This paper will examine the concepts of integrity and moral residue as they relate to nursing practice in the current health care environment. I will begin with my definition and conception of ethical practice, and, based on that, will go on to argue for the importance of recognizing that nurses often find themselves in the position of compromising their moral integrity in order to maintain their self‐survival in the hospital or health care environment. I will argue that (...) moral integrity is necessary to a moral life, and is relational in nature. When integrity is threatened, the result is moral distress, moral residue, and in some cases, abandonment of the profession. The solution will require more than teaching bioethics to nursing students and nurses. It will require changes in the health care environment, organizational culture and the education of nurses, with an emphasis on building a moral community as an environment in which to practise ethically. (shrink)

This paper introduces the concept of moral residue to global health, and shows how its presence undermines crucial interventions and research, especially in the global south. Lingering feelings of anxiety, anger, blame or frustration often exist among local populations, where previous interventions or research have left traces of harm and/or exploitation. The existence of such feelings reflects the presence of moral residue, recognizing the moral experiences of epistemic injustices, which in turn undermines critical interventions and (...) research through outright rejection or passive non-compliance among affected populations. While such situations have been variously interpreted and relevant strategies developed to address the issues, little to no consideration is made on the implications of moral residue experiences in global health contexts and how to address them. This paper demonstrates the presence of moral residue in global health and proffers an African ethical approach, a harmony framework, for addressing moral residue issues, as part of a holistic approach towards tackling population health crises without compromising health gains for affected populations in the global south. (shrink)

Transplant coordinators play a pivotal role in the process of obtaining consent for live or dead donation of organs. The objective of the project is to unveil emotional experiences and ethical conduct of transplant coordinators using a qualitative research methodology. Ten transplant coordinators who have worked for more than 20 years in this job were recruited by using a purposive sampling technique. The transplant coordinators spoke of negative feelings and moral distress with regard to futile care of family members (...) of deceased donors as well as of living donors. Transplant coordinators experience moral distress on a daily basis; being compelled to compromise their integrity causes moral distress and moral residue, hence, training and support should be offered to them. (shrink)

To what extent can one be saddled with responsibility or guilt as a result of actions committed not by oneself but by others with whom one has a familial or national connection or some other communal association? The issue of communal guilt has been extensively discussed, and there has been no shortage of writers willing to apply the notion of communal responsibility and guilt to Germany after the Holocaust. But the whole notion of communal guilt is deeply puzzling. How can (...) evil actions cast a shadow over the future in this way to generate obligations or guilt on the part of those who did not in any way participate in those actions? In this article, I will focus on a question that is a smaller-scale analogue of the question of communal guilt, one which raises similar perplexities but in a more tractable way. I will concentrate on the restoration of relations with perpetrators of great evil in cases in which their whole-hearted repentance is not in doubt. Most of us feel a strong antipathy to the restoration of relations with such a perpetrator. What explains and supports that emotive reaction is the subject of this article, and its conclusions are suggestive of promising approaches to the question of communal guilt. (shrink)

Residual categories such as »not elsewhere categorized« densely populate modern information systems. This article roughly categories two types of modern information surveillance and notification systems, statistical and event-based. It examines the nature of residual categories arising from each, and proposes some methodological considerations for how these impact moral order within information infrastructure. The article concludes with comments about how the inclusion of lived experience might ameliorate a sort of moral gridlock often encountered today in large-scale information systems.

The demands of morality can seem straightforward. Be kind to others. Do not lie. Do not murder. But moral life is not so simple. We are often confronted with difficult situations in which someone is going to get hurt no matter what we do, in which we cannot meet all of our obligations, in which loyalties come into conflict, in which we cannot help everyone who needs it, or in which we must compromise on important values. It is natural (...) to describe such situations as moral dilemmas. This chapter is about the psychology of how we represent, process, and make decisions about what to do when moral life is difficult in this way. Our first aim is to provide some conceptual clarity on what exactly turns a choice situation into a moral dilemma. Here, we propose a normative account of moral dilemmas in terms of moral appropriate feelings of conflict in response to strongly conflicting reasons. Our second aim is to critically survey existing psychological work, providing an overview of some important findings, while raising questions for future research. (shrink)

Bad things happen; and not just to bad people, but with apparent indifference to the moral or other qualities of the victims. For the theist who believes that the world is created and governed by an all-powerful and perfectly good God, this is a notorious difficulty. In fact the problem of evil is surely the most persuasive consideration available in favour of atheism.

Ong, Caroline As health systems become more complex, moral distress is increasingly being recognised as a significant phenomenon amongst health professionals. It can be described as the state of being distressed when one is unable to act according to what one believes to be morally right. It may compromise patient care, the health professional involved and the organisation. Cumulative experiences of incompletely resolved moral distress - a phenomenon which is called moral residue - may leave us (...) susceptible to more frequent and more severe moral distress. Clear open communication, respect, inclusivity, openness to differences, compassion, support, education and the capacity to grow in self-awareness are key aspects in minimising moral distress. Early recognition of its symptoms and addressing both personal and external constraints of actions can also minimise moral residue and build resilience to further distress. (shrink)

