Moral distress is a phenomenon of increasing concern in nursing practice, education and research. Previous research has suggested that moral distress is associated with perceptions of ethical climate, which has implications for nursing practice and patient outcomes. In this study, a randomly selected sample of registered nurses was surveyed using Corley’s Moral Distress Scale and Olson’s Hospital Ethical Climate Survey (HECS). The registered nurses reported moderate levels of moral distress intensity. Moral distress intensity and frequency were found to be inversely (...) correlated with perceptions of ethical climate. Each of the HECS factors (peers, patients, managers, hospitals and physicians) was found to be significantly correlated with moral distress. Based on these findings, we highlight insights for practice and future research that are needed to enhance the development of strategies aimed at improving the ethical climate of nurses’ workplaces for the benefit of both nurses and patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:diacritics 30.2 (2000) 25-42 [Access article in PDF] What is Political Feeling? Bernadette Meyler Anthony Cascardi. Consequences of Enlightenment. Cambridge: Cambridge UP,1999. As disaffection with poststructuralism increases, but new paradigms have not yet emerged, theorists have begun to reconsider the ties that current thought maintains with the tradition it critiques, in particular, its affiliations with the Enlightenment. Focus has inevitably fallen on the writings of Immanuel Kant, which (...) in the act of codifying Enlightenment rationality simultaneously initiated its dissolution. Disputes tend to arise, however, over the precise nature and cause of the hairline fracture that prevents Kant's Critiques from attaining the unity to which they aspire. Even greater controversy centers on the advisability of possible responses: should we set the bones, break open the gap, or provide an entirely new limb? In Consequences of Enlightenment, Anthony Cascardi undertakes a detailed discussion of how various theoretical schools interpret the fissure, and the problems posed by their accounts. Not simply remaining content with this critique of critiques, Cascardi presents his own stance, advising that we embrace Kant's recourse to "feeling" in the Critique of Judgment as an inevitable entailment of the Kantian system. Whereas Horkheimer and Adorno's Dialectic of Enlightenment argues that the opposition between Kantian reason and Nietzschean irrationalism represents the undoing of the Enlightenment, Cascardi responds that Kant's own writings encompass the duality. As an essential moment of what he terms the Enlightenment's "aesthetic critique," the resistance that feeling poses to "the unity of experience"--or to the unity of the Critique of Pure Reason and the Critique of Practical Reason--should be embraced. Cascardi further maintains that this "should" entails political consequences, although his text does not itself fully elaborate a vision of what these might be.The fact that such a rich suggestion remains relatively undeveloped is perhaps inevitable in a book of such comprehensive scope. Consequences of Enlightenment is a text that seems to call the reader to the task of continuing the multiple projects that Cascardi has initiated. I will attempt to articulate what those endeavors might be, and to propose points in his work upon which future inquiry could be focused. Because Cascardi's goals are two-pronged--to examine twentieth-century thinkers' Kantian inheritance and to engage directly with the "aesthetic critique" of Kant--it is sometimes difficult to ascertain whether Consequences of Enlightenment attributes certain positions to Kant or to his interpreters. Although this difference might not seem significant given Cascardi's claims about the persistence of Kantian aporias in the work of his inheritors, returning to Kant may allow us to ask how we should proceed in developing the political potentials of aesthetic critique. Two principal questions arise in this regard. The first inquires whether and how one can think aesthetics with politics; in other words, [End Page 25] what is political feeling? The second question provides a more limited point of entry into the same problem by focusing on the Critique of Judgment itself; what politics are entailed respectively by the beautiful and the sublime?Cascardi discusses the Kantian sublime only twice in detail during the course of Consequences of Enlightenment, once in chapter 4, "Communication and Transformation: Aesthetics and Politics in Habermas and Arendt," and for the second time, and most provocatively, in chapter 7, "Feeling and/as Force." In treating Hannah Arendt, who, in her 1970 Lectures on Kant's Political Philosophy, attempted to derive a Kantian account of the political from the Critique of Judgment, Cascardi explains that she tried to complete the Enlightenment by erroneously "turning from the indeterminacy of the aesthetic in Kant to a politics that designates democratic community as its field or object-domain"; he then asserts that, "Specifically, the politics that Arendt would claim to derive from Kant's aesthetics is a democratic politics of the beautiful..." [156]. Subsequently elaborating on the reasons that Arendt overemphasized the beautiful, seemingly at the expense of the sublime, Cascardi writes, "Arendt's tendency to privilege the beautiful over the sublime must be seen as part of her larger effort to construct a rational politics. For this effort, she takes... (shrink)

