Moral distress is now being recognized as a frequent experience for many health care providers, and there's good evidence that it has a negative impact on the health care work environment. However, contemporary discussions of moral distress have several problems. First, they tend to rely on inadequate characterizations of moral distress. As a result, subsequent investigations regarding the frequency and consequences of moral distress often proceed without a clear understanding of the phenomenon being discussed, and thereby risk substantially misrepresenting the (...) nature, frequency, and possible consequences of moral distress. These discussions also minimize the intrinsically harmful aspects of moral distress. This is a serious omission. Moral distress doesn't just have a negative impact on the health care work environment; it also directly harms the one who experiences it. In this paper, I claim that these problems can be addressed by first clarifying our understanding of moral distress, and then identifying what makes moral distress intrinsically harmful. I begin by identifying three common mistakes that characterizations of moral distress tend to make, and explaining why these mistakes are problematic. Next, I offer an account of moral distress that avoids these mistakes. Then, I defend the claim that moral distress is intrinsically harmful to the subject who experiences it. I conclude by explaining how acknowledging this aspect of moral distress should reshape our discussions about how best to deal with this phenomenon. (shrink)

La 4e de couv. indique : "Prenant ici toute l’initiative, Elisabeth Weber a choisi, en les présentant, vingt entretiens parmi tous ceux auxquels Jacques Derrida a participé depuis près de vingt ans. Elle s’est donné pour cela un certain nombre de critères, et d’abord celui de la diversité : celle des sujets (la question des femmes, la poésie, la drogue, le sida, l’enseignement, en particulier celui de la philosophie, et, croisant tous ces thèmes, la politique et les médias), celle des (...) tons (analytique ou joueur, militant ou « autobiographique »), celle des destinataires (en France, en Europe, Outre-Altantique).". (shrink)

Nair-Collins and Joffe (2023) rightly call attention to an incompatibility between brain-based criteria for death, as defined by the Uniform Determination of Death Act (UDDA), and what the current...

Volume 20, Issue 9, September 2020, Page 31-33.

Discharges against medical advice (AMA) make up a significant number of hospital discharges in the United States, and often involve vulnerable patients who struggle to obtain adequate medical care. Unfortunately, much of the AMA discharge process focuses on absolving the medical center of liability for what happens to these patients once they leave the acute setting. Comparatively little attention is paid to the ethical obligations of the medical team once an informed decision to leave the acute care setting AMA has (...) been made. Via a case narrative, we offer an ethical framework that we believe can help guide an ethically defensible AMA discharge process. By emphasizing our duty to provide the best care possible under the circumstances, we contend, our ethical obligations to promote the patient's best interests can still be met despite their decision to leave the acute setting against medical advice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"Everything is Breath":Critical Plant Studies' Metaphysics of MixtureElisabeth Weber (bio)In her book Braiding Sweetgrass: Indigenous Wisdom, Scientific Knowledge, and the Teachings of Plants, Robin W. Kimmerer contrasts two creation stories that are thoroughly incompatible. One starts with an all-powerful male creator calling the world and its vegetation and animals into existence through words, and forming the first human beings from clay; the other starts with Skywoman tumbling through the (...) air with seeds in her fist from the Tree of Life growing in Skyworld. One ends with the condemnation of woman to give birth in "very severe" pains, with the cursing of the ground ordered to "produce thorns and thistles" as punishment for man who will eat his food only after "painful toil," and the expulsion from the garden; the other ends in gratitude for the collective caring of the animals, with the creation of "a garden for the well-being of all." One includes an original fall from grace whose burden will be passed down from generation to generation; the other acknowledges suffering without a trace of the burden of unearned guilt. One predicts death as a return to the dust from whence mankind was created; the other imagines death as becoming plant and fruit, as becoming gift, a rejoining the spirits of all ancestors, human and others, who surround the living in everything that is. The threat of one is the inexorability of a trajectory "from dust to dust" and the latter's association, with Plato, of something so diffuse that it doesn't merit a concept or idea; the promise of the other is an abiding relationship with all that is, the reciprocity of giving and gratitude, and the gladly assumed responsibility for the "inspirited" land.Kimmerer comments:Same species, same earth, different stories. Like Creation stories everywhere, cosmologies are a source of identity and orientation to the world. They tell us who we are. We are inevitably shaped by them no matter how distant they may be from our consciousness. One story leads to the generous embrace of the living world, the other to banishment. One woman is our ancestral gardener, a cocreator of the good green world that would be the home of her descendants. The other was an exile, just passing through an alien world on a rough road [...].1 [End Page 117]Cosmologies express collective imaginairies that have evolved over hundreds, even thousands of years. The Iroquois story recounted and rendered accessible by Kimmerer is one of countless creation stories that constitute an "important genre in many preliterate traditions" (Zolbrod 5). Kimmerer suggests that even though the Judeo-Christian creation story may have receded into the background of Western collective consciousness, it plays a role in the planet's devastation. What strikes the reader in the story of Skywoman is the centrality of reciprocity, of relation, and, as the woman's name indicates, the significance of the sky. While this might mean, on planet Earth, the atmosphere–the Earth's sky is blue because of the surrounding atmosphere–the implications of the sky's preponderance reach beyond the planetary into the cosmological. The "sky is not what is above. The sky is everywhere: it is the space and the reality of mixture and movement, the definite horizon starting from which everything has to draw itself" (Coccia 218-219) in order to breathe and live.In order to continue to breathe, breathe in the long-term, the long-term, that is, as Barbara Kingsolver put it in one of her poems, "from a tree's / way of thinking" (7), non-human kin's "way of thinking" will need to play a role in humans' self-understanding. Kyle Whyte underlines that it is not enough to respond with urgency to specific ecological crises (fires, flooding, etc.) alone, but, rather, "urgency must be aimed at addressing ecological and relational tipping points together":U.S. settler colonialism, for example, in a short period of time, inflicted displacement, drastic ecological changes, and lost or disrupted relationships with hundreds of species that indigenous peoples depended on through kinship ties for generations. These changes are more extreme than what many nonindigenous persons fear most about moving beyond... (shrink)

