This work proposes that pain meets the requirements of being characterized as a secondary quality, as it covers, like a color, a determined extension. The argument seeks to establish a literal pain-color analogy through an inquiry into the intensity and location of the pain. From the classic intensity/location relationship reported by patients with acute appendicitis, three degrees of pain are distinguished: mild, moderate, and severe. The objective is only achieved by examining the Body’s extensional determinations (primary quality) insofar as each (...) of these degrees of pain covers three particular measures. Once these three measures have been explored according to the perforation process (tissue damage), the work ends by identifying pain as a transcendent moment. (shrink)

Health care professionals’ and trainees’ conceptions of their responsibilities to patients can change over time for a number of reasons: evolving career goals, desires to serve different patient populations, and changing family obligations, for example. Some changes in conceptions of responsibility are healthy, but others express moral damage. Clinicians’ changes in their conceptions of what they are responsible for express moral damage when their responses to others express a meager, rather than robust, sense of what they (...) owe others. At least two important expressions of moral damage in the context of health care are these: callousness and divestiture. Callousness describes the poor condition of a clinician's capacity for moral perception; when her capacity to accurately appreciate features of moral relevance that configure others’ needs, vulnerabilities, and desert of care diminishes, such that she fails to respond with care to those for whom she has duties to care, she is callous. Callousness has been explored in detail elsewhere,1 and so the focus of this paper is divestiture. A clinician divests when the value of responding with care to others becomes less centrally and importantly constitutive of his personal and professional identity. Divestiture has important consequences for patients and health professions education, which I will explore here. (shrink)

I argue that communities have a moral responsibility to repair and prevent moral damage that some survivors of domestic violence may experience. This responsibility is grounded in those communities’ complicity in domestic violence and the moral damage that may result. Drawing on Claudia Card’s work on domestic violence, I first explain two forms of moral damage that some survivors may experience. These are: 1) normative isolation, or abusive environments that are marked by distorted (...) moral standards about the abuse itself, and 2) coerced self-betrayal, the coercive entrapment of the survivor’s agency, emotions, and beliefs to express the will of the abuser. Though the abuser is always the primary cause of abuse, I argue that survivors’ communities can contribute to a climate that facilitates domestic violence by, for instance, sustaining harmful norms about gender roles, shaming survivors, protecting abusers, and not wanting to interrupt “private matters.” When this complicity exists, I argue that communities have a moral responsibility to create structures that repair and prevent moral damage from domestic violence. Finally, I sketch out some practical considerations for building these structures. These involve creating violence-resistant communities that protect survivors, hold abusers accountable, and help survivors reclaim their agencies. (shrink)

A critically revised Aristotelian-based virtue ethics has something potentially useful to offer to those engaged in analyzing oppression and creating liberatory projects. A critical virtue ethics can help clarify one of the ways in which oppression interferes with flourishing; specifically, it helps clarify an aspect of oppression that can be called "moral damage.".

The psychological and neurobiological processes underlying moral judgement have been the focus of many recent empirical studies1–11. Of central interest is whether emotions play a causal role in moral judgement, and, in parallel, how emotion-related areas of the brain contribute to moral judgement. Here we show that six patients with focal bilateral damage to the ventromedial prefrontal cortex (VMPC), a brain region necessary for the normal generation of emotions and, in particular, social emotions12–14, produce an abnor- (...) mally ‘utilitarian’ pattern of judgements on moral dilemmas that pit compelling considerations of aggregate welfare against highly emotionally aversive behaviours (for example, having to sacrifice one person’s life to save a number of other lives)7,8. In contrast, the VMPC patients’ judgements were normal in other classes of moral dilemmas. These findings indicate that, for a selective set of moral dilemmas, the VMPC is critical for normal judgements of right and wrong. The findings support a necessary role for emotion in the generation of those judgements. (shrink)

Neuroimaging studies of brain-damaged patients diagnosed as in the vegetative state suggest that the patients might be conscious. This might seem to raise no new ethical questions given that in related disputes both sides agree that evidence for consciousness gives strong reason to preserve life. We question this assumption. We clarify the widely held but obscure principle that consciousness is morally significant. It is hard to apply this principle to difficult cases given that philosophers of mind distinguish between a range (...) of notions of consciousness and that is unclear which of these is assumed by the principle. We suggest that the morally relevant notion is that of phenomenal consciousness and then use our analysis to interpret cases of brain damage. We argue that enjoyment of consciousness might actually give stronger moral reasons not to preserve a patient's life and, indeed, that these might be stronger when patients retain significant cognitive function. (shrink)

