Background Rare diseases are generally poorly understood from scientific and medical standpoints due, to their complexity and low prevalence. As a result, individuals living with rare diseases struggle to obtain timely diagnoses and suitable care. These clinical difficulties add to the physical and psychological impacts of living with chronic and often severe medical conditions. From the standpoint of pragmatist ethics, the morally problematic situations that adults living with rare diseases experience matter crucially. However, there is little known (...) about these experiences.Methods A survey study was conducted with 121 adults living with rare diseases in Québec, Canada, to identify morally problematic situations encountered in the healthcare system and everyday life as part of a participatory action research project. Morally problematic situations elicited internal tensions and constraints to agency.Results Adults living with rare diseases experienced morally problematic situations of stigmatization, disbelief, and sometimes abuse in the healthcare system. These situations were compounded by diagnostic delays, inadequate care, and suboptimal follow-up, and led some individuals to opt-out of medical care. In their personal lives, these individuals sometimes found themselves in situations of physical and financial dependency. They often also had to give up professional occupations, academic training, or life projects.Conclusions Adults living with rare diseases experience important morally problematic situations navigating the healthcare system and their everyday lives, some of which could be alleviated through interventions developed through future participatory action research. (shrink)

Rare diseases, defined as having a prevalence inferior to 1/2000, are poorly understood scientifically and medically. Appropriate diagnoses and treatments are scarce, adding to the burden of living with chronic medical conditions. The moral significance of rare disease experiences is often overlooked in qualitative studies conducted with adults living with rare diseases. The concept of morally problematic situations arising from pragmatist ethics shows promise in understanding these experiences. The objectives of this study were to (1) acquire an (...) in-depth understanding of morally problematic situations experienced by adults living with rare diseases in the province of Québec and (2) to develop an integrative model of the concept of morally problematic situations. To this end, an online survey targeting this population was developed through a participatory action research project. Respondents provided 90 long testimonies on the most important morally problematic situations they faced, often in healthcare settings. An integrative model was developed based on various qualitative analyses of these testimonies and relevant literature. The integrative model showcases that morally problematic situations have causes (i.e., contextual and relational factors, personal factors, jeopardized valuations), have affective repercussions (i.e., emotions and feelings, internal tensions), prompt action (i.e., through empowerment strategies leading to the evolution of situations), and elicit outcomes (i.e., factual consequences, residual emotions and feelings, positive or negative resolutions). In sum, this study advances understanding of the moral experiences of adults living with rare diseases while proposing a comprehensive conceptual tool to guide future empirical bioethics research on moral experiences. (shrink)

Previous research on youths’ online risky experiences has mostly utilized quantitative designs. However, some of this research does not account for youths’ views and perceptions. This qualitative study fills this gap by describing online problematic situations from the perspectives of European youths, focuses on classifying online problematic situations based on youths’ perspectives and interrelates these with their developmental contexts. As a theoretical framework, the co-construction model was adopted, which proposes that youths’ online and offline worlds are (...) interconnected. Interviews and focus groups were conducted with youths between the ages of 9 and 16 from Belgium, the Czech Republic, Greece, Malta, Italy, Portugal, Romania, Spain, and the United Kingdom. Youths’ responses reflected the complexity of the various problematic situations online they encountered or indirectly experienced, and how such experiences were interconnected with the developmental contexts of peer relationships, parent-child relationships, romantic relationships, school, sexuality, identity, health, and morality. We recommend the development of complex educational programs focused on youths about problematic situations online, which discuss the possible situations they may encounter and how to deal with them. (shrink)

Most rare diseases are poorly understood, affected individuals struggle tobe timely diagnosed and to access tailored, appropriate, and affordablecare. Following pragmatist theory, individuals living with rare diseasesmay experience these obstacles as morally problematic situations, wherethey struggle with actualizing their cherished values amid their lifecircumstances. These embedded and contextualized lived episodes aredistinct from moral challenges and moral issues, which are more abstract,decontextualized, and speculative moral matters. We sought to uncoverthe moral matters of adults living with rare diseases in (...) the qualitativeliterature while elucidating the moral dimensions of morally problematicsituations. Moral matters were extracted from 25 qualitative studies andsubjected to thematic and interpretive analyses. The uncovered moralissues addressed abstract considerations relating to accessibility, limitedknowledge, and unpredictability of illness manifestations. Moralchallenges and morally problematic situations spanned across the fourphases of the medical trajectory: the diagnostic odyssey, the diagnosis,clinical care and treatment, and medical follow-up. Moral challengesnamely pertained to poor communication of diagnoses, lack of shareddecision-making, and lack of holistic support. Morally problematicsituations featured moral dimensions, namely (1) internal tensions (e.g.,being misunderstood), (2) constraints to agency (e.g., powerlessness anddisempowerment), in addition to (3) empowerment and selfadvocacystrategies (e.g., being assertive and demanding), notably in episodeswhere support from clinicians lacked. This study highlights the usefulnessof distinguishing these three types of moral matters in ethical analysis. Italso shows how moral dimensions of morally problematic situations carryexistential importance for affected individuals. (shrink)

Common understandings of neuroethics, i.e., of its distinctive nature, are premised on two distinct sets of claims: (1) neuroscience can change views about the nature of ethics itself and neuroethics is dedicated to reaping such an understanding of ethics; (2) neuroscience poses challenges distinct from other areas of medicine and science and neuroethics tackles those issues. Critiques have rightfully challenged both claims, stressing how the first may lead to problematic forms of reductionism while the second relies on debatable assumptions (...) about the nature of bioethics specialization and development. Informed by philosophical pragmatism and our experience in neuroethics, we argue that these claims are ill-founded and should give way to pragmatist reconstructions. Namely, neuroscience, much like other areas of empirical research on morality, can provide useful information about the nature of morally problematic situations but it does not need to promise radical and sweeping changes to ethics based on neuroscientism. Furthermore, the rationale for the development of neuroethics as a specialized field need not to be premised on the distinctive nature of the issues it tackles or of neurotechnologies. Rather, it can espouse an understanding of neuroethics as both a scholarly and a practical endeavor dedicated to resolving a series of problematic situations raised by neurological and psychiatric conditions. (shrink)

Taking multidimensional ethics scale approach, this article describes an empirical survey of top managers’ moral decision-making patterns and their change from 1994 to 2004 during morally problematic situations in the Finnish context. The survey questionnaire consisted of four moral dilemmas and a multidimensional scale with six ethical dimensions: justice, deontology, relativism, utilitarianism, egoism and female ethics. The managers evaluated their decision-making in the problems using the multidimensional ethics scale. Altogether 880 questionnaires were analysed statistically. It is concluded (...) that relying on the utilitarian principles is a core ethical evaluation criterion amongst top business managers in Finland. This study proves that managers’ moral decision-making patterns change over time. According to the results of this research, managers’ moral decision-making became more multidimensional during the study period. The change is explained by the inclusion of female ethics items in the scale which allows managers to show more diversity in their decision- making, the change in the Finnish economic context from depression to economic prosperity and growth during the study period, which is conducive to the spread of post materialist values, such as the importance of social relations and the increasing public discussion of the importance ethical issues in business. (shrink)

The development of increasingly intelligent and autonomous technologies will eventually lead to these systems having to face morally problematic situations. This gave rise to the development of artificial morality, an emerging field in artificial intelligence which explores whether and how artificial systems can be furnished with moral capacities. This will have a deep impact on our lives. Yet, the methodological foundations of artificial morality are still sketchy and often far off from possible applications. One important area of (...) application of artificial systems with moral capacities is geriatric care. The goal of this article is to afford the methodological foundations for artificial morality, i.e., for implementing moral capacities in artificial systems in general, and to discuss them with respect to an assistive system in geriatric care which is capable of moral learning. (shrink)

Background In this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored. Research design A qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used. Ethical considerations Approval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary. Findings Based on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or (...) moral doubt are included. Coercive administration of medicines, coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness. Conclusion Moral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves. (shrink)

