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.

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.4 (2004) 411-425 [Access article in PDF] Vulnerability, Vulnerable Populations, and Policy Mary C. Ruof "Special justification is required for inviting vulnerable individuals to serve as research subjects and, if they are selected, the means of protecting their rights and welfare must be strictly applied."Guideline 13: Research Involving Vulnerable Persons International Ethical Guidelines for Biomedical Research Involving Human Subjects Council for International Organizations (...) of Medical Sciences (CIOMS) and World Health Organization (WHO) Geneva, Switzerland, 2002 Within medical research and healthcare certain groups are afforded special protections and services because of their designation as vulnerable. The vulnerable require special justification to participate in human subject research in order to eliminate potential human rights abuses. The Nuremberg Code of 1947 was written in response to the extreme human subject abuses that occurred under the Nazi regime, and, although the intent of the 1947 Code was to protect human rights, rigid voluntary consent requirements deprived some individuals of the right to participate in clinical trials. Recent human research guidelines, such as the CIOMS/WHO guidelines referenced above and the guidelines referenced in Section V of this Scope Note, attempt to balance both protection from abuse in research and access to new, experimental treatments for the vulnerable.Although various protective guidelines stipulate special protections for vulnerable populations, the concept of vulnerability and consequently the criteria designating vulnerable populations remain vague. Precisely who are the vulnerable? The word "vulnerability" stems from the Latin vulnerare, "to wound." (Oxford Encyclopedic English Dictionary 1995). In clinical research, the term [End Page 411] vulnerable generally is applied to individuals who are unable to give informed consent or who are susceptible to coercion. The Common Rule (45 CFR 46, Subpart A) includes as vulnerable research subjects: children, prisoners, pregnant women, and persons who are handicapped, mentally disabled, economically disadvantaged, or educationally disadvantaged. Although the Common Rule specifies certain vulnerable categories, the guidelines were not intended to be exclusive, leaving open the interpretation of vulnerability.In medical research and health policy, vulnerability is an abstract concept that has concrete effects both for those labeled vulnerable and for those not. Clinical researchers, healthcare workers, ethical reviewers, and policymakers must be able to identify vulnerable subjects to establish how healthcare resources will be allocated and who will qualify for special protections and socialized benefits. Attempts to quantify vulnerability in clear, measurable ways have met little if any consensus. As Alexander Morawa (II, 2003, p. 150) states, "There is no single approach to definition of vulnerability. In fact, there is no purposeful categorisation at all."Difficulties in defining vulnerability have prompted discourse surrounding its utility as a qualifying factor in the allocation of health resources and its appropriateness as a guiding principle in bioethics. Some of the authors cited in this Scope Note argue against the labeling and categorization of vulnerable individuals and populations. "Labeling individuals as 'vulnerable' risks viewing vulnerable individuals as 'others' worthy of pity, a view rarely appreciated" (III, Danis and Patrick 2002, p. 320). The categories of vulnerable groups listed under the Common Rule have been the source of controversy, "for example, many find the suggestion that pregnant women are vulnerable to be quite sexist" (IV, DeBruin 2001, p. 7). Instead of creating categories of vulnerable populations, would it not be better to derive an account of just treatment from a just social policy at large that encompasses human vulnerabilities (II, Brock 2002, p. 283).For some of the authors listed here, the concept of vulnerability is essential to bioethics. Robert Goodin (I, 1985, p. 107) writes that the vulnerability of other human beings is the source of our special responsibilities to them. In contrast to the four American principles of biomedical ethics—autonomy, nonmaleficence, beneficence, and justice—the four principles of European bioethics and biolaw include vulnerability along with autonomy, dignity, and integrity. According to, Jacob Dahl Rendtorff and Peter Kemp (I, 2000, p. 274) "the principle of vulnerability is ontologically prior to the other [European] principles, it expresses better than all of the other ethical principles... the finitude of the human condition."Some of the... (shrink)

This study examined the relationship between moral distress intensity, moral distress frequency and the ethical work environment, and explored the relationship of demographic characteristics to moral distress intensity and frequency. A group of 106 nurses from two large medical centers reported moderate levels of moral distress intensity, low levels of moral distress frequency, and a moderately positive ethical work environment. Moral distress intensity and ethical work environment were correlated with moral distress frequency. Age was negatively correlated with moral distress intensity, (...) whereas being African American was related to higher levels of moral distress intensity. The ethical work environment predicted moral distress intensity. These results reveal a difference between moral distress intensity and frequency and the importance of the environment to moral distress intensity. (shrink)

Just Life reorients ethics and politics around the generativity of mothers and daughters rather than the right to property and the sexual proprieties of the Oedipal drama. Invoking two concrete universals – everyone is born of a woman and everyone needs to eat – Rawlinson rethinks labor and food as relationships that make ethical claims and sustain agency. Just Life counters the capitalization of bodies under biopower with the solidarity of sovereign bodies.

