Despite over three decades of research into the sources and costs of what has become an “epidemic” of moral distress among healthcare professionals, spanning many clinical disciplines and roles, there has been little significant progress in effectively addressing moral distress. We believe the persistent sense of frustration, helplessness, and despair still dominating the clinical moral distress narrative signals a need for re-orientation in the way moral distress is understood and worked with. Most fundamentally, moral distress reveals moral investment and energy. (...) It is the troubled call of conscience, an expression of fidelity to moral commitments seen as imperiled or compromised.It is crucial that we find ways to empower clinicians in heeding this call—to support clinicians’ moral agency and voice, foster their moral resilience, and facilitate their ability to contribute to needed reform within the organizations and systems in which they work. These objectives must inform creative expansion in the design of strategies for addressing moral distress in the day-to-day of clinical practice. We include suggestions about promising directions such strategies might take in the hope of spurring further innovation within clinical environments. (shrink)

This paper examines the ‘justice’ and ‘care’ orientations in ethical theory as characterized in Carol Gilligan's research on moral development and the philosophical work it has inspired. Focus is placed on challenges to the justice orientation – in particular, to the construal of impartiality as the mark of the moral point of view, to the conception of moral judgment as essentially principle-driven and dispassionate, and to models of moral responsibility emphasizing norms of formal equality and reciprocity. Suggestions are made about (...) the implications of these challenges, and of the care orientation in ethics, for the ethical theory taught, the issues addressed, and the skills and sensitivities encouraged through bioethical education. Keywords: bioethical education, ethics of care, impartiality, moral judgment, moral psychology CiteULike Connotea Del.icio.us What's this? (shrink)

: The feminist ethic of care has often been criticized for its inability to address four problems--the problem of exploitation as it threatens care givers, the problem of sustaining care-giver integrity, the dangers of conceiving the mother-child dyad normatively as a paradigm for human relationships, and the problem of securing social justice on a broad scale among relative strangers. We argue that there are resources within the ethic of care for addressing each of these problems, and we sketch strategies for (...) developing the ethic more fully. (shrink)

Given dramatic increases in recent decades in the pace of scientific discovery and understanding of the functional organization of the brain, it is increasingly clear that engagement with the neuroscientific literature and research is central to making progress on philosophical questions regarding the nature and scope of human freedom and responsibility. While patterns of brain activity cannot provide the whole story, developing a deeper and more precise understanding of how brain activity is related to human choice and conduct is crucial (...) to the development of realistic, just, and intellectually rigorous models of human agency and moral responsibility. In this special issue, we acknowledge that “free will” and “moral responsibility” are not concepts with which neuroscience can directly engage, and instead focus on self-governance, and the capacities that contribute to self-governance, which are more tractable for scientific investigation and are prerequisites for the presence of moral responsibility. (shrink)

Pornographic speech harms women by playing a key role in sustaining the social conditions through which women's liberty and equality are undercut. Though there is a principled moral and constitutional basis for pursuing a legal strategy in fighting pornography, we should not overestimate the effectiveness of the law or underestimate its potential dangers. The struggle against pornography must be waged through education, expressive exploration, and protest, not through the law.

Morally contoured empathy is a form of reasonable partiality essential to the healthy care of dependents. It is critical as an epistemic aid in determining proper moral responsiveness; it is also, within certain richly normative roles and relationships, itself a crucial constitutive mode of moral connection. Yet the achievement of empathy is no easy feat. Patterns of incuriosity imperil connection, impeding empathic engagement; inappropriate empathic engagement, on the other hand, can result in self-effacement. Impartial moral principles and constraints offer at (...) best meager protection against these perils, and hence serve poorly in securing morally contoured empathy. More nuanced and practical guidance should be sought in normatively substantive conceptions of our roles and relationships and their defining moral stakes. These, joined with more abstract moral tools, can facilitate rich, narratively textured interpretations of moralitys demands. While the content of our normative conceptions must be continually debated, engaging in this debate is vital to the achievement of proper empathy, and thus to effective, respectful, morally healthy care of dependents. (shrink)

Moral distress can consist in anxiety or concern about one’s capacity to meet challenges to one’s integrity; it can also consist in the sense that one has failed to meet these challenges, betraying fundamental moral values or commitments. When the sense of moral failure is compounded by feelings of frustration or impotence, of being constrained or impeded in one’s ability to act as one believes one ought, one experiences moral disempowerment. Drawing on narratives of moral distress emerging from work in (...) the clinical context, this essay explores a distinction between cases in which moral distress does, and does not, center around the experience of moral disempowerment. When moral distress is tied to moral disempowerment, the acute personal toll is joined with broader moral costs, for effective moral agency is stymied. If we are to support individuals’ resilience and effectiveness in working constructively with moral distress, we need to understand and redress the social, systemic, and institutional factors contributing to moral disempowerment. (shrink)