Neuroimaging studies of brain-damaged patients diagnosed as in the vegetative state suggest that the patients might be conscious. This might seem to raise no new ethical questions given that in related disputes both sides agree that evidence for consciousness gives strong reason to preserve life. We question this assumption. We clarify the widely held but obscure principle that consciousness is morally significant. It is hard to apply this principle to difficult cases given that philosophers of mind distinguish between a range (...) of notions of consciousness and that is unclear which of these is assumed by the principle. We suggest that the morally relevant notion is that of phenomenal consciousness and then use our analysis to interpret cases of brain damage. We argue that enjoyment of consciousness might actually give stronger moral reasons not to preserve a patient's life and, indeed, that these might be stronger when patients retain significant cognitive function. (shrink)

The Polluter Pays Principle (PPP) states that polluters should bear the burdens as- sociated with their pollution. This principle has been highly contested because of the pu- tative impossibility of considering individuals morally responsible for an important amount of their emissions. For the PPP faces the so-called excusable ignorance objec- tion, which states that polluters were for a long time non-negligently ignorant about the negative consequences of greenhouse gas emissions and, thus, cannot be considered morally responsible for their negative consequences. (...) This paper focuses on the concept of moral responsibility as it appears in the excusable ignorance objection. I claim that this objection stems from a narrow notion of moral responsibility and that a more fundamen- tal notion of moral responsibility would pave the way to overcome it. I show that it should be out of the question whether historical polluters should bear some burdens asso- ciated with climate change because of their historical emissions. The relevant question is which kind of burdens they can legitimately be asked to bear. I argue that this notion of moral responsibility allows us to assign burdens of symbolic reparation, which are at the core of ‘Loss and Damage’ policies. (shrink)

I explore how considerations about psychological damage connect with moral theories.

Despite a significant effort to reduce civilian casualties, a large number of civilians have been killed and injured by the military forces of the Western powers undertaking military operations in remote regions. However, there is no requirement in the just war tradition (JWT) and international humanitarian law (IHL) to provide reparation for the victims of unintended and proportional attacks. This article seeks to establish moral grounds for responsibility to provide reparation for “collateral damage” by focusing on the distinct (...) characteristics of expeditionary intervention and supplementing JWT with the frameworks of corrective justice and restorative justice. We propose that the elective, non-reciprocal, and asymmetrical natures of expeditionary interventions give rise to a special obligation to provide reparation for the civilian harms permitted by the JWT, on the basis of the fair distribution of risks and the need to restore damaged relationships. (shrink)

Despite a significant effort to reduce civilian casualties, a large number of civilians have been killed and injured by the military forces of the Western powers undertaking military operations in remote regions. However, there is no requirement in the just war tradition (JWT) and international humanitarian law (IHL) to provide reparation for the victims of unintended and proportional attacks. This article seeks to establish moral grounds for responsibility to provide reparation for “collateral damage” by focusing on the distinct (...) characteristics of expeditionary intervention and supplementing JWT with the frameworks of corrective justice and restorative justice. We propose that the elective, non-reciprocal, and asymmetrical natures of expeditionary interventions give rise to a special obligation to provide reparation for the civilian harms permitted by the JWT, on the basis of the fair distribution of risks and the need to restore damaged relationships. (shrink)

A sophisticated and intellectually powerful analysis of culpability and moral responsibility in war, This book focuses on the causes of many episodes of foreseeable collateral damage. Trenchant, original, and ranging across security studies, international law, ethics, and international relations, Accountability for Killing will reshape our understanding of the ethics of contemporary war.

Michael Cholbi thinks that the claim that motive internalism (MI), the thesis that moral beliefs or judgments are intrinsically motivating, is the best explanation for why moral beliefs are usually accompanied by moral motivation. He contests arguments that patients with ventromedial (VM) frontal brain damage are counterexamples to MI by denying that they have moral beliefs. I argue that none of the arguments he offers to support this contention are viable. First, I argue that given (...) Cholbi's own commitments, he cannot account for VM patients' behavior without attributing moral beliefs to them. Secondly, I show that his arguments that we should not believe their self-reports are unconvincing. In particular, his argument that they cannot self-attribute moral beliefs because they have a defective theory of mind is flawed, for it relies upon a misreading of both the empirical and theoretical literatures. The avenues remaining to Cholbi to support motive internalism are circular, for they rely upon an internalist premise. I provide an alternative picture consistent with neuroscientific and psychological data from both normals and those with VM damage, in which connections between moral belief and motivation are contingent. The best explanation for all the data is thus one in which MI is false. (shrink)