In Welfare, Happiness, and Ethics, L.W. Sumner defends two significant constraints on one’s theory of welfare: formality and generality. An adequate theory of welfare, claims Sumner, must give a constitutive account of the “good-for” relation. This constitutive account must be sufficiently general that any entity whose status as a welfare subject is uncontroversial falls within its scope. This paper will argue that Sumner’s proposed constraints are particularly significant to utilitarian arguments for the equal moral considerability of non-human animals. In the (...) absence of these constraints, the inconsistency that is alleged to follow from denying moral considerability to non-human animals, while affirming it for humans, fails to obtain. I will focus on Peter Singer’s argument for the equal moral considerability of non-human animals, in order to support the conclusion that questions about the formality and generality of welfare are significant areas of further research for philosophers of animal welfare. (shrink)

Clare Palmer has recently argued that most humans have special obligations to assist domesticated animals, because domestication creates vulnerable, dependent individuals, and most humans benefit from the institution of domestication. I argue that Palmer has given us no grounds for accepting this claim, and that one of the key premises in her argument for this claim is false. Next, I argue that voluntarism, which is the view that one acquires special obligations only by consenting to those obligations in some way, (...) offers a plausible explanation of the sorts of cases that motivate Palmer’s analysis. I conclude that voluntarism allows us to explain the prevalent intuition that special obligations to assist often obtain for domesticated animals, but rarely obtain for wild animals. (shrink)

Taking its point of departure in a childhood memory of Derrida around raising silkworms, this essay explores the urgency invoked in the same memory of ‘conjuring green’. Following the polysemy of the French verb ( conjurer means to ‘ward off’, ‘cause (a spirit or ghost) to appear’, ‘implore’, and literally, ‘swear together’), the conjured green binds the child and later the writer surreptitiously to both the community and language of Islam, in which the colour green evokes the gardens of paradise, (...) and the infinitely differentiated proliferation of plants whose anthology encroaches upon and undermines any ontology. Along the meandering lines of Derrida’s meditation on the conjured, warded-off, mourned and celebrated green, the Qur’anic Muslim’s joy and radiance whose roots are the same as those for ‘vividness’ and ‘flourishing’, are grafted onto Hildegard von Bingen’s viriditas, the greening power or force which the German mystic Hildegard von Bingen understood as the living soul of creation; and Darwin’s discovery of the movement of plans as ‘circumnutation’, a Derridian term avant la lettre, that captures the dynamic of plants in Derrida’s Glas. (shrink)

Harrowing stories reported in the media describe Covid‐19 ravaging through families. This essay reports professional experiences of this phenomenon, family clustering, as encountered during the pandemic's spread across Southern California. We identify three ethical challenges following from it: Family clustering impedes shared decision‐making by reducing available surrogate decision‐makers for incapacitated patients, increases the emotional burdens of surrogate decision‐makers, and exacerbates health disparities for and the suffering of people of color at increased likelihood of experiencing family clustering. We propose that, in (...) response to these challenges, efforts in advance care planning be expanded, emotional support offered to surrogates and family members be increased, more robust state guidance be issued on ethical decision‐making for unrepresented patients, ethics consultation be increased in the setting of conflict following from family clustering dynamics, and health care professionals pay more attention to systemic and personal racial biases and inequities that affect patient care and the surrogate experience. (shrink)

John Searle claims that social-scientific laws are impossible because social phenomena are physically open-ended. William Butchard and Robert D’Amico have recently argued that, by Searle’s own lights, money is a social phenomena that is physically closed. However, Butchard and D’Amico rely on a limited set of data in order to draw this conclusion, and fail to appreciate the implications of Searle’s theory of social ontology with regard to the physical open-endedness of money. Money is not physically open-ended in the strong (...) sense that Butchard and D’Amico require, and their argument for the possibility of social-scientific laws fails as a result. (shrink)

" In this volume, the paradoxes, impossibilities, and singular chances that haunt the necessity of "living together" are evoked in Derrida's essay "Avowing--The Impossible: 'Returns,' Repentance, and Reconciliation," around which the ...

The prevalence of antibiotic resistant microbes has led to a call for new antibiotics development. Due to the irresponsible practices of the medical community in prescribing antibiotics, much of the demand for new antibiotics is suspect. I argue that the social contract, which properly includes human relationships with laboratory animals, requires a conservative attitude toward new antibiotics development. This attitude places limits on the justificatory role of demand in determining whether a particular research project meets the conditions for morally justified (...) research, as defined by Rollin’s utilitarian principle. (shrink)