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)
Although moral distress is now a well-recognized phenomenon among all of the healthcare professions, few evidence-based strategies have been published to address it. In morally distressing situations, the “presenting problem” may be a particular patient situation, but most often signals a deeper unit- or system-centered issue. This article describes one institution’s ongoing effort to address moral distress in its providers. We discuss the development and evaluation of the Moral Distress Consultation Service, an interprofessional, unit/system-oriented approach to addressing and ameliorating moral (...) distress. (shrink)
The naturalistic fallacy is mentionedfrequently by evolutionary psychologists as anerroneous way of thinking about the ethicalimplications of evolved behaviors. However,evolutionary psychologists are themselvesconfused about the naturalistic fallacy and useit inappropriately to forestall legitimateethical discussion. We briefly review what thenaturalistic fallacy is and why it is misusedby evolutionary psychologists. Then we attemptto show how the ethical implications of evolvedbehaviors can be discussed constructivelywithout impeding evolutionary psychologicalresearch. A key is to show how ethicalbehaviors, in addition to unethical behaviors,can evolve by natural selection.
The main objective of this essay is to validate some of the principal, currently competing, mammalian consciousness-brain theories by comparing these theories with data on both cognitive abilities and brain organization in birds. Our argument is that, given that multiple complex cognitive functions are correlated with presumed consciousness in mammals, this correlation holds for birds as well. Thus, the neuroanatomical features of the forebrain common to both birds and mammals may be those that are crucial to the generation of both (...) complex cognition and consciousness. The general conclusion is that most of the consciousness-brain theories appear to be valid for the avian brain. Even though some specific homologies are unresolved, most of the critical structures presumed necessary for consciousness in mammalian brains have clear homologues in avian brains. Furthermore, considering the fact that the reptile-bird brain transition shows more structural continuity than the stem amniote-mammalian transition, the line drawn at the origin of mammals for consciousness by several of the theorists seems questionable. An equally important point is that consciousness cannot be ruled out in the absence of complex cognition; it may in fact be the case that consciousness is a necessary prerequisite for complex cognition. (shrink)
BackgroundGeneral practitioners often act as gatekeeper, authorizing patients’ access to hospital care. This gatekeeping role became even more important during the current COVID-19 crisis as uncertainties regarding COVID-19 made estimating the desirability of hospital referrals complex, both for COVID and non-COVID suspected patients. This study explored Dutch general practitioners’ experiences and ethical dilemmas faced in decision making about hospital referrals in times of the COVID-19 pandemic.MethodsSemi-structured interviews with Dutch general practitioners working in the Netherlands were conducted. Participants were recruited via (...) purposive sampling. Thematic analysis was conducted using content coding.ResultsFifteen interviews were conducted, identifying four themes: one overarching regarding COVID-19 uncertainties, and three themes about experienced ethical dilemmas: the patients’ self-determination vs. the general practitioners’ paternalism, the general practitioners’ duty of care vs. the general practitioners’ autonomy rights, the general practitioners’ duty of care vs. adequate care provision.ConclusionsLack of knowledge about COVID-19, risks to infect loved ones, scarcity of hospital beds and loneliness of patients during hospital admission were central in dilemmas experienced. When developing guidelines for future crises, this should be taken into account. (shrink)
Recent discussions of boundary theory, particularly in the field of ethnic relations, emphasize varying degrees of porousness of social boundaries and the importance of considering the effects of the intersections of multiple boundaries, most notably those of gender, ethnicity/race, and class. It is also increasingly acknowledged that within-group characteristics, including identities, of subordinate as well as of dominant groups may change, without their becoming less authentic distinctive collectivities. This article examines the changing identities of a specific collectivity—French-speaking Canadian women living (...) in Ontario—who, during the past century, have been either marginalized by, or excluded from, several larger collectivities for various reasons—religion, race/ethnicity, language, nationalism, region, and gender—related to boundary definitions of their multiple, intersecting identities. It explores the emergence of these various marginalities and the ability of these feminists to construct institutions and agendas on their own terms. (shrink)
