This paper makes the case for a pluralist, contextualist view of nursing ethics. In defending this view, I briefly outline two current perspectives of nursing ethics – the Traditional View and the Theory View. I argue that the Traditional View, which casts nursing ethics as a subcategory of healthcare ethics, is problematic because it (1) fails to sufficiently acknowledge the unique nature of nursing practice; and (2) applies standard ethical frameworks such as principlism to moral problems which tend to alienate (...) or undermine nursing ethical concerns. Alternatively, the Theory View, which aims to build an independent and comprehensive theory of nursing ethics, is also found wanting because it (1) fails to sufficiently acknowledge the heterogeneous nature of nursing practices; (2) overemphasizes the differences and undervalues the similarities between nurses and other health professionals; and (3) assumes that one ethical framework can be meaningfully applied across diverse moral problems and contexts.My alternative, is to argue that nursing ethics inquiry should take a pluralist and critical stance towards available ethical frameworks and the negotiation of the ethical realm. On this view, the search for moral consensus or a unique ethical framework for nursing is replaced by the task of working strategically with multiple frameworks in order to expand the moral agency of nurses and empower them to positively engage with moral uncertainty as an inevitable feature of living a moral life. I conclude by indicating some of the implications that this has for the teaching of nursing ethics. (shrink)

Moral distress has received much attention in the international nursing literature in recent years. In this article, we describe the evolution of the concept of moral distress among nursing theorists from its initial delineation by the philosopher Jameton to its subsequent deployment as an umbrella concept describing the impact of moral constraints on health professionals and the patients for whom they care. The article raises worries about the way in which the concept of moral distress has been portrayed in some (...) nursing research and expresses concern about the fact that research, so far, has been largely confined to determining the prevalence of experiences of moral distress among nurses. We conclude by proposing a reconsideration, possible reconstruction and multidisciplinary approach to understanding the experiences of all health professionals who have to make difficult moral judgements and decisions in complex situations. (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)

In the last three decades, considerable theoretical and empirical research has been undertaken on the topic of moral distress among health professionals. Understood as a psychological and emotional response to the experience of moral wrongdoing, there is evidence to suggest that—if unaddressed—it contributes to staff demoralization, desensitization and burnout and, ultimately, to lower standards of patient safety and quality of care. However, more recently, the concept of moral distress has been subjected to important criticisms. Specifically, some authors argue that the (...) standard account of moral distress elucidated by Jameton :542–551, 1984) does not refer to a discrete phenomenon and/or that it is not sufficiently broad and that this makes measuring its prevalence among health professionals, and other groups of workers, difficult if not impossible. In this paper, we defend the standard account of moral distress. We understand it as a concept that draws attention to the social, political and contextual determinants of moral agency and brings the emotional landscape of the moral realm to the fore. Given the increasing pressure on health professionals worldwide to meet efficiency, financial and corporate targets and reported adverse effects of these for the quality and safety of patient care, we believe that further empirical research that deploys the standard account moral distress is timely and important. (shrink)

This article briefly outlines some of the key problems with the way in which the moral realm has traditionally been understood and analysed. I propose two alternative views of what is morally interesting and applicable to nursing practice and I indicate that instability has its upsides. I begin with a moral tale – a 'Good Samaritan' story – which raises fairly usual questions about the nature of morality but also the more philosophically fundamental question about the relationship between subjectivity and (...) moral agency. I then consider this relationship from the perspectives of two twentieth century philosophers: Emmanuel Levinas and Michel Foucault. Levinas' basic point is that the experience of ethical subjectivity is made possible through others: the demand to respond to the existence of others is the basic social structure that precedes individual freedom. If Levinas posits intersubjectivity as a fundamental or primitive feature of the moral realm, Foucault poses an even more basic question: how have moral subjects and relations of obligation been constituted? The aim of ethical inquiry, for Foucault, is to describe the network of discourses, institutions, relations, and practices through which certain kinds of subjects are constituted and constitute themselves, e.g. as a kind of person who can act morally. Finally, I consider some recent research in philosophy of nursing which illustrates how Levinasian and/or Foucauldian perspectives can deepen understanding of nurses' moral practices, specifically, the work of Norwegian public health nurses, Canadian pediatric nurses, and Irish midwives. I suggest that in spite of the instability of morality in general and the particular ethical challenges that face nurses, there are grounds for hope and possible strategies for living in unstable times. (shrink)

