The notion of “relational” autonomy—as described by feminist scholars such as Susan Sherwin and Anne Donchin—has been the subject of a significant body of literature over the last few years and has recently generated some interest within the field of bioethics. Although the focus of this interest has been the autonomy of ordinary moral agents, the analysis of relational autonomy can usefully be extended to apply to the autonomy of professionals, not only as individual moral agents, but in their roles (...) as professionals as well. In this paper, I argue that professional autonomy, rightly understood, is relational in nature. This understanding of professional autonomy stands to improve our understanding of professional ethics, as well as providing a particular, concrete example of what we mean when we call autonomy “relational” and “socially embedded. (shrink)

Unable to answer the call of our patients: mental health nurses’ experience of moral distress When health practitioners’ moral choices and actions are thwarted by constraints, they may respond with feelings of moral distress. In a Canadian hermeneutic phenomenological study, physicians, nurses, psychologists and non‐professional aides were asked to identify care situations that they found morally distressing, and to elaborate on how moral concerns regarding the care of patients were raised and resolved. In this paper, we describe the experience of (...) moral distress related by nurses working in mental healthcare settings who believed that lack of resources (such as time and staff) leads to dispiritedness, lack of respect, and absence of recognition (for both patients and staff) which severely diminished their ability to provide quality care. The metaphors of flashlight and hammer are used to elaborate nurses’ possible responses to intolerable situations. (shrink)

The moral distress of psychologists working in psychiatric and mental health care settings was explored in an interdisciplinary, hermeneutic phenomenological study situated at the University of Alberta, Canada. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychologists described specific incidents in which they felt their integrity had been compromised by such factors as institutional and interinstitutional demands, team conflicts, and interdisciplinary disputes. They described dealing with the resulting moral distress by such means as (...) silence, taking a stance, acting secretively, sustaining themselves through work with clients, seeking support from colleagues, and exiting. Recognizing moral distress can lead to a significant shift in the way we perceive moral choices and understand the moral context of practice. (shrink)

This article presents the development, validation and application of an instrument to measure everyday moral distress in different health care settings. The concept of moral distress has been discussed and developed over 20 years. A few instruments have been developed to measure it, predominantly in nursing. The instrument presented here consists of two factors: level of moral distress, and tolerance/openness towards moral dilemmas. It was tested in four medical departments and three pharmacies, where 259 staff members completed a questionnaire. The (...) two factors were found to be reliable. Differences in levels of moral distress were found between pharmacies and clinical departments, and between the youngest and oldest age groups; departmental staff and the youngest group experienced higher levels of moral distress. Departments reported less tolerance/openness towards moral dilemmas than pharmacies. The instrument needs to be tested further, but its strengths are the focus on everyday ethical dilemmas and its usefulness in different health care settings. (shrink)

We can freely cross disciplinary boundaries, as well as the line between theory and practice, and allow practices to cast their light back on the theory and show us its deficiencies. In short, this approach reorients some much-discussed issues of professional, business, and military ethics and reveals them as variations on one deeply rooted theme. The author does not treat current institutions as final and unalterable. If these arrangements frustrate moral evaluation, she finds that an argument for change. To make (...) intelligent changes, however, we need a clear view of the reasoning that makes them seem natural and inevitable. That is what this book attempts to do. In the process, the author also reexamines the concept of "person." Not all cultures put so much stress on the idea as Western - and particularly American - cultures do. If we wish to keep this emphasis, then here is another argument for change. (shrink)

Book reviewed in this article: he Powers of Psychiatry. By Jonas Robitscher.

While the UK Home Office’s proposals to preventively detain people with what it has called dangerous severe personality disorder have been subjected to debate and criticism the deeply troubling jurisprudential issues in these proposals have not yet entered into public debate in a way that their seriousness deserves.1 It is good that a commentator as well known as Professor Szasz is speaking out on this issue.Professor Szasz focuses upon a crucial question by calling into question the medicalisation of terms like (...) dangerousness and mental illness.2 There is a great temptation for legislators and the public to treat these terms as if they are purely scientific terms and to think of risk assessment as a precise science. I don’t share Professor’s Szasz’s worry about how psychiatry is using these terms but I think there are some important questions about how these concepts function in the public sphere.This issue is important enough to justify the use of some rhetorical claims because such claims can serve to bring out what are neglected and important issues. In raising the following objections I am not attempting to refute the message that is in Szasz’s article or to say that he is not making an important point but rather to attempt to sharpen the issues and to suggest ways that we can respond to Professor Szasz’s challenge.Psychiatry has progressed in a number of ways since Professor Szasz wrote The Myth of Mental Illness.3 The science is much better, we have much better medications, and psychiatrists are acutely aware of the tension between treating their patient and their obligations to the public interest.So when Professor Szasz says: “Psychiatrists offer to relieve the disturbed person of the burden of coping …. (shrink)

In Relational Responsibility, the authors attempt to transform the concept of responsibility in such a way that the relational process replaces the individual as the central concern. This volume invites practices that replace alienation and isolation with meaning-building dialogue. Relational Responsibility will be a valuable resource in the study of communication theory, sociology, social theory, interpersonal and group communication, conflict management, and child abuse.

Ethics of Psychiatry addresses the key ethical and legal issues in mental health care. With selections by Paul S. Applebaum, Christopher Boorse, Kerry Brace, Peter R. Breggin, Paula J. Caplan, Glen O. Gabbard, Donald H.J. Hermann, Lawrie Reznek, Thomas Szasz, Jerome Wakefield, Bruce J. Winick, and Robert M. Veatch, among others, this sourcebook offers the latest research in psychiatry, psychology, advocacy, mental health law, social services, and medical ethics relevant to the rational autonomy of psychiatric patients.

Thomas Hobbes took a new look at the ways in which society should function, and he ended up formulating the concept of political science. His crowning achievement, Leviathan, remains among the greatest works in the history of ideas. Written during a moment in English history when the political and social structures as well as methods of science were in flux and open to interpretation, Leviathan played an essential role in the development of the modern world. This edition of Hobbes' landmark (...) work is based on the original text. It incorporates the author's own corrections and retains the period spelling and punctuation, offering both flavorful authenticity and the utmost clarity of expression. (shrink)