Conventional management strategies for anti-corporate anger involve its negative construal as an inappropriate irrationality in need of containment. An alternative account is offered in which such anger comprises a healthy and health-sustaining component of care-based moral agency directed not only toward the affiliative advancement of connection among community members, but also toward the (political) resistance to violation, injustice, and carelessness through which disconnection from responsive community relationships occurs. The role of anger in care-based moral agency is (...) demonstrated through discussion of the classic case of environmental and human health crisis at Love Canal, New York. (shrink)

Research in moral psychology has recently raised questions about the impact of context and the environment on the way the human mind works. In a 2012 call to action, Paley wrote: “If some of the conclusions arrived at by moral psychologists are true, they are directly relevant to the way nurses think about moral problems, and present serious challenges to favoured concepts in nursing ethics, such as the ethics of care, virtue, and the unity of the person” (...) (p. 80). He urges nurse ethicists and scholars to evaluate the impact these findings may have for moral theory.In this paper, I review some of Paley's (Nursing Philosophy, 13, 2012, 80) critique, focusing on the argument that theories of nursing ethics have failed to account for the role of context; both in terms of its impact on the way nurses make moral judgements and in terms of the environment's influence on the way the mind works. I then examine nursing literature on moral agency, and focus on the role of the environment and context play within existing theory. I argue that theories of moral agency have often accounted for the role of context on the way nurses make decisions; however, less attention has been paid to its impact on the mind. With this background, I use insights from the fields of moral philosophy and moral psychology to refine the conceptualization of nurse moral agency in a way that is reflective of current cognitive, philosophical and nursing practice‐based science. (shrink)

This paper investigates the process of moral agency development as a community-supported process. Based on a multimethod qualitative inquiry, including diaries, focus groups, and documentary analysis, we analyze the experiences of middle managers in two Norwegian hospitals during the first year of the COVID-19 pandemic. We find that moral agency is developed through a community-embedded value inquiry, emerging in three partially overlapping steps. The first step is marked by moral reflex, an intuitive, value-driven, pre-reflective response (...) to a crisis situation. In the second step, the managers involved the community in value calibration, a collective-ethical sensemaking. In the third step, they took active stances to translate values into actions, with an increased awareness of values and an ability to explain and justify their actions. We label the steps, respectively: value inquiry-in-action, value inquiry-on-action and reflective enactment of value. An analysis of the process reveals two aspects critical for moral agency development: it happens through confrontation with uncertainty, and it is relational, that is, embedded in a community. While uncertainty forces an intuitive moral response, dialogical reflection in the community develops value awareness and relationships of mutual care and support. (shrink)

This paper articulates and defends a noncognitive, care-based view of identification, of what privileged psychic subset provides the source of self-determination in actions and attitudes. The author provides an extended analysis of "caring," and then applies it to debates between Frankfurtians, on the one hand, and Watsonians, on the other, about the nature of identification, then defends the view against objections.

We argue that a command and control system can undermine a commander’s moral agency if it causes him/her to process information in a purely syntactic manner, or if it precludes him/her from ascertaining the truth of that information. Our case is based on the resemblance between a commander’s circumstances and the protagonist in Searle’s Chinese Room, together with a careful reading of Aristotle’s notions of ‘compulsory’ and ‘ignorance’. We further substantiate our case by considering the Vincennes Incident, when (...) the crew of a warship mistakenly shot down a civilian airliner. To support a combat commander’s moral agency, designers should strive for systems that help commanders and command teams to think and manipulate information at the level of meaning. ‘Down conversions’ of information from meaning to symbols must be adequately recovered by ‘up conversions’, and commanders must be able to check that their sensors are working and are being used correctly. Meanwhile ethicists should establish a mechanism that tracks the potential moral implications of choices in a system’s design and intended operation. Finally we highlight a gap in normative ethics, in that we have ways to deny moral agency, but not to affirm it. (shrink)

When health professionals experience moral distress during routine clinical practice, they are challenged to maintain integrity through conscientious practice guided by ethical principles and virtues that promote the dignity of all human beings who need care. Their integrity also needs preservation during a crisis like the COVID-19 pandemic, especially when faced with triage protocols that allocate scarce resources. Although a crisis may change our ability to provide life-saving treatment to all who need it, a crisis should not change the (...) ethical values that should always be guiding clinical care. Enduring ethical commitments should encourage clinicians to base treatment decisions on the medical needs of individual patients. This approach contrasts with utilitarian attempts to maximize selected aggregate outcomes by using scoring systems that use short-term and possibly long-term prognostic estimates to discriminate between patients and thereby treat them unequally in terms of their eligibility for life-sustaining treatment. During times of crisis and calm, moral communication allows clinicians to exercise moral agency and advocate for their individual patients, thereby demonstrating conscientious practice and resisting influences that may contribute to compartmentalization, moral injury, and burnout. (shrink)

A moral agent is an individual who is capable of choosing and acting in accordance with judgments about what is right, wrong, good, bad, worthy, or unworthy. Such individuals are thought to be free and hence responsible for what they do. The obstacles to freedom and responsibility raise philosophical problems in regard to moral agency.

This essay examines the goals of care and the exercise of guardianship authority in the long-term care of persons with Alzheimer's disease and other forms of chronic, progressive dementia. It counters philosophical views that deny both agency and personhood to individuals with Alzheimer's on definitional or analytic conceptual grounds. It develops a specific conception of the quality of life and offers a critique of hedonic conceptions of quality of life and models of guardianship that are based on a hedonic (...) legal standard of “best interests.” As an alternative, it proposes a conception of quality of life based on the notions of “semantic agency” and “memorial personhood.”. (shrink)

The ethics of care and Confucian care ethics are both characterised by relations-based moral reasoning and decision-making. Acknowledging this similarity, this article compares and contrasts these two ethics, highlighting Western and Eastern moral concerns. One of the main differences between the two ethical theories is their different focus on vulnerability and inequality as factors in achieving equality in the ethics of care; another is the reciprocity, rather than equality, dimension in Confucian ethics. Both theories enshrine the view that (...) the characteristics of care offer scope for developing the capacity for judgement. However, a fundamental difference is revealed when considering that Confucian ethics emphasises care as a virtue in the cultivation of one's moral agency, whereas the ethics of care sees care as both a disposition and practice, and the caring relationship to be a primary means of moral evaluation. For the care ethicists, the practice of care embraces communicative morality, within fluid, dynamic interpersonal relationships - in sharp contrast to Confucian care practices, which are constructed within formal standards and fixed, role-based relationships. (shrink)