A strong tradition in philosophy denies the possibility of moral dilemmas. Recently, several philosophers reversed this tradition. In this dissertation, I clarify some fundamental issues in this debate, argue for the possibility of moral dilemmas, and determine some implications of this possibility. ;In chapter I, I define moral dilemmas roughly as situations where an agent morally ought to adopt each of two alternatives but cannot adopt both. Moral dilemmas are resolvable if and only if one of (...) the moral oughts overrides the other. ;In chapter II, I criticize several opponents of moral dilemmas, including utilitarians, Kant, Aquinas, and Ross. My main criticism is that no opponent of moral dilemmas can adequately justify moral residue . ;Chapters III and IV concern the two main arguments against the possibility of moral dilemmas. First, the argument for 'ought' implies 'can' runs as follows. If the agent cannot adopt both, then it is not the case that the agent ought to adopt both. But the agent ought to adopt both, since the agent ought to adopt each . Thus, the defining judgements of a moral dilemma seem to imply a contradiction. In response, I argue that the relation between 'ought' and 'can' is not a logical implication but a conversational implicature. ;Chapter IV concerns the argument from 'ought' implies 'permitted': If the agent ought to adopt one alternative, then the agent is permitted to adopt that alternative, which means that it is not the case that the agent ought not to adopt that alternative. But the agent ought not to adopt that alternative, since the agent ought to adopt the other alternative and cannot adopt both. I respond that 'ought' does not logically imply but conversationally implicates 'permitted'. ;In chapter V, I argue that, despite recent claims, both moral realism and anti-realism are compatible with the possibility of moral dilemmas. Thus, there are several reasons to accept and no reasons to deny the possibility of moral dilemmas. (shrink)

Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its (...) importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration. (shrink)

As professionals, nurses are engaged in a moral endeavour, and thus confront many challenges in making the right decision and taking the right action. When nurses cannot do what they think is right, they experience moral distress that leaves a moral residue. This article proposes a theory of moral distress and a research agenda to develop a better understanding of moral distress, how to prevent it, and, when it cannot be prevented, how to manage (...) it. (shrink)

For it's Tommy this, an' Tommy that, an' "Chuck him out, the brute!"But it's "Saviour of 'is country" when the guns begin to shoot;An' it's Tommy this, an' Tommy that, an' anything you please;An' T...

For it's Tommy this, an' Tommy that, an' "Chuck him out, the brute!"But it's "Saviour of 'is country" when the guns begin to shoot;An' it's Tommy this, an' Tommy that, an' anything you please;An' T...

Abstract Studying a concept as complex as moral distress is an ongoing challenge for those engaged in empirical ethics research. Qualitative studies of nurses have illuminated the experience of moral distress and widened the contours of the concept, particularly in the area of root causes. This work has led to the current understanding that moral distress can arise from clinical situations, factors internal to the individual professional, and factors present in unit cultures, the institution, and the larger (...) health care environment. Corley et al. ( 2001 ) was the first to publish a quantitative measure of moral distress, and her scale has been adapted for use by others, including studies of other disciplines (Hamric and Blackhall 2007 ; Schwenzer and Wang 2006 ). Other scholars have proposed variations on Jameton’s core definition (Sporrong et al. 2006 , 2007 ), developing measures for related concepts such as moral sensitivity (Lutzen et al. 2006 ), ethics stress (Raines 2000 ), and stress of conscience (Glasberg et al. 2006 ). The lack of consistency and consensus on the definition of moral distress considerably complicates efforts to study it. Increased attention by researchers in disciplines other than nursing has taken different forms, some problematic. Cultural differences in the role of the nurse and understanding of actions that represent threats to moral integrity also challenge efforts to build a cohesive research-based understanding of the concept. In this paper, research efforts to date are reviewed. The importance of capturing root causes of moral distress in instruments, particularly those at unit and system levels, to allow for interventions to be appropriately targeted is highlighted. In addition, the issue of studying moral distress and interaction over time with moral residue is discussed. Promising recent work is described along with the potential these approaches open for research that can lead to interventions to decrease moral distress. Finally, opportunities for future research and study are identified, and recommendations for moving the research agenda forward are offered. Content Type Journal Article Pages 1-11 DOI 10.1007/s10730-012-9177-x Authors Ann B. Hamric, School of Nursing, Virginia Commonwealth University, P.O. Box 980567, Richmond, VA 23298-0567, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

Abstract:When people reason on the basis of moral rules, do they suppose that in the absence of a prohibitory rule they are free to act, or do they suppose that morality always requires a justification establishing a permission to act? In this essay we present a series of learning experiments that indicate when learners tend to close their system on the basis of natural liberty and when on the principle of residual prohibition. Those who are taught prohibitory rules tend (...) to infer natural liberty while those taught permission rules tend to infer residual prohibition. In mixed cases, where learners are taught both types of rules, there is some tendency to suppose that natural liberty is the default. Both natural liberty and its denial can be learned; is there a reason to adopt one system of moral rules or the other? We argue that systems of social morality based on a principle of natural liberty have a striking advantage over their competitors: they are well adapted to effectively exploring the constant novel circumstances that arise in open, dynamic, societies. (shrink)