Why the narrative self? -- Contemporary interest in narrative theory -- Is the self real or illusory? -- Dennett's brand of naturalism -- The heterophenomenological method (HM) -- Consciousness and the self -- The naturalist narrative self -- Puzzle cases -- The HM and the narrative self -- The limitations of Dennett's account -- The limits of language -- Epistemological fragility -- Ontological fragility -- Naturalism and phenomenology -- Confronting naturalism -- Phenomenology and hermeneutics -- The detour of interpretation -- (...) Reflexivity -- The problem of personal identity -- The number of selves, identity relations and truth -- The capable self and its narrative identity -- Narrative identity and aristotelian muthos -- Narrative recounting of human lives -- LPSE-identity and literary puzzle cases -- Certainty, knowledge and attestation -- Narrative attestation -- Fact and fiction -- Narrative attestation -- The limitations of Ricoeur's account -- Selective appeals to literary and psychoanalytic discourses -- Focus on the self-examining self -- The ontological status of the narrative self -- The epistemological status of the narrative self -- The practical self -- Why the narrative self? (shrink)

In April 2004 the Irish Government commissioned Judge Maureen Harding Clark to compile a report to ascertain the rate of caesarean hysterectomies at Our Lady of Lourdes Hospital in Drogheda, Republic of Ireland. The report came about as a result of complaints by midwives into questionable practices that were mainly (but not solely) attributed to one particular obstetrician. In this article we examine the findings of this Report through a feminist lens in order to explore what a feminist reading of (...) the Report and the events that led to the inquiry will bring to light. We consider how sex and gender feature in the Lourdes case, draw attention to the deeply gendered asymmetries of power and privilege that existed between the men and women at the centre of this inquiry, and explore the impact such asymmetries had on this particular situation. (shrink)

The Republic of Ireland has some of the most restrictive abortion legislation in the world which grants to the ‘unborn’ an equal right to life to that of the pregnant woman. This article outlines recent developments in the public discourse on abortion in Ireland and explains the particular cultural and religious context that informs the ethical case for access to abortion services. Our perspective rests on respect for two very familiar moral principles – autonomy and justice – which are at (...) the centre of social and democratic societies around the world. This article explains the context for the deployment of these concepts in order to support the claim that the current legislation and its operationalisation in clinical practice poses serious risks to the health, lives and well-being of pregnant women, tramples on their autonomy rights and requires of them a self-sacrifice that is unreasonable and unjust. (shrink)

This title offers an ethical framework for end-of-life decision making in healthcare settings. Its objective is to foster and support ethically and legally sound clinical practice in end-of-life treatment and care in Ireland.

Background The impact of healthcare ethics educational interventions on participants’ ethical development is rarely reported on and assessed; even less attention is paid to educational interventions that focus on end-of-life ethical issues. Aim To evaluate the impact of the Ethical Framework for End-of-Life Care Study Sessions Programme on the moral development of healthcare staff who are delivering end-of-life care. Methods The EOLCSS was delivered to 20 multi-disciplinary health care staff in Ireland in May 2013. Effect on moral reasoning was measured (...) pre and post education using the Defining Issues Test 2. Inferential statistics were used to examine the relationships between change in DIT2 scores and demographic variables. Results Participants experienced moral reasoning development following receipt of EOLCSS. Age and previous ethics education contributed to the observed changes in moral reasoning. Conclusions Receipt of the EOLCSS may contribute to moral reasoning development in practicing healthcare professionals. (shrink)