This commentary is a response to Contextual Integrity as a General Conceptual Tool for Evaluating Technological Change by Elizabeth O’Neill (Philosophy & Technology (2022)). It argues that while contextual integrity (CI) might be an useful addition to the toolkit of approaches for ethical technology assessment, a CI approach might not be able to uncover all morally relevant impacts of technological change. Moreover, the inherent conservatism of a CI approach might be problematic in cases in which we encounter new (...) kinds of morally problematic situations, such as climate change, or when technology reinforces historically grown injustices. (shrink)

There have been recurrent reports of fragilities in the Brazilian health system, especially in public institutions. In this commentary, I argue that moral distress in nursing in Brazil can still be considered an innovative and important subject of study. I also highlight the relevance of engaging educational institutions in the development of policies about environmental sustainability. It is relevant to continue studying moral distress in nursing and in health care generally in order to contribute to the transformation of reality by (...) confronting the multiple common situations in the work environment that are recognized by many as morally problematic because they infringe upon the rights of people, patients, and health care professionals and are an affront to environmental health. (shrink)

The key to moral behavior is often perceived to consist of ignoring rational self-interest and instead following norms recommended by religious tradition and moral philosophy. A central issue is the connection between these ambitions and actual behavior. Are an idealistic mood and an ethics of ambition the way out of an iron cage of individualistic rational behavior? Or is ethics best served by rules and incitements in harmony with rationality? The article discusses morality from the perspective of compliance. A normative (...) suggestion in the Prisoner’s Dilemma exemplifies the case of prudent morality. The player should contribute if the expected value of that choice exceeds his payoff of mutual defection. The article questions the value of an absolute morality and suggests a morality that is more of a prudent policy than a categorical imperative. A conviction favoring a good average result in the long run is the most relevant argument for complying with a rule. The structure of economic games can give useful insights about problematic situations and consequences of different strategies. Being prudent rather than doing good might be a better policy not only for the agent, but also for organizations and society. (shrink)

There is agency in all we do: thinking, doing, or making. We invent a tune, play, or use it to celebrate an occasion. Or we make a conceptual leap and ask more abstract questions about the conditions for agency. They include autonomy and self-appraisal, each contested by arguments immersing us in circumstances we don’t control. But can it be true we that have no personal responsibility for all we think and do? Agency: Moral Identity and Free Will proposes that deliberation, (...) choice, and free will emerged within the evolutionary history of animals with a physical advantage: organisms having cell walls or exoskeletons had an internal space within which to protect themselves from external threats or encounters. This defense was both structural and active: such organisms could ignore intrusions or inhibit risky behavior. Their capacities evolved with time: inhibition became the power to deliberate and choose the manner of one’s responses. Hence the ability of humans and some other animals to determine their reactions to problematic situations or to information that alters values and choices. This is free will as a material power, not as the conclusion to a conceptual argument. Having it makes us morally responsible for much we do. It prefigures moral identity. Closely argued but plainly written, Agency: Moral Identity and Free Will speaks for autonomy and responsibility when both are eclipsed by ideas that embed us in history or tradition. Our sense of moral choice and freedom is accurate. We are not altogether the creatures of our circumstances. (shrink)

Moral distress names a widely discussed and concerning clinician experience. Yet the precise nature of the distress and the appropriate practical response to it remain unclear. Clinicians speak of their moral distress in terms of guilt, regret, anger, or other distressing emotions, and they often invoke them interchangeably. But these emotions are distinct, and they are not all equally fitting in the same circumstances. This indicates a problematic ambiguity in the moral distress concept that obscures its distinctiveness, its relevant (...) circumstances, and how individual clinicians and the medical community should practically respond to it. We argue that, in a range of situations that are said to be morally distressing, the characteristic emotion can be well‐understood in terms of what Bernard Williams calls “agent‐regret.” We show what can thereby be gained in terms of a less ambiguous concept and a more adequate ethical response to this distinctive and complex clinician experience. (shrink)

Rationality bashing has become a popular sport. Critiques have quite rightly challenged models of rational planning that follow a linear progression from predefined ends to achieved goals. There have been several alternative theoretical and empirical developments including incrementalist projects, network theories, critical communication approaches, and heuristic models. Notwithstanding critiques of linear models of policy-making and planning, rationality as a general idea remains an important reference point for designing and evaluating policy-making and for orientating planning projects. We suggest that the concept (...) of rationality needs to be revised rather than abandoned and this article discusses how rationality in decision making may be reconstructed. We first review and critique some of the main preconceptions of rationality in policy-making and planning. We then discuss the nature and purpose of rationality from the perspective of John Dewey’s pragmatist philosophy and in light of contemporary theoretical and empirical analyses. We position rationality as a procedural standard of excellence that evolves and informs practices in the context of problematic situations. We propose that a theory of rationality, as a guide for planning and policy, should be developed for application in concrete problematic situations and at the same time should play a normative role and be orientated to moral, socio-historical, and ecological considerations. Dewey’s pragmatist theory is a promising source for such considerations. In this article we identify four ‘pillars’ of pragmatism to support such a revised rationality construct: (i) situationality, (ii) normativity, (iii) philosophical via media between foundationalism and relativism, and (iv) democratic inquiry. We discuss the application of a pragmatist rationality, that we refer to as ‘situational transactive’ rationality, using a model of decision making that builds on current understandings in planning and policy science. Finally, we discuss some of the possible advantages and challenges of undertaking such a pragmatist revision of rationality. (shrink)

Experience machines, popularized in print by Robert Nozick and on the screen by the Wachowskis’ film The Matrix, provide highly or perfectly realistic experiences that are more pleasant and less painful than those generated in real life.1 The recent surge in virtual reality and neuro-prosthetic technologies is making the creation of real-world experience machines seem inevitable and perhaps imminent.2 Given the likelihood of the near-future availability of such machines, it behooves ethicists to consider the moral status of their potential uses. (...) In this chapter, we investigate the use of experience machines in palliative and end-of-life care situations. We pair up various kinds of experience machines with patients in a range of conditions, to illuminate the moral problems and benefits of using experience machines in this way. We argue that the use of Nozickian experience machines to treat patients in most conditions would be morally problematic, most notably for the negative effects on patients’ characters and real-world relationships. Informed by this initial moral analysis, we describe an experience machine that is more closely related to a virtual reality game, and argue that it can avoid the moral problems encountered by Nozickian experience machines. In fact, we argue that this new kind of experience machine could improve some patients’ characters and relationships with real-world people. We conclude that some kinds of experience machines could benefit many patients, especially those in extreme pain and those not in the position to meaningfully interact with their loved ones in reality. We also note that certain kinds of experience machines could be useful for religious people, for whom the range of palliative and end-of-life care options is often thought to be relatively narrow. (shrink)

ABSTRACT Pragmatism as a theoretical enterprise has been criticized since its inception for not having a coherent account of the role of power and violence in human affairs as well as a moral justification and criteria for marshaling arguments in favor of democracy. In this essay I approach recent developments in pragmatic democratic theory with those persistent criticisms in mind. Rather than lacking justificatory resources and underthematizing the role of violence and asymmetrical power relations, Robert Talisse's and James Bohman's works, (...) respectively, demonstrate the epistemological depth and power of updating pragmatism as a theory of situated and critical political inquiry. However, each could be extended by utilizing a more robust description of the problematic situation polities currently face. Specifically, I turn to Dewey for guidance in how our pragmatic epistemological and evaluative practices might incorporate the facts of our problematic situation. I do this in terms of the power structures of economic processes both in terms of contract and in terms of the intellectual discourses that attempt to scientifically describe these processes. (shrink)

The proliferation of prenatal genetic testing likely to follow from advances in genetic science invites reconsideration of the moral status of abortion. In this article I examine arguments surrounding the moral status of the fetus. I conclude that secular philosophy should ultimately admit that the moral status of the fetus is uncertain, and that this uncertainty itself makes abortion morally problematic. While this does not imply that abortion is always morally wrong or that it should be legally (...) prohibited, it does recommend a presumption in favor of preserving fetal life except in special circumstances. A relevant worry is that the rise of eugenic abortion gives new force to slippery slope arguments that we will be led down a path to a situation where more fetuses are terminated for relatively trivial reasons and that this will promote other bad social consequences. This might justify legislative discouragement of certain genetic interventions. (shrink)