Disavowals such as "That's not who I am" are one way to distance ourselves from unsavory actions in order to try to mitigate our responsibility for them. Although such disclaimers can be what Harry Frankfurt calls "shabbily insincere devices for obtaining unmerited indulgence," they can also be a way to renew our commitments to new values as part of the processes of aspiration and moral improvement. What, then, separates backsliding aspirants from those in denial who seek unmerited indulgence? Drawing (...) on Christine Korsgaard, on the one hand, and Heidegger and Merleau-Ponty, on the other, I propose a two-dimensional account of practical identity that makes sense of a certain kind of self-ignorance and helps us distinguish the aspirant from the superficially similar cases of denial and resignation. A key factor is how one responds to what I call residual practical identities. (shrink)

Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. Search (...) terms included “moral injury” and “moral distress,” identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs. (shrink)

In this paper, I defend the view that we can have perceptual moral knowledge. First, I motivate the moral perception view by drawing on some examples involving perceptual knowledge of complex non‐moral properties. I argue that we have little reason to think that perception of moral properties couldn't operate in much the same way that our perception of these complex non‐moral properties operates. I then defend the moral perception view from two challenging objections that (...) have yet to be adequately addressed. The first objection is that the moral perception view has implausible commitments concerning the morally blind, people who would claim not to perceive wrongness. The second objection is that the moral perception view is not really compatible with a wide range of the main candidate moral theories. I argue that the moral empiricist has plausible responses to both of these objections. I then address three residual concerns that my defense raises. (shrink)

In this article I explore the contribution of ethical analysis and theological reflection to understanding and responding to moral injury of healthcare workers in light of the COVID pandemic. I begin by critically appraising the relevance of moral injury for healthcare contexts, and suggest that the term ‘medical moral injury’ should be used to differentiate it from ‘military moral injury’. I briefly relate medical moral injury to other relevant phenomena, such as moral dilemmas, (...) class='Hi'>moral distress, and moral residue, arguing that moral injury in healthcare contexts might take chronic as well as acute forms. I suggest that agent regret might play an important role in understanding medical moral injury. The associated distinction between harms and wrongs, and so regret and remorse, help us identify different kinds of moral injury, and the distinct role that apology plays in each instance. Theological reflection on penitence, forgiveness, and lament also contributes to understanding and responding to potentially morally injurious events. I conclude that while psychological intervention plays an important role in medical moral injury, moral and theological perspectives provide both crucial lenses through which to understand these potentially injurious moral landscapes, and resources to assist healthcare workers in navigating them more safely. (shrink)

Moral properties would supervene upon non-moral properties and be conceptually autonomous. That, according to Simon Blackburn, would make them if not impossible at least mysterious, and evidence for them best explained by theorists who say they are not real. In fact moral properties would not challenge in ways Blackburn has contended. There is, however, something new that can be gathered from his arguments. What would the supervenience of moral properties and their conceptual autonomy from at least (...) total non-moral properties entail not only for Intuitionists, who ‘knew this all along,’ but for all moral realists, that there are synthetic necessary moral principles? There is for all moral realists the problem of explaining ‘what in the world’ makes possible these necessities. (shrink)

When thinking about ethics, technology is often only mentioned as the source of our problems, not as a potential solution to our moral dilemmas. When thinking about technology, ethics is often only mentioned as a constraint on developments, not as a source and spring of innovation. In this paper, we argue that ethics can be the source of technological development rather than just a constraint and technological progress can create moral progress rather than just moral problems. We (...) show this by an analysis of how technology can contribute to the solution of so-called moral overload or moral dilemmas. Such dilemmas typically create a moral residue that is the basis of a second-order principle that tells us to reshape the world so that we can meet all our moral obligations. We can do so, among other things, through guided technological innovation. (shrink)

Moral properties would supervene upon non‐moral properties and be conceptually autonomous. That, according to Simon Blackburn, would make them if not impossible at least mysterious, and evidence for them best explained by theorists who say they are not real. In fact moral properties would not challenge in ways Blackburn has contended. There is, however, something new that can be gathered from his arguments. What would the supervenience of moral properties and their conceptual autonomy from at least (...) total non‐moral properties entail not only for Intuitionists, who ‘knew this all along,’ but for all moral realists, that there are synthetic necessary moral principles? There is for all moral realists the problem of explaining ‘what in the world’makes possible these necessities. (shrink)

The traditional debate about moral dilemmas concerns whether there are circumstances in which an agent is subject to two obligations that cannot both be fulfilled. Realists maintain there are. Irrealists deny this. Here I defend an alternative, methodologically-oriented position wherein the denial of genuine moral dilemmas functions as a regulative ideal for moral deliberation and practice. That is, moral inquiry and deliberation operate on the implicit assumption that there are no genuine moral dilemmas. This view (...) is superior to both realism and irrealism in accounting for moral residue and other crucial phenomenological dimensions of our experience of moral dilemmas. (shrink)

Moral properties would supervene upon non‐moral properties and be conceptually autonomous. That, according to Simon Blackburn, would make them if not impossible at least mysterious, and evidence for them best explained by theorists who say they are not real. In fact moral properties would not challenge in ways Blackburn has contended. There is, however, something new that can be gathered from his arguments. What would the supervenience of moral properties and their conceptual autonomy from at least (...) total non‐moral properties entail not only for Intuitionists, who ‘knew this all along,’ but for all moral realists, that there are synthetic necessary moral principles? There is for all moral realists the problem of explaining ‘what in the world’makes possible these necessities. (shrink)