Ethics raises questions about what kind of society we ought to be, questions that are at the heart of this case. Increasingly, inequalities in healthcare fueled by lack of access, inadequate insurance coverage, and rising costs are creating dilemmas in the proper distribution of healthcare resources. Questions of distributing scarce and valuable resources are fundamentally questions of justice. The classic definition of justice is the duty to give to each person what they deserve and can legitimately claim so that justice (...) is understood as a moral obligation to help persons exercise their rights. Distributive justice, i.e., what distribution of resources is fair, equitable, and appropriate, thus turns on the concept of rights. One of the key questions in this case is whether and to what extent this patient has a right to treatment for his heart disease. In the classic understanding of justice, he must assert and we as a society must agree that he has a right to treatment for his heart condition before we are morally obligated to provide this care. Are there limits to this patient's right to healthcare? If so, what are they? The differing principles of distributive justice use different criteria to rank or weight decisions regarding the proper and just distribution of healthcare services. In this case, at least two competing but ethically valid principles can be identified: the humanitarian principle and the libertarian principle. (shrink)
One hypothesis of isocortical evolution requires tangential migration of glutaminergic neurons. A second requires invasion of collothalamic afferents into the dorsal pallium, a territory that in sauropsids is solely lemnopallial. A third alternative is noted here – duplication of the original collopallial territory. The duplicated region would be formed by radial migration of excitatory neurons and would maintain its collothalamic innervation.
The target article does not consider neural data on primate spatial representations, which we suggest provide grounds for believing that navigational space may be three-dimensional rather than quasi–two-dimensional. Furthermore, we question the authors' interpretation of rat neurophysiological data as indicating that the vertical dimension may be encoded in a neural structure separate from the two horizontal dimensions.
We extend the discussion in the target article about distinctions between extrinsic coding and the alternative we and the target article both favor, intrinsic coding. Central to our thinking about intrinsic coding is population coding and the concept of high-dimensional neural response spaces.
High-hope and low-hope research participants (males and females), as preselected on the basis of a dispositional self-report scale, choose freely between brief audiotaped messages that varied in depressive content. In the first experiment, the messages were of either positive or negative content. Highhope as compared to low-hope persons preferred listening to the positive tapes (no differences related to Gender), and this Hope main effect remained after the shared variance related to depression and positive and negative affectivity were removed. In a (...) modified replication, the contents of the tapes were comprised of successful or unsuccessful goal-attainment statements related to hopeful thinking. High-hope as compared to low-hope persons again preferred to listen to the successful goal pursuit messages (no differences related to Gender), and this Hope main effect on listening choices remained after the shared variances related to depression, positive and negative affectivity, and self-esteem were removed. Implications are discussed. (shrink)
Activists’ investigations of animal cruelty expose the public to suffering that they may otherwise be unaware of, via an increasingly broad-ranging media. This may result in ethical dilemmas and a wide range of emotions and reactions. Our hypothesis was that media broadcasts of cruelty to cattle in Indonesian abattoirs would result in an emotional response by the public that would drive their actions towards live animal export. A survey of the public in Australia was undertaken to investigate their reactions and (...) responses to. The most common immediate reaction was feeling pity for the cattle. Women were more likely than men to feel sad or angry. Most people discussed the media coverage with others afterwards but fewer than 10 % contacted politicians or wrote to newspapers. We conclude that the public were emotionally affected by the media coverage of cruelty to cattle but that this did not translate into significant behavioral change. We recommend that future broadcasts of animal cruelty should advise the public of contact details for counseling and that mental health support contacts, and information should be included on the websites of animal advocacy groups to acknowledge the disturbing effect animal cruelty exposes can have on the public. (shrink)
This paper attempts to outline some of the important concepts and ideas used in system analysis which is taken to be a general mode of analysis used in all sciences. Systems are seen from three perspectives: that involving the relationship between system and environment, that involving interaction between several systems, and that involving one type of system composed of other types of systems. The writers also discuss the concepts "structure" and "equilibrium" as they apply to system analysis, the point being (...) made that the use of these concepts in the social sciences has often been vague or even incorrect. (shrink)