For nursing, the idea of bearing witness is of utmost importance. Nurses are present with persons who experience changes in their health and quality of life and who live intense and profound moments of struggling, questioning, and finding meaning. Nurses are also with persons from moment to moment as their lives unfold, and when joy, serenity, contentment, vulnerability, sadness, fear, and suffering are experienced. In this paper, it is proposed that bearing witness is a moral way of engaging in (...) the nurse–person relationship. Based on Levinas’s ethics of the face, it is claimed that bearing witness is enacting one’s moral responsibility, which arises from the encounter with the other. Drawing on Parse’s human becoming theory, ways of witnessing and bearing witness are defined and discussed. It is suggested that bearing witness is a human‐to‐human way of being‐relating, a mode of human coexistence. Bearing witness is being present and attentive to the truth of another’s experiences. Moreover, in this paper, the ways nurses enact their moral agency and bear witness to others placed in their care, or turn away, are explored. Nurses’ moral agency is located in the constrained moral space of contemporary health care. Hence, the creation of a moral space, which allows nurses to enact their moral responsibility of bearing witness to other persons’ experiences of health and quality of life, is called for. In doing so, it is suggested that the act of bearing witness needs a specific nursing knowledge base and a recognition that being present and being with another is a valuable nursing practice that is utterly meaningful for persons who are living through difficult times. (shrink)

Background: Legislative changes are resulting in assisted death as an option for people at the end of life. Although nurses’ experiences and perspectives are underrepresented within broader ethical discourses about assisted death, there is a small but significant body of literature examining nurses’ experiences of caring for people who request this option. Aim: To synthesize what has been learned about nurses’ experiences of caring for patients who request assisted death and to highlight what is morally at stake for nurses who (...) undertake this type of care. Design: Qualitative meta-synthesis. Methods: Six databases were searched: CINAHL, Medline, EMBASE, Joanna Briggs Institute, PsycINFO, and Web of Science. The search was completed on 22 October 2014 and updated in February 2016. Of 879 articles identified from the database searches, 16 articles were deemed relevant based on inclusion criteria. Following quality appraisal, 14 studies were retained for analysis and synthesis. Results: The moral experience of the nurse is defined by a profound sense of responsibility, shaped by contextual forces that nurses navigate in everyday end-of-life care practice, and sustained by intra-team moral and emotional support. Discussion: The findings of this synthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The findings further demonstrate that to fully appreciate the ethics of assisted death from a nursing standpoint, it is necessary to understand the broader constraints on nurses’ moral agency that operate in everyday end-of-life care. Ethical considerations: Research ethics board approval was not required for this synthesis of previously published literature. Conclusion: In order to understand how to enact ethical practice in the area of assisted death, the moral experiences of nurses should be investigated and foregrounded. (shrink)

(2001). The Care-Based Ethic of Nazi Medicine and the Moral Importance of What We Care About. The American Journal of Bioethics: Vol. 1, No. 1, pp. 64-74.

Moral distress is a phenomenon that has been receiving increasing attention in nursing and other health care disciplines. Moral distress is a concept that entered the nursing literature – and subsequently the health care ethics lexicon – in 1984 as a result of the work done by American philosopher and bioethicist Andrew Jameton. Over the past decade, research into moral distress has extended beyond the profession of nursing as other health care disciplines have come to question the (...) impact of moral constraint on individual practitioners, professional practice, and patient outcomes. Along with increased interest in the phenomenon of moral distress have come increasing critiques – critiques that in their essence point to a serious lack of conceptual clarity in the definition, study, and application of the concept. Foundational to gaining conceptual clarity in moral distress in order to develop strategies to prevent and ameliorate the experience is a careful revisiting of the epistemological assumptions underpinning our knowledge and use of the concept of moral distress. It is our contention that the conceptual challenges reveal flaws in the original understanding of moral distress that are based on an epistemological stance that holds a linear conception of cause and effect coupled with a simplistic perspective of ‘constraint’ and ‘agency’. We need a more nuanced approach to our study of moral distress such that our ontological and epistemological stances help us to better appreciate the complexity of moral agents acting in organizational contexts. We believe that critical realism offers such a nuanced approach. (shrink)

Because health care professions exist to provide a good for society, ethical questions are inherently part of them. Such professions and their members can be assessed based on how effective they are in developing knowledge and enacting practices that further the health and well‐being of individuals and society. The complexity of contemporary health care environments makes it important to prepare clinicians who can anticipate, recognize, and address problems that arise in practice or that prevent a profession from fulfilling its service (...) goals and obligations. Different health care professions have evolved distinct perspectives about appropriate goals for, and the purposes of, their clinicians, even when the goal of improving health and well‐being for society is shared across professions. While medicine and nursing goals are shared in principle, they differ in the particulars. Given the centrality to nursing of ethical questions, the profession has a collective responsibility to help clinicians at all levels of practice become ethically savvy and to reinforce their moral agency as needed. Both knowledge of nursing ethics and knowledge of the interdisciplinary field of bioethics are critical to nursing work. (shrink)

Recent developments, both in the cognitive sciences and in world events, bring special emphasis to the study of morality. The cognitive sciences, spanning neurology, psychology, and computational intelligence, offer substantial ad- vances in understanding the origins and purposes of morality. Meanwhile, world events urge the timely synthesis of these insights with traditional ac- counts that can be easily assimilated and practically employed to augment moral judgment, both to solve current problems and to direct future action. The object of the (...) following paper is to present such a synthesis in the form of a model of moral cognition, the ACTWith model of conscience. The purpose of the model is twofold. One, the ACTWith model is intended to shed light on personal moral dispositions, and to provide a tool for actual human moral agents in the refinement of their moral lives. As such, it relies on the power of personal introspection, bolstered by the careful study of moral exemplars available to all persons in all cultures in the form of literary or religious fig- ures, if not in the form of contemporary peers and especially leadership. Two, the ACTWith model is intended as a minimum architecture for fully func- tional artificial morality. As such, it is essentially amodal, implementation non-specific and is developed in the form of an information processing control system. There are given as few hard points in this system as necessary for moral function, and these are themselves taken from review of actual human cognitive processes, thereby intentionally capturing as closely as possible what is expected of moral action and reaction by human beings. Only in satisfying these untutored intuitions should an artificial agent ever be properly regarded as moral, at least in the general population of existing moral agents. Thus, the ACTWith model is intended as a guide both for individual moral develop- ment and for the development of artificial moral agents as future technology permits. (shrink)

Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs’ perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants’ moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work (...) environment. We used quantitative instruments and explored participants’ perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses. (shrink)

BackgroundAlthough nurses are crucial to ensure patients’ peaceful death in hospitals, many nurses experience various ethical conflicts during end-of-life care. Therefore, research on nurses’ entire ethical decision-making process is required to improve nurses’ ethical decision-making in end-of-life care. This study aimed to identify Korean nurses’ ethical decision-making process based on their moral sensitivity to end-of-life patients.MethodsIn total, 171 nurses caring for terminal patients responded to the survey questionnaire. To measure the participants’ moral sensitivity and ethical decision-making process, we (...) used the Korean version of the Moral Sensitivity Questionnaire and Nurses’ Ethical Decision-Making around End of Life Care Scale. Finally, multiple linear regression analysis was used to investigate the effect of moral sensitivity on nurses’ ethical decision-making.ResultsThe mean of moral sensitivity was 4.8 ± 0.5 (out of 7), and that of ethical decision-making was 4.6 ± 0.5 (out of 6). Among the sub-dimensions of ethical decision-making, the highest score was in perceived professional accountability (5.2 ± 0.5), and the lowest in moral reasoning and moral agency (3.9 ± 0.6); the score of moral practice was 4.4 ± 0.7. In the multiple linear regression model, moral sensitivity (β = 0.852, p <.001), clinical department (β = − 7.018, p =.035), ethics education (β = 20.450, p <.001), job satisfaction (β = 5.273, p <.001), and ethical conflict (β = − 2.260, p = 0.031) were influential ethical decision-making factors.ConclusionsThis study revealed a gap between nurses’ thoughts and practices through the ethical decision-making process. They failed to lead their thought to moral practice. It also implies that moral sensitivity could positively affect nurses’ ethical decision-making. To make nurses morally sensitive, exposing them to various clinical cases would be helpful. Additionally, ethics education and clinical ethics supporting services are valuable for improving nurses’ ethical decision-making. If nurses improved their ethical decision-making regarding end-of-life care, their patients could experience a better quality of death. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Acting Person and Christian Moral Life by Darlene Fozard WeaverSameer YadavThe Acting Person and Christian Moral Life By Darlene Fozard Weaver WASHINGTON, DC: GEORGETOWN UNIVERSITY PRESS, 2011. 215 PP. $32.95In this carefully argued and theologically subtle study of human moral agency, Darlene Fozard Weaver describes a large-scale shift in theological ethics away from an “act-centered” approach and toward a more “person-centered” approach. She (...) catalogues the shift via recent debates between those with “traditionalist” and “revisionist” attitudes toward the moral status of particular actions in Roman Catholic ethics. Whereas the traditionalist position claims that the intrinsic evil of particular acts is determinative of the moral blameworthiness of the acting person, revisionists hold that the moral status of any act is more fundamentally determined by the orientation of the person to his or her act. This revisionist movement toward a person-centric analysis reflects a wider trend that also includes Protestant ethics, particularly in the twentieth-century resurgence of virtue ethics prompted by MacIntyre and Hauerwas. [End Page 210]Against this backdrop, Weaver wishes to side neither with those traditional act-centric models that culminated in the regulation of personal acts found in pre–Vatican II penitential manuals nor with the more recent person-centric models that privilege the moral interiority of the acting person. Each, she argues, has its gains and losses. The traditional picture rightly gives our particular actions their own fundamental moral significance, but at the expense of tending toward a kind of Pelagianism. The revisionist picture recognizes the irreducibility of our subjective orientation to particular acts, but it leaves the moral significance of personal actions and our resources for navigating moral dilemmas problematically open-ended. Crucially, both pictures, with their narrow fixation on moral culpability, restrict the moral significance of personal actions.Weaver’s contribution is to sketch an account acknowledging the irreducibility of the fundamental orientation of the acting person to his or her acts, while attending to the way that particular actions retain their power for determining that orientation. She builds a picture of this reflexive relation between person and act by way of its instantiation in the relation of sin to particular sins; intimacy with God as bound up in our actual relations to self and others; fidelity to God as a matter not primarily of moral culpability but of moral responsibility in negotiating the particular demands that others place on us; truthfulness before God as the kind of naming of our actions required by the vision of fidelity shared by our community; and reconciliation with God as realized in the healing enabled by acts of forgiveness for our breaches of fidelity. Each moment in this development of her overall picture carefully builds upon the moment preceding it to produce a rich and compelling picture of human moral economy as an outworking of (rather than meriting of) divine grace.Throughout the book, Weaver’s theological interests in moral theorizing are stressed over the philosophical ones, and this may disappoint readers wondering how a theology of human action supervenes on issues such as (in) compatibilism about free will or the metaphysics of agent causation. Although Weaver’s refocusing of our attention on the significance of particular actions is salutary, her criticism of virtue-based approaches as incomplete is attenuated by her dependence upon the Hauerwasian conception of virtue to explicate the very notion of reflexivity that she defends. Such worries notwithstanding, Weaver has given us an extraordinarily fruitful framework for Christian moral theology. Moreover, it is expressed lucidly and makes excellent use of literary sources and current events to illustrate her analysis. Given its depth and accessibility, the book not only is required reading for Christian moral theologians but also deserves a wider readership from anyone interested in making theological sense of human agency. [End Page 211]Sameer YadavIndiana Wesleyan UniversityCopyright © 2015 Society of Christian Ethics... (shrink)