The idea of moral pluralism generates a dilemma for the practice of philanthropy. Characteristically, the practice of philanthropy assumes unity, coherence, or convergence among the diverse virtues and moral aims that it pursues. In the philanthropic tradition, it is recognized that the goals of a particular philanthropy will vary. Yet, if these are sincere expressions of the philanthropic will, each represents some portion of the manifold activity of “doing good” according to particularized choice or style. The relevant analogy (...) should be drawn to the slogan of “giving to the college of your choice” or to worship of the one god in your own way, where the plurality of expression is not only consistent with the residual value of education or of religion, but articulates the pragmatic way to realize the underlying values of a pluralistic society. Historically, this reflects the place of a unifying religious vision of the nature of the good or of a secular conception of a public philosophy which recognized the common good. Even etymologically, the love of mankind suggests a single passion that is directed beneficently to the shared values of mankind. The theory and practice of contemporary philanthropy is necessarily pluralistic, however, and it reflects the range of decisions by individuals with different interests and values in a pluralist, democratic society. The legitimized and recognized range of philanthropies in modern societies demonstrates divergent and even conflicting perceptions of the common good or the public interest. Thus, the range of philanthropies includes support for bird watching and for business opportunities of minorities, which may require some decisions on “comparable worth” and competitive allocation of resources. (shrink)

The standard attribution of ought implies can rules out the possibility of Kantianism permitting the existence of moral dilemmas. Against this, I argue that Kantianism both can and should permit the existence of moral dilemmas. This new take on moral dilemmas should be of particular urgency to those hoping to radicalize Kant, I argue, because the work of oppression theorists shows that moral dilemmas are particularly likely to strike those who are already most vulnerable. The insights (...) of oppression theory also suggest that the heretofore overlooked social and political implications of moral dilemmas are just as philosophically significant as the metaethical and ethical implications. (shrink)

Background Encounters of moral distress have long-term consequences on healthcare workers’ physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. Research Objective The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a (...) southern U.S. academic medical center. Participants & Research Context Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. Research Design Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine’s National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. Ethical Considerations Ethics approval was obtained from the university and medical center institutional review boards. Findings Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. Conclusion Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being. (shrink)

John Maynard Keynes, in a biographical essay that is as remarkable for the insight it provides into his own thinking as for what it says about its subject, described the trajectory of Malthus's intellectual career as follows: ‘from being a caterpillar of a moral scientist and chrysalis of an historian, he could at last spread the wings of his thought and survey the world as an economist’. Malthus himself had resisted this conclusion in the introduction to his Principles of (...) Political Economy — meant as a riposte to David Ricardo's way of proceeding — when he stated that ‘the science of political economy bears a nearer resemblance to the science of morals and politics than to that of mathematics’. For understandable reasons, however, some modern economists find Keynes's characterization more attractive, particularly when it also allows them to regret the fact that the free flight of the positive economist in Malthus was often impeded by historical and moral residues left over from earlier existences. By adopting this position they are able to discount awkward problems relating to the historical origins and professional identity of their discipline — those problems connected with Malthus's religious beliefs and theological standpoint that have to be confronted when his explicit claims as a Christian moral scientist are taken seriously. Lack of sympathy on the part of economists when faced with the moral and theological dimensions of Malthus's writings has a long history that goes back to Ricardo, who criticized his friend's confusion, as he saw it, of moral and economic considerations. James Mill, as always, was more outspoken in regretting the intellectual fetters that inevitably went with Malthus's clerical status. Some economic demographers, in modern times, have also criticized Malthus for intermingling ‘moralistic and scientific aims almost inextricably’, thereby imparting what they regard as an untestable or tautological air to his exposition of the population principle. (shrink)

The unethical overuse of antibiotics to seek to achieve a shortening of the treatment period raises the cost of health services and poses a threat to humanity due to the gradual development of antibiotic resistance. Other consequences of our modern passion for antibiotics have appeared. Small concentrations of antibiotic residues in sewage waters slow down the metabolism of anaerobic microorganism thereby reducing the overall performance of the anaerobic fermentation used to detoxify and digest sewage and other collected organic wastes. Reduced (...) biogas yields represents a serious threat to the energy self-sufficiency of some waste-water treatment plants, so it might change them from energy producers into energy consumers. Morally justifiable production of renewable energy from bio-waste is also threatened by antibiotic residues that remain in the bio-waste. (shrink)

