Research on moral distress has paid limited attention to nurses’ responses and actions. In a survey of nurses’ perceptions of moral distress and ethical climate, 292 nurses answered three open-ended questions about situations that they considered morally distressing. Participants identified a range of situations as morally distressing, including witnessing unnecessary suffering, being forced to provide care that compromised values, and negative judgments about patients. They linked these situations to contextual constraints such as workload and described responses, including feeling incompetent and (...) distancing themselves from patients. Participants described considerable effort to effect change, calling into question the utility of defining moral distress as an “inability to act due to institutional constraints” or a “failure to pursue a right course of action.” Various understandings of moral distress operated, and action was integral to their responses. The findings suggest further conceptual work on moral distress and effort to support system-level change. (shrink)

Whereas evidence-based medicine (EBM) encourages the translation of medical research into decision-making through clinical practice guidelines (CPGs), patient-centred care (PCC) aims to integrate patient values through shared decision-making. In order to successfully integrate EBM and PCC, I propose a method of orienting physician decision-making to overcome the different obligations set out by a formally-rational EBM and substantively-rational ethics of care. I engage with Weber’s concepts “the ethic of responsibility” andverstehenas a new model of clinical reasoning that reformulates the relationship between (...) medical knowledge and social values, while demonstrating the relevance of the classical sociological cannon to contemporary medical humanities. (shrink)

Many countries have attempted to transition to democracy following conflict or repression, but the basic meaning of transitional justice remains hotly contested. In this book, Colleen Murphy analyses transitional justice - showing how it is distinguished from retributive, corrective, and distributive justice - and outlines the ethical standards which societies attempting to democratize should follow. She argues that transitional justice involves the just pursuit of societal transformation. Such transformation requires political reconciliation, which in turn has a complex set of (...) institutional and interpersonal requirements including the rule of law. She shows how societal transformation is also influenced by the moral claims of victims and the demands of perpetrators, and how justice processes can fail to be just by failing to foster this transformation or by not treating victims and perpetrators fairly. Her book will be accessible and enlightening for philosophers, political and social scientists, policy analysts, and legal and human rights scholars and activists. (shrink)

This case study explored how a teacher, Mr. Smith, and his students experienced a mandated performance assessment while simultaneously preparing for an end of the year high-stakes, multiple-choice assessment. We employed qualitative research methods to examine how the teacher enacted a mandated performance assessment during a unit on Byzantium and how students described their learning and classroom experiences from the unit. Drawing on Grant's idea of ambitious teaching and learning of history and Ball's work on policy realization, analysis of these (...) data indicated that Mr. Smith interpreted and enacted a performance assessment in ways that differed from how district and state policy makers intended. Despite an assessment that the district designed to promote historical thinking skills, students learned primarily factual knowledge. (shrink)

In the previous four papers in this series, individual versus structural or contextual factors have informed various understandings of moral distress. In this final paper, we summarize some of the key tensions raised in previous papers and use these tensions as springboards to identify directions for action among practitioners, educators, researchers, policymakers and others. In particular, we recognize the need to more explicitly politicize the concept of moral distress in order to understand how such distress arises from competing values within (...) power dynamics across multiple interrelated contexts from interpersonal to international. We propose that the same socio-political values that tend to individualize and blame people for poor health without regard for social conditions in which health inequities proliferate, hold responsible, individualize and even blame health care providers for the problem of moral distress. Grounded in a critical theoretical perspective of context, definitions of moral distress are re-examined and refined. Finally, recommendations for action that emerge from a re-conceptualized understanding of moral distress are provided. (shrink)

In this work, Colleen Clements presents her case for the need to subject the field of bioethics to a critical external analysis apart from the current postmodern assumptions. Clements argues that, since the 1970s, bioethics has refuted human values in favour of political consensus building. This failure to recognize basic human values in the ethical critique of modern medicine has lead to a dehumanization of the medical system by the field. Clements proceeds to advocate a naturalistic theory of bioethics (...) that reinstates primary human values. (shrink)

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

Volume 20, Issue 7, July 2020, Page 185-187.

While the focus examines multiple levels and perspectives on care, it will go beyond description and analysis to discuss ethical, intersectional, and life-sustaining ways in which care may be enhanced.