As the quality movement in health care now enters its fourth decade, the language of quality is ubiquitous. Practitioners, organizations, and government agencies alike vociferously testify their commitments to quality and accept numerous forms of governance aimed at improving quality of care. Remarkably, the powerful phrase ‘‘quality of care’’ is rarely defined in the health care literature. Instead it operates as an accepted and assumed goal worth pursuing. The status of evidence-based medicine, for instance, hinges on its ability to improve (...) quality of care, and efforts are made by both proponents and detractors to unpack the contents and outcomes of evidence-based practice while the contents of ‘‘quality of care’’ are presumed to be understood. Because the goals of medicine are far from obvious, this paper investigates the neglected term, ‘‘quality of care,’’ in an effort to understand what it is that health care practices are so uncritically assumed to be striving for. Finding lack of consensus on the terminology in the quality literature, I propose that the term operates rhetorically by way of persuasive appeal (and lack of descriptive meaning). Unsatisfied that ‘‘quality of care’’ operates as a mere buzzword in morally contentious debates over resource allocation and duties of care, I implore health care communities to go beyond mere commitments to quality and, instead, to focus attention on the difficult task of specifying what counts as quality care within an economically constrained health care system. (shrink)

Empirical evidence indicates that much of human behavior is unconscious and automatic. This has led some philosophers to be skeptical of responsible agency or personhood in the moral sense. I present two arguments defending agency from these skeptical concerns. My first argument, the “margin of error” argument, is that the empirical evidence is consistent with the possibility that our automatic behavior deviates only slightly from what we would do if we were in full conscious control. Responsible (...) class='Hi'>agency requires only that our actions more or less express our conscious goals and values. My second argument is a non-realist defense of moral agency. If we are willing to reject metaethical realism about agents, then there may be good reasons why we should retain the concept of agency in our moralizing, even if automaticity undermines the belief that we are really in conscious control of our behavior. We can do this by adopting a “reactive attitudes” approach to moral responsibility. On this view, agency is determined not by actual features of human psychology but by the attitudes and practices that we ought to adopt in response to the actions and motivations of individuals. (shrink)

Although we theorize that nurses ‘make a difference’ to patient outcomes and speculate that this happens because nurses ‘care’, there is so far little evidence to support this nebulous claim. Efforts to promote care as the defining characteristic of nursing, and an ‘ethic of care’ as the ethical basis of nursing, have sparked debate within the discipline. This debate has resulted in a polarization that has effectively stalled productive discourse on the issues. Moreover, the focus on care has been at (...) the expense of understanding the true nature of the relationship between caring and the broader base of ethical knowledge that underpins nursing and that must underpin nursing if it is a viable practice profession. This paper used the framework of philosophical argument to explore the moral and ethical foundations of nursing from the perspective of personal and public morals, and responsive nurse–patient relationships as the reflection of ethical nursing knowledge. The foundation of ethical nursing knowledge is the personal moral sense that resides within the individual and that nurses hold in common with others. Personal moral knowledge is transformed into disciplinary ethical knowledge specific to nursing through disciplinary consensus. Responsive relationships are conceptualized in the nursing literature as founded on three essential elements: respect, trust, and mutuality. These three elements are grounded in ethical nursing knowledge; therefore responsive nurse–patient relationships reflect both personal moral knowledge and disciplinary ethical knowledge. By facilitating the articulation of ethical nursing knowledge in practice, responsive relationships connect theory, ethical knowledge, and clinical outcomes. (shrink)

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals (...) of the nursing profession, CERN sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

The subject of this article is moral agency in nursing, studied by the use of an applied philosophical method. It draws upon nurses’ accounts of how they see intrinsic value in their work and believe that they make a difference to patients in terms that leave their patients feeling better. The analysis is based on the philosophy of Iris Murdoch to reveal how nurses’ accounts demonstrated that they hold a view of themselves and their professional practice that is (...) intrinsically linked to, and dependent upon, their capacity to see good in the work they do. (shrink)

This paper discusses Confucian notions of moral autonomy and moral agency that do not follow strict and ideal notions of autonomy that one can find in many Western theories of moral philosophy. In Kantian deontology, for example, one's autonomy, specifically one's rational will to follow universal moral rules, is a necessary condition of moral agency and moral responsibility. In Confucian moral philosophy, however, this type of strict moral autonomy is rarely (...) observed. A Confucian moral agent is often depicted as a partially heteronomous individual who often accepts and follows others' moral authority and considers external contingencies in her moral deliberations. Yet active moral agency is maintained in Confucian philosophy. In this paper, I will explain and analyze a partially heteronomous but active form of moral agency in Confucian moral philosophy. First, I will survey different notions of moral autonomy and explore philosophical theories of partial autonomy and heteronomy. Second, I will discuss, on the basis of interactive, responsive, and situated notions of the self, how Confucian moral agency can be explained without strict standards of autonomy. In Confucianism, morality or virtuosity reflects the relational, responsive, and situated nature of human being that resonates with other human beings and their environmental contingencies. Mencius, for example, acknowledges and discusses interactive or relational nature of moral action and the dependency of the moral self on external conditions of life without giving up active moral effort and full moral responsibility. Third, based on my analysis of moral autonomy and responsibility in early Confucian philosophy, I will argue that Confucian moral philosophy provides a unique way of understanding moral agency, not through self-enclosed independency but through relational and interactive interdependency of communal agency. (shrink)

This paper discusses the philosophical issues pertaining to Kantian moral agency and artificial intelligence. Here, our objective is to offer a comprehensive analysis of Kantian ethics to elucidate the non-feasibility of Kantian machines. Meanwhile, the possibility of Kantian machines seems to contend with the genuine human Kantian agency. We argue that in machine morality, ‘duty’ should be performed with ‘freedom of will’ and ‘happiness’ because Kant narrated the human tendency of evaluating our ‘natural necessity’ through ‘happiness’ as (...) the end. Lastly, we argue that the Kantian ‘freedom of will’ and ‘faculty of choice’ do not belong to any deterministic model of ‘agency’ as these are sacrosanct systems. The conclusion narrates the non-feasibility of Kantian AI agents from the genuine Kantian ethical outset, offering a utility-based Kantian ethical performer instead. (shrink)

