Ethik und Seelsorge sind Bereiche, in denen menschliches Sein und Handeln reflektierend begleitet wird, um Orientierung, Unterstützung oder Trost zu geben. Bei Berufen, in denen Menschen auf eine gewaltverstrickte Lebenswelt treffen, ihrerseits staatlich legitimiert Gewalt ausüben und selbst von Gewalt betroffen sind, tauchen dabei besondere Widersprüche und Sinnfragen auf. Diese Herausforderungen in den Blick zu nehmen und an der Schnittstelle von Philosophie und praktischer Theologie zu erörtern, so wie es der Münsteraner Theologe Werner Schiewek richtungsweisend vorgezeichnet hat, ist das Ziel (...) des vorliegenden Bandes. (shrink)

Nurses and other medical practitioners often experience moral distress: they feel an anguished sense of responsibility for what they take to be their own moral failures, even when those failures were unavoidable. However, in such cases other people do not tend to think it is right to hold them responsible. This is an interesting mismatch of reactions. It might seem that the mismatch should be remedied by assuring the practitioner that they are not responsible, but I argue that this denies (...) something important that the phenomenon of moral distress tells us. In fact, both the practitioners’ tendencies to hold themselves responsible and other people’s reluctance to hold the practitioners responsible get something right. The practitioners may be right that they are responsible in the sense of having failed to meet a binding moral requirement, even when the requirement was impossible to meet. This makes moral distress a fitting response because it correctly represents their own action as a wrongdoing. However, others may meanwhile be right that the practitioners are not responsible in the sense of being culpable and blameworthy. To blame others, or oneself, for certain failures, including those that are unavoidable, would be unfair. My claim depends on distinguishing between the fittingness and the fairness of holding someone (including oneself) responsible for moral failure. Having drawn the distinction, I suggest that moral distress should be addressed in a way that both recognizes it as a fitting response and avoids the unfairness of blame. (shrink)

Conscience is an idea that has significant currency in liberal democratic societies. Yet contemporary moral philosophical scholarship on conscience is surprisingly sparse. This paper seeks to offer a rigorous philosophical account of the role of conscience in moral life with a view to informing debates about the ethics of conscientious objection in medicine. I argue that conscience is concerned with a commitment to moral integrity and that restrictions on freedom of conscience prevent agents from living a moral life. In section (...) one I argue that conscience is a principle of moral awareness in rational agents, and that it yields an awareness of the personal nature of moral obligation. Conscience also monitors the coherence between an agent’s identity-conferring beliefs and intentions and their practical actions. In section two I consider how human beings are harmed when they are forced to violate their conscience. Restrictions on the exercise of conscience prevent people from living in accord with their own considered understanding of the requirements of morality and undermine one’s capacity for moral agency. This article concludes with a consideration of how a robust theory of conscience can inform our understanding of conscientious objection in medicine. I argue that it is in the interest of individual practitioners and the medical profession generally to foster moral agency among doctors. This provides a prima facie justification for permitting at least some kinds of conscientious objection. (shrink)

Das Thema „moralischer Stress / moralische Verletzung“ hat als Gegenstand der sozialwisschenschaftlichen, psychologischen und auch ethischen Forschung in den letzten Jahren an Bedeutung gewonnen. Dieses Kapitel stellt dar, was unter diesen Begriffen zu verstehen ist. Anhand ausgewählter Berufsfelder wird die Problematik und die Praxisrelevanz dieses Forschungsbereichs aus ethischer Perspektive dargestellt. Ansatzweise werden zwei Aspekte angesprochen, die bei der Prävention bzw. Heilung von moralischen Verletzungen hilfreich sein könnten, gleichwohl weiterer Forschung bedürfen: Ein philosophisch fundierter Begriff von „Vertrauen“ und die Relevanz von (...) „Ethiklehre“ in der (akademischen) Berufsausbildung. (shrink)

