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)

Dies is die erste Untersuchung, die das Gesamtwerk von Hans Jonas in den Blick nimnt. Dabei zeigt sie, warum dessen Religionsphilosophie, Naturphilosophie und Anthropologie die Konsequenzen zeiteigen, die dem Prinzip Verantwortung und besonders seiner Bioethik zu Grunde liegen. Zudem demonstriert der Verfasser,wie eine organische Naturphilosophie ein substantielles Verstandnis vom Menschem schafft, wodurch allein eine tragfahige Bioethik - mit den Problemen, die siehum Lebensbeginn und Lebensende des Menschen gruppieren - begrunder werden kannt. Eine bahnbrechende Arbeit die auf eine eigene Bioethik des (...) Verfassers hoffen lasst. (shrink)

The feminist sex wars have been characterized by debates between radical feminists and sex radical feminists about women's experiences of empowerment versus oppression in the sex industry. Based on a qualitative study of the experiences of exotic dancers, this article introduces a new theoretical paradigm to the feminist sex wars that values the contributions of both sex radicals and radical feminists. It articulates a twofold temporal dimension of sex workers' experiences: how women's feelings of pleasure and empowerment gradually decline over (...) time and how good and bad experiences rapidly transform into their opposites over the course of a single evening, making the strip bar a volatile and unsettling space for performers. (shrink)

" Façonner le monde atome par atome " : tel est l'objectif incroyablement ambitieux affiché par les promoteurs américains de la " National Nanoinitiative ", lancée en 1999. Un projet global de " convergence des sciences ", visant à " initier une nouvelle Renaissance, incorporant une conception holiste de la technologie fondée sur [..] une analyse causale du monde physique, unifiée depuis l'échelle nano jusqu'à l'échelle planétaire. " Ce projet démiurgique est aujourd'hui au coeur de ce qu'on appelle la " (...) technoscience ", étendard pour certains, repoussoir pour d'autres. En précisant dans ce livre la signification de ce concept, pour sortir enfin du sempiternel conflit entre technophiles et technophobes, son auteur propose d'abord une sorte d'archéologie du terme " technoscience ". Loin d'être un simple renversement de hiérarchie entre science et technique, il s'agit d'un changement de régime de la connaissance scientifique, ayant désormais intégré la logique entrepreneuriale du monde des affaires et mobilisant des moyens considérables. Surtout, Bernadette Bensaude-Vincent montre que le brouillage de la frontière entre science et technique n'est que la manifestation d'un tremblement plus général, marqué par l'effacement progressif des distinctions traditionnelles : nature/artifice, inerte/vivant, matière/esprit, homme/machine, etc. Alors que nos sociétés sont silencieusement reconfigurées par les nanotechnologies, Internet, le génie génétique ou les OGM, ce livre montre l'importance de faire enfin pleinement entrer les questions de choix technologiques et scientifiques dans la sphère du politique et dans l'arène publique. Car la technoscience est un processus historique qui engage la nature en la refaçonnant et qui implique la société dans son ensemble. (shrink)