Bernadette M Tobin; Development in Virtues, Journal of Philosophy of Education, Volume 20, Issue 2, 30 May 2006, Pages 201–214, https://doi.org/10.1111/j.1467-9.

It is in its Consequentialist mood that Australian philosophizing most clearly displays the 'no-nonsense' quality that we are tempted to think of as a national virtue: I hope this volume goes some way to showing the dangers of our being tempted by such flattering but ultimately shallow (and indeed morally coarse) national myths.

„On 23rd February 2022, when the editors had worked out topical issues of dispute relating to politics, ethics, technology and religion for a Hans Jonas Centre conference on responsibility for the future and discourse ethics, it was suddenly foreseeable that Russia would invade the core area of Ukraine the next night. We immediately informed our Ukrainian colleagues that we would allow them asylum, if desired, and invite them to the conference in Bad Kissingen as keynote speakers. In no time at (...) all, the new programme for the confer-ence was ready: After commemorating Hans Jonas' honorary doctorate in Berlin under the motto ‘Fatalism would be a mortal sin’ exactly 30 years ago, we now focus on ‘Discourse despite war’. After that, we discuss digitalisation as well as theology, philosophy and commitment". With contributions by Prof. Dr. Claus Altmayer; Harald Asel, M.A.; Dorothee Bär, MdB; Dr. Thomas Bausch; Prof. Dr. Dietrich Böhler; Prof. Dr. Michael Bongardt; Wolfgang Freese; Bernadette Herrmann, M.A.; Sebastian Höpfl; Bischof em. Prof. Dr. Dr. h.c. mult. Wolfgang Huber; Dr. Grigori Katsakoulis; Pfarrer Wolfgang Klein; Wolfgang Korb; Dr. Lena Kornyeyeva; Prof. Dr. Dr. h.c. Klaus Leisinger; Prof. Dr. Dr. h.c. Hans Lenk; Prof. Dr. Ulf Liedke; Prof. Dr. Alfons Matheis; Dr. Olaf Meyer; Dr. Jürgen Naeher-Zeiffer; Stephanie von Dallwitz; Dr. Marianne Rabe; Dr. Manuela Rottmann, MdB; PD Dr. Dr. Thomas Rusche; Prof. Dr. Johann Michael Schmidt; Dr. Eva-Maria Schwickert; Maritta Strasser, M.A.; OB Dr. Dirk Vogel and Prof. Dr. Anatoliy Yermolenko. (shrink)

Family members do not have an official position in the practice of euthanasia and physician assisted suicide in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could serve as a starting point (...) for further empirical and ethical inquiry. A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families’ experiences and grief after EAS. 4) Family and ‘the good euthanasia death’ according to Dutch physicians. Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making. (shrink)

Approaches to business ethics can be roughly divided into two streams: ‹codes of behavior’ and ‹forms of subjectification’, with code-oriented approaches clearly dominating the field. Through an elaboration of poststructuralist approaches to moral philosophy, this paper questions the emphasis on codes of behaviour and, thus, the conceptions of the moral and responsible subject that are inherent in rule-based approaches. As a consequence of this critique, the concept of a practice-based ‹ethics of responsiveness’ in which ethics is never final but rather (...) always ‹to come’, is investigated. In such an approach the ethical self is understood as being continuously constituted within power/knowledge relations. Following this line, we ask how one can become a responsible subject while also acknowledging certain limits of full responsibility. We thereby explore responsibility as a considered but unconditional openness in response to the other. (shrink)