At a time of acute danger, people commonly petition God for help for themselves or their loved ones; such as praying that an avalanche heading in one's direction be diverted, or that an organ donor be found for one's dying child. Such prayer seems natural and, indeed, for believers, reasonable and acceptable. It seems perverse to condemn such typical prayer, as wrong. But once we closely examine what is actually happening in such situations, we shall see that frequently prayer (...) of this sort is morally problematic. I argue that such prayer ought to be seen as a form of action (rather than, say, mere hope), thereby needing to meet the higher moral standards that apply to actions; and that the assumption of the benevolence of the deity does not suffice to make such prayer legitimate. (shrink)

This article reports on a survey of the moral problems that Dutch nurses experience during their everyday practice. A questionnaire was developed, based on published literature, panel discussions, in-depth interviews and participation observations. The instrument was tested in a pilot study and proved to be useful. A total of 2122 questionnaires were sent to 91 institutions in seven different health care settings. The results showed that nurses were not experiencing important societal issues such as abortion and euthanasia as morally (...) the most problematic, but rather situations such as verbally aggressive behaviour of colleagues towards patients, keeping silent about errors, and medical treatment given against the wishes of patients. Moral problems occurred especially when nurses experienced feelings of powerlessness with regard to the well-being of patients. Moreover, these moral problems proved to be related to institutional organization, leadership, and collaboration with colleagues and other disciplines. Nurses appeared to have a limited awareness of the moral dimensions of their practice. (shrink)

Moral dilemmas set a challenge for ethical theory. They are situations where agents seem to be under an obligation both to do, and to refrain from doing, a specific act. Are such situations possible? What is their exact nature? These are the questions that _Moral Dilemmas_ tries to answer. The book argues that moral theories should not allow for the possibility of irresolvable dilemmas, for situations in which no right answer exists. To this end, arguments seeking to (...) prove the existence of irresolvable dilemmas, especially the argument from the incommensurability of values, are discussed at length and refuted. The book shows that though on the normative level dilemmas are resolved, they typically involve a high moral cost for which there is no adequate compensation. This moral cost is the source of the regret and pain suffered by agents in moral dilemmas. Thus, moral dilemmas do not point to any inconsistency in our moral reasoning or theory, but to a problematic aspect of the human condition; at times (probably less often than is usually believed), human beings are justified, and even required, to dirty their hands by behaving in ways that in ordinary situations would be strictly forbidden and condemned. (shrink)

Dewey's understanding of growth is inseparably intertwined with his distinctively pragmatic understanding of the self-community relation and of knowledge as experimental. Within this framework, growth emerges as a process by which individual communities achieves fuller, richer, more inclusive, and more complex interactions with their environment by incorporating the perspective of "the other". Growth involves reintegration of problematic situations in ways which lead to expansion of self, of community, and of the relation between the two. In this way growth (...) and workability go hand in hand, for growth involves the resolution of conflict through reconstructive expansion of contexts which work in bringing about the desired resolution. And in this way growth and workability properly understood in their concrete fullness are inherently moral, and the ethical dimension of business decisions involves consideration of both. In this sense, pragmatism can hold that the ultimate goal in the nurturing of moral maturity, whether for individuals, communities, or corporations, is the development of the ability for ongoing self-directed growth. (shrink)

This article is about the recent and profound changes in the conceptualization of dementia, especially the turn towards prevention. The main argument is that more attention needs to be paid to “situated prevention” — the framing of internationally circulating data on the “new dementia” in different contexts. After introducing some of the more problematic issues related to the “new dementia,” a first comparison of major preventive clinical trials in Europe and in North America will be provided. The major insight (...) stemming from situating the global message of preventing dementia is recognition of the responsibility researchers and policy makers bear with respect to the implicit and potential moral narratives in emerging scientific landscapes. (shrink)

This article reports on a survey of the moral problems that Dutch nurses experience during their everyday practice. A questionnaire was developed, based on published literature, panel discussions, in-depth interviews and participation observations. The instrument was tested in a pilot study and proved to be useful. A total of 2122 questionnaires were sent to 91 institutions in seven different health care settings. The results showed that nurses were not experiencing important societal issues such as abortion and euthanasia as morally (...) the most problematic, but rather situations such as verbally aggressive behaviour of colleagues towards patients, keeping silent about errors, and medical treatment given against the wishes of patients. Moral problems occurred especially when nurses experienced feelings of powerlessness with regard to the well-being of patients. Moreover, these moral problems proved to be related to institutional organization, leadership, and collaboration with colleagues and other disciplines. Nurses appeared to have a limited awareness of the moral dimensions of their practice. (shrink)

The continuous inclusion of new technologies in organizations challenges business ethics and creates new problematics in work life. Managers in particular are challenged insofar as they must learn how to adapt general technological hardware to local organizational needs and work habits. Based on new empirical research conducted in Danish health care organizations, it investigates how managers experience technologies and how these experiences affect their professional ethics; it asks: a) What kinds of ethics do managers consider when using new technologies? b) (...) How are these ethics negotiated? Using a techno-human practice approach—which takes into account both human and non-human entities as the basis of moral judgment—the new technologically-induced ethical dilemmas faced by managers are discussed. A typology of techno-ethics is introduced, which presents situated ways of engaging with technologies in businesses. By employing multiple ethics connected to the use of technologies in organizations might make managers more ethically responsible in decisions concerning technologies. (shrink)

This article describes the results of research that investigated whether student nurses identified the moral aspects of everyday nursing care situations and, if so, how they dealt with them. We intended to elucidate the role of mentoring situations in moral development. Student written documents reflecting discussions during mentoring situations were analysed quantitatively and qualitatively. The students studied in one of the three nursing schools involved in the research. In only a small proportion of cases (<13%) did the (...) students identify the ethical questions in those situations. The results indicate that the nursing students rarely identified moral issues, implying that there was little conscious moral reflection and deliberation in their mentoring situations dealing with their problematic experiences during their internship. Additional competences will be required for session leaders in order to allow mentoring situations to play a more prominent role in moral development. (shrink)

This paper presents the results of training an artificial neural network (ANN) to classify moral situations. The ANN produces a similarity space in the process of solving its classification problem. The state space is subjected to analysis that suggests that holistic approaches to interpreting its functioning are problematic. The idea of a contributory or pro tanto standard, as discussed in debates between moral particularists and generalists, is used to understand the structure of the similarity space generated by the (...) ANN. A spectrum of possibilities for reasons, from atomistic to holistic, is discussed. Reasons are understood as increasing in nonlocality as they move away from atomism. It is argued that contributory standards could be used to understand forms of nonlocality that need not go all the way to holism. It is also argued that contributory standards may help us to understand the kind of similarity at work in analogical reasoning and argument in ethics. Some objections to using state space approaches to similarity are dealt with, as are objections to using empirical and computational work in philosophy. (shrink)

Background Over the past few decades, moral distress has been examined in the nursing literature. It is thought to occur when an individual has made a moral decision but is unable to act on it, often attributable to constraints, internal or external. Varying definitions can be found throughout the healthcare literature. This lack of cohesion has led to complications for study of the phenomenon, along with its effects to nursing practice, education and targeted policy development. Objectives The aim of this (...) analysis was to uncover unique definitions of moral distress as found in the nursing literature and to examine the relationship between these definitions. Research Design and Context Morse’s method of concept clarification was applied given the large body of literature which includes definitions, descriptions and measurements of the concept in research. The steps include (a) conducting a literature review; (b) analysing the literature; and (c) identifying, describing, comparing, and contrasting attributes, antecedents and consequences of each category. Findings Each of the 18 included studies described constraints in their definition of moral distress, whether implied or explicitly stated. External constraints are widely described as obstacles outside of the individual, whether institutional, systemic or situational, while internal constraints are located within the individuals themselves and are described as personal limitations, failings or weakness of will. Conclusion Upon reviewing these definitions, we determined that the term ‘internal constraints’ is problematic due to the emphasis of responsibility on the individual experiencing moral distress. We propose an alteration to ‘internal characteristics’ that will assume less responsibility of change from the individual to place a heavier onus on systemic and institutional constraints. (shrink)