All articles in May 2019’s special issue of Bioethics offer profound insights into the issue of “being a burden to others” in relation to wishes to die, which are highly relevant for ethical debates about end‐of‐life care and physician‐assisted dying. In this reply, we wish to stress the importance of acknowledging and analyzing the sociopolitical context of the phenomenon “being a burden” in relation to wishes to die and we will show how this analysis could benefit from a care ethical (...) approach. As discussions in care ethics have made clear, caring practices are both social and political practices. An empirical and ethical analysis of “being a burden” therefore needs to take institutional and societal norms and structures into account, in addition to first‐person experiences and concepts such as caring needs, relational autonomy, and interdependency. Besides the relevance of the sociopolitical context for the phenomenon “being a burden” as such, the sociopolitical context also seems relevant for the investigation of the phenomenon, which we will illustrate by reflecting on “being a burden” in relation to the practice of physician‐assisted dying in the Netherlands. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Evaluation, Standards, Normalization: Historico-philosophical Formations and the Conditions of Possibility for Checklist Thought Bernadette Baker University of Wisconsin-Madison In education today a new vocabulary has emerged that is far more than just words. In the context of educational policy the setting of goals or objectives is now being subsumed under terms such as statewidestandards, child development is now being adjectivized by descriptors such as learning disability or emotionally (...) disturbed, and the evaluation ofclassroom-based performance is now being collated in aportfolio. These are more than just buzz words-at one level they are new ways of governing children and teachers, of organizing action, and of perceiving the world. What, for instance, does it tell us about ourselves when first-grade students Mikey, Enrique, Waldo, orDonal are introduced to visitors to the school by labels such as LD, ED, ADD, ADHD, and so forth, rather thanby their name? What does it tell us about ourselves when we say a curriculum or program of study is in line with the standards established somewhere else? And what story do we think is being narratedin the documentation of a child's performance in portfolio form across a semester or year? In consideringwhyterms suchasstandards, child development, or even evaluation have such contemporary currency I am necessarily drawn into a study of the timespaces in which they did not have such currency at all. This paper maps four moves into a moment that I think of as a rather long present-day-a present that is not simply this morning, yesterday, or the daybefore, but one that links the subjectivities ofthose now living in educational workto those made available about one hundred years ago. The four moves that I analyze here can be thought of as conditions of possibility for the operation of contemporary educational mies of reasoning, especially those that have formed around the resurgent popularity of"checklist thought" in reform efforts. The four moves collectively historicize how notions of standards, child development, and evaluation can pop up as commonsensical tropes through which to gather and degather action in the educational field. The first ofthese moves is that which flows from the operation ofan ideal to the operation of a norm. The second move is that which flows between the advent of statistics and the advent of eugenics. The third move is that which flows between the appearance ofnovels and fiction and the novel ficticityoffacts. And the fourth move is that which flows from the fictions of child development narratives to the stories that standards tell us. Collectively, these historico-philosophical moves will enable reconsideration of what we think evaluation, standards, and norms for child development actually narrate, lending food for thought to the specificityoftheir uptake in music education. From Ideal to Norm One way inwhichto examinethe shift from a seventeenth-century concept of the ideal to the nineteenth-century concept of the norm is by telling a story that was told in the early twentieth century. At this time when the educational field was formalizing, there was great care taken to record discussions held at conferences. When conferenceproceedings werepublished, theywere usually structured so that the presenter's paper©Philosophy ofMusic Education ReviewlO, no. 1 (Fall, 2002): 92-101. Bernadette Baker 93 was followed by a transcript of the conversation held after it. Like today, in the discussion time, audience members asked questions or made comments. Unlike today, the names of such participating audience members were typed into the proceedings and their specific questions or comments were written up as part ofreporting on the paper presented. In a discussion held at a conference in 1 905 on the topic of methods for training children labeledas feebleminded, apresenterhadspokenof the positive uses of a vegetable garden in the disciplining of feebleminded girls. The audience members relayed their own versions of experimenting with gardening and gathering, some complaining oftoo little space and others indicating the effects of having too many fields from which to gather. Dr. Dunlap was one such participant, indicatingimplicitlytheeffectsofhavingtoo many choices. In the spirit ofthe hunter/gatherer dichotomy, thegirlslabeledas feeblemindedatthe institutionwhereDr. Dunlap worked weresentout to pick com. The following story emerged. Dr. Dunlap: Our girls go out under an attendant and gather vegetables... (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)

Zusammenfassung In diesem Aufsatz wird erstens der Frage nach den gesellschaftlichen Umgangsweisen von europäischen Gesellschaften der Neuzeit mit religiös gerahmter, weiblicher Nahrungsabstinenz nachgegangen. Zweitens werden Überlegungen dahingehend angestellt, welche Bedingungen und Faktoren für die Persistenz dieser relativ marginalisierten Praxis im untersuchten Zeitraum ausgemacht werden können. Dabei wird in der Argumentation für einen wissensgeschichtlichen Ansatz plädiert. Mit diesem Instrumentarium können u. a. auch hybride Erklärungsweisen der historischen Akteure rekonstruiert werden, die nicht einfach den Kategorien „natürlich“ bzw. „übernatürlich“ zugeordnet werden können. Der (...) Gegenstand der Fallstudie sind nahrungsabstinente Katholikinnen Westeuropas im Zeitraum von 1780 bis 1980. Nahrungsabstinenz hat dabei auf der objektsprachlichen Ebene sowohl die Bedeutung von Nicht-essen können oder wollen bis hin zur völligen Abwesenheit des Bedürfnisses nach „irdischer“ Nahrung. (shrink)