In many countries grappling with the politics of equal recognition, the experiences, beliefs and reasons for action of people who identify as non-binary are starting to be seen as valid and intelligible.1 And, despite some gender clinics still responding cautiously to requests for non-standard medical interventions, their treatment needs are now recognised in major clinical guidelines. This is the current social context in which Notini and colleagues outline the case of ‘Phoenix’, an 18-year-old birth-assigned woman, who has requested the indefinite (...) continuation of puberty suppression, a treatment that was initiated when the client was 11 years old to mitigate their intense distress at the onset of puberty. Drawing on a conception of health as overall well-being, the authors conclude that OPS is ‘consistent with the proper goals of medicine’, and that there are ‘equity-based reasons’ for offering OPS to adults as a group. They concede that the physical risks are greater for OPS than for hormonal interventions generally provided to people with a binary gender identity. They also acknowledge the need for ‘a fine-grained ethical evaluation of Phoenix’s particular situation’ to assess whether the potential benefits of OPS outweigh the potential harms for this individual. Here I respectfully raise three points to amplify the authors’ discussion. First, there seem to be significant ethical issues of a general, not a particular, kind arising from the type of individual evaluation they call for. Following initial screening for significant mental distress and other major vulnerabilities, the key undertaking …. (shrink)

Summary With regard to the dynamics of human experience and behavior, Gestalt theoretical psychotherapy (GTP) relies mainly on Kurt Lewin’s dynamic field theory of personality. GTP is carried out by including a re-interpretation of Lewin’s theory in some aspects of psychotherapeutic practice in relation to critical realism. Human experience and behavior are understood to be functions of the person and the environment (including the other individuals therein) in a psychic field (life space), which encompasses both of these mutually dependent factors. (...) The anthropological model of this approach is, therefore, not mono-personal but, a priori, structural and relational in nature. It does not one-sidedly focus on the “inner components” of a person, but on the interrelation of the individual and a given environment, which affects experience and behavior. After a brief introduction of these basic concepts, this lecture will focus especially on Lewin’s concept of tension-systems, which may be considered as the Gestalt theoretical counterpart of Freud’s drive theory. Further, we define the basic assumptions which underlie GTP and explain how the person moves through her/his life experience in terms of Gestalt psychology. (shrink)

The promises of nanotechnology have been framed by a variety of metaphors, that not only channel the attention of the public, orient the questions asked by researchers, and convey epistemic choices closely linked to ethical preferences. In particular, the image of the ‘therapeutic missile’ commonly used to present targeted drug delivery devices emphasizes precision, control, surveillance and efficiency. Such values are highly praised in the current context of crisis of pharmaceutical innovation where military metaphors foster a general mobilization of resources (...) from multiple fields of cutting-edge research. The missile metaphor, reminiscent of Paul Ehrlich’s ‘magic bullet’, has framed the problem in simple terms: how to deliver the right dose in the right place at the right moment? Chemists, physicists and engineers who design multi-functional devices operating in vitro can think in such terms, as long as the devices are not actually operating through the messy environment of the body. A close look at what has been done and what remains to be done suggests that the metaphor of the “therapeutic missile” is neither sufficient, nor even necessary. Recent developments in nanomedicine suggest that therapeutic efficacy cannot be obtained without negotiating with the biological milieu and taking advantage of what it affords. An ‘oikological’ approach seems more appropriate, more heuristic and more promising than the popular missile. It is based on the view of organism as an oikos that has to be carefully managed. The dispositions of nanocapsules have to be coupled with the affordances of the environment. As it requires dealing with nanoparticles as relational entities (defined by their potential for interactions) rather than as stable substances (defined by intrinsic properties) this metaphor eventually might well change research priorities in nanotechnology in general. (shrink)

Considering the “Born-Alive” Rule and Possession of Sperm Following Death Content Type Journal Article Category Recent Developments Pages 323-327 DOI 10.1007/s11673-011-9324-0 Authors Bernadette Richards, Law School, The University of Adelaide, South Australia, Australia Bill Madden, School of Law, University of Western Sydney, Sydney, NSW, Australia Tina Cockburn, School of Law, Queensland University of Technology, Brisbane, Qld, Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 8 Journal Issue Volume 8, Number 4.