Moral judgments, whether delivered in ordinary experience or in the courtroom, depend on our ability to infer intentions. We forgive unintentional or accidental harms and condemn failed attempts to harm. Prior work demonstrates that patients with damage to the ventromedial prefrontal cortex deliver abnormal judgments in response to moral dilemmas and that these patients are especially impaired in triggering emotional responses to inferred or abstract events, as opposed to real or actual outcomes. We therefore predicted that VMPC (...) patients would deliver abnormal moral judgments of harmful intentions in the absence of harmful outcomes, as in failed attempts to harm. This prediction was confirmed in the current study: VMPC patients judged attempted harms, including attempted murder, as more morally permissible relative to controls. These results highlight the critical role of the VMPC in processing harmful intent for moral judgment. (shrink)

This article focuses on the ethical implications of so-called ‘collateral damage’. It develops a moral typology of collateral harm to innocents, which occurs as a side effect of military or quasi-military action. Distinguishing between accidental and incidental collateral damage, it introduces four categories of such damage: negligent, oblivious, knowing and reckless collateral damage. Objecting mainstream versions of the doctrine of double effect, the article argues that in order for any collateral damage to be morally (...) permissible, violent agents must comply with high standards of care. In order for incidental harm to be permissible, an agent must take pains to avoid such harm even at higher cost to him- or herself. It is argued that accidentally but negligently caused collateral damage may be just as difficult to excuse as incidental harm. Only if high precautionary standards of care are met, can unintended harm to innocents – incidental or accidental – be permissible. In practice, such a strong commitment to avoiding harm to civilians may well lead us to question more generally and rethink more radically how violent conflicts ought to be fought, how military violence ought to be used and whether there are better ways of achieving those aims that we think are legitimate than those we are currently using. (shrink)

Review of Neta C. Crawford's "Accountability for Killing: Moral Responsibility for Collateral Damage in America's Post-9/11 Wars".

Many morally important facts about the way we affect one another, in particular the psychological damage we can inflict, are hard to imagine .

Hilde Lindemann Nelson focuses on the stories of groups of people--including Gypsies, mothers, nurses, and transsexuals--whose identities have been defined by those with the power to speak for them and to constrain the scope of their actions. By placing their stories side by side with narratives about the groups in question, Nelson arrives at some important insights regarding the nature of identity. She regards personal identity as consisting not only of how people view themselves but also of how others view (...) them. These perceptions combine to shape the person's field of action. If a dominant group constructs the identities of certain people through socially shared narratives that mark them as morally subnormal, those who bear the damaged identity cannot exercise their moral agency freely.Nelson identifies two kinds of damage inflicted on identities by abusive group relations: one kind deprives individuals of important social goods, and the other deprives them of self-respect. To intervene in the production of either kind of damage, Nelson develops the counterstory, a strategy of resistance that allows the identity to be narratively repaired and so restores the person to full membership in the social and moral community. By attending to the power dynamics that constrict agency, Damaged Identities, Narrative Repair augments the narrative approaches of ethicists such as Alasdair MacIntyre, Martha Nussbaum, Richard Rorty, and Charles Taylor. (shrink)

describes connections between a series of related papers.

Our ethical obligations to another being depend at least in part on that being’s capacity for a mental life. Our usual approach to inferring the mental state of another is to reason by analogy: If another being behaves as I do in a circumstance that engenders a certain mental state in me, I conclude that it has engendered the same mental state in him or her. Unfortunately, as philosophers have long noted, this analogy is fallible because behavior and mental states (...) are only contingently related. If the other person is acting, for example, we could draw the wrong conclusion about his or her mental state. In this article I consider another type of analogy that can be drawn between oneself and another to infer the mental state of the other, substituting brain activity for behavior. According to most current views of the mind–body problem, mental states and brain states are non-contingently related, and hence inferences drawn with the new analogy are not susceptible to the alternative interpretations that plague the behavioral analogy. The implications of this approach are explored in two cases for which behavior is particularly unhelpful as a guide to mental status: severely brain–damaged patients who are incapable of intentional communicative behavior, and nonhuman animals whose behavioral repertoires are different from ours and who lack language. (shrink)

Edmund Pellegrino claims that medical ethics must be derived from a perception of the patient's damaged humanity, rather than from the self-imposed duties of professionals. This essay explores the meaning and examines the challenges to this patient-centered ethic. Social scientific and bioethical interpretations of medicine constitute one kind of challenge. A more pervasive challenge is the ascendancy of managed care, and especially investor-owned, for-profit managed care. A list of questions addressed to patients, physicians and organizations is offered as one means (...) of assessing this threat and moving toward morally trustworthy relationships. (shrink)