BackgroundSerious ethical problems have been anecdotally identified in the care of children with osteogenesis imperfecta (OI), which may negatively impact their moral experiences, defined as their sense of fulfillment towards personal values and beliefs.Research aimsTo explore children’s actual and desired participation in discussions, decisions, and actions in an OI hospital setting and their community using art-making to facilitate their self-expression.Research designA focused ethnography was conducted using the moral experiences framework with data from key informant interviews; participant observations, semi-structured (...) interviews, and practice-based research (art-making) with 10 children with OI; and local documents.Participants and research contextThe study was conducted at a pediatric, orthopedic hospital.Ethical considerationsThis study was approved by McGill University Institutional Review Board.Findings/resultsChildren expressed desires to participate in their care, but sometimes lacked the necessary resources and encouragement from healthcare providers. Art-making facilitated children’s voice and participation in health-related discussions.ConclusionsHealthcare providers are recommended to consider the benefits of art-making and educational resources to reduce discrepancies between children’s actual and desired participation in care and promote positive moral experiences. (shrink)

Technology is pervasive and overwhelming in the intensive care setting. It has the power to inform and direct the nursing care of critically ill patients. Technology changes the moral and social dynamics within nurse—patient encounters. Nurses use technology as the main reference point to interpret and evaluate clinical patient outcomes. This shapes nurses’ understanding and the kind of care provided. Technology inserts itself between patients and nurses, thus distancing nurses from patients. This situates nurses into positions of power, granting (...) them epistemic authority, which constrains them as moral agents. Technology serves to categorize and marginalize patients’ illness experience. In this article, moral agency is examined within the technologically-mediated context of the intensive care unit. Uncritical use of technology has a negative impact on patient care and nurses’ view of patients, thus limiting moral agency. Through examination of technology as it frames cardiac patients, it is demonstrated how technology changes the way nurses understand and conceptualize moral agency. This article offers a new perspective on the ethical discussion of technology and its impact on nurses’ moral agency. Employing reflective analysis using the technique of embodied reflection may help to ensure that patients remain at the centre of nurses’ moral practice. Embodied reflection invites nurses critically to examine how technology has reshaped conceptualization, understanding, and the underlying motivation governing nurses’ moral agency. (shrink)

Ockham’s theory of natural rights was based on a careful definition of the basic juridical terms dominium and ius utendi, as well as on the idea of human agency and morality. By defining a right as a licit power of action in accordance with right reason (recta ratio), Ockham placed rights firmly in the agent. A right was a subjective power of action. Ockham’s theory of natural rights was influential for later natural rights theories. Its advocates included leading thinkers (...) of the sixteenth and seventeenth centuries, whose views on the right to life, its relation to the right to property, and the state of nature resembled those ideas already developed by Ockham approximately three hundred years earlier. (shrink)

Albert Musschenga | : The central question of this article is, Are animals morally responsible for what they do? Answering this question requires a careful, step-by-step argument. In sections 1 and 2, I explain what morality is, and that having a morality means following moral rules or norms. In sections 3 and 4, I argue that some animals show not just regularities in their social behaviour, but can be rightly said to follow social norms. But are the norms they (...) follow also moral norms? In section 5, I contend, referring to the work of Shaun Nichols, that the basic moral competences or capacities are already present in nonhuman primates. Following moral rules or norms is more than just acting in accordance to these norms; it requires being motivated by moral rules. I explain, in section 6, referring to Mark Rowlands, that being capable of moral motivation does not require agency; being a moral subject is sufficient. Contrary to moral agents, moral subjects are not responsible for their behaviour. Stating that there are important similarities between animal moral behaviour and human, unconscious, automatic, habitual behaviour, I examine in section 7 whether humans are responsible for their habitual moral behaviour, and if they are, what then the grounds are for denying that moral animals are responsible for their behaviour. The answer is that humans are responsible for their habitual behaviour if they have the capacity for deliberate intervention. Although animals are capable of intervention in their habitual behaviour, they are not capable of deliberate intervention. | : La question centrale dans cet article est celle de savoir si les animaux sont moralement responsables de ce qu’ils font. Répondre à cette question nécessite une argumentation minutieuse et progressive. Dans les sections 1 et 2, j’explique ce qu’est la moralité, et qu’être doté de moralité signifie de se conformer à des règles ou à des normes morales. Dans les sections 3 et 4, je pose que certains animaux ne se contentent pas de montrer des régularités dans leur comportement social, mais qu’ils suivent aussi véritablement des normes sociales. Toutefois, les normes qu’ils suivent sont-elles morales? Dans la section 5, je prétends, en me référant aux travaux de Shaun Nichols, que les compétences ou capacités morales de base sont déjà présentes chez les primates non humains. Respecter des règles ou des normes morales est bien plus que d’agir conformément à ces normes; cela requiert d’être motivé par des règles morales. Dans la section 6, me référant à Mark Rowlands, j’explique que d’être capable de motivation morale ne nécessite pas d’être un agent moral; le fait d’être un sujet moral suffit. Contrairement aux agents moraux, les sujets moraux ne sont pas responsables de leur comportement. Affirmant qu’il y a de grandes similitudes entre le comportement moral d’un animal et le comportement inconscient, automatique et habituel d’un humain, je me penche, dans la section 7, sur la question de savoir si les humains sont responsables de leur comportement moral habituel, et si tel est le cas, sur quelle base on peut alors nier le fait que les animaux sont eux aussi responsables de leur comportement. La réponse à cette question est que les humains sont responsables de leur comportement habituel s’ils disposent d’une capacité d’intervention réfléchie, délibérée. Bien que les animaux soient capables d’intervenir dans leurs comportements habituels, ils ne peuvent le faire de manière réfléchie, délibérée. (shrink)