The paper considers the problematic relation between a person and her action as it is expressed in the problem of blame and moral judgement. I argue that blaming someone for her action does affect our moral judgement of her, but does not imply condemnation of her moral character. I use the example of Dmitri Karamazov to show that a response to a particular situation, although shaped by the previous character of the person, does not follow from it and can (...) in turn affect and change the person's character by changing the way in which she perceives what is valuable. (shrink)

Recent medical and bioethics literature shows a growing concern for practitioners’ emotional experience and the ethical environment in the workplace. Moral distress, in particular, is often said to result from the difficult decisions made and the troubling situations regularly encountered in health care contexts. It has been identified as a leading cause of professional dissatisfaction and burnout, which, in turn, contribute to inadequate attention and increased pain for patients. Given the natural desire to avoid these negative effects, it seems (...) to most authors that systematic efforts should be made to drastically reduce moral distress, if not altogether eliminate it from the lives of vulnerable practitioners. Such efforts, however, may be problematic, as moral distress is not adequately understood, nor is there agreement among the leading accounts regarding how to conceptualize the experience. With this article I make clear what a robust account of moral distress should be able to explain and how the most common notions in the existing literature leave significant explanatory gaps. I present several cases of interest and, with careful reflection upon their distinguishing features, I establish important desiderata for an explanatorily satisfying account. With these fundamental demands left unsatisfied by the leading accounts, we see the persisting need for a conception of moral distress that can capture and delimit the range of cases of interest. (shrink)

Epistemic injustice has undergone a steady growth in the medical ethics literature throughout the last decade as many ethicists have found it to be a powerful tool for describing and assessing morally problematic situations in healthcare. However, surprisingly scarce attention has been devoted to how epistemic injustice relates to physicians’ professional duties on a conceptual level. I argue that epistemic injustice, specifically testimonial, collides with physicians’ duty of nonmaleficence and should thus be actively fought against in healthcare (...) encounters on the ground of professional conduct. I do so by fleshing out how Fricker’s conception of testimonial injustice conflicts with the duty of nonmaleficence as defined in Beauchamp and Childress on theoretical grounds. From there, I argue that testimonial injustice produces two distinct types of harm, epistemic and non-epistemic. Epistemic harms are harms inflicted by the physician to the patient qua knower, whereas non-epistemic harms are inflicted to the patient qua patient. This latter case holds serious clinical implications and represent a failure of the process of due care on the part of the physician. I illustrate this through examples taken from the literature on fibromyalgia syndrome and show how testimonial injustice causes wrongful harm to patients, making it maleficent practice. Finally, I conclude on why nonmaleficence as a principle will not be normatively enough to fully address the problem of epistemic injustice in healthcare but nevertheless may serve as a good starting point in attempting to do so. (shrink)