There has been little scholarly attention given to explaining exactly how and why Socrates thinks that wrongdoing damages the soul. But there is more than a simple gap in the literature here, we shall argue. The most widely accepted view of Socratic moral psychology, we claim, actually leaves this well-known feature of Socrates’ philosophy absolutely inexplicable. In the first section of this paper, we rehearse this view of Socratic moral psychology, and explain its inadequacy on the issue of (...) the damaging consequences of wrongdoing. We then go on to provide our own account of the way in which injustice damages the soul, and then draw conclusions about how Socratic moral psychology should be understood. (shrink)

It has long been known that brain damage has important negative effects on one’s mental life and even eliminates one’s ability to have certain conscious experiences. It thus stands to reason that when all of one’s brain activity ceases upon death, consciousness is no longer possible and so neither is an afterlife. It seems clear that human consciousness is dependent upon functioning brains. This essay reviews some of the overall neurological evidence from brain damage studies and concludes that (...) our argument from brain damage has been vindicated by such overwhelming evidence. It also puts forth a more mature philosophical rationale against an afterlife and counters several replies to the argument. -/- 1. Philosophical Background -- 2. The Dependence of Consciousness on the Brain: Some Preliminary Evidence -- 3. Brain Damage, Lesion Studies, and the Localization of Mental Function - 3.1 Perception - 3.2 Awareness, Comprehension, and Recognition - 3.3 Memory - 3.4 Personality - 3.5 Language - 3.6 Emotion - 3.7 Decision-Making - 3.8 Social Cognition and Theory of Mind - 3.9 Moral Judgment and Empathy - 3.10 Neurological Disorders and Disease - 3.11 The Unity of Consciousness -- 4. Objections and Replies - 4.1 Souls, Minds, and Energy Fields - 4.2 The Instrument Theory - 4.3 The Embodied Soul Alone is Affected -- 5. Conclusion. (shrink)

In this article, I argue that victims of domestic violence characteristically suffer from two distinct kinds of moral harm: moral damage and moral injury. Moral damage occurs when the ability to develop or sustain good moral character has been compromised by an agent’s circumstances. Moral injury refers to a kind of psychological anguish that follows from when an agent causes or becomes causally implicated in actions that we ordinarily would understand to be (...) morally grievous offenses because of their circumstances. A person can experience moral damage or moral injury separately, but the experiences of moral damage and moral injury can also overlap. Because abusers often expect victims to adopt morally deficient dispositions and often implicate victims in wrongdoing, I argue that victims of domestic violence characteristically suffer from both moral damage and moral injury. By appreciating the different yet overlapping moral experiences of the victim, we become better positioned to identify strategies for responding to and repairing the different harms they suffer. (shrink)

After offering an opening consideration of the hazards of neoliberalism, I address the general shape of the crisis of care that has evolved under its auspices. Two aspects of this crisis require greater attention: the moral precarity of caregivers and the relational harms of neoliberal capitalism. Thus, I first consider the moral precarity that caregivers experience by drawing on a concept that originates in scholarly work on the experiences of healthcare workers and combat veterans, namely, moral injury. (...) Through this concept, we can see how caregivers in late-stage capitalism face a seemingly unavoidable violation of their own significant moral beliefs. Second, I examine how the crisis of care results not only in individual harms of moral injury but also in harms to relationships themselves, as I continue to track the impact of moral injury on our intrapersonal and interpersonal lives. Ultimately, I argue that an important facet of the crisis of care is how it operates as a crisis of relationality in which our intrapersonal and interpersonal connections are placed under practical and moral strain. In taking a broader view, we can see how the fraying of particular intrapersonal and interpersonal connections can accumulate, resulting in the unraveling of wider webs of interdependency, just when we need them most. Throughout the paper, I zero in on the moral implications of the crisis of care driven by neoliberalism, featuring the damages that caregivers and their relationships sustain when situated in morally precarious ways. In doing so, I drive home the point that the crisis of care under neoliberalism is as much a moral and relational crisis as it is a political and economic one. (shrink)

Richard McCormick justified his move to proportionalism in part because of the perceived inadequacy of the Grisez-Finnis approach to morality to answer the following question: “What is to count for turning against a basic good, and why?” In this paper, I provide the beginnings of an account of what it means to intend damage to a good; I then show that the account is readily exportable to judgments regarding killing and lying defended by Grisez and others. I then indicate (...) that the account comports well with some of what Grisez says about sexual morality and suggest areas in which further clarification is necessary. In thus proceeding, I hope to inoculate the Grisez view from McCormick's reservations. (shrink)