Although clinical ethics support services are becoming increasingly prevalent in Europe and North America, they remain an uncommon feature of the Irish healthcare system and Irish health professionals lack formal support when faced with ethically challenging cases. We have developed a variant on existing clinical ethics decision-making tools which is designed to build capacity and confidence amongst Irish practitioners and enable them to confront challenging situations in the absence of any dedicated support structure. The tool provided below follows a transparent (...) stepwise procedure which avoids an overcomplicated analysis while remaining sensitive to the complexity of the issues addressed. The novelty of the tool lies in the explicit association it makes between each step in the process and one or more responsibilities based on established norms of ethical decision-making in the public domain. (shrink)

Background:A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population.Research aim:To identify challenges in implementing the ‘Let Me Decide’ advance care planning programme in long-term-care.Research design:This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families.Participants and research context:long-term-care residents in two nursing homes and one community hospital.Ethical considerations:The local research ethics committee granted ethical approval.Findings:Following implementation, over (...) 50% of all residents had completed some form of end-of-life care plan. Of the 70 residents who died in the post-implementation period, 14% had no care plan, 10% (with capacity) completed an advance care directive and lacking such capacity, 76% had an end-of-life care plan completed for them by the medical team, following discussions with the resident (if able) and family. The considerable logistical challenge of releasing staff for training triggered development of an e-learning programme to facilitate training.Discussion:The challenges encountered were largely concerned with preserving resident’s autonomy, avoiding harm and suboptimal or crisis decision-making, and ensuring residents were treated fairly through optimisation of finite resources.Conclusions:Although it may be too late for many long-term-care residents to complete their own advance care directive, the ‘ Let Me Decide’ programme includes a feasible and acceptable option for structured end-of-life care planning for residents with variable capacity to complete an advance care directive, involving discussion with the resident (to the extent they were able) and their family. While end-of-life care planning was time-consuming to deliver, nursing staff were willing to overcome this and take ownership of the programme, once the benefits in improved communication and enhanced peace of mind among all parties involved became apparent in practice. (shrink)

Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making would be better understood (...) as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)

In this new textbook two Catholic ethicists with extensive teaching experience present a moral theology based on vision. David Matzko McCarthy and James M. Donohue draw widely from the Western philosophical tradition while integrating biblical and theological themes in order to explore such fundamental questions as What is good? The fourteen chapters in Moral Vision are short and thematic. Substantive study questions engage with primary texts and encourage students to apply theory to everyday life and common human experiences. The (...) book is accessibly written and flexible enough to fit into any undergraduate or seminary course on ethics. (shrink)

Este artículo analiza el prólogo de 1812 a la Ciencia de la lógica (WdL) y responde a los planteos: ¿de qué trata esta obra?, ¿qué hay de lógico en la expresión “lógica”?, ¿es ”lógica” un nombre sustituto para “metafísica” o, más bien, la WdL es la inauguración de una disciplina completamente nueva y que dista de la metafísica en el sentido tradicional? Concluyo que la lógica es aquí el desarrollo del concepto expresada como libertad social.

Kierkegaard’s psychological thought has always been acknowledged as very rich—Reinhold Niebuhr hailed him as the greatest psychologist of the soul since Augustine—and has had a major influence on Heidegger, Sartre, and existential psychoanalysis. Nevertheless, his accomplishment has not always been fully appreciated, in part because it is so scattered across his works. As Vincent McCarthy demonstrates in Kierkegaard as Psychologist, Kierkegaard was pursuing “psychology” before there was a formally recognized academic field bearing that name, and a coherent thread runs (...) through the so-called pseudonymous works. McCarthy elucidates often-difficult texts, highlights the rich psychological dimension of Kierkegaard’s thought, and provides an introduction for the nonspecialist and a commentary on Kierkegaard’s psychology that will interest both specialists and nonspecialists, while engaging in rich comparisons with such figures as Freud and Heidegger. (shrink)