The study of social, ethical, and political issues from a naturalistic perspective has been pervasive in social sciences and the humanities in the last decades. This articulation of empirical research with philosophical and normative reflection is increasingly getting attention in academic circles and the public spheres, given the prevalence of urgent needs and challenges that society is facing on a global scale. The contemporary world is full of challenges or what some philosophers have called ‘existential risks’ to humanity. Nuclear wars, (...) natural and/or engineered pandemics, climate change, global totalitarianism, and emergent technologies, are some of the challenges mentioned by many authors devoted to the study of long-term potential risks for the survival of the human species. However, while there are many reasons to be a pessimist about the future of humanity, there is also a lot of ink wasted in showing that the world today is far better than we had in the past and also that there have been many instances of social and moral progress in the last centuries. Some authors have even claimed that “we have made more progress over the last 100 years than in the first 100,000”. According to ‘our world in data’, some of the most relevant advances of humanity in the last centuries have to do with the reduction of poverty and/or inequality, better health and security, the decline of violence and war, and the development of democracy and institutional mechanisms to guarantee individual freedom and rights. Yet, there is a more concrete concern that our world faces nowadays, and requires a particularly detailed analysis. In a few words, the advance in information and communication technologies, the huge volume of people migration because of prevalent instances of global inequality, and the reality of an interconnected world that just mirrors an extensive history of massive human intergroup relations open the question about the feasibility of social and moral progress in the contexts of diverse, multicultural, and unequal societies. This makes it crucial to reflect not only on whether human societies may keep advancing on a path of social progress, but how this can be achieved by addressing the challenges of inequality and potential intergroup conflict. This concern closely relates to the further consolidation of democratic values and the achievement of a more generalized consideration of the equal moral value of human individuals far from group, ethnic, or collective distinctions. This vision of progress follows the moral convictions that have been considered right and worthy to be pursued by most ethical theories explored by philosophers and social scientists so far. This work aims to contribute to the study of the mechanisms and feasibility of social and moral progress grounded on the precept of human equality and is guided by the idea that social and moral progress in a plural world requires the accomplishment of a more democratic and tolerant society. These forms of progress have already been defined by philosophers Allen Buchanan and Russel Powell as inclusivist forms of moral progress. According to these authors, inclusivist moral progress is featured by the transformation of moral judgments, motivations, and norms guided by the rejection of “group-based restrictions on moral standing and moral status” (2018). The work of Buchanan and Powell is fundamental for the argumentation developed in this work since they have pioneered a more complex debate in the field of evolutionary social sciences and philosophical anthropology. In brief, these authors have inquired how human nature, conceptualized by the advances in evolutionary thinking and the empirical sciences, is related to our moral convictions and the possibilities that we have to establish certain forms of social and moral progress. The work of Buchanan and Powell contributes to the debate on moral progress by incorporating empirically-informed concepts and arguments. With this objective in mind, they develop their discussion around a generalized tension between exclusivist and inclusivist forms of moral progress. This tension revolves around the question of whether and to what extent human moral concerns, motivations, and norms, are limited or bounded by social identities, group thinking, or collective values. This question is at the center of this work. In other words, I aim to answer whether and to what extent the nature of our social and moral cognition hinders or enables the development of inclusivist forms of morality and moral progress. As I mentioned so far, the distinction between exclusivist and inclusivist forms of morality has a practical implication and facilitates the reflection on the mechanisms and feasibility of concrete forms of progress based on the precept of human equality, which is the road to progress that we should follow according to most ethical theories. The distinction between exclusivist and inclusivist morality is not used here as a form of summarizing highly divergent descriptive approaches to morality, but as a way to address the practical implications of morality research, particularly around the question of the feasibility of social forms of progress based on the precept of equality and tolerance. My objective then has less to do with offering a conceptualization of human morality or with the proposition of a new ethical perspective. Instead, I aim to identify, from an empirically informed perspective, what enables the achievement of egalitarian forms of social progress, to subsequently offer a normative reflection about what we should do if we want to accomplish such inclusivist forms of progress. This task is of great relevance, having in mind that some theoretical proposals on the matter have claimed that human prosocial behavior and morality are constrained by exclusivist fixed tendencies as a product of our evolutionary history. According to these views, human morality is a group-centered cognitive and behavioral expression that has severe limits in its scope and extent, which hinders in the end the emergence of inclusivist forms of moral concerns and behaviors. These claims align with the philosophical intuition about the ‘dissociation of empathy’, or the fact that human individuals tend to express empathy and sympathy preferably for members of their group whereas their empathic and moral concern and recognition for outgroup individuals tend to be reduced or eliminated in real-life social interactions. Multiple theorists have expressed, however, that these assumptions are wrong for empirical and philosophical reasons, which results in a serious challenge to the conception of human morality as exclusivist by nature. Furthermore, simple intuition and practical experience constantly show us that human individuals can develop and endorse a broad spectrum of moral considerations and adopt an arguably inclusivist stance concerning the kind of persons or agents that deserve moral concern. Moreover, and adopting a historical perspective, the expansion of cultural and commercial exchanges, the consolidation of democracy, the development of welfare states, or the emergence of institutions based on the concept of universal human rights, have partially driven human progress based on the impartial concern for the well-being of persons. These historical instances of cultural evolution and institutional design have shown that it is feasible to promote behaviors and attitudes grounded in impersonal prosocial and inclusivist principles. This optimistic perspective, however, still begs the question of the exact relationship between social, cultural, and historical contexts, and the emergence of certain behavioral expressions of inclusivist morality. This is crucial since a great number of human individuals around the world still do not make part of these instances of social progress, and some authors have suggested that such instances of social and moral progress are particularly favored by the contexts of the WEIRD world, that is the world of Western, Educated, Industrialized, Rich, and Democratic societies. Some of these approaches consider moral inclusivity a ‘luxury good’ and follow the ‘dependency thesis’ according to which the expression of moral inclusivity depends on the presence of very concrete material conditions that trigger inclusivist and impersonal prosocial tendencies that human beings are not able to express in threatening contexts without physical security. This thesis is problematic for various reasons and has led to incomplete explanations about the enabling and causal factors of inclusivist moral progress, as well as unsatisfactory suggestions about what we should do to foster the accomplishment of more generalized instances of progress based on inclusivist concerns. In an attempt to contribute to this debate, the main objective of this thesis is to offer an alternative proposal about the nature of human morality and a more detailed reflection on what we should do if we want to further accomplish such instances of progress. More precisely, this work adopts a particular developmental and constructivist vision of human morality to answer the question of how feasible it is to reach generalized forms of social progress based on the precepts of moral inclusivity. Furthermore, it offers some ideas about what are the most adequate and favorable conditions to foster such progress both at the individual and the collective level. At this point, a preliminary clarification of some starting points is necessary. In the first place, and contrary to what other authors have proposed when debating moral progress from an empirically-based approach, my perspective adopts a radical developmental and constructivist perspective, following particularly the conceptual and empirical ideas of the social-domain theory in moral psychology. From this perspective, morality is a domain of normative and social knowledge that develops and emerges in human interactions. Moral concerns, judgments, and norms are not only the result of the expression of innate adaptive intuitions, nor the product of social conformity and a simple process of mirroring the normativity that communities have established to organize their social life. Human individuals, instead, construct moral concerns and judgments during their situated interactions. More specifically, the constructivist tradition claims that we need to research how moral concerns, judgments, and reasons emerge in social interactions and how human beings construct the content of their moral knowledge in the first place. Based on these ideas, morality is defined here as the result of a constructive process through which human individuals, by the means of constant interactions on a background of mutual respect and recognition, develop evaluative concerns about how we ought to treat others, and how to ‘care’ and ‘respect’ others’ well-being, needs, and vulnerabilities. This developmental-constructivist theory of human psychology contributes to an alternative understanding of the origins of moral variability and informs a very particular normative stance about the most desirable contexts needed for the urgent accomplishment of inclusivist forms of morality in contemporary societies. This is so given that the very same definition of morality adopted presupposes the feature of inclusivity. The main objective of this work is then to argue, based on a developmental perspective, what are the most favorable conditions to foster the development of moral inclusivity and what we should do to accomplish concrete instances of moral progress that truly help us to overcome our most urgent moral challenges. The whole thesis is organized as follows. In part I, I show how received visions about human social evolution have informed conceptions of morality as an adaptive function evolved to solve the challenges of cooperative life. Based on these assumptions, some theories argue that human morality is limited by the boundaries of group thinking, and always obeys the mandates of collective interests and the will of the majority. However, this conception has problematic implications from a normative and ethical perspective. The aim of Chapter 1 is to present this introductory debate in detail. In chapter 2, I consider a relevant amount of scientific evidence that helps to consolidate a more optimistic and inclusivist perspective about the starting conditions of human prosocial behavior. Later, I will summarize some ideas offered to explain the possible evolutionary mechanisms that led to the consolidation of these inclusivist capacities. However, I will also show how evolutionary theories that share the same adaptationist foundations but initially seem relevant to explain the feasibility of moral inclusivity, result incomplete when considering the complexity of moral behavior and its ethical implications. Part II is devoted to presenting a developmental alternative to the adaptationist versions around the starting conditions of morality. In this section, I first summarize the epistemological, conceptual, and empirical basis of a constructivist perspective already proposed by several authors in the last decades. This is the goal of chapter 3. More precisely, I adopt the conceptualization of morality established by the social-domain theory school and clarify its conception of the situated development of moral concerns, motivations, and norms. All these ideas are essential for my argumentation on the feasibility of inclusivist moral progress offered later. Chapter 4 provides a more detailed idea of constructivist thinking about moral development, by analyzing one particular dimension: the development of moral concerns for fairness and the sense of justice in distributive dilemmas. In Part III, I assume a constructivist perspective on morality to contribute to the philosophy of moral progress. In particular, I discuss the implications of such a perspective for the conceptualization of human moral nature and discuss what are the most favorable conditions for moral inclusivity to emerge. Answering that question is of enormous relevance since favoring the transition of human societies towards more inclusivist forms of moral concern and behavior supposes a more generalized accomplishment of our most urgent moral convictions. Previous developmental or culturally-sensible attempts to explore this issue are already on the market. As mentioned before, most authors have approached the topic by situating the cultural evolution and development of (inclusivist) moral progress in the WEIRD world. For instance, some of these authors claim that very concrete material conditions (mostly present in the Western World) have been necessary for triggering inclusivist and impersonal prosocial tendencies that human beings are not able to express in threatening contexts without physical security. Despite their interest in explaining inclusivist morality and the feasibility of inclusivist forms of progress following a naturalistic and culturally situated approach, these theories are problematic for two main reasons. In the first place, most of the authors that explain moral progress tend to focus exclusively on the consolidation of liberal values in the Western world and the underlying adoption of laws, social-epistemic practices, and public narratives about tolerance and inclusivity, as unequivocal signs of inclusivist morality. Nevertheless, there is an enormous distance between the institutional and public support of inclusivist moral values or the construction of public images of tolerance and inclusivity, and the real materialization of impersonal moralities in situated social interactions. Secondly, the variability of human moral behavior is far bigger than most of the theories in moral psychology and moral progress tend to assume. Accordingly, inclusivist and exclusivist forms of morality may develop simultaneously in similar or divergent geographical and socio-ecological environments, including those with harsh conditions such as competition for scarce resources, potential intergroup conflict, and risks of disease transmission. In addition, harsh environmental conditions are usually present in almost all societies around the globe, and the presence of socio-ecological conditions such as physical security and prosperity, predominant in highly resourced populations, do not prevent the existence of exclusivist moral tendencies. My model explores a different perspective on the relationships between cultural, institutional, and historical factors, and the situated development of human morality. This supposes a clear distinction from previous approaches to the matter since it offers a different view on what we should do to pursue further instances of inclusivist social progress. In the fifth chapter, I first analyze the proposals of some defenders of the ‘dependency’ theory. The attention is focused on the ‘Evolutionary Developmental Model’ proposed by Buchanan and Powell (2018). Based on a critique of this approach, I will argue that to explain the evolution and development of human morality in its multiple manifestations, it is essential to put focus on social interactions. This also involves a different perspective on human-environment relations that in line with a constructivist worldview makes an innovative contribution to the philosophy of moral behavior and moral progress. Later, in the sixth chapter, I will define my alternative relational view of inclusivist morality and I will offer my view on how to establish favorable conditions that make inclusivist morality possible. Complementing the constructivist approach, my conception is based on the essential role of equality and individuality and on how moral inclusivity is favored if moral concerns do not develop driven by the accomplishment of group-centered, binding, and communitarian concerns and values. In brief, my relational model suggests that the accomplishment of moral inclusivity not only depends on the overall achievement of certain levels of physical security or economic prosperity. Instead, its development is favored by transforming the interactional contexts in which moral concerns towards autonomy and individuality emerge. In arguing so, I will need to start with a critique of contemporary situated and embodied approaches in ethics. Then, I will show how societies guided by the accomplishment of group-centered values of power, dominance, and relational inequality tend to express exclusivist moral behaviors, while individualistic societies tend to be more inclusivist. Starting from this diagnosis, my final attempt is then to reflect on which are the best conditions for the moral valuation of individuality to emerge and what we should do to promote the accomplishment of moral inclusivity at the societal level. (shrink)