This article is concerned with theories and therapeutic practices that interpret post-traumatic combat stress as a ‘moral injury’ produced by the shock of carrying out lethal violence in uncertain battlefield conditions. While moral injury is said to share many symptoms with post-traumatic stress disorder (PTSD), its proponents – military and Veterans Health Administration clinical psychologists, chaplains, and some psychiatrists – are concerned by PTSD’s inability to account for the meaning-based moral and ethical distress that counterinsurgency battlefields in Iraq and Afghanistan (...) are allegedly especially prone to produce in US soldiers. Moral injury theorists seem to want to describe a phenomenon that is both more profound than PTSD but which, as clinical psychologists Shira Maguen and Brett Litz state, is not itself a mental disorder. In this article, I examine the links between moral injury theory’s fringe diagnostic status and the fringe status of the kinds of violence it understands as uniquely injurious to soldiers’ psyches. Moral injury valorizes war-fighting and military culture while casting war as a source of almost inevitable psychopathology. I argue that moral injury theory represents an effort to carve out a distinct domain of psychological expertise but also a negotiation of the tension between war violence’s ‘normal’ practice and its excessive or morally hazardous manifestations – both of which link mental illness directly to the politics of war violence and post-war care. (shrink)

Although post-traumatic stress disorder is now constituted by a set of characteristic symptoms, its roots lie in Post-Vietnam Syndrome, a label generated by a Vietnam-era advocacy movement that focused not on symptoms but on war’s traumatic context. When Post-Vietnam Syndrome was subsumed into the abstract, individualistic, symptom-centered language of DSM-III and rendered as PTSD, it not only lost this focus on context but also neglected the experiences of veterans who suffer from things done or witnessed, not primarily from what was (...) done to them, in war. This agent-related trauma has been rediscovered in contemporary work on moral injury, but moral injury too is increasingly subjected to the hegemony of the symptom. Focusing on symptoms, however, unhelpfully pathologizes and individualizes trauma, neglects traumatic context, and legitimates problematic therapeutic approaches. Trauma researchers and clinicians should decenter the language of symptoms and focus instead on context and on alternative accounts of trauma. (shrink)

Being in a mood—such as an anxious, irritable, depressed, tranquil, or cheerful mood—tends to alter the way we react emotionally to the particular objects we encounter. But how, exactly, do moods alter the way we experience particular objects? Perceptualism, a popular approach to understanding affective experiences, holds that moods function like "colored lenses," altering the way we perceive the evaluative properties of the objects we encounter. In this essay, I offer a phenomenological analysis of the experience of being in a (...) mood that illustrates the limitations of the colored lens metaphor and demonstrates the basic inadequacy of the perceptualist account of moods. I argue that when we are in a mood, it is common to experience a kind of "emotional disconnection" in which we perceive evaluative properties that would normally elicit strong emotional reactions from us, but nonetheless we find that, in our present mood, we remain emotionally numb to these perceptions. Such experiences of "seeing but not feeling" are difficult to understand from within the perceptualist paradigm. Building on the work of Martin Heidegger, I sketch an alternative, phenomenological analysis of moods that can better account for experiences of emotional disconnection. On this alternative account, being in a mood does not merely alter the content of our perceptions but, rather, alters the way we interpret the overall significance of what we perceive, relative to a certain situational context. (shrink)

Although previous treatments of affective injustice have identified some particular types of affective injustice, the general concept of affective injustice remains unclear. This article proposes a novel articulation of this general concept, according to which affective injustice is defined as a state in which individuals or groups are deprived of “affective goods” which are owed to them. On this basis, I sketch an approach to the philosophical investigation of affective injustice that begins by establishing which affective goods are fundamental, and (...) then considers which subsidiary goods—such as freedoms, resources, opportunities, and forms of recognition—may be necessary for the provision of those fundamental affective goods. Drawing from and developing ideas in the extant literature, I argue that two such fundamental affective goods include subjective well-being and emotional aptness. I then show that by analyzing deprivations of the subsidiary goods that enable a person to pursue and attain subjective well-being and emotional aptness, it is possible to shed new light on the cases of affective injustice that have been described in the extant literature, while also identifying other kinds of cases that have not been theorized to the same extent. (shrink)