Contemporary development goals of the Philippines, like those of many post-colonial states in the Third Word, strongly emphasize the need to catch up with the living standards of western industrialized countries. This article argues that following the western model of development through industrialization can only exacerbate existing socio-economic and ecological problems. The article contends that an historically appropriate and total development should aim for a reconstitution of natural, social, and moral ecologies. Drawing from historical sources, the first part of (...) the article examines the ecological consequences of Spanish colonization in order to provide the rationale for a definition of development as a reconstitution of damaged ecologies. The second part propose that the ethics of post-colonial development should be based on equality of access to life-sustaining resources and the transformation of values. The article conceptualizes ethics as a social discourse that defends human communities from further environmental and social degradation. (shrink)

The clinical literature on moral injury sometimes mentions the making of amends as part of a possible treatment plan. However, it is typically unclear how clinicians are conceiving of the making of amends or “atonement,” particularly in the context of the debilitating cluster of symptoms known as moral injury. This chapter reviews some culturally prominent conceptions of atonement. It then raises a number of objections to these and recommends an alternative model – a “reconciliation theory” of atonement – (...) that can avoid these objections. This theory conceives of wrongdoing as damaging relationships among victims, wrongdoers, and communities, and of atonement as repairing this damage. Atonement for serious wrongdoing isn't easy, but it isn't impossible either. Atonement comes in degrees. When pursued well, it offers benefits to victims and communities as well as to wrongdoers themselves. (shrink)

Given the existence of “marginal human cases”, it is often argued that we must either acknowledge that some human beings have less moral status than some non-human animals, or commit to the idea that moral status is held by humans qua human. In this paper, the moves available on both sides are shown to be unsatisfactory, and an argument for moral status that avoids both of the standard positions is suggested. Ultimately, it is argued that the discussion (...) of moral status is confused when marginal human cases are seen as posing a unique, rather than a general, theoretical problem. (shrink)

This article aims to explore the concept of victimless damage. This refers to paradoxical cases where a perpetrator and a moral wrong can be easily identified, but where somehow the role of the victim as such can be questioned. In order to explore this concept, I will first offer a typology of cases that could be labelled under this umbrella concept—namely, cases of deceased victims, biotechnological or no-identity cases, and the ones related to lack of awareness due to (...) epistemic injustice. Then, after highlighting the common traits and discussing some fuzzy cases, I will flesh out the main arguments for and against of the existence of and need for this concept, on the basis of both moral objectivism and subjectivism. In my view, delving into these arguments could shed some light on the metaethical debate on the sine qua non conditions of moral damage and its relation to moral wrongness. Finally, I will conclude by advocating for the need to introduce a gradational concept of moral damage and the second-person perspective into moral philosophy in order to take into account potential cases of victimless damage, but without having to accept the premises of moral realism. (shrink)

Contrary to criticisms by Thomas McInerney, Durable Goods proposes a realistic and empirically testable “covenantal” ethic for moving management and labor beyond tactics of mutual coercion and evasion. Nonetheless, two questions asked by McInerney remain germane. First, should the moral claims of management and labor always receive equal moral consideration, as a matter of justice? To this substantive question Durable Goods admittedly provides a less than satisfactory answer. Second, can the normative theory proposed by Durable Goods, based in (...) part as it is on the Bible, meet the standards of cogency, coherence, and parsimony appropriate to business ethics as a field of rigorous inquiry? This methodological question remains unaddressed. (shrink)

Stereotypes are false or misleading generalizations about groups, generally widely shared in a society, and held in a manner resistant, but not totally, to counterevidence. Stereotypes shape the stereotyper’s perception of stereotyped groups, seeing the stereotypic characteristics when they are not present, and generally homogenizing the group. The association between the group and the given characteristic involved in a stereotype often involves a cognitive investment weaker than that of belief. The cognitive distortions involved in stereotyping lead to various forms of (...) moral distortion, to which moral philosophers have paid insufficient attention. Some of these are common to all stereotypes—failing to see members of the stereotyped groups as individuals, moral distancing, failing to see subgroup diversity within the group. Other moral distortions vary with the stereotype. Some attribute a much more damaging or stigmatizing characteristic (e.g. being violent) than others (e.g. being good at basketball). But the characteristic in question must also be viewed in its wider historical and social context to appreciate its overall negative and positive dimensions. (shrink)

Moral Repair examines the ethics and moral psychology of responses to wrongdoing. Explaining the emotional bonds and normative expectations that keep human beings responsive to moral standards and responsible to each other, Margaret Urban Walker uses realistic examples of both personal betrayal and political violence to analyze how moral bonds are damaged by serious wrongs and what must be done to repair the damage. Focusing on victims of wrong, their right to validation, and their sense (...) of justice, Walker presents a unified and detailed philosophical account of hope, trust, resentment, forgiveness, and making amends - the emotions and practices that sustain moral relations. Moral Repair joins a multidisciplinary literature concerned with transitional and restorative justice, reparations, and restoring individual dignity and mutual trust in the wake of serious wrongs. (shrink)