Il cambiamento climatico globale pone sfide senza precedenti ai nostri mo- di di concepire la morale e la politica. Siamo abituati a vedere un problema morale in situazioni in cui un individuo chiaramente identificabile inten- zionalmente ne danneggi un altro, a sua volta chiaramente identificabile; e in cui sia gli individui coinvolti, che il danno in questione, stiano fra loro in una relazione spazio-temporale di vicinanza. Il cambiamento climatico glo- bale danneggerà senz'altro milioni di persone, ma secondo modalità com- pletamente (...) diverse da queste. Dal punto di vista politico, d'altro canto, l'in- trattabilità del fenomeno è dovuta al fatto che siamo abituati a prendere de- cisioni pubbliche in base a preferenze momentanee, piuttosto che interessi a lungo termine e valori condivisi. Per affrontare il cambiamento climatico globale abbiamo dunque bisogno di riformare sia i nostri modi di concepire la problematicità morale, che il nostro stile di deliberazione politica. Per fare questo, è necessario partire dagli individui: fornendo una visione ideale di che tipo di carattere sia più adatto per vivere in un mondo globalizzato e altamente interconnesso come il nostro.Global climate change poses unprecedented challenges to our moral and political systems. We are used to see a situation as morally problematic when a clearly identifiable individual intentionally damages another, her- self clearly identifiable; and when these individuals, as well as the damage done, are close in space and time. Global climate change will certainly da- mage millions of people, but will do so in ways quite different from that. From the political point of view, the intractability of the problem is due to our often taking public decisions based on transitory preferences, rather than long-term interests and shared values. In order to face global climate change, we thus need to reform both our ways of conceiving moral pro- blems, and our style of political deliberation. To do so, we must begin from individuals: providing an ideal of character for what is required to live in a highly interconnected, globalized world. (shrink)

In America today, the problem of achieving racial justice--whether through "color-blind" policies or through affirmative action--provokes more noisy name-calling than fruitful deliberation. In Color Conscious, K. Anthony Appiah and Amy Gutmann, two eminent moral and political philosophers, seek to clear the ground for a discussion of the place of race in politics and in our moral lives. Provocative and insightful, their essays tackle different aspects of the question of racial justice; together they provide a compelling response to our nation's most (...) vexing problem.Appiah begins by establishing the problematic nature of the idea of race. He draws on the scholarly consensus that "race" has no legitimate biological basis, exploring the history of its invention as a social category and showing how the concept has been used to explain differences among groups of people by mistakenly attributing various "essences" to them. Appiah argues that, while people of color may still need to gather together, in the face of racism, under the banner of race, they need also to balance carefully the calls of race against the many other dimensions of individual identity; and he suggests, finally, what this might mean for our political life.Gutmann examines alternative political responses to racial injustice. She argues that American politics cannot be fair to all citizens by being color blind because American society is not color blind. Fairness, not color blindness, is a fundamental principle of justice. Whether policies should be color-conscious, class conscious, or both in particular situations, depends on an open-minded assessment of their fairness. Exploring timely issues of university admissions, corporate hiring, and political representation, Gutmann develops a moral perspective that supports a commitment to constitutional democracy.Appiah and Gutmann write candidly and carefully, presenting many-faceted interpretations of a host of controversial issues. Rather than supplying simple answers to complex questions, they offer to citizens of every color principled starting points for the ongoing national discussions about race. (shrink)

This chapter contrasts moral motivation, as a problematic thing, with the apparently straightforward motives of self‐interest. It also contrasts moral dilemmas, in which one has to find an acceptable action in the midst of conflicting responsibilities and obligations, with practical or prudential dilemmas, in which the problem is getting as much as he/she can of what he/she want. The problem is that these contrasts are all different. They cut in different directions. For any two of the contrasts there are (...) situations which link the 'moral' side according to one contrast with the 'non‐moral' or merely self‐interested side according to the other. Thus in the case of the ageing addict self‐interest as getting what you want and self‐interest as getting a better life conflict. The chapter also gives the example that combines the plots of two famous novels (George Eliot's Silas Marner, and Balzac's novel Le Pe're Goriot), each clearly making a quasi‐moral point. (shrink)

Trolley cases are widely considered central to the ethics of autonomous vehicles. We caution against this by identifying four problems. Trolley cases, given technical limitations, rest on assumptions that are in tension with one another. Furthermore, trolley cases illuminate only a limited range of ethical issues insofar as they cohere with a certain design framework. Furthermore, trolley cases seem to demand a moral answer when a political answer is called for. Finally, trolley cases might be epistemically problematic in several (...) ways. To put forward a positive proposal, we illustrate how ethical challenges arise from mundane driving situations. We argue that mundane situations are relevant because of the specificity they require and the scale they exhibit. We then illustrate some of the ethical challenges arising from optimizing for safety, balancing safety with other values such as mobility, and adjusting to incentives of legal frameworks. (shrink)

The Battered Woman Syndrome, like the Cycle Theory of Violence, helps to illuminate the situation of the person victimized by domestic violence. However, it may also contribute to the violence of the battering situation. In this paper, I explore some of the implications of the Battered Woman Syndrome for domestic violence cases wherein an abused woman kills her abuser. I begin by delineating some of the circumstances of a domestic violence situation. I then discuss the particular moral issue of subjectivity (...) or moral personhood involved in instances wherein a woman victimized by domestic violence responds by killing her batterer. Finally, I argue that the Battered Woman Syndrome and similar alternatives to or qualifications of self-defense are problematic because they strip a woman of her moral subjectivity. I conclude with a brief articulation of a proposal for reform of the criminal justice system specifically aimed at cases wherein there has been a long history of abuse or violence. This reform is unique because it does not rely on a separate standard of reasonableness particular to battered women, but arises out of consideration of the moral implications of legal proceedings involving domestic violence. (shrink)

Fictionalism has recently returned as a standard response to ontologically problematic domains. This article assesses moral fictionalism. It argues (i) that a correct understanding of the dialectical situation in contemporary metaethics shows that fictionalism is only an interesting new alternative if it can provide a new account of normative content: what is it that I am thinking or saying when I think or say that I ought to do something; and (ii) that fictionalism, qua fictionalism, does not provide us (...) with any new resources for providing such an account. (shrink)

How much surveillance is morally permissible in the pursuit of a socially desirable goal? The proportionality question has received renewed attention during the 2020 Coronavirus pandemic, because governments in many countries have responded to the pandemic by implementing, redirecting or expanding state surveillance, most controversially in the shape of collection and use of cell-phone location data to support a strategy of contact tracing, testing and containment. Behind the proportionality question lies a further question: in what way does a state (...) of emergency affect the proportionality of morally permissible surveillance? On the qualitative difference view, a state of emergency has the effect of suspending or altering at least some of the constraints on morally permissible action that apply under ordinary circumstances. On the quantitative difference view, the only difference between states of emergency and ordinary circumstances is that the stakes are greater in a state of emergency. If the qualitative difference view is true, then there are situations, perhaps such as the current Coronavirus pandemic, during which the proportionality condition employs a much less demanding ratio between social goods achieved and the badness of the surveillance performed. The overall objective of this article is to argue against the qualitative and for the quantitative difference view. I proceed by first setting out in somewhat greater detail how we must understand the qualitative difference view (section two). I then present a series of problematic implications of adopting the qualitative difference view and argue that jointly these give us sufficient reason to reject it (section three). This entails that our account of morally permissible surveillance should be unexceptional, i.e. the quantitative difference view: there is no morally significant difference between proportionality in ordinary circumstances and proportionality in emergencies, simply a spectrum of smaller to greater potential goods and bads of surveillance. In order to flesh out the implications of the quantitative view, I briefly sketch an unexceptional theory of proportional surveillance in exceptional circumstances (section four). The last section (five) summarises and concludes. (shrink)

The development of increasingly intelligent and autonomous technologies will eventually lead to these systems having to face morally problematic situations. This is particularly true of artificial systems that are used in geriatric care environments. The goal of this article is to describe how one can approach the design of an elder care robot which is capable of moral decision-making and moral learning. A conceptual design for the development of such a system is provided and the steps that (...) are necessary to implement it are described. (shrink)