Moral distress has been covered extensively in the nursing literature and increasingly in the literature of other health professions. Cases that cause nurses’ moral distress that are mentioned most frequently are those concerned with prolonging the dying process. Given the standard of aggressive treatment that is typical in intensive care units (ICUs), much of the existing moral distress research focuses on the experiences of critical care nurses. However, moral distress does not automatically occur in all end-of-life (...) circumstances, nor does every critical care nurse suffer its damaging effects. What are the practices of these nurses? What specifically do they do to navigate around or through the distressing situations? The nursing literature is lacking an answer to these questions. This article reports a study that used narrative analysis to explore the reported practices of experienced critical care nurses who are skilled at and comfortable working with families and physicians regarding the withdrawal of aggressive treatment. A major finding was that these nurses did not report experiencing the dam-Moral Agency, Moral Imagination, and Moral Community: Antidotes to Moral Distress Terri Traudt, Joan Liaschenko, and Cynthia Peden-McAlpine Terri Traudt, MBC, MA, is a Communications Consultant specializing in bioethics at the Center for Bioethics at the University of Minnesota, in Minneapolis. [email protected] Joan Liaschenko, PhD, RN, FAAN, is a Professor at the Center for Bioethics and Nursing at the University of Minnesota. Cynthia Peden-McAlpine, PhD, ACNS, BC, is an Associate Professor in the School of Nursing at the University of Minnesota. © 2016 by The Journal of Clinical Ethics. All rights reserved. aging effects of moral distress as described in the nursing literature. The verbal communication and stated practices relevant to this finding are organized under three major themes: (1) moral agency, (2) moral imagination, and (3) moral community. Further, a total of eight subthemes are identified. The practices that constitute these themes and subthemes are further detailed and discussed in this article. Understanding these practices can help mitigate critical care nurses’ moral distress. (shrink)

Background Rare diseases are generally poorly understood from scientific and medical standpoints due, to their complexity and low prevalence. As a result, individuals living with rare diseases struggle to obtain timely diagnoses and suitable care. These clinical difficulties add to the physical and psychological impacts of living with chronic and often severe medical conditions. From the standpoint of pragmatist ethics, the morally problematic situations that adults living with rare diseases experience matter crucially. However, there is little known about these experiences.Methods (...) A survey study was conducted with 121 adults living with rare diseases in Québec, Canada, to identify morally problematic situations encountered in the healthcare system and everyday life as part of a participatory action research project. Morally problematic situations elicited internal tensions and constraints to agency.Results Adults living with rare diseases experienced morally problematic situations of stigmatization, disbelief, and sometimes abuse in the healthcare system. These situations were compounded by diagnostic delays, inadequate care, and suboptimal follow-up, and led some individuals to opt-out of medical care. In their personal lives, these individuals sometimes found themselves in situations of physical and financial dependency. They often also had to give up professional occupations, academic training, or life projects.Conclusions Adults living with rare diseases experience important morally problematic situations navigating the healthcare system and their everyday lives, some of which could be alleviated through interventions developed through future participatory action research. (shrink)

Background Healthcare leader support and facilitation for ethics work are of great importance for healthcare professionals’ handling of ethical issues, moral distress, and quality care provision. A digital tool for ethical reflection in long-term care was developed in response to the demand for appropriate tools. Research aim This study aimed to explore healthcare leaders’ expectations of using a digital tool for ethical reflection among their home nursing care staff. Research design A qualitative research design with vignettes and focus group (...) interviews was used. The data were analyzed using reflexive thematic analysis. Participants and Research Context The sample comprised ten healthcare leaders from municipal long-term care in Norway. Ethical Considerations Participation was voluntary and based on informed consent. The Norwegian Agency for Shared Services in Education and Research approved this study. Findings The analysis resulted in the development of three themes representing leaders’ expectations of the tool: (i) giving staff a voice, (ii) revealing ethics in practice, and (iii) keeping the pot boiling. Discussion Leaders must be informed about the ethical issues experienced to engage in supportive measures for their staff. Digital channels can increase the democratization, safety, and efficiency of communication between employees and leaders and increase awareness of ethical aspects in daily care work. The leaders had positive expectations of employees’ activities and benefits from using the tool for ethical reflection. However, they admitted that realizing the tool’s potential to ensure continuity in ethics work requires considerable organizational and leader involvement. Conclusions This study shows that healthcare leaders are open to digital solutions for managing ethics work in home nursing care. Both opportunities and important prerequisites for successfully implementing the digital tool were identified. (shrink)

Psychopaths have long been of interest to moral philosophers, since a careful examination of their peculiar deficiencies may reveal what features are normally critical to the development of moral agency. What underlies the psychopath's amoralism? A common and plausible answer to this question is that the psychopath lacks empathy. Lack of empathy is also claimed to be a critical impairment in autism, yet it is not at all clear that autistic individuals share the psychopath's amoralism. How is (...) empathy characterized in the literature, and how crucial is empathy, so described, to moral understanding and agency? I argue that an examination of moral thinking in high-functioning autistic people supports a Kantian rather than a Humean account of moral agency. (shrink)

Background:Moving into the last phase of life comprises a developmental transition with specific needs and risks. Facilitating transitions is an important component of the work of nurses. When curative interventions are no longer helpful, nurses enact key roles in caring for patients and families.Aim:The aim of this study was to examine the experiences of registered nurses in acute care settings as they worked with patients and families to facilitate transition to comfort-focused care.Research design:Sampling, data collection, and data analysis were guided (...) by constructivist grounded theory, chosen because of its strength in identifying and explicating social processes.Participants and context:A purposeful sample of 26 registered nurses working in acute care hospitals in one community in the northeastern United States participated in this study through semi-structured interviews.Ethical considerations:The study received approval from the university’s Institutional Review Board for the Protection of Human Subjects. Participants provided informed consent.Findings:Nurses facilitated transition to comfort-focused care by enacting their moral commitments to patients and families. They focused on building relationships, honoring patient self-determination, and maintaining respect for personhood. In this context, they discerned a need for transition, opened a discussion, and used diverse strategies to facilitate achieving consensus on the part of patients, family members, and care providers. Regardless of how the process unfolded, nurses offered support throughout.Discussion:Achievement of consensus by all stakeholders is critical in the transition to comfort-focused care. This study deepens our understanding of how nurses as moral agents utilize specific strategies to assist progress toward consensus. It also offers an example of recognizing the moral agency of nurses through listening to their voices.Conclusion:Increased understanding of effective nursing strategies for facilitating transition to comfort-focused care is essential for developing needed evidence for excellent care and strengthening end-of-life nursing education. (shrink)

