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)

In the helping professions, codes of ethics and decision-making models have been the primary vehicles for determining what constitutes ethical practice. These strategies are insufficient since they assume that shared meanings exist and that the contradictory universal principles of codes can be reconciled. Also, these tools do not emphasize the significance of context for ethical practice. This book takes a new critical theoretical approach, which involves exploring how social workers construct what is a ethicala in their work, especially when they (...) are positioned at the intersection of multiple paradoxes, including that of two opposing responsibilities in society: namely, to care for others but also to prevent others from harm. The book is built on narratives from actual front-line workers and therefore is more applicable and grounded for practitioners and students, offering many suggestions for sound practice. It illustrates that an understanding of ethics differs from worker to worker and is heavily influenced by context, workersa values, and what they take up as the primary discourses that frame their perceptions of the profession. While recognizing the oppressive potential of social work, the book is rooted in a perspective that ethical practice can contribute to a more socially just society.". (shrink)

Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case‐based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from (...) moral philosophy, including consequentialism, deontology, and principlism.In this article we hope to make a case for augmenting the focus of education in medical ethics. We propose complementing the traditional approach to medical ethics with a more embedded approach, one that has been described by others as “microethics,” the ethics of everyday clinical practice. (shrink)

This paper studies the construction of ethics in interactions between professionals in meetings, in relation to the rationing of resources. The research context is a supported housing unit targeted at clients with mental health and substance abuse problems. The service is provided for a municipality, which expects good progress of the clients. The research question is: how do the professionals produce implicit ethical justifications for setting limits to helping, even though the need for professional help is not called into question? (...) Five types of justification appear in the data covering 28 meetings. However, these types of justification do not solve the central ethical difficulty arising in the conversations. Limiting help would easily push people out of reach of all help. Thus, in spite of the talk about ethical justification, workers do not ultimately resort to limiting help in situations with no real alternatives for getting help. The ethical principle of following non-exclusionary practices is highly prioritized. (shrink)

Recent UK reports have revealed extensive evidence of unethical care practices. Older and vulnerable patients in some British health services have experienced appalling and avoidable suffering. Explanations for, and solutions to, these care failures have been proposed with wide-ranging recommendations. Many of these have direct implications for clinical ethics with additional frameworks for ethical values proposed, a heightened awareness of the moral culture of organisations acknowledged and a renewed interest in the ethics component of professional education debated. In this paper, (...) I suggest that we integrate insights from the slow movement into clinical ethics practice. Distinctions are made between fast and slow healthcare practice and between fast and slow ethics. I argue that, whilst there is a place for both, slow ethics enables us to assume a more positive stance in relation to ‘crisis’, and requires that we learn from past accounts and scholarship and consider the role of clinical ethics in sustaining caring cultures. (shrink)