How do people understand science? How do they feel about science, how do they relate to it, what do they hope from it and what do they fear about it? Science of the People: Understanding and using science in everyday contexts helps answer these questions as the result of painstaking interviewing by Professor Joan Solomon of all and sundry in a fairly atypical small town. The result is a unique overview of how a very wide range of adults, united (...) only by local geography, relate to science. Many of the findings run contrary to what is widely believed about how science is learnt and about how people view it. Chapters include:An Approach to AwarenessPublics for Science?Ethics and ActionInterpretation and ChangeJoan Solomon, who sadly died before this book could be published, enjoyed an international reputation in science education. After a long career teaching science in secondary schools she moved into the university sector and ending up holding chairs of science education at the Open University, King's College London and the University of Plymouth. She was a world leader in her subject and inspired classroom teachers and wrote a number of very influential papers with some of them. She produced many important books, booklets and other resources to help science teachers and science educators get to grips with the history and philosophy of science and the teaching of energy, amongst other topics. This book is essential reading for those involved in Science education and educational policy. (shrink)

Saving the World and Healing the Soul treats the heroic and redemptive trials of Jason Bourne, Bruce Wayne, Bella Swan, and Katniss Everdeen. The Bourne films, Christopher Nolan's Batman trilogy, the Twilight saga, and the Hunger Games series offer us stories to live into, to make connection between our personal loves and trials and a good order of the world.

The article is a plea for ethicists to regard probability as one of their most important concerns. It outlines a series of topics of central importance in ethical theory in which probability is implicated, often in a surprisingly deep way, and lists a number of open problems. Topics covered include: interpretations of probability in ethical contexts; the evaluative and normative significance of risk or uncertainty; uses and abuses of expected utility theory; veils of ignorance; Harsanyi’s aggregation theorem; population size problems; (...) equality; fairness; giving priority to the worse off; continuity; incommensurability; nonexpected utility theory; evaluative measurement; aggregation; causal and evidential decision theory; act consequentialism; rule consequentialism; and deontology. (shrink)

In spite of feminist recognition that hierarchical organizations are an important location of male dominance, most feminists writing about organizations assume that organizational structure is gender neutral. This article argues that organizational structure is not gender neutral; on the contrary, assumptions about gender underlie the documents and contracts used to construct organizations and to provide the commonsense ground for theorizing about them. Their gendered nature is partly masked through obscuring the embodied nature of work.jobs and hierarchies, common concepts in organizational (...) thinking, assume a disembodies and universal worker. This worker is actually a man; men's bodies, sexuality, and relationships to procreation and paid work are subsumed in the image of the worker. Images of men's bodies and masculinity pervade organizational processes, marginalizing women and contributing to the maintenance of gender segregation in organizations. The positing of gender-neutral and disembodied organizational structures and work relations is part of the larger strategy of control in industrial capitalist societies, which, at least partly, are built upon a deeply embedded substructure of gender difference. (shrink)

Is it possible to donate unpaired vital organs, foreseeing but not intending one's own death? We argue that this is indeed psychologically possible, and thus far agree with Charles Camosy and Joseph Vukov in their recent paper on 'double effect donation.' Where we disagree with these authors is that we see double effect donation not as a morally praiseworthy act akin to martyrdom but as a morally impermissible act that necessarily disrespects human bodily integrity. Respect for bodily integrity goes beyond (...) avoiding the aim to kill: not all side effects of deliberate bodily interventions can be outweighed by intended benefits for another even if the subject fully consents. It is not any necessary intention to kill or harm another or oneself that makes lethal donation/harvesting illicit but the more immediate intention to accept or perform surgery on an (innocent) person combined with the foresight of lethal harm and no health-related good for him or her. Double effect donation falls foul of the first condition of double effect reasoning in that the immediate act is wrong in itself. We argue further that the wider effects of such donation would be socially disastrous and corrupting of the medical profession: doctors should retain a sense of nonnegotiable respect for bodily integrity even when they intervene on willing subjects for the benefit of others. (shrink)