Recent Developments Content Type Journal Article Pages 113-119 DOI 10.1007/s11673-011-9300-8 Authors Bernadette Richards, University of Adelaide, Adelaide, South Australia Bill Madden, School of Law, University of Western Sydney, Sydney, NSW, Australia Tina Cockburn, School of Law, Queensland University of Technology, Brisbane, Qld, Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 8 Journal Issue Volume 8, Number 2.

One of the core goals of Digital Health Technologies (DHT) is to transform healthcare services and delivery by shifting primary care from hospitals into the community. However, achieving this goal will rely on the collection, use and storage of large datasets. Some of these datasets will be linked to multiple sources, and may include highly sensitive health information that needs to be transferred across institutional and jurisdictional boundaries. The growth of DHT has outpaced the establishment of clear legal pathways to (...) facilitate the collection, use and transfer of potentially sensitive health data. Our study aimed to address this gap with an ethical code to guide researchers developing DHT with international collaborative partners in Singapore. We generated this code using a modified Policy Delphi process designed to engage stakeholders in the deliberation of health data ethics and governance. This paper reports the outcomes of this process along with the key components of the code and identifies areas for future research. (shrink)

Bernadette M Tobin; An Aristotelian Theory of Moral Development, Journal of Philosophy of Education, Volume 23, Issue 2, 30 May 2006, Pages 195–211, https://doi.

Farmers perceive and appraise climate change, related risks and opportunities as well as adaptation measures differently. Such differences are not well understood and rarely considered in extension services, outreach activities and agricultural policies. We aim to develop empirically based farmer types, who differ in their socio-cognitive and emotional processes towards droughts, their expected drought impacts, their appraisal of drought adaptation measures, and their previous and intended implementation of such measures. The Model of Private Pro-Active Adaptation to Climate Change provides the (...) theoretical foundation for a three-phase procedure of semi-structured interviews, a standardized survey and a qualitative workshop. The principal component analysis reveals eight socio-cognitive and emotional processes of relevance for forming the famer types of drought adaptation: perceived opportunities resulting from droughts, perceived effectiveness of drought adaptation measures, negative affect towards droughts, perceived work effort and perceived social approval of drought adaptation measures, fatalism, trust in public measures, and perceived self-efficacy. Cluster analyses of these processes yield four types of Austrian farmers. The social implementers perceive themselves as capable, and drought adaptation measures as effective, socially approved, and effortless. The unaffected profiteers have hardly been affected by droughts and perceive beneficial impacts due to a decline in precipitation. The trusting fearfuls have already experienced severe drought impacts and express intense negative affect towards droughts. The passive fatalists focus on avoidance and do neither trust in important others nor in public measures. The identified farmer types of drought adaptation may support the design of climate and agricultural policy instruments and of tailor-made education and communication programs, for instance to increase self-efficacy and reduce fatalism. (shrink)

Dans un territoire de la République de plus en plus fragmenté, l’appréciation du bon ordre est de plus en plus difficile pour l’autorité civile de police municipale, maire ou préfet. L’occupation de l’espace et les conflits qui en résultent sont mal anticipés par la planification de l’urbanisme comme l’illustrent les grands rassemblements d’hommes, le désarroi des campagnes et les quartiers sensibles. L’ordre public doit s’exercer dans la proximité mais sous bonne régulation zonale.

Most people do their utmost to avoid any and every type of suffering; yet, as this experience-based article shows, Newman, early in life, came to realize from his own illnesses that physical suffering can bring the sufferer to an awareness of the presence of God and so be an important part of personal spiritual development.

Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and other health care practitioners (...) have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:ABORTION AS A SACRAMENT: MIMETIC DESIRE AND SACRIFICE IN SEXUAL POLITICS Bernadette Waterman Ward SUNY-Oswego "If men got pregnant, abortion would be a sacrament." That familiar taunt is mostly aimed at Roman Catholics to humiliate them for their purportedly religious and anti-rational opposition to abortion. It is conventional to sniffthat the "religious assumptions" on which disapproval of abortion is "typically based" are "highly questionable" (Chambers 1). But the (...) cultural theories of René Girard suggest that it is because men don't get pregnant that abortion already is a sacrament. The key elements of sacrificial religion, as Girard defines it, are the presence of intolerable tension that must lead to social disruption; the choice of a victim who cannot strike back to absorb the community's violence; and the concealment ofthe function ofthe sacrifice, which employs actual violence for the purpose of stabilizing institutional violence. Abortion in America is upheld not as medical or even political policy, but as, in fact, a religious sacrifice. Girard's definition ofreligion requires neither a moral code nor a divinity nor a metaphysical grounding. The cult of Dionysus, to name only one example, evidently endorsed nothing we would recognize as a general code of morality; Buddhism, a far more august example, does not focus on a divinity; animism proposes no universal metaphysics. As to sacraments, Bernadette Waterman Ward19 Thomas Aquinas, following St. Augustine, did not scruple to call nonChristian sacrifices sacraments oftheir religions, "Whether true or false."' Scapegoating defines religious sacrifice. It protects the sacrificing community and promotes its unity—so long as all believe that the scapegoat must suffer. Often the victim is called an enemy to some established order; sacrifice is always conservative, even if it upholds an inherently unstable system. Because powerlessness, not real disruptive power, is the criterion for becoming a scapegoat, sacrifice requires a strong shared illusion. Classical religions provide unopposable gods to choose the tragically necessary victims, allowing strong ambivalence to surround the sacrifice itself. Ifthis is not present, the death or banishment takes on a different character—more political than religious, though Girard notes a fundamental unity between those two methods ofcontrolling mimetic violence. Mimetic violence originates in illusion surrounding a rivalry. Often there is an object involved, such as territory or wealth or political rank, but the object, which seems important, is actually irrelevant. The rivalry can continue, seeking new objects, whatever concrete acquisitions either party makes or loses. General, aimless rivalry dominates a social world of fragile, undefined selves in which anyone can be a model for imitation, and therefore anyone can be a threat to one's sense ofself. What an imitator actually seeks is to have whatever is desirable; most desirable ofall, perhaps, is the ability to know what is desirable, a mysterious quality that is constantly attributed to others; Girard calls this quality "being." From the nursery we are each other's disciples, wanting each other's toys not because of their inherent virtue so much as because someone else has seen some virtue in them. As human desire has no real single object, it has no closure; envy and revenge threaten others in a widening net of destruction. In the classic scenario, the model whose "being" has become matter for imitation finds himself in competition for the object, and attacks the rival, who returns in kind. A disciple who can rally aspire to the model's status can become a dangerous, even a deadly rival; in imagination, and sometimes in reality, they turn each other intp monsters. Yet as the desire has no single object, neither has the rage: the violence can be easily transferred to another object than one's rival. Sometimes those who are uneasy about their status in relation to one another can cement a powerful unity by focusing blame on some common target: a scapegoat. The Orwellian scenario is in fact the normal scenario: individuals caught in the maelstrom of social instability 'Summa Theologiae, 3a.61.1 31. 20Abortion as a Sacrament seek to avoid victimization by diverting the violence into blame and destruction directed, first of all, against someone else—and, if possible, against someone who cannot strike back: a sacrifice. Not all sacrificial religious... (shrink)

The Medical Innovation Bill continues its journey through Parliament. On 23 January 2015, it was debated for the final time in the House of Lords and with one final amendment, the House moved to support the Bill, which then moved to the House of Commons on 26 January. It will be debated again on 27 February 2015. The Bill’s purpose is to encourage responsible innovation in medical treatment. Although this goal is laudable, it is argued that the Bill is unnecessary (...) and has the potential to undermine the very cause it aims to advance. More useful for encouraging responsible innovation is the continued education of health-care professionals on how the law already supports practitioners who look to improve care through responsible innovation. (shrink)

Stakeholder theory provides a framework for investigating the relationship between corporate social performance (CSP) and corporate financial performance. This relationship is investigated by examining how change in CSP is related to change in financial accounting measures. The findings provide some support for a tenet in stakeholder theory which asserts that the dominant stakeholder group, shareholders, financially benefit when management meets the demands of multiple stakeholders. Specifically, change in CSP was positively associated with growth in sales for the current and subsequent (...) year. This indicates that there are short-term benefits from improving CSP. Return on sales was significantly positively related to change in CSP for the third financial period, indicating that long-term financial benefits may exist when CSP is improved. (shrink)