This paper explores the possibility of moral conflict in Kant’s ethics. An analysis of the only explicit discussion of the topic in his published writings confirms that there is no room for genuine moral dilemmas. Conflict is limited to nonconclusive ‘grounds’ of obligation. They arise only in the sphere of ethical duty and, though defeasible, ought to be construed as the result of valid arguments an agent correctly judges to apply in the situation at hand. While it is (...) difficult to determine in theory what makes some of them stronger than others, these ‘grounds’ can account for practical residue in conflict cases and for a plausible form of agent regret. The principle that ‘ought implies can’ survives intact. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Moral Distress for the Physician AssistantSharyn L. KurtzMy morning rounds as an inpatient medical oncology physician assistant began as usual. I arrived at the hospital early to receive 7 a.m. sign out from the covering resident. The overnight report began favorably. All patients remained stable. Even my patient, whom I will call Mrs. Walker,* had a quiet night. However, given her tenuous admission presentation, including altered mental status, (...) hypercalcemia (high levels of calcium in the blood), atrial fibrillation with rapid ventricular response (irregular, rapid heart function), widespread metastatic lung cancer, and recent neurosurgery to stabilize her spine, I decided to prioritize Mrs. Walker’s morning evaluation.Examining her medical chart proved reassuring. Her tachycardia (rapid heart rate) had been better controlled over the past two days. Her hypercalcemia had been treated, such that she was no longer somnolent. In fact, she was now arousable, conversant, and able to offer some input regarding her healthcare wishes. However, because she was experiencing intermittent delirium, her husband continued to act as her primary medical decision–maker.As her health care proxy, Mr. Walker had experienced conflict with the medical team during his wife’s prior hospital admission. However, even though Mr. Walker lived greater than 45 minutes from the hospital and was not able to visit regularly, he and I spoke daily by phone, which allowed me the opportunity to offer regular medical updates. Mr. Walker felt overwhelmed with his wife’s condition, but he was comfortable with the care the medical team had provided thus far. He was encouraged by the small improvements we had noted since her hospital admission five days prior.Mr. Walker stated on hospital admission that he wished for DNR/I orders to be placed, since this cohered with his wife’s previously stated wishes. However, he still wanted “everything else done” in terms of treating his wife’s medical conditions, including treatment of her atrial fibrillation, pain, and electrolyte anomalies. Most of all, he hoped Mrs. Walker would soon have increased mobility, which he felt would grant his wife the best quality of life possible. He was adamant that “being active” was what Mrs. Walker wished for, and that she had never wanted to be confined to bed.Mr. Walker’s requests seemed reasonable. Although Mrs. Walker’s lung cancer was widespread, and although many on the medical team felt she would not improve to the point where palliative chemotherapy could be considered, [End Page E13] she had stabilized. Her recent spine surgery had been successful, and she was healing adequately. The neurosurgeons had cleared Mrs. Walker for increased activity out of bed as soon as she could be fitted with a lumbar brace. The pain and palliative care specialists felt that Mrs. Walker’s residual back pain and delirium could be well managed with oral medications.Prior to my entering Mrs. Walker’s room to begin her physical evaluation, I was met by her seasoned nurse, whom I will call Amy. “Sharyn,” Amy warned, “Mrs. Walker’s heart rate is 150 and she is complaining of chest pain.” I entered Mrs. Walker’s room, and she was notably uncomfortable, grasping her chest. The monitor showed that Mrs. Walker’s heart rate was in fact in the 150’s. She was pale, short of breath, and wheezing. “Mrs. Walker,” I asked, “how severe is your chest pain on a scale from 1 to 10?” Mrs. Walker replied, “Nine.” I asked Amy to obtain an EKG, to provide oxygen, and to administer an IV medication that would slow Mrs. Walker’s heart rate. I stepped out of the room to place the computer orders, and I paged my attending physician to let him know about Mrs. Walker’s change in status. After hearing the update, my attending physician, whom I will call Dr. Clark, stated that he agreed with all of my treatment decisions thus far. He was on his way into the hospital. I planned out my next steps with him on the phone and returned to the patient’s room.The monitor gave evidence that Mrs. Walker’s heart rate was improving. Mrs. Walker reported that her pain was now “4 out of... (shrink)

Is the idea of the voluntary important? Those who think so tend to regard it as an idea that can be metaphysically deepened through a theory about voluntary action, while those who think it a superficial idea that cannot coherently be deepened tend to neglect it as unimportant. Parting company with both camps, I argue that the idea of the voluntary is at once important and superficial—it is an essentially superficial notion that performs important functions, but can only perform them (...) if we refrain from deepening it. After elaborating the contrast between superficial and deepened ideas of the voluntary, I identify the important functions that the superficial idea performs in relation to demands for fairness and freedom. I then suggest that theories trying to deepen the idea exemplify a problematic moralization of psychology—they warp psychological ideas to ensure that moral demands can be met. I offer a three-tier model of the problematic dynamics this creates, and show why the pressure to deepen the idea should be resisted. On this basis, I take stock of what an idea of the voluntary worth having should look like, and what residual tensions with moral ideas this leaves us with. (shrink)

Background: COVID-19 pandemic has led to heightened moral distress among healthcare providers. Despite evidence of gendered differences in experiences, there is limited feminist analysis of moral distress. Objectives: To identify types of moral distress among women healthcare providers during the COVID-19 pandemic; to explore how feminist political economy might be integrated into the study of moral distress. Research Design: This research draws on interviews and focus groups, the transcripts of which were analyzed using framework analysis. Research (...) Participants and Context: 88 healthcare providers, based in British Columbia Canada, participated virtually. Ethical Considerations: The study received ethical approval from Simon Fraser University. Findings: Healthcare providers experienced moral dilemmas related to ability to provide quality and compassionate care while maintaining COVID-19 protocols. Moral constraints were exacerbated by staffing shortages and lack of access to PPE. Moral conflicts emerged when women tried to engage decision-makers to improve care, and moral uncertainty resulted from lack of clear and consistent information. At home, women experienced moral constraints related to inability to support children’s education and wellbeing. Moral conflicts related to lack of flexible work environments and moral dilemmas developed between unpaid care responsibilities and COVID-19 risks. Women healthcare providers resisted moral residue and structural constraints by organizing for better working conditions, childcare, and access to PPE, engaging mental health support and drawing on professional pride. Discussion: COVID-19 has led to new and heightened experiences of moral distress among HCP in response to both paid and unpaid care work. While many of the experiences of moral distress at work were not explicitly gendered, implicit gender norms structured moral events. Women HCP had to take it upon themselves to organize, seek out resources, and resist moral residue. Conclusion: A feminist political economy lens illuminates how women healthcare providers faced and resisted a double layering of moral distress during the pandemic. (shrink)