While the history of philosophy has traditionally given scant attention to food and the ethics of eating, in the last few decades the subject of food ethics has emerged as a major topic, encompassing a wide array of issues, including labor justice, public health, social inequity, animal rights and environmental ethics. This handbook provides a much needed philosophical analysis of the ethical implications of the need to eat and the role that food plays in social, cultural and political life. Unlike (...) other books on the topic, this text integrates traditional approaches to the subject with cutting edge research in order to set a new agenda for philosophical discussions of food ethics. The Routledge Handbook of Food Ethics is an outstanding reference source to the key topics, problems and debates in this exciting subject and is the first collection of its kind. Comprising over 35 chapters by a team of international contributors, the Handbook is divided into 7 parts: the phenomenology of food gender and food food and cultural diversity liberty, choice and food policy food and the environment farming and eating other animals food justice Essential reading for students and researchers in food ethics, it is also an invaluable resource for those in related disciplines such as environmental ethics and bioethics. (shrink)

Feminist bioethics poses a challenge to bioethics by exposing the masculine marking of its supposedly generic human subject, as well as the fact that the tradition does not view womens rights as human rights. This essay traces the way in which this invisible gendering of the universal renders the other gender invisible and silent. It shows how this attenuation of the human in man is a source of sickness, both cultural and individual. Finally, it suggests several ways in which images (...) drawn from womens experience and womens bodies might contribute to a constructive rethinking of basic ethical concepts. (shrink)

Ornaments are the most common and ubiquitous art form of the Late Pleistocene. This fact suggests a common, fundamental function somewhat different to other kinds of Paleolithic art. While the capacity for artistic expression could be considerably older than the record of preserved art would suggest, beads signal a novel development in the efficiency and flexibility of visual communication technology. The Upper Paleolithic was a period of considerable regional differentiation in material culture, yet there is remarkable consistency in the dominant (...) shapes and sizes of Paleolithic beads over more than 25,000 years and across vast areas, even though they were made from diverse materials and, in the case of mollusc shells, diverse taxonomic families. Cultural and linguistic continuity cannot explain the meta-pattern. The evidence indicates that widespread adoption of beads of redundant form was not only about local and subregional communication of personal identity or group affinity, but also an expansion in the geographic scale of social networks. The conformity of the beads grew spontaneously and in a self-organizing manner from individuals’ interest in tapping into the network as a means for spreading social and environmental risk. (shrink)

ABSTRACT This essay focuses on two underlying presumptions that impinge on the effort of UNESCO to engender universal agreement on a set of bioethical norms: the conception of universality that pervades much of the document, and its disregard of structural inequalities that significantly impact health. Drawing on other UN system documents and recent feminist bioethics scholarship, we argue that the formulation of universal principles should not rely solely on shared ethical values, as the draft document affirms, but also on differences (...) in ethical values that obtain across cultures. UNESCO's earlier work on gender mainstreaming illustrates the necessity of thinking from multiple perspectives in generating universal norms. The declaration asserts the ‘fundamental equality of all human beings in dignity and rights’1 and insists that ‘the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition’2 yet it does not explicitly recognize disparities of power and wealth that deny equal dignity and rights to many. Without attention to structural (as opposed to merely accidental) inequities, UNESCO's invocation of rights is so abstract as to be incompatible with its avowed intention. (shrink)

After we die, our persona may live on in the minds of the people we know well. Two essential elements of this process are mourning and acts of commemoration. These behaviors extend well beyond grief and must be cultivated deliberately by the survivors of the deceased individual. Those who are left behind have many ways of maintaining connections with their deceased, such as burials in places where the living are likely to return and visit. In this way, culturally defined places (...) often serve as metaphors of social association and shared experience. Humans are the only kind of animal that buries their dead, and this gesture is preserved in Paleolithic sites as early as 120,000 years ago. Though not the only method of honoring the dead in human cultures, the emergence of burial traditions in the Middle Paleolithic implies that both Neandertals and early anatomically modern humans had already begun to conceive of the individual as unique and irreplaceable. Claims of primitive mortuary behavior in earlier periods than the Middle Paleolithic fall short in that they lack any signs of positive social-spatial associations between the deceased and survivors. The archaeological evidence for burial behavior in the Middle Paleolithic provides the first clear translation of mourning into a stereotypical action. These burials therefore may represent the first ritualized bridge between the living and the deceased in human evolutionary history. (shrink)

This paper investigates the exemplarity of medicine in Foucault's analyses of knowledge generally. By tracing the development of his concept of power and its relation to knowledge, it offers an account of Foucault's unconventional philosophical project. Finally, it specifies Foucault's strategy for undermining processes of normalisation.