Following extended periods of conflict or repression, political reconciliation is indispensable to the establishment or restoration of democratic relationships and critical to the pursuit of peacemaking globally. In this book, Colleen Murphy offers an innovative analysis of the moral problems plaguing political relationships under the strain of civil conflict and repression. Focusing on the unique moral damage that attends the deterioration of political relationships, Murphy identifies the precise kinds of repair and transformation that processes of political reconciliation (...) ought to promote. Building on this analysis, she proposes a normative model of political relationships. A Moral Theory of Political Reconciliation delivers an original account of the failure and restoration of political relationships, which will be of interest to philosophers, social scientists, legal scholars, policy analysts, and all those who are interested in transitional justice, global politics, and democracy. (shrink)

This article offers suggestions for categorizing combat-related moral injuries, highlights possible causes of these injuries in veterans, and touches upon broadly-conceived measures to prevent and repair them. The first part identifies three prevailing definitions – lost trust, guilt, and harm to one’s capacity for right action and moral virtue – and argues for an emphasis on the latter. In service of highlighting areas for future empirical research and clinical awareness, the second part outlines possible veteran-related causes associated with (...) these three definitions, including unwarranted distrust of authorities, misapplying the theodicy problem to human acts, undue survivor’s guilt, wars that fail to meet ad bellum criteria, causing permissible collateral damage, and killing combatants without regret and for pleasure. The third part mentions strategies for preventing character harm, and then discusses the cognitive, rehabituative, and psychological aspects of moral repair. (shrink)

BackgroundMoral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes.MethodsA regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine (...) the level of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice.ResultsThe mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9).ConclusionsFemale, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals. (shrink)

Pietsch, Chelsea In a claim of negligence, plaintiffs must be able to prove that they have suffered some sort of damage or loss. Proving damage is usually a straightforward task which involves making a comparison between the plaintiff's position before and after the alleged negligence. However, what damage has been done if a doctor's negligence results in the conception and subsequent birth of a child? Is it ever possible to conceive of life as damage? These questions (...) must ultimately be addressed in wrongful birth claims where parents seek compensation for the conception and/or birth of a life that would not have existed but for the doctor's negligent advice or treatment. However, they are not as easy for judges to answer as you may think. Judges have a duty to resolve such matters - not with reference to vague notions of 'common sense' or 'community interests' - but in accordance with established law. However, what if there is no statute or precedent that speaks on the matter? How should judges resolve such 'novel' issues? Can judges rely on 'common sense' or arguments about 'community interests' in these limited circumstances? The question of whether or not a child may be categorised as damage for the purpose of satisfying a claim in negligence is such an issue. In this essay I acknowledge that, in the absence of guiding legal rules and principles, judges have no choice but to resolve novel questions on grounds of policy considerations. I suggest, however, that a distinction should be made between legal and public policy and that reliance on the former, not the latter, may be used to assert that children are blessings, not injuries. While it may be morally desirable for the issue to end there, this is not the case. Legal policy has also developed the notion of reproductive autonomy in such a way that suggests the opposite may also be true. In an attempt to resolve these conflicting values, I propose the damage in wrongful birth cases is not the conception and/or birth of a child but rather a doctor's infringement on their patient's reproductive autonomy, which warrants legal recognition in the form of compensation. (shrink)

I set forth and defend an analysis of corporate moral responsibility (retrospective moral liability), which, I argue, ought to serve as the foundation for corporate legal responsibility, punishment, and compensation for environmental damage caused by corporations.

Current developments in empirical moral psychology have spawned a new perspective on the traditional metaethical question of whether moral judgment is based on reason or emotion. Psychologists and cognitive neuroscientists such as Joshua Greene argue that there is empirical evidence that emotion is essential for one particularly important subclass of moral judgments: so-called ?deontological judgments.? In this paper, I scrutinize this claim and argue that neither the empirical evidence for Greene's dual process-theory of moral judgment nor (...) the normative conclusions it is supposed to yield can be maintained. More specifically, I argue that the evidence from neuroimaging relies on a problematic reverse inference, that the behavioral data are flawed, and that the findings from focal brain damage do not support the model. From a normative point of view, Greene fails to show that we ought to discount the intuitions that give rise to deontological judgments because they respond to morally irrelevant factors: firstly, I show that they do not pick up on the factors Greene deems to be morally irrelevant in the first place, and secondly, I argue that there generally is reason to trust our deontological intuitions. (shrink)