This essay critically assesses two strategies of accommodation used by defenders of impartialism in ethics to argue that the care orientation represents no genuine challenge to impartialist theoretical paradigms. One strategy focuses on impartiality as a constraint on moral deliberation, the other as a constraint on moral justification. While highlighting respects in which the commitment to impartiality is more consonant with the care orientation than many advocates of care have acknowledged, this essay attempts to clarify crucial ways in which each (...) accommodationist strategy falls, thus locating some of the more important contributions and challenges the care orientation offers to moral theory. (shrink)

Terri Traudt, Joan Liaschenko, and Cynthia Peden-McAlpine’s study contributes to a much-needed reorientation in thinking about and working with the challenges of moral distress. In providing a vital example of nurses able to navigate morally distressing situations in positive and constructive ways, and offering an analysis of the component elements of these nurses’ success, the study helps identify promising directions we might take in addressing the epidemic of moral distress. It also invites important questions, concerning the challenges faced by clinicians (...) who do not who work in healthy “moral communities,” who lack the ethical competencies, and who don’t have the presumptive authority and recognition enjoyed by the seasoned clinicians studied here. We explore some of these questions, and suggest ways we might build on the insights of Traudt and colleagues’ study. (shrink)

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was administered to representative samples of 1000 respondents (...) in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/protective highlights counter normative consequences and opposes the use enhancers. The Individual/proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern. (shrink)

We introduce what we call the Emergent Model of forgiving, which is a process-based relational model conceptualizing forgiving as moral and normative repair in the wake of grave wrongs. In cases of grave wrongs, which shatter the victim’s life, the Classical Model of transactional forgiveness falls short of illuminating how genuine forgiveness can be achieved. In a climate of persistent threat and distrust, expressions of remorse, rituals and gestures of apology, and acts of reparation are unable to secure the moral (...) confidence and trust required for moral repair, much less for forgiveness. Without the rudiments of a shared moral world — a world in which, at the very least, the survivor’s violation can be collectively recognized as a violation, and her moral status and authority collectively acknowledged and respected — expressions of remorse, gestures and rituals of apology, or promises of compensation have no authority as meaningful communicative acts with reparative significance. Accordingly, we argue that repair in the wake of traumatic violence involves ‘world-building,’ which supports the ability of survivors to move from despair to hope, from radical and disabling distrust to trust and engagement, and thus from impotence to effective agency. Our Emergent Model treats forgiveness as a slowly developing outcome of a series of changes in a person’s relationship to the trauma and its aftermath, in which moral agency is regained. We argue that forgiveness after grave wrongs and world-shattering harm, when it occurs, emerges from other phenomena, such as cohabitation within a community, gestures of reconciliation, working on shared projects, the developing of trust. On this view, forgiveness is an emergent phenomenon; it entails taking and exercising normative power—coming to claim one’s own moral authority in relation to oneself, one’s assailant, and one’s community. The processes that ultimately constitute forgiving are part and parcel of normative repair more broadly construed. (shrink)

Trust is more than mere reliance on another person. To trust someone is to rely on her goodwill for the care of something valuable. It is to have a confident expectation that the other person will take care of the valuable thing because she recognizes its value to you. It is to expect her to take care of it because she recognizes that she should take care of it. Therefore trust is a robustly moral attitude.

C.M. Concepcion's review of “Pornography: An Uncivil Liberty?” fundamentally misconstrues the position defended in that article. This paper examines possible sources of this misconstrual, focusing critical attention on the narrowly crafted, morally loaded notion of “pornography” that figures centrally in the original argument under review. Pornography is not a category of speech that can be characterized as having one crucial meaning or message, nor is the message of pornography easily identifiable in instances of pornographic speech. This raises the problem of (...) interpretive privilege, which haunts many of the antipornography arguments being offered in the contemporary debate, including the author's own earlier argument. (shrink)

Contrary to the popular belief that feminism has gained a foothold in the many disciplines of the academy, the essays collected in Theorizing Backlash argue that feminism is still actively resisted in mainstream academia. Contributors to this volume consider the professional, philosophical, and personal backlashes against feminist thought, and reflect upon their ramifications. The conclusion is that the disdain and irrational resentment of feminism, even in higher education, amounts to a backlash against progress.