Giving Voice To Values (GVV) serves as a framework to teach individuals methods to speak up when they witness actions that are contrary to their professional and personal values. This essay illustrates how GVV serves as a catalyst to advance both research and teaching activities.

Medical practice is animated by the intention to cure; it aims to relieve the immense variety of sufferings to which human beings are subject in virtue of the conditions of their embodied existence. My purpose here is to demonstrate how a philosophical analysis of the formal structures and kinds of human suffering provides an essential foundation for determining certain ethical dimensions of the physician's relation to his suffering patient. Can paternalism in medical practice be justified by the aim of relieving (...) suffering? What are the scope and limits of the patient's responsibility for his suffering, and what difference does this make in the physician's response to it? How is the suffering that medical treatment itself exacts in the name of cure to be justified? Such questions can be answered only by an analysis of the sense or value of suffering in human life. Keywords: suffering, sin, autonomy, paternalism, patient values CiteULike Connotea Del.icio.us What's this? (shrink)

Few works have had the impact on contemporary philosophy exerted by Hegel's Phenomenology of Spirit. Twentieth-century philosophers in France were bound together by a reading of Hyppolite's translation and commentary. Sartre, Merleau-Ponty, Lacan, and Bataille were all shaped by Kojève's lectures on the book. Late twentieth-century philosophers such as Derrida, Lyotard, Deleuze, and Irigaray all operate against a Hegelian horizon. Similarly, in Germany Heidegger, Adorno, and Habermas developed their philosophies in large part through an engagement with Hegel. In the United (...) States the book has had a profound influence on feminism and gender studies. Thinkers as diverse as Butler, Benhabib, Mills, and Honig have developed political theories as well as theories of sexual difference by rereading Hegel's reading of Antigone. As Derrida suggests, this text must be read. It lays out the infrastructures and architectures of life in the modern nation state. It unfolds a grand narrative of the ways of thinking and acting that comprise human experience in "our time." The purpose of the text is to effect a transformation in readers, so that they cease to think of themselves as particular humans and come to know that their existence inheres in membership in a complex community-social, cultural, economic, religious, aesthetic, and political infrastructures that form the culture of possibilities in which self-consciousness emerges and is sustained. Rawlinson's reading reveals how Hegel's politics of the "we" is undermined both by his effacement of sexual difference and by his misappropriation of art as a "betrayal of substance." Both of these gestures discount specificity in favor of a generic subject and a mutual recognition in which the other is the same. She uses Hegel's own critique of abstraction against him to rethink the "we" as a community of difference, figured materially in the differentiated styles or signatures of art, and in so doing argues that that the task of phenomenology is never completed and that the abstract concepts of logic will always be dependent on phenomenology's productive or generative movement. In her reading Hegel is neither a metaphysician nor a subjective idealist. He is a phenomenologist, analyzing experience to articulate the ways in which humans generate narratives and material infrastructures to sustain the complexities of life. (shrink)

Giving Voice To Values (GVV) serves as a framework to teach individuals methods to speak up when they witness actions that are contrary to their professional and personal values. This essay illustrates how GVV serves as a catalyst to advance both research and teaching activities.

What are the driving forces of cultural macroevolution, the evolution of cultural traits that characterize societies or populations? This question has engaged anthropologists for more than a century, with little consensus regarding the answer. We develop and fit autologistic models, built upon both spatial and linguistic neighbor graphs, for 44 cultural traits of 172 societies in the Western North American Indian (WNAI) database. For each trait, we compare models including or excluding one or both neighbor graphs, and for the majority (...) of traits we find strong evidence in favor of a model which uses both spatial and linguistic neighbors to predict a trait’s distribution. Our results run counter to the assertion that cultural trait distributions can be explained largely by the transmission of traits from parent to daughter populations and are thus best analyzed with phylogenies. In contrast, we show that vertical and horizontal transmission pathways can be incorporated in a single model, that both transmission modes may indeed operate on the same trait, and that for most traits in the WNAI database, accounting for only one mode of transmission would result in a loss of information. (shrink)

