while each is conceptually independent of every other? How can the one thing which is mind and body be wholly and accurately conceived to be a mode of either of their respective attributes while modes of differing attributes are also conceptually independent? The interpretations of substance-attribute identity given by John Clark Murray, T. L. S. Sprigge, and Errol E. Harris, in their writings in which they advocate reading Spinoza as an absolute idealist, are argued to be disadvantageous in dealing with the evident parallelism of the attributes. Finally, a proposed solution, offered by an alternative absolute idealist interpretation of substance-attribute identity, is developed in response to each of the above questions. (shrink)

This essay explores the relationships between labour and community formation in order to think through how, where, and when diasporic solidarities are imagined or refused. I draw on ethnographic research among Jamaican women contracted for seasonal work in US hotels to situate diasporic calls and responses in relation to specific contexts and a changing global political economy. I show how global geopolitical shifts not only shape the processes of identity formation and social reproduction, but also condition the perpetuation of notions (...) of nationalized racial hierarchies and ideologies of progress. I also show that hotel workers’ notions of ‘America’ and their commitment to the ‘American Dream’ shapes their subjectivities as migrant workers/consumers and, in their assessment, differentiates them from African-Americans, particularly those most immediately affected by Hurricane Katrina. In doing so, I demonstrate that one of the ideological hegemonies of diaspora is the idea that an individual's capacity to affect their own social mobility and that of their social network always outstrips the ‘locals’ in diasporic elsewheres. (shrink)

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This Article examines the genesis and evolution of the Restatements of Property. The author argues that, while the Restatement (First) of Property took as its original purpose to restate the law, in the course of its creation it was turned to reform. Subsequent Restatements of Property are dedicated almost wholly to reform. The author concludes that this shift in objectives has sparked criticism and rendered these works of less value and interest to the legislatures, bench and the bar, which have (...) largely ignored the property Restatements. (shrink)

D. A. Lloyd Thomas; VIII—Political Decision Procedures1, Proceedings of the Aristotelian Society, Volume 70, Issue 1, 1 June 1970, Pages 141–160, https://doi.or.

There are a number of grounds for criticizing what the state requires of one, and for thinking that one no longer has an obligation to obey it. I will begin by attempting to locate liberalism amongst such grounds. It is useful for this purpose to contrast two headings under which these grounds may fall. Firstly, there are criticisms concerning the content of the requirements of the state. In this case exception is taken to what it is that the law requires (...) quite apart from the process by which it was arrived at. If Jews are legally prevented from practising certain professions, and objection is taken because no state should make laws debarring persons from certain professions on religious grounds, the objection is one of content. Secondly, there are grounds concerning the procedure by which a decision was reached. If it is thought that the British Government ought not to have signed the Treaty of Rome because no referendum was taken on whether the electorate wanted Britain to join, exception is taken to the procedure by which this decision was made. The objection could be made by one who thought that British entry was the best policy. liberalism lays down principles concerning the permissible content of what is required by the state. (shrink)

In this essay an ‘objective’ account of intrinsic value is proposed and partly defended. It is claimed that a kind of value exists which is, or may reasonably be supposed to be, a property of certain objects. The presence of such value is not to be wholly accounted for as the ‘projection’ of certain human feelings elicited by the object thought to be of value, nor by the object's meeting certain operative human conventions prescribing what is to be admired, nor (...) by its being conformable, in some way, to human needs or desires. Hume, of course, would have none of this. It is hoped to show that if one adopts Hume's account, then his attempt to show that there nevertheless will be convergence in the long run as to what is of aesthetic value is forced and unsuccessful. By contrast, on the ‘objective’ account convergence is to be expected. This, of course, only shows the superiority of the ‘objective’ account so long as there is an expectation of long-term convergence. This is not an expectation of most contemporary value ‘subjectivists’, and therefore the argument will not be directly relevant to their positions. (shrink)

Because of the nature of preventive vaccination programs, the viability of these public health interventions is particularly susceptible to public perceptions. This is because vaccination relies on a concept of ‘herd immunity’, achievement of which requires rational public behavior that can only be obtained through full and accurate communication about risks and benefits. This paper describes how irrational behavior that threatens the effectiveness of vaccination programs – both in crisis and non-crisis situations – can be tied to public perceptions created (...) by media portrayals of health risks. I concentrate on childhood vaccination as an exemplar of ‘non-crisis’ preventive vaccination, and on the recent flu vaccine shortage as a ‘crisis’ situation. The paper concludes with an examination of the steps necessary to resolve these threats through better public communication. (shrink)