This paper analyzes how the figure of the childhas been used to authorize a series ofboundaries that have constituted thelimit-points of educational theories orphilosophies. Limit-points are the conceptualboundaries that educational theories produce,move within, respond to, and make use ofbecause the perception is that they cannot beargued away or around at the time. A method ofcomparative historico-philosophy is used tocontrast limit-points in Platonic figurationsof the child and education with childcenteredand eugenic theories of the late nineteenth andtwentieth century West. The figuration of (...) thechild in both periods is imbricated in formingboundaries around a power-motion-reason nexusand in delineating what necessity and justicemean. The meaning-space that the child canoccupy in relation to such concepts has shiftedwith them and has been important to depictingUtopian and cosmological imaginings atdifferent historical moments and forauthorizing in turn what counts as anappropriate and/or realistic educationalphilosophy. (shrink)

Responding to recent calls from within critical MOS and organizational ethics studies to explore questions of difference and inclusion ‘beyond unity and fixity’, this paper seeks to enrich the debate on difference and its negotiation in organizations, thereby foregrounding difference as the contested and ever-changing outcome of power-invested configurations of practice. The paper presents an ethnographic study conducted in a psychosocial day-care centre that positions itself as a ‘space of multiplicity’ wherein ‘it is normal to be different’. Highlighting the context-specific (...) challenges and struggles encompassing mental ill-health as a category of difference deviating from the norm, our paper contributes to a critical-affirmative understanding of difference. We foster an approach that values normative orientations such as ‘egalitarian difference’ and ‘difference as multiplicity’ yet avoids idealising portrayals of an ethics of difference that challenges normalcy and unconditionally favours otherness and calls for ‘radically other kinds of difference’. (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)

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.

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.

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)

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)

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)

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.

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)

The current empirical research and normative arguments on physician-assisted dying in the Netherlands seem insufficient to provide ethical guidance to general practitioners in the practice of PAD, due to a gap between the evidence and arguments on the one hand and the uncertainties and complexities as found in everyday practice on the other. This paper addresses the problems of current ethical arguments and empirical research and how both seem to be profoundly influenced by the Dutch legislative framework on PAD and (...) a certain view on ethics. Furthermore, the paper elaborates on how other approaches to empirical research in bioethics, such as found in the broad field of narrative research, could supplement the empirical and ethical evaluation of PAD in the Netherlands. This paper also addresses the challenging question of how empirical data—in this case narratives—relate to normativity. The paper is written in the form of a personal narrative of the author, a young Dutch general practitioner and researcher in bioethics. This style is intentionally chosen, to illustrate how work context and professional background influence the observations one makes and the questions one may ask about the topic of PAD. In addition, by using this style, this paper not only gives a different perspective on a much-contested bioethical issue, but also on the challenges faced when a physician–bioethicist has to navigate different disciplinary fields and epistemological paradigms, especially since the ‘empirical turn’ in bioethics. (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)

Synthetic biologists are extremely concerned with responsible research and innovation. This paper critically assesses their culture of responsibility. Their notion of responsibility has been so far focused on the identification of risks, and in their prudential attitude synthetic biologists consider that the major risks can be prevented with technological solutions. Therefore they are globally opposed to public interference or political regulations and tend to self-regulate by bringing a few social scientists or ethicists on board. This article emphasizes that ethics lies (...) beyond prudence and requires a cultural evaluation of the modes of existence of the various microorganisms designed by synthetic biologists, independently of their potential applications. (shrink)

This paper offers a rhizomatic reading of Foucault scholarship in anglophone educational research. It delineates unique parameters of an educational field, the conditions of receptivity for Foucault's work, and identifies three temporary plateau-formations that have erupted in educational research. Indebted to (non-formulaic) principles of connectivity and heterogeneity, multiplicity, and asignifying ruptures the analysis brings to notice the recombinatorial attributes of the discipline of education through attention to what is encamped and what seeps in debates over his work.

Croire ne peut s’appréhender sans son corollaire, douter. Le doute revêt des formes diverses que l’on retrouve en particulier chez les couples en thérapie. Dans ce cadre, pour tenter d’en approcher l’origine et la nature, l’auteur s’appuie sur les concepts d’identification projective, intrusive, adhésive, et de contenance développés par Meltzer. Dans cette perspective, un lien peut être fait entre la relation de couple et celle du bébé à son premier objet. La thérapie de couple est envisagée comme une tentative pour (...) chacun de passer du doute destructeur au doute positif, constructeur, permettant un véritable croire en l’autre et au couple. (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)

Bernadette M Tobin; Richard Peters's Theory of Moral Development, Journal of Philosophy of Education, Volume 23, Issue 1, 30 May 2006, Pages 15–27, https://doi.

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)