This article argues that introductory ethics classes can unwittingly create or confirm skeptical views toward morality. Introductory courses frequently include critical discussion of skeptical positions such as moral relativism and psychological egoism as a way to head off this unintended outcome. But this method of forestalling skepticism can have a residual (and unintended) skeptical effect. The problem calls for deeper pedagogical-cum-philosophical engagement with the underlying sources of skepticism. The paper provides examples of how to do this and explains the (...) additional benefits of teaching moral skepticism. (shrink)

Moral distress is one of the core topics of clinical ethics. Although there is a large and growing empirical literature on the psychological aspects of moral distress, scholars, and empirical investigators of moral distress have recently called for greater conceptual clarity. To meet this recognized need, we provide a philosophical taxonomy of the categories of what we call ethically significant moral distress: the judgment that one is not able, to differing degrees, to act on one’s (...) class='Hi'>moral knowledge about what one ought to do. We begin by unpacking the philosophical components of Andrew Jameton’s original formulation from his landmark 1984 work and identify two key respects in which that formulation remains unclear: the origins of moral knowledge and impediments to acting on that moral knowledge. We then selectively review subsequent literature that shows that there is more than one concept of moral distress and that explores the origin of the values implicated in moral distress and impediments to acting on those values. This review sets the stage for identifying the elements of a philosophical taxonomy of ethically significant moral distress. The taxonomy uses these elements to create six categories of ethically significant moral distress: challenges to, threats to, and violations of professional integrity; and challenges to, threats to, and violations of individual integrity. We close with suggestions about how the proposed philosophical taxonomy of ethically significant moral distress sheds light on the concepts of moral residue and crescendo effect of moral distress and how the proposed taxonomy might usefully guide prevention of and future qualitative and quantitative empirical research on ethically significant moral distress. (shrink)

À partir de l ’ article 51 de la Charte des Nations unies, ce texte examinequelques problèmes posés dans l ’ histoire des idées politiques par l ’ argument de la légitime défense dans le cadre de la justification politique de la guerre et en fonction de laréflexion philosophique sur le thème de la guerre juste. Il envisage analytiquement cetargument, en mettant en lumière l ’ importance qu ’ il accorde à la souveraineté nationale,puis l ’ ambiguïté de la notion (...) de « droit naturel » des États sur laquelle il se fonde. Or,conçue de manière « réaliste », au lieu d ’ être vectrice de désordres, la légitime défenseoffre paradoxalement le moyen d ’ une intégration des relations internationales, dans lesystème westphalien comme dans le système onusien. L ’ article aborde enfin la pertinencephilosophique et politique de la « légitime défense préventive ». (shrink)

The reappearance of the question of moral judgments by historians makes a reappraisal of the issues timely. Almost all that has been written on the subject addresses only the propriety of moral judgments in the written texts historians produce. However, historians have to make moral choices when selecting a subject upon which to write; and they make a tacit moral commitment to write and teach honestly. Historians usually dislike making explicit moral evaluations, and have little (...) or no training in how to do so. They can argue it’s not their job; they are only finders of fact. Historians holding a determinist view of actions do not think it appropriate to blame people for doing what they couldn’t help doing; for those believing there is an overall pattern to history, individual morality is beside the point. Finally, since earlier cultures had values different from ours, it seems unjust to hold them to contemporary standards. This essay modifies or rejects these arguments. Some historians have manifested ambivalence, acknowledging it is difficult or impossible to avoid making moral evaluations . Ordinary-language philosophers, noting that historiography has no specialized vocabulary, see it as saturated by the values inherent in everyday speech and thought. I argue that the historicist argument about the inevitably time-bound limitation of all values is exaggerated. Historians who believe in the religious grounding of values obviously disagree with it; but even on a secular level, morals are often confused with mores. If historians inevitably make moral evaluations, they should examine what philosophical ethicists—virtue ethicists, deontologists, and consequentialists—have said about how to make them; and even if they find no satisfactory grounding for their own moral attitudes, it is a brute fact that they have them. I end with an argument for “strong evaluations”—neither treating them as a troublesome residue in historiography nor, having despaired of finding a solid philosophical ground for moral evaluations, concluding that they are merely matters of taste. I believe historians should embrace the role of moral commentators, but that they should be aware that their evaluations are, like all historical judgments, subject to the criticisms of their colleagues and readers. Historians run little risk of being censorious and self-righteous; the far greater danger is acquiescing in or contributing to moral confusion and timidity. (shrink)