BackgroundWhether patients in the vegetative state (VS), minimally conscious state (MCS) or the clinically related locked-in syndrome (LIS) should be kept alive is a matter of intense controversy. This study aimed to examine the moral attitudes of lay people to these questions, and the values and other factors that underlie these attitudes.MethodOne hundred ninety-nine US residents completed a survey using the online platform Mechanical Turk, comprising demographic questions, agreement with treatment withdrawal from each of the conditions, agreement with a (...) series of ethical principles and three personality tests.ResultsMore supported treatment withdrawal from VS (40.2 % agreed, 17.6 % disagreed) than MCS (20.6 %, 41.2 %) or LIS (25.3 %, 35.8 %). Agreement with treatment withdrawal was negatively correlated with religiosity (r = −0.272, P < 0.001), though showed no significant relationship with need for cognition or empathy, and only a partial association with utilitarian judgment in a standard moral dilemma. Support for treatment withdrawal was most strongly associated with endorsement of the importance of patient autonomy, dignity, suffering, best interests. Distributive justice was not given significant weight by most. Importantly, agreement with treatment withdrawal was noticeably higher when considered from a first as opposed to third person perspective for VS (Z = −6.056, P < 0.001), MCS (Z = −6.746, P < 0.001) and LIS (Z = −6.681, P < 0.001).ConclusionLay attitudes to withdrawal of treatment in brain damaged patients are largely shaped by values similar to those central to the secular ethical debate. Neither traditional values such as the sanctity of life nor utilitarian values relating to resource allocation seem to play a central role. Far greater weight is given to autonomy, which may explain why participants were far more willing to endorse withdrawal of treatment when the issue was presented in the first person, or in relation to a concrete case involving a patient’s explicit wishes. Surveys focusing on abstract cases presented in the third person may not provide an accurate picture of lay attitudes to these critical ethical questions. (shrink)

Moral distress has been covered extensively in the nursing literature and increasingly in the literature of other health professions. Cases that cause nurses’ moral distress that are mentioned most frequently are those concerned with prolonging the dying process. Given the standard of aggressive treatment that is typical in intensive care units (ICUs), much of the existing moral distress research focuses on the experiences of critical care nurses. However, moral distress does not automatically occur in all end-of-life (...) circumstances, nor does every critical care nurse suffer its damaging effects. What are the practices of these nurses? What specifically do they do to navigate around or through the distressing situations? The nursing literature is lacking an answer to these questions. This article reports a study that used narrative analysis to explore the reported practices of experienced critical care nurses who are skilled at and comfortable working with families and physicians regarding the withdrawal of aggressive treatment. A major finding was that these nurses did not report experiencing the dam-Moral Agency, Moral Imagination, and Moral Community: Antidotes to Moral Distress Terri Traudt, Joan Liaschenko, and Cynthia Peden-McAlpine Terri Traudt, MBC, MA, is a Communications Consultant specializing in bioethics at the Center for Bioethics at the University of Minnesota, in Minneapolis. [email protected] Joan Liaschenko, PhD, RN, FAAN, is a Professor at the Center for Bioethics and Nursing at the University of Minnesota. Cynthia Peden-McAlpine, PhD, ACNS, BC, is an Associate Professor in the School of Nursing at the University of Minnesota. © 2016 by The Journal of Clinical Ethics. All rights reserved. aging effects of moral distress as described in the nursing literature. The verbal communication and stated practices relevant to this finding are organized under three major themes: (1) moral agency, (2) moral imagination, and (3) moral community. Further, a total of eight subthemes are identified. The practices that constitute these themes and subthemes are further detailed and discussed in this article. Understanding these practices can help mitigate critical care nurses’ moral distress. (shrink)

Since Jonathan Shay's work with Vietnam veterans, moral injury has largely focused on the harm done to soldiers' moral character through their participation in warfare. This essay argues for the inclusion of noncombatants in the scope of inquiry involving moral injury. Specifically, it argues for the necessity of ordinary citizens assuming responsibility for the moral injury done to soldiers and civilians alike in the post‐9/11 wars.