The practical phenomenon of moral diversity is a central feature of many contemporary societies and poses a distinct problem to moral theory building. Because of its goal to settle the moral question fully and exclusively and/or to provide better understanding of moral disagreement, traditional first-order moral theory often does not provide sufficient guidance to address this phenomenon and moral agency in deeply morally diverse societies. In this article, I move beyond traditional first-order (...) class='Hi'>moral theorizing and, based on multilevel social contract theory (Moehler 2018, 2020a), develop a practically sound notion of moral agency for morally diverse societies. The interrelational and dynamic notion of integrated moral agency developed in this article demands that agents actively exercise their rational and affective capacities, are receptive to the capacities of others, and are aware of the type of moral interaction in which they engage with others. The notion of integrated moral agency helps agents to reconcile conflicting first-order moral directives and to maximally protect agents’ autonomy in morally diverse societies. (shrink)

This thesis aims to elucidate an apparent paradox about the role of emotion in moral agency. A number of lines of concern suggest emotion may have serious negative impact on moral agency. On the other hand, there are considerations that suggest emotion also plays a crucial role in motivating, informing and even constituting moral agency. Significantly, there is a strong connection between participant reactive attitudes and ascription of moral status as agent or subject. (...) Nonemotional agents could not hold such attitudes. Also, removing participant reactive attitudes imposes a peculiar and incoherent form of solipsism about moral agency. Given this necessary role for emotion, can we give an account of emotion that will also meet the worries? I examine, as crucial examples, three recurrent lines of concern about emotion - that it threatens our capacities for objectivity, rationality, and autonomy - to tease out the descriptive assumptions about emotion, and the normative assumptions about moral agency, that these objections are based on. I then offer three lines of argument towards resolving these worries. The first addresses the worries directly, and the other two shift blame off emotion. First, then, I argue that the normative concerns can largely be met by a descriptive account that views emotion as cognitive. However, “judgementalist” cognitive accounts that assimilate emotion to belief may make emotion metaethically respectable at the cost of making it meta-ethically redundant. Also, such accounts are descriptively less than plausible. A better approach, I argue, is to allow that belief may play a significant role in emotion but to also allow at least a quasicognitive role to the distinctively affective element in emotion: feeling. I also argue for a hrther revision of cognitive accounts to emphasise that emotions reflect features of those who feel them. If we were different, our emotions would be different. So, secondly, I argue that a number of the features that power worries about emotions have their sources in what those who feel them are like, rather than in emotions as such. However, both human nature and emotion are capable of significant plasticity and diversity. We are also capable of a considerable - but not infinite - degree of self-determination both about what we are like and what our emotions are like. Finally, I argue that the normative assumptions that power the objections to emotion are themselves in need of revision - and in some tension with each other. This leads to a McGufin-theory of emotion in moral agency: Problems with emotion’s place in moral agency serve as indicators of unresolved tensions in our thinking about moral agency, rather than just indicators of problems with emotion as such. In view of this, I also argue for caution in any attempts to change emotion to fit particular ideals of moral agency. (shrink)

Considerations of nonhuman animal moral agency typically base their reasoning and (very often negative) verdict on a capacity‐focused approach to moral agency. According to this approach, an entity is a moral agent if it has certain intrapersonal features or capacities, typically in terms of conscious reflection and deliberation. According to a practice‐focused notion of moral agency, however, an entity is a moral agent in virtue of being a participant of a moral (...) responsibility practice (MRP). I argue that a practice‐focused approach to moral agency, combined with empirical evidence from research on canid social play and cognition, with support from The Function Argument, makes the notion of nonhuman animal moral agency more likely than usually indicated. However, the support is not absolute, as the practice‐focused approach itself may be put into question. I describe how this objection prompts us to critically assess any empirical, metaethical, or normative assumptions on these matters. These questions, in turn, raise a number of further questions of how we should conceive of, use, and evaluate whatever standards of moral agency we adopt. (shrink)

Arguably, one of the most exciting recent advances in moral philosophy is the ongoing scientific naturalization of normative ethics and metaethics, in particular moral psychology. A relatively neglected area in these improvements that is centrally important for developing a scientifically based naturalistic metaethics concerns the nature and acquisition of successful moral agency. In this paper I lay out two examples of how empirically based findings help us to understand and explain some cases of successful moral (...) agency. These are research in moral internalization and aggression management. Using these examples, I sketch some lessons for investigating successful moral learning and moral action. My proposal reflects a common theme in scientifically based philosophy generally: the shift from the armchair methods of analyzing concepts and finding a priori foundations, the enterprise of first philosophy, to an effort to study the phenomena themselves, using empirical findings and theories to answer philosophical questions about these phenomena, an endeavor recently characterized as second philosophy. (shrink)

Some commentators have condemned Kant’s moral project from a feminist perspective based on Kant’s apparently dim view of women as being innately morally deficient. Here I will argue that although his remarks concerning women are unsettling at first glance, a more detailed and closer examination shows that Kant’s view of women is actually far more complex and less unsettling than that attributed to him by various feminist critics. My argument, then, undercuts the justification for the severe feminist critique of (...) Kant’s moral project. (shrink)

Contemporary literature includes a wide variety of definitions of empathy. At the same time, the revival of sentimentalism has proposed that empathy serves as a necessary criterion of moral agency. The paper explores four common definitions in order to map out which of them best serves such agency. Historical figures are used as the backdrop against which contemporary literature is analysed. David Hume’s philosophy is linked to contemporary notions of affective and cognitive empathy, Adam Smith’s philosophy to (...) projective empathy, and Max Scheler’s account to embodied empathy. Whereas cognitive and projective empathy suffer from detachment and atomism, thereby providing poor support for the type of other-directedness and openness entailed by moral agency, embodied and affective empathy intrinsically facilitate these factors, and hence are viewed as fruitful candidates. However, the theory of affective empathy struggles to explain why the experience of empathy includes more than pure affective mimicry, whilst embodied empathy fails to take into account forms of empathy that do not include contextual, narrative information. In order to navigate through these difficulties, Edith Stein’s take on non-primordial experience is used as a base upon which a definition of affective empathy, inclusive of an embodied dimension, and founded on a movement between resonation and response, is sketched. It is argued that, of the four candidates, this new definition best facilitates moral agency. (shrink)