Revisionist interpretation of Mill needs to be extended to deal with a residue of puzzles about his moral theory and its connection with his theory of liberty. The upshot shows his reinterpretation of his Benthamite tradition as a form of ‘philosophical utilitarianism’; his definition of the art of morality as collective self-defence; his ignoring of maximization in favour of ad hoc dealing in utilities; the central role of his account of the justice of punishment; the marginal role of (...) the internal sanction in his criterion of moral wrong; his deep respect for common-sense morality; and his restriction of the scope of morality so as to claim for the utilitarian tradition the whole realm of the aesthetics of conduct as part of a general theory of practical reason. (shrink)

This paper discusses whether the collateral harm of imprisonment to the close family members and children of prison inmates may give rise to special moral obligations towards them. Several collateral harms, including decreased psychological wellbeing, financial costs, loss of economic opportunities, and intrusion and control over their private lives, are identified. Two competing perspectives in moral philosophy are then applied in order to assess whether the harms are permissible. The first is consequentialist and the second is deontological. It (...) is argued that both of them fails and therefore it is hard to defend the position that allowing for these harms would be morally permissible, even for the sake of the overall aims of incarceration. Instead, it is argued that these harms imply that imprisonment should only be used as a last resort. Where it is necessary, it should give rise to special moral obligations. Using the notion of residual obligation, these obligations are defended, categorized and clarified. (shrink)

The production of renewable energy in agricultural biogas plants is being widely criticized because—among other things—most of the feedstock comes from purpose-grown crops like maize. These activities generate competitive pressure to other crops that are used for feeding or food production, worsening their affordability. Unique pretreatment technology that allows substitution of the purpose-grown crops by farming residues was built 6 years ago on a commercial basis in Pěčín under modest funding and without publicity. The design of the concept; financial assessment (...) and moral viewpoint were analyzed based on practical operating data. It showed that the apparatus improves economic, environmental and moral acceptance as well. However, according to the government’s view, public funding for this type of processing was shortened, “because waste materials represent a lower cost”. The impact of such governance was analyzed as well. (shrink)

The article presents proofs of the context freeness of a family of typelogical grammars, namely all grammars that are based on a uni- ormultimodal logic of pure residuation, possibly enriched with thestructural rules of Permutation and Expansion for binary modes.

In lieu of an abstract, here is a brief excerpt of the content:Comments on “Moral Complicity in Induced Pluripotent Stem Cell Research”W. Malcolm Byrnes, Ph.D. and Edward J. FurtonIn his article titled “Moral Complicity in Induced Pluripotent Stem Cell Research,” Mark T. Brown (2009) unfortunately mischaracterizes my ethical analysis of the use of induced pluripotent stem (iPS) cells for replacement therapies, or treatments (Byrnes 2008). In my paper, which Brown cites, I argue that, just as it is ethically (...) acceptable for parents to allow their children and themselves to be immunized using vaccines produced by cell lines derived from human fetuses aborted in the past, it is also acceptable for persons in the future to benefit from treatments that use iPS cells validated using human embryonic stem (ES) cell lines [End Page 202] derived in the past. The assumption I make is that iPS cells would have to be shown to be functionally equivalent to human ES cells—i.e., validated—before they could be used for cell replacement treatments. (If it turns out that this assumption is incorrect, and primate or even mouse ES cells can be used for the validation, then all residual ethical problems will disappear and there will be no ethical problems whatsoever associated with iPS cells.) I wrote:... [I]n both cases, the origin of the treatment is in a one-time event: either the one-time use of aborted fetuses to obtain cell lines (e.g., MRC-5 and WI- 38) to grow weakened virus strains for vaccine production, or the one-time destruction of human embryos to validate iPS cells, which then effectively replace embryonic stem cells. In the latter case, if no additional embryonic stem cell lines are derived, then derivation of the existing lines could be considered a “one-time” event in the past, albeit an event that extended over a several-year period(Byrnes 2008, p. 287, emphasis added).Note the phrase “if no additional embryonic stem cell lines are derived.” The derivation of ES cell lines inherently involves destruction of embryos; indeed, that is why many people, including me, are opposed to human ES cell research. In my article, I am arguing that, if no additional ES cell lines are derived, then no additional human embryos will be destroyed, and the destruction of human embryos will lie in the past. In this case, embryo destruction could be considered a past event, just as the abortion of a human fetus from which vaccine-producing cell lines were derived is a past, albeit tragic, event.In the process of building his argument that proponents of iPS cell research are morally complicit in embryo destruction, Brown (2009, p. 15) casts me as being in favor of the “derivation of new embryonic stem [cell lines].” This is the exact opposite of my position. In fact, I am opposed to further destruction of human embryos. I believe that the hundreds of ES cell lines already in existence are more than sufficient to validate iPS cells and so no additional lines need to be derived. This means that no additional human embryos will need to be destroyed.Apparently based on the misperception that I support future destruction of human embryos, Brown concludes that “Byrnes’s endorsement of ongoing iPSC validation studies would seem to implicate him and those who follow his lead in formal and material complicity in what they perceive as moral evil” (p. 16). He writes that “explicit formal complicity would attach because he [Byrnes] knowingly and intentionally recommends that embryos be killed in order to facilitate a transition to a future in which no more embryos need be destroyed” (p. 16). Additionally, my “followers” and I would be guilty of “proximate material complicity” as well as “remote material complicity” (p. 16). Unfortunately, this broad condemnation is based on a misconception of my actual position.An additional problem involves Brown’s use of a quotation he attributes to me: [End Page 203]Once embryonic stem cells are used to successfully validate iPS cells, they will no longer be needed and their association with iPS cells will lie in the past. Is there not an element of sadness and resignation in accepting something (iPS cells) associated with an unjust act (destruction of an... (shrink)