Agent-centered morality has been a serious challenge to ethical theories based on agent-neutral morality in defining what is the moral point of view. In this paper, my concern is to examine whether arguments for agent-centered morality, in particular, arguments for agent-centered option, can be justified. -/- After critically examining three main arguments for agent-centered morality, I will contend that although there is a ring of truth in the demands of agent-centered morality, agent-centered morality is more problematic than agent-neutral morality. (...) Nevertheless, we need to take seriously the challenges to agent-neutral morality by finding a way to reflect the insight of agent-centered morality within the framework of agent-neutral morality without collapsing it into agent-centered morality. As a way of doing so, I suggest that we need to integrate the situated, rather than transcendental, nonideal, rather than idealized, and dialogical, rather than monological, perspectives developed in feminist ethics, into agent-neutral morality. (shrink)

This paper takes a virtuist approach to medical ethics to explore, from an empirical angle, ideas about settled ways of living a good life. Qualitative research methods were used to analyse the ways in which a group of 15 general practitioners articulated notions of good doctoring and the virtues in their work. I argue that the GPs, whose talk is analysed here, defined good general practice in terms of the ideals of accessibility, comprehensiveness, and continuity. They regarded these ideals significant (...) both for the way they dealt with morally problematic situations and for how they conducted their professional lives more generally. In addition, I argue that the GPs who articulated these ideals most clearly were able to, in part, because they shared the experience of working in rural areas. This experience helped them to develop an understanding of the nature of general practice that their urban colleagues were less able to draw on. In that sense, the structural and organisational framework of general practice in rural areas provided the context for their understanding of ideals in general practice. (shrink)

Abstract Studying a concept as complex as moral distress is an ongoing challenge for those engaged in empirical ethics research. Qualitative studies of nurses have illuminated the experience of moral distress and widened the contours of the concept, particularly in the area of root causes. This work has led to the current understanding that moral distress can arise from clinical situations, factors internal to the individual professional, and factors present in unit cultures, the institution, and the larger health care (...) environment. Corley et al. ( 2001 ) was the first to publish a quantitative measure of moral distress, and her scale has been adapted for use by others, including studies of other disciplines (Hamric and Blackhall 2007 ; Schwenzer and Wang 2006 ). Other scholars have proposed variations on Jameton’s core definition (Sporrong et al. 2006 , 2007 ), developing measures for related concepts such as moral sensitivity (Lutzen et al. 2006 ), ethics stress (Raines 2000 ), and stress of conscience (Glasberg et al. 2006 ). The lack of consistency and consensus on the definition of moral distress considerably complicates efforts to study it. Increased attention by researchers in disciplines other than nursing has taken different forms, some problematic. Cultural differences in the role of the nurse and understanding of actions that represent threats to moral integrity also challenge efforts to build a cohesive research-based understanding of the concept. In this paper, research efforts to date are reviewed. The importance of capturing root causes of moral distress in instruments, particularly those at unit and system levels, to allow for interventions to be appropriately targeted is highlighted. In addition, the issue of studying moral distress and interaction over time with moral residue is discussed. Promising recent work is described along with the potential these approaches open for research that can lead to interventions to decrease moral distress. Finally, opportunities for future research and study are identified, and recommendations for moving the research agenda forward are offered. Content Type Journal Article Pages 1-11 DOI 10.1007/s10730-012-9177-x Authors Ann B. Hamric, School of Nursing, Virginia Commonwealth University, P.O. Box 980567, Richmond, VA 23298-0567, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

In recent years, the phenomenon of moral distress has been critically examined—and for a good reason. There have been a number of different definitions suggested, some that claimed to be consistent with the original definition but in fact referred to different epistemological states. In this paper, we re‐examine moral distress by exploring its relationship with moral agency. We critically examine three conceptions of moral agency and argue that two of these conceptions risk placing nurses' values at the center of moral (...) action when it ought to be the patient's values that shape nurses' obligations. We propose that the conception of moral agency advanced by Aimee Milliken which re‐centers patient values, should be more broadly accepted within nursing. We utilize a case example to demonstrate a situation in which the values of a patient's parents (surrogates) justifiably constrained nurses' moral agency, creating moral distress. Through an examination of constraints on nurse agency in this case, we illustrate the problematic nature of ‘narrow' moral distress and the value of re‐considering moral distress. Finally, we provide an action‐oriented proposal identifying mediating steps that we argue have utility for nurses (and other healthcare professionals) to mediate between experiences of narrow moral distress and the exercise of moral agency. (shrink)

This paper addresses Peter Singer's claim that cognitive ability can function as a universal criterion for measuring moral worth. I argue that Singer fails to adequately represent cognitive capacity as the object of moral knowledge at stake in his theory. He thus fails to put forth credible knowledge claims, which undermines both the trustworthiness of his moral theories and the morality of the actions called for by these theories. I situate Singer's methods within feminist critiques of moral reasoning and moral (...) epistemology, and argue that Singer's methods are problematic for moral reasoning because they abstract from their object valuable contextual features. I further develop this claim by showing the importance of embodiment for the construal of objects of moral knowledge. Finally, I develop the moral and scholarly implications of this critique. By showing that the abstract, universal methods of reasoning Singer employs cannot credibly construe the objects of ethical inquiry, I call into question the validity of these methods as a means to moral knowledge in general. Furthermore, since moral reasoning takes place within an embodied moral landscape, it is itself a moral enterprise. Singer's moral reasoning, and ours, must be held accountable for its knowledge claims as well as its concrete effects in the world. (shrink)

This paper addresses the question of delegation of morality to a machine, through a consideration of whether or not non-humans can be considered to be moral. The aspect of morality under consideration here is protection of privacy. The topic is introduced through two cases where there was a failure in sharing and retaining personal data protected by UK data protection law, with tragic consequences. In some sense this can be regarded as a failure in the process of delegating morality to (...) a computer database. In the UK, the issues that these cases raise have resulted in legislation designed to protect children which allows for the creation of a huge database for children. Paradoxically, we have the situation where we failed to use digital data in enforcing the law to protect children, yet we may now rely heavily on digital technologies to care for children. I draw on the work of Floridi, Sanders, Collins, Kusch, Latour and Akrich, a spectrum of work stretching from philosophy to sociology of technology and the “seamless web” or “actor–network” approach to studies of technology. Intentionality is considered, but not deemed necessary for meaningful moral behaviour. Floridi’s and Sanders’ concept of “distributed morality” accords with the network of agency characterized by actor–network approaches. The paper concludes that enfranchizing non-humans, in the shape of computer databases of personal data, as moral agents is not necessarily problematic but a balance of delegation of morality must be made between human and non-human actors. (shrink)

The question of the world in itself — the world beyond its correlation with experience in the broadest sense — is one of the sore points of phenomenology and becomes especially acute in the light of modern discussions around correlationism. These discussions, in one way or another, make phenomenology come around to the classical distinction between the phenomenon and the thing-in-itself, with the help of which Kant outlines the field of ethics as a special world lying on the other side (...) of the correlation of knowledge and object constitutive for nature. Philosophy deals with the thing-in-itself in the proper, positive sense of the word, not as phenomenology (transcendental philosophy, which reveals the correlation of knowledge and reality in the world of phenomena and the futility of attempts by theoretical reason to know anything beyond phenomena), but as a critique of practical reason. The article attempts to consider the opposition of the thing-in-itself and the phenomenon in the context of the criticism that Kant’s practical philosophy is subjected to in Hegel’s The Phenomenology of Spirit and to explicate the arguments that this criticism makes available to phenomenology for rethinking the problem of Ding an sich and the ethical dimension of the epoche. The first part of the article examines the Hegelian analysis of the main contradiction contained in the Kantian opposition of duty as something that is in itself, and nature as a phenomenon (this opposition forms what Hegel calls the moral worldview): duty does not depend on nature and therefore does not need natural (phenomenal) realization in actions, but at the same time, duty is nothing but the necessity of actions and, consequently, the necessity of a phenomenon. This contradiction, as Hegel shows, leads to the disintegration of the moral worldview and, thus, turns into the sublation of the absolute separation of duty (thing in itself) and nature (phenomenon). The restitution of the difference between the moral an sich and the phenomenon within conscience — a phenomenon that arises as a result of the destruction of the moral worldview — turns into a new paradox, which demonstrates that the thing-in-itself (ethical good), since it is freed from the phenomenon, is not only unreal, but also turns into its own opposite. The paradox consists in the fact that the consciousness of duty, taken in its independence from the phenomenal realization in actions, becomes evil itself, turning to hypocrisy in the moral judgment about other people’s actions. In the second part of the article, the significance of the Hegelian critique of Kant’s practical philosophy for the phenomenological destruction of the difference between the thing-in-itself and the phenomenon and the problematization of the ethical dimension of the phenomenological method is explicated. Tracing the naive origins of this difference in the natural attitude and their transformation in Kantian philosophy, the author tries to consider the sublation of the opposition of the thing-in-itself and the phenomenon in the field of ethics as one of the possible paths to phenomenology. It is shown how the necessary relation of the supra-worldly an sich with the situational nature of its phenomenal realization in actions calls into question the possibility of a phenomenological epoche. The author also seeks to demonstrate that the problematization of the difference between the thing-in-itself and the phenomenon does not turn phenomenology into a system in the Hegelian sense. (shrink)