This article discusses two complementary themes that play an important role in contemporary South African political philosophy: (1) the racist tradition in Western philosophy; and (2) the role of ubuntu in regaining an authentic African identity, which was systematically suppressed during the colonial past and apartheid. These are also leading themes in Mogobe Ramose’s African Philosophy Through Ubuntu. The first part concentrates on John Locke. It discusses the thesis that the reprehensible racism of many founders of liberal political philosophy has (...) lethally infected liberal theory. This view neglects the distinction between genesis and justification. Political liberalism has since cleansed itself of the prejudices of its spiritual ancestors. Liberal human rights exclude racism as a matter of principle. The second part discusses the claim that the ubuntu philosophy provides a better basis for a constitution in a modern society than political liberalism. A major problem is that ubuntu is an essentially contested concept. Some philosophers consider ubuntu to be a moribund notion (Matolino); others see it as a vital concept par excellence. In the latter case, it is elaborated from sundry incompatible political views, ranging from African nationalism (Ramose) via humanist communitarianism (Metz) to liberalism (Mboti). Conclusion: as an essentially contested ideological concept, ubuntu should not be a decisive constitutional standard for the application of state force. In contrast, the constitutional model of political liberalism provides a reasonable alternative, as it is designed precisely to solve the problem of social plurality and ideological contest. (shrink)

Universals are a class of mind independent entities, usually contrasted with individuals, postulated to ground and explain relations of qualitative identity and resemblance among individuals. Individuals are said to be similar in virtue of sharing universals. An apple and a ruby are both red, for example, and their common redness results from sharing a universal. If they are both red at the same time, the universal, red, must be in two places at once. This makes universals quite different from individuals, (...) and controversial. (shrink)

Studies of consumer complaint behavior have shown that many elderly consumers are very reluctant to pursue their rights through the complaint process when they encounter problems with products or services. This passive complaint behavior may be very costly to the elderly, who often live on fixed incomes. This paper presents a theory developed in experimental psychology that may help explain why clderly consumers are more likely than other consumers to incur losses rather than engage in complaint activity. The theory, known (...) as learned helplessness (LH), refers to a process whereby noncontingent reinforcement produces the expectation that events are uncontrollable.The theory of learned helplessness is presented and related to specific behaviors of dissatisfied elderly consumers that have been reported in the literature. Strategy implications of the theory are discussed for counselors, consumer affairs practitioners, and others interested in helping elderly consumers exercise their rights. (shrink)

The purpose of this exploratory and descriptive study was to examine old-age dementia in the Hmong community of Milwaukee, Wisconsin. Formal and informal Hmong leaders were interviewed to determine the prevalence of dementia in the Hmong community and how it is perceived and experienced. Interviews revealed few cases of dementia among the Hmong. Dementia was perceived as a natural part of the life cycle, rather than as a devastating disease that robs individuals of their autonomy. Treatment is not sought for (...) dementia. Some of the common manifestations of dementia, such as wandering and combativeness, were rare or non-existent in the Hmong community. Individuals with dementia are cared for in their sons' homes. Nursing home placement in advanced dementia was only acceptable if sanctioned by the entire extended family. Further research on the Hmong perception of and experience with dementia needs to be conducted in other Hmong communities to validate the generalizability of these results. (shrink)

Corine Pelluchon is professor of philosophy at Paris-Est-Marne-La-Vallée and one of the foremost feminist political philosophers and bioethicists in France. Her major works, which have been translated into Spanish, German, Korean, Greek, Italian, and Japanese, include L’autonomie brisée. Bioéthique et philosophie, La raison du sensible. Entretiens autour de la bioéthique, and Eléments pour une éthique de la vulnérabilité. Les hommes, les animaux, la nature.Recently, Bloomsbury published a translation of Les...

Engaging the World explores Luce Irigaray’s writings on sexual difference, deploying the resources of her work to rethink philosophical concepts and commitments and expose new possibilities of vitality in relationship to nature, others, and to one’s self. The contributors present a range of perspectives from multiple disciplines such as philosophy, literature, education, evolutionary theory, sound technology, science and technology, anthropology, and psychoanalysis. They place Irigaray in conversation with thinkers as diverse as Charles Darwin, Claude Lévi-Strauss, Gilles Deleuze, René Decartes, and (...) Avital Ronell. While every essay challenges Irigaray’s thought in some way, each one also reveals the transformative effects of her thought across multiple domains of contemporary life. (shrink)