The present and future rapid increase in the hospital population of geriatric patients is discussed with particular reference to the problem of advanced brain degeneration. The consequences of various clinical management options are outlined and it is suggested that extreme attempts either to preserve or terminate life are medically, morally and socially unacceptable. The preservation of life in senile patients has important economic consequences. In achieving a decision on the medical management of patients with advanced brain decay it is suggested (...) that substantial help would be derived from: knowledge of the previously declared wishes of individual patients; improvements in geriatric assessments; broader consultation with relatives, and greater use of inter-disciplinary discussion in the preparation of criteria for terminating medical efforts to maintain survival. (shrink)

This article offers suggestions for categorizing combat-related moral injuries, highlights possible causes of these injuries in veterans, and touches upon broadly-conceived measures to prevent and repair them. The first part identifies three prevailing definitions – lost trust, guilt, and harm to one’s capacity for right action and moral virtue – and argues for an emphasis on the latter. In service of highlighting areas for future empirical research and clinical awareness, the second part outlines possible veteran-related causes associated with (...) these three definitions, including unwarranted distrust of authorities, misapplying the theodicy problem to human acts, undue survivor’s guilt, wars that fail to meet ad bellum criteria, causing permissible collateral damage, and killing combatants without regret and for pleasure. The third part mentions strategies for preventing character harm, and then discusses the cognitive, rehabituative, and psychological aspects of moral repair. (shrink)

Moral legitimacy entails intrinsic value and helps executives convince firm’s stakeholders and the general public of the ethical acceptability of an institution or its activities or projects. Social license to operate is the social approval of those affected by a certain business activity, and it is receiving increasing attention, especially in the context of controversial projects such as mining and public works. Moral legitimacy provides ethical support to SLO. Drawing from the Aristotelian-Thomistic tradition and taking substantive justice and (...) the common good of society as the key references, this paper applies the Triple Font of Morality Theory and proposes four criteria which serve to evaluate moral legitimacy: contribution of the project or activity to the common good in a better way than other alternatives, morality of the means and procedures employed, ethical evaluation of the situation including stakeholder concerns and needs, and ethical evaluation of reasonably foreseeable consequences associated with the project and how to minimize possible damage or risks, and balance foreseeable negative consequences and benefits. The application of these criteria is illustrated through a project, presented as a case study, which certainly involved controversy and problems with SLO. The project was the construction of a rail tunnel for a high-speed train near the foundations of the Sagrada Familia, the well-known monumental church in Barcelona, Spain. (shrink)

Part 1. Introduction -- Introduction: Navigating the Perfect Moral Storm in Light of a Thirty-Five Year Debate -- Thirty-Five Year Climate Change Policy Debate -- Part 2. Priority Ethical Issues -- Ethical Problems with Cost Arguments -- Ethics and Scientific Uncertainty Arguments -- Atmospheric Targets -- Allocating National Emissions Targets -- Climate Change Damages and Adaptation Costs -- Obligations of Sub-national Governments, Organizations, Businesses, and Individuals -- Independent Responsibility to Act -- Part 3. The Crucial Role of Ethics in (...) Climate Change Policy Making -- Why Has Ethics Failed to Achieve Traction? -- Conclusion: Navigating the Perfect Moral Storm. (shrink)

John Harris recently argues that the moral bioenhancement proposed by Persson and Savulescu can damage moral agency by depriving the recipients of their freedom to fall (freedom to make wrongful choices) and therefore should not be pursued. The link Harris makes between moral agency and the freedom to fall, however, implies that all forms of moral enhancement, including moral education, that aim to make the enhancement recipients less likely to “fall” are detrimental to (...) class='Hi'>moral agency. In this paper, I present a new moral agency-based critique against the moral bioenhancement program envisaged by Persson and Savulescu. I argue that the irresistible influences exerted by the bioenhancement program harms our capabilities for conducting accurate self-reflection and forming decisions that truly express our will, which subsequently undermine our moral agency. (shrink)

With respect to questions of fact, people use heuristics – mental short-cuts, or rules of thumb, that generally work well, but that also lead to systematic errors. People use moral heuristics too – moral short-cuts, or rules of thumb, that lead to mistaken and even absurd moral judgments. These judgments are highly relevant not only to morality, but to law and politics as well. Examples are given from a number of domains, including risk regulation, punishment, reproduction and (...) sexuality, and the act/omission distinction. In all of these contexts, rapid, intuitive judgments make a great deal of sense, but sometimes produce moral mistakes that are replicated in law and policy. One implication is that moral assessments ought not to be made by appealing to intuitions about exotic cases and problems; those intuitions are particularly unlikely to be reliable. Another implication is that some deeply held moral judgments are unsound if they are products of moral heuristics. The idea of error-prone heuristics is especially controversial in the moral domain, where agreement on the correct answer may be hard to elicit; but in many contexts, heuristics are at work and they do real damage. Moral framing effects, including those in the context of obligations to future generations, are also discussed. (shrink)

Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and (...) communicating their values and responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life. (shrink)