It may be the case that the most challenging moral problem of the twenty‐first century will be the relationship between the individual moral agent and the practices and institutions in which the moral agent is embedded. In this paper, we continue the efforts that one of us, Joan Liaschenko, first called for in 1993, that of using feminist ethics as a lens for viewing the relationship between individual nurses as moral agents and the highly complex institutions (...) in which they do the work of nursing. Feminist ethics, with its emphasis on the inextricable relationship between ethics and politics, provides a useful lens to understand the work of nurses in context. Using Margaret Urban Walker's and Hilde Lindemann's concepts of identity, relationships, values, and moral agency, we argue that health care institutions can be moral communities and profoundly affect the work and identity and, therefore, the moral agency of all who work within those structures, including nurses. Nurses are not only shaped by these organizations but also have the power to shape them. Because moral agency is intimately connected to one's identity, moral identity work is essential for nurses to exercise their moral agency and to foster moral community in health care organizations. We first provide a brief history of nursing's morally problematic relationship with institutions and examine the impact institutional master narratives and corporatism exert today on nurses’ moral identities and agency. We close by emphasizing the significance of ongoing dialogue in creating and sustaining moral communities, repairing moral identities, and strengthening moral agency. (shrink)

Background Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern (...) the unique circumstances surrounding end-of-life care and its consequential impacts. Research objectives To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design A qualitative descriptive approach was employed. Participants and research context Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings The moral distress-inducing factors and nurses’ perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress. (shrink)

The connection between ethics and theological vision has become increasingly important for ethics as we better appreciate how the moral agent is embedded in a framework that affectively and intellectually shapes her moral reasoning. Moral reasoning is always reasoning within (that is, within a moral framework, a religious worldview, and/or a set of ideological commitments). A similar framing occurs in literature, which I refer to as its “horizon.” A literary text's horizon comprises the theological and metaphysical (...) commitments that are implied by the text and that the reader relies on to make sense of it. I suggest that there is a parallel between how moral frameworks and literary horizons operate in that both shape moral judgment. I argue that in using literature as a resource for ethics, the same contemporary currents that have led us to appreciate the embeddedness of moral reasoning should also encourage us to give more careful attention to the theological or metaphysical vision implied by a text. Such a “theo-ethical” reading of literature provides a richer understanding of particular moral goods and the interplay between those goods and ethical themes like agency, hope, and redemption. I substantiate this claim with a reading of William Blake's Jerusalem: The Emanation of the Giant Albion. (shrink)

In this paper, I present a general profile of individuals with psychopathy, autism, and acquired sociopathy as well as look specifically at the abilities of these individuals with respect to the moral domain. These individuals are individually and collectively interesting because of their significant affective and social impairments. I argue that none of these individuals should be considered full moral agents based on a proposed account of moral agency consisting of the following two necessary conditions: the (...) capacity for moral judgment and the capacity for moral motivation. Since each of these groups of individuals fails to satisfy the criteria in a different way, these arguments help to distinguish three primary ways in which emotion contributes to moral motivation. I conclude with a suggested general implication of this discussion for related debates in moral theory. (shrink)

Reductionists about agency maintain that an agent’s causing something is reducible to states and events involving the agent causing something. Some worry that reductionism cannot accommodate robust forms of agency, such as self-determination. One reductionist answer to this worry, which I call ‘identification reductionism,’ contends that self-governing agents are identified with certain attitudes, and so these attitudes’ causing a decision count as the agent’s self-determining the decision. I argue that a prominent species of identification reductionism developed by Harry (...) Frankfurt, Agnieszka Jaworska, Jeffrey Seidman, and David Shoemaker—according to which an agent is identified with his (deepest) cares—is inadequate. (shrink)

There is a striking similarity between the philosophy of Martin Heidegger and Harry G. Frankfurt: they both argue that the temporal nature of human existence and agency is due to the fact that humans care about things. Even though Heidegger’s concept of care and Frankfurt’s concept of caring are very different, they are worth comparing because they play a similar role and have similar significance in their thinking. This comparison also offers an opportunity for a desired dialog between philosophers (...) working in those two different traditions. I argue that the two views can complement each other: Though Frankfurt provides a detailed psychological description of caring, his concept of caring is too mentalistic and leads to solipsism. Thus, his theory can be enriched with the help of Heidegger’s view based on the concept of Being-in-the-world. (shrink)

The aim of this study was to analyse experiences of moral concerns in intensive care nursing. The theoretical perspective of the study is based on relational ethics, also referred to as ethics of care. The participants were 36 intensive care nurses from 10 general, neonatal and thoracic intensive care units. The structural characteristics of the units were similar: a high working pace, advanced technology, budget restrictions, recent reorganization, and shortage of experienced nurses. The data consisted of the participants’ examples (...) of ethical situations they had experienced in their intensive care unit. A qualitative content analysis identified five themes: believing in a good death; knowing the course of events; feelings of distress; reasoning about physicians’ ‘doings’ and tensions in expressing moral awareness. A main theme was formulated as caring about - caring for: moral obligations and work responsibilities. Moral obligations and work responsibilities are assumed to be complementary dimensions in nursing, yet they were found not to be in balance for intensive care nurses. In conclusion there is a need to support nurses in difficult intensive care situations, for example, by mentoring, as a step towards developing moral action knowledge in the context of intensive care nursing. (shrink)

An important question for a naturalized philosophical psychology is what constitutes moral agency (MA). The two prominent scientific theories to which such a philosophical approach might appeal, those of cognitive developmental theory (CDT) and social learning theory (SLT), currently face an investigative dilemma: The better theories of the acquisition of beliefs and the performance of action based on them, the SLTs, seem to be irrelevant to the phenomenon of MA and the theories that seem to be relevant, the (...) CDTs, are unsatisfactory in their accounts of acquisition and action. In this paper I take up the cause of SLT accounts of MA. Critics of SLT accounts of MA can be interpreted as arguing that they are irrelevant to MA because they lack one or more of five functional criteria that require MA to be integral morally motivated cognitive agency. I argue that SLT accounts of MA, and specifically Bandura's social cognitive theory, (SCT), when applied to issues of MA, meet these criteria. Assuming the merits of SLT explanations of both the acquisition of beliefs and the performance of actions based on them, I conclude that SLTs generally, and specifically Bandura's SCT, are promising candidates for explaining MA. If so, they merit the attention of naturalistic philosophical psychologists. (shrink)