There is an essential tension in Hume's account of explanation in the moral sciences. He holds the familiar (though problematic) view that explanations of action are causal explanations backed by the laws of human nature. But he also tenders a rational and historical model of explanation which has been neglected in Hume studies. Developed primarily in the Essays and put into practice in the History of England, this model holds that explanations in the moral sciences cite agents? reasons for (...) acting in definite historical situations. Such explanations are context?dependent, social (not psychological) in content, essentially post hoc, and provide insufficient grounds for prediction. The tension between Hume's two models is considerable, not to say inconsistent. We would best understand him as trying to reconcile the two. Each provides different and equally important kinds of intelligibility. Until this is appreciated, the one?sided interpretation of Hume as a psychological reductionist and a covering?law theorist will continue. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:An Unconscious Dimension of Thinking, Situations, and La Vida:Reflections on Bethany Henning's Dewey and the Aesthetic UnconsciousGregory Pappasthis book is doing different related and valuable things. First, Bethany Henning explores a neglected dimension of Dewey's thought. In particular, the book inquires into the dimension of the unconscious and tries to develop what she considers an "implicit" "theory of the unconsciousness" or of the "aesthetic unconscious" in Dewey's philosophy. (...) Then, based on all of the above, it provides a diagnosis and possible solution to a problem with philosophers and with American culture.The neglected dimension of Dewey's thought that Henning explores highlights the ways in which Dewey foresaw what feminist thinkers have said, and recent scientific accounts of human life and thinking are confirming: What we "feel" (what is "qualitative," "ineffable," and "noncognitive") is key to how to think and how to live (guidance and meaning). It has therefore been puzzling to me (along with John McDermott, Tom Alexander, Mark Johnson, and a few others) why even Dewey scholarship has to a large extent neglected exploring this aspect of his thought. Frustrated with Bertrand Russell, Dewey says that "Mr. Russell has not been able to follow the distinction I make between the immediately had material of non-cognitively experienced situations and the material of cognition—a distinction without which my view cannot be understood" (LW 14:33; emphasis added).More importantly, by neglecting this insight and these aspects of his thought, we have failed to utilize one of the most important resources to diagnose sociopolitical-moral problems today! This is what I have been trying to do in recent years, and I see Dr. Henning as trying to do the same. She is not just providing a theory of the unconscious for the sake of speculation, but she does so with instrumental intent, in the hope that it will help us better approach a concrete social-cultural problem we suffer in our society, a topic to which I will return. [End Page 84]My reading of Dewey and the Aesthetic Unconscious has provoked a few questions:(a). Is there, in Dewey, a conception of aesthetic and religious experience that can be understood as an "implicit theory of the unconscious"?(b). Even if there is one, do we need one? For what purpose?(c). What would we miss if we were to say what needs to be said and explored by Henning by using different terms/concepts and avoiding the possible misunderstanding and dangers of making reference to "the unconscious"?(d). Would Henning agree that the problematic aversion or repression in American culture that concerns us is more than that of the unconscious, the qualitative, body, and nature that form the focus of her book?(e). Henning agrees that we need more than art and "deep" psychology to ameliorate the problems that concern us. What is this "more"? How?In regard to (b), I can think of one good purpose, which Henning develops in Dewey and the Aesthetic Unconscious: to engage in a dialogue with psychoanalysis and contemporary philosophies that draw from psychoanalysis and feminism (e.g., Kristeva) or, in general, other academics concerned with the same problems. I also wondered as I was reading the book why Henning does not put Carl Jung in dialogue with Dewey as well, just as a matter of curiosity. But I wonder, if we need to develop a "theory of the unconsciousness" or of the "aesthetic unconsciousness" to both make a contribution to the "depth" of lived experience (La Vida) and also deal with the social-cultural problems that concern us.There are dangers with talking about or making reference to "the" unconsciousness or "the" aesthetic unconsciousness and theorizing about them. The problem is that it comes across as a noun, and not as way of participating in La Vida or nature, that is continuous in a significant way with what is more conscious and more cognitive: we are at any time more or less conscious. But Henning seems aware of all of this. She is careful enough to make clear that she is acknowledging continuity, but I confess to "feeling" uncomfortable sometimes with her reference to that... (shrink)

James Sterba describes the egoist as thinking only egoist reasons decide the rationality of choices of action, the altruist, only altruistic reasons, that each in effect begs the question of what reasons there are against the other, and that the only non-question-begging and therefore rationally defensible position in this controversy is the middle-ground position that high-ranking egoistic reasons should trump low ranking-altruistic considerations and vice versa, this position being co-extensive with morality. Therefore it is rationally obligatory choose morally. I (...) object that the mere fact that a position is intermediate between two extremes does not mean it isn’t question-begging; that Sterba’s style of argument could be used to prove anything and therefore proves nothing; that it can be used to prove obvious falsehoods and therefore doesn’t necessarily track the truth; that it can be used to prove the truth of contingent, empirically obvious falsehoods when, since it is necessary a prior that one ought to be moral, something can be a good argument for the rationality of morality only if the argument’s style would entail only truths necessary a priori; that Sterba’s argument cannot inherit plausibility from what Sterba describes as the decision theoretic idea that when choosing among options where we have no evidence that one is more appropriate than the other, we must treat them as equally choice-worthy, since there is no such idea in decision theory, and shouldn’t be (for when, for example, there is no evidence that x exists and no evidence that x does not exist, one should believe that x does not exist; one should not chose as if x’s existence and non-existence were equally likely); that Sterba’s argument style is not analogous to the compromise strategies recommended in bargaining theory, nor in negotiating situations (although it would profit Sterba to consider David Gauthier’s approach in seeking to demonstrate that morality is both a middle ground between egoism and altruism, and is rationally obligatory); that it is problematic to see egoistic and altruistic reasons as commensurable and therefore admitting of a middle ground, especially a unique middle ground; that in any case, egoistic and altruistic reasons are not exhaustive of the reasons there could be; that the only sense in which moving to middle ground results in the parties not begging the question against each other is that it means they would be agreeing with each other and therefore not holding positions against each other, whether question-beggingly or otherwise, a fact which offers neither any rationally compelling reason to move her position closer to that of the other (for how can the mere fact that if we agreed we wouldn’t be begging the question against each other be a reason to agree?); and that even if morality is both rationally obligatory and a middle ground between egoism and altruism, it won’t be in any interesting sense true that this holds because the alternative would be question-begging, which means that analyzing the basis of the rationality of morality as being found in this principle of argumentation theory misconceives the nature of morality. (shrink)

As various kinds of resources become scarce within the context of today's population, consumption, and environmental problems, conflicts of interest will become more evident, competition become more intense, and certain kinds of ‘unwanted’ behavioural strategies might have a tendency to emerge and be used by a growing number of individuals. In such situations, humans may activate group adaptations. If we have group adaptations, like a tendency to classify humans into in-groups and out-groups and to develop moralities favouring one's in-group, (...) it may be problematic to extend our morality outside our own group, especially in environmental situations where resources become scarce. For such reasons, Unto Others touches upon important topics which cannot be ignored. It is crucial to focus on the conditions under which it will be possible to develop a morality for all humans. (shrink)