In this chapter, we discuss a selection of current views of the neural correlates of consciousness (NCC). We focus on the different predictions they make, in particular with respect to the role of prefrontal cortex (PFC) during visual experiences, which is an area of critical interest and some source of contention. Our discussion of these views focuses on the level of functional anatomy, rather than at the neuronal circuitry level. We take this approach because we currently understand more about experimental (...) evidence at this coarse level and because these results are appropriate for arbitrating between current theoretical frameworks. We discuss the Two-Visual-Systems Hypothesis (Milner & Goodale 1995; 2006), Local Recurrency (Lamme 2010; Lamme 2006), Higher Order (Lau 2008; Lau & Rosenthal 2011) and Global Workspace theories (Baars 1997; Baars 2005; Dehaene & Naccache 2001; Dehaene 2014). Despite the apparent stark differences between conscious and unconscious perceptual processing, available evidence suggests that their neural substrates must be largely shared. This indicates that the difference in neural activity between conscious and unconscious perceptual processing is likely to be subtle and highly specialized. We argue that current experimental evidence about the involvement of specific activity in prefrontal cortex supports the higher order neural theory of consciousness. In consequence, imaging techniques that focus only on marked differences between conscious and unconscious level of activity are likely to be insensitive to the relevant neural activity patterns that underlie conscious experiences. Finally, it follows from the evidence we discuss that the functional advantages of conscious over unconscious perceptual processing may be more limited than commonly thought. (shrink)

This book's basic aim is "to clarify the relationship between revolutionary practice and moral reasoning" (p. 2). This aim primarily involves presenting a complex argument to show that revolution cannot be justified in the usual sense of what it means to justify an act precisely because the ordinary moral courts of appeal are called into question by revolutionaries. This is so because, for Gunnemann, revolution is, fundamentally, a rejection of an existing understanding of the problem of evil and (...) an attempt to put forward a new solution to the problem of evil. Following the pioneering work of Thomas Kuhn in philosophy of science, Gunnemann holds that ordinary moral courts of appeal are rejected by revolutionaries because such courts of appeal "imply residual confidence in the existing theodicy and the revolutionary loses his case merely by submitting to such a process" (p. 43). Hence, revolution is better understood as an apocalyptic event or as a religious conversion than as a moral act. For Gunnemann, conflicting paradigm solutions to the problem of evil—defined by Max Weber as the incongruity between destiny and merit—are at the heart of the moral meaning of revolution. (shrink)

Rare diseases, defined as having a prevalence inferior to 1/2000, are poorly understood scientifically and medically. Appropriate diagnoses and treatments are scarce, adding to the burden of living with chronic medical conditions. The moral significance of rare disease experiences is often overlooked in qualitative studies conducted with adults living with rare diseases. The concept of morally problematic situations arising from pragmatist ethics shows promise in understanding these experiences. The objectives of this study were to (1) acquire an in-depth understanding (...) of morally problematic situations experienced by adults living with rare diseases in the province of Québec and (2) to develop an integrative model of the concept of morally problematic situations. To this end, an online survey targeting this population was developed through a participatory action research project. Respondents provided 90 long testimonies on the most important morally problematic situations they faced, often in healthcare settings. An integrative model was developed based on various qualitative analyses of these testimonies and relevant literature. The integrative model showcases that morally problematic situations have causes (i.e., contextual and relational factors, personal factors, jeopardized valuations), have affective repercussions (i.e., emotions and feelings, internal tensions), prompt action (i.e., through empowerment strategies leading to the evolution of situations), and elicit outcomes (i.e., factual consequences, residual emotions and feelings, positive or negative resolutions). In sum, this study advances understanding of the moral experiences of adults living with rare diseases while proposing a comprehensive conceptual tool to guide future empirical bioethics research on moral experiences. (shrink)

Individualists hold that moral responsibility can be ascribed to single human beings only. An important collectivist objection is that individualism is morally deficient because it leaves a normative residue. Without attributing responsibility to collectives there remains a “deficit in the accounting books” (Pettit). This collectivist strategy often uses judgment aggregation paradoxes to show that the collective can be responsible when no individual is. I argue that we do not need collectivism to handle such cases because the individualist analysis (...) leaves no responsibility-deficit. Harm suffered in such situations can have only two sources. Harm is either due to culpable wrongdoing by individuals. Harm is then redressed by holding these individuals responsible. Or harm does not result from culpable wrongdoing. Such harm may have to be redressed too, but not because anyone is responsible for it. Therefore, the charge of moral insensitivity against individualist accounts can be rejected. Furthermore, in the last section of the chapter I will show that collectivist talk about moral responsibility can be used for ethically questionable purposes as well. Collectivists cannot claim the moral high ground. (shrink)