In this article, the author addresses two feminist issues: first, how to conceptualize intersectionality, the mutual reproduction of class, gender, and racial relations of inequality, and second, how to identify barriers to creating equality in work organizations. She develops one answer to both issues, suggesting the idea of “inequality regimes” as an analytic approach to understanding the creation of inequalities in work organizations. Inequality regimes are the interlocked practices and processes that result in continuing inequalities in all work organizations. Work (...) organizations are critical locations for the investigation of the continuous creation of complex inequalities because much societal inequality originates in such organizations. Work organizations are also the target for many attempts to alter patterns of inequality: The study of change efforts and the oppositions they engender are often opportunities to observe frequently invisible aspects of the reproduction of inequalities. The concept of inequality regimes may be useful in analyzing organizational change projects to better understand why these projects so often fail and why they succeed when this occurs. (shrink)

When Carol Gilligan (1982) first introduced the ethic of care she did so from the discipline of psychology using empirical data that questioned Kohlberg's (1981) negative assumptions about the mora...

The inquiry into the moral status of artificial intelligence (AI) is leading to prolific theoretical discussions. A new entity that does not share the material substrate of human beings begins to show signs of a number of properties that are nuclear to the understanding of moral agency. It makes us wonder whether the properties we associate with moral status need to be revised or whether the new artificial entities deserve to enter within the circle of moral consideration. This raises the (...) foreboding that we are at the gates of an anthropological crisis: the properties bound to moral agency have been exclusively possessed in the past by human beings and have shaped the very definition of being human. In this article, I will argue that AI does not lead us to an anthropological crisis and that, if we adhere to the history and philosophy of technology, we will notice that the debate on the moral status of AI uncritically starts from an anthropology of properties and loses sight of the relational dimension of technology. First, I will articulate three criteria for analyzing different anthropological views in philosophy of technology. Second, I will propose six anthropological models: traditional, industrial, phenomenological, postphenomenological, symmetrical, and cyborg. Third, I will show how the emergence of AI breaks with the dynamics of increased relationality in the history and philosophy of technology. I will argue that this aspect is central to debates about the moral status of AI, since it sheds light on an aspect of moral consideration that has been obscured. Finally, I will reject entirely relational approaches to moral status and propose two hybrid possibilities for rethinking it. (shrink)

Michael H. McCarthy has carefully studied the writings of Bernard Lonergan (Canadian philosopher-theologian, 1904-1984) for over fifty years. In his 1989 book, The Crisis of Philosophy, McCarthy argued for the superiority of Lonergan's distinctive philosophical project to those of his analytic and phenomenological rivals. Now in Authenticity as Self-Transcendence: The Enduring Insights of Bernard Lonergan, he develops and expands his earlier argument with four new essays, designed to show Lonergan's exceptional relevance to the cultural situation of late modernity. (...) The essays explore and appraise Lonergan's cultural mission: to raise Catholic philosophy and theology to meet the intellectual challenges and standards of his time. (shrink)

The moth snowstorm, a phenomenon Michael McCarthy remembers from his boyhood when moths 'would pack a car's headlight beams like snowflakes in a blizzard,' is a distant memory. Wildlife is being lost, not only in the wholesale extinctions of species but also in the dwindling of those species that still exist. The Moth Snowstorm records in painful detail this rapid dissolution of nature's abundance and proposes a radical solution: that we recognize our capacity to love the natural world. Arguing (...) that neither sustainable development nor ecosystem services have proven adequate as defenses against pollution, habitat destruction, species degradation, and climate change, McCarthy asks us to consider nature as an intrinsic good and an emotional and spiritual resource, capable of inspiring joy, wonder, and even love. An award-winning environmental journalist, McCarthy presents a clear, well-documented picture of what he calls 'the great thinning' around the world, while interweaving the story of his own early discovery of wilderness and a childhood saved by nature. Drawing on the truths of poets, the studies of scientists, and the author's long experience in the field, The Moth Snowstorm is part elegy, part ode, and part argument, resulting in a passionate call to action. (shrink)