The U.S. Centers for Disease Control and Prevention (CDC 2015) estimates that 35 percent of American adults are obese, while 69 percent are overweight. The CDC also estimates that nearly one in every five children in the United States is obese. The National Bureau of Economic Research estimates that medical treatments of obesity cost US$168.4 billion a year, or 16.5 percent of national spending on medical care (Cawley and Meyerhoefer 2010). Public Health England (n.d.) estimates that 25 percent of the (...) adult population in England is considered obese, while 62 percent of adults are overweight. The World Health Organization (WHO) estimates that in North America, large portions of Central and South America, most of Europe, Russia, and Australia, 60 percent of the population is overweight. The United States and the United Arab Emirates have the highest obesity rates, according to the WHO, at 32.6 and 33.8 percent, respectively. The rest of North America, those large portions of Central and South America, Europe, Russia, and Australia exhibit rates over 20 percent (WHO n.d.). (shrink)

As Brillant-Savarin remarked in 1825 in his classic text Physiologie du Goût, “Tell me what you eat, and I will tell you who you are.” Philosophers and political theorists have only recently begun to pay attention to food as a critical domain of human activity and social justice. Too often these discussions treat food as a commodity and eating as a matter of individual choice. Policies that address the global obesity crisis by focusing on individual responsibility and medical interventions ignore (...) the dependency of human agency on a culture of possibilities. -/- The essays collected here address this lack in philosophy and political theory by appreciating food as an origin of human culture and a network of social relations. They show how an approach to the current global obesity epidemic through individual choice deflects the structural change that is necessary to create a culture of healthy eating. Analyzing the contemporary food crises of obesity, malnutrition, environmental degradation, and cultural displacement as global issues of public policy and social justice, these essays display the essential interconnections among issues of social inequity, animal rights, environmental ethics, and cultural identity. They call for new solidarities and new public policies to ensure the sustainable practices necessary to the production and distribution of wholesome and satisfying food. -/- Lévi-Strauss located the origin of ethics in table manners. By learning what and how to eat, humans learned respect for others, for the earth, and for the other forms of life that sustain human existence. Lévi-Strauss fears that in our time this “lesson in humility” coursing throughout the mythologies of “savage peoples” may have been forgotten, so that the world is treated as a thing to be appropriated and the extinction of species and cultures as an inevitable result of the ascendancy of global capital. This volume makes clear the need to change the way we eat, if we are to live on the earth together with what Lévi-Strauss calls “decency and discretion.”. (shrink)

Labor and Global Justice combines conceptual and theoretical perspectives across a multiplicity of relevant differences, both geographical and disciplinary, to develop a transnational perspective on labor and justice and to make clear how justice requires a rethinking of the relation between labor and global capital.

Dear IJFAB Readers,This tenth anniversary issue of IJFAB will be the last to appear under the Stony Brook masthead. In 2007, on the day of the blizzard that came to be known as the St. Patrick’s Day Snowstorm, the “protoeditorial board” met at Stony Brook Manhattan to begin creating IJFAB. We were guided in this endeavor by the late, great Anne Donchin, a cofounder of FAB as well as a beloved mentor and friend. As a philosopher, Anne held that concepts (...) imply practical commitments or creeds. She had a very clear idea of the creed of FAB, and she meant, through her gentle but firm guidance, to see that IJFAB adhered to it.1First, IJFAB was always to maintain an international or transnational perspective. Urgent... (shrink)

The territorial contraction and speaker-reduction undergone by the Welsh language during the past few centuries has resulted in its categorization by many linguists as an obsolescent language. This study illustrates that, although it is undeniably showing some signs of decline, Welsh stands in marked contrast to many previously documented cases of language death. Against this backdrop of contraction a steady revitalization is taking place. Based upon extensive fieldwork in two sociolinguistically contrasting communities, this book is the first to examine the (...) position and nature of contemporary Welsh with reference to both obsolescence-related developments and changes under way in the dialects. Jones focuses on immersion education, long heralded as the saviour of the language and, by examining the variety of Welsh being produced by immersion pupils, seeks to determine whether this claim is justified, or whether such pupils are in fact 'speaking immersion'. As well as discussing the recent linguistic change shown by contemporary Welsh within the language death framework, the author examines the ways in which the language has been standardized and their repercussions for language maintenance. By way of comparison these tensions and implications are also explored with reference to the other varieties of P-Celtic, namely Breton and Cornish. Series Information: Oxford Studies in Language Contact Series Editor: Professor Suzanne Romaine, Merton College, Oxford Series ISBN: 0-19-961466-0 Series Description: Most of the world's speech communities are multilingual, and contact between languages is thus an important force in the everyday lives of most people. Studies of language contact should therefore form an integral part of work in theoretical, social, and historical linguistics. This series makes available a collection of research monographs which present case studies of language contact around the world. As well as providing an indispensable source of data for the serious researcher, it contributes significantly to theoretical developments in the field. (shrink)