It is easy to call for public engagement (or dialogue) around difficult, morally fraught policy topics such as synthetic biology, but it is quite another thing to make sure that the deliberation is meaningful, as Kaebnick, Gusmano, and Murray aptly insist it should be. The surveys, focus groups, and public dialogues that have been held about synthetic biology to date show a very low level of public knowledge about it. Focus group findings also suggest that the in­herent uncertainty and complexity (...) surrounding synthetic biology give rise to greater ambivalence moving forward. The Science and Technology Innovation Program at the Woodrow Wilson International Center for Scholars and Hart Research Associates presented respondents with a “balanced description” of synthetic biology in nation­wide phone surveys and eight sessions of focus groups and found that, after respondents received information, the percentage saying that the risks outweighed the ben­efits consistently increased.In my view, the Hart research suggests three very im­portant conclusions about how best to structure public deliberation. First, information about uncertainty may not inform the public in any meaningful way. Second, the purpose of assessing public opinion and conduct­ing public deliberation is crucially important. Third, as Kaebnick, Gusmano, and Murray point out, the type and framing of the information given and the timing of the discussion matters a great deal for shaping the content. (shrink)

Debates about how knowledge is made and valued in evidence-based medicine (EBM) have yet to understand what discursive, social, and historical conditions allowed the EBM approach to stabilize and proliferate across western medical education. This paper uses a genealogical approach to examine the epistemological tensions that emerged as a result of various problematizations of uncertainty in medical practice. I explain how the problematization of uncertainty in the literature and the contingency of specific social, political, economic, and historical relations allowed the (...) EBM approach to become a programmatic and pedagogical focus of the Faculty of Medicine at McMaster University and beyond. (shrink)

The opioid crisis has continued despite efforts to intervene on its identified causes. In this article, we analyse responsibility claims in pain and addiction medical journals concerning the opioid crisis. Selected journals represent the opioid crisis as a medical problem. Using the method of discourse analysis, we examine 32 sampled articles from 3 medical journals published over the past decade to understand how the cause of the opioid crisis is represented. Drawing upon the sociological concept of responsibilization, we observe and (...) explain two patterns in the responsibility claims. Pain medicine specialty journals tended to responsibilize physicians for their part in the crisis, whereas the addiction journal directed responsibility toward users. Despite some differences in proposed solutions, statements in both journals tend to responsibilize individual behaviours as the cause of the crisis. Accordingly, each article suggested solutions that target these behaviours. We argue that by focusing on individual behaviours, other factors and social conditions related to the crisis are omitted, including pharmaceutical companies, regulators, and health system infrastructure. We advocate for the need to redefine the assumptions related to the cause of the opioid crisis in order to consider alternative solutions. (shrink)

Several recent studies indicate that cheating has become both more prevalent and more socially acceptable. In this article I draw parallels between market values and student attitudes about cheating. They include: (1) reduction of a broad range of goods to their economic value, (2) use of non-reciprocity as a guiding principle, (3) valuing the appearance of virtue over real virtue, and (4) reframing dishonesty in a positive light. I posit two ways that market culture influences the willingness to cheat, and (...) discuss the media's role in transmitting this influence. The article concludes with the suggestion that attempts to curtail cheating by further policing students may only exacerbate the problem in the long run. The same contextual factors that help mitigate undesirable market behavior, when cultivated in the classroom, can help to curb student cheating. (shrink)

Hegemonic masculinity, a framework where stereotypically masculine traits are over-emphasized, plays a central role in sport, partly due to an excessive focus on winning. This type of masculinity marginalizes those that do not possess specific traits, including many women and men. I argue sport reform focused on mitigating hypercompetitive attitudes can reduce this harmful and marginalizing hegemonic masculinity in sport. I make this argument first by challenging the dichotomous nature of sport, especially in recognizing that all outcomes are a blend (...) of winning and losing, that ties are relevant and informative outcomes to contests, and that winning and losing do not always tell accurate stories of the outcome. Secondly, I contend that expanding the potential outcomes in sport can help broaden the emphasis of competitive sport to take into account playing well and improving, in terms of both the test and the contest. I conclude that these reforms decrease hegemonic masculinity, making sport better for all. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 39.4 (2001) 491-533 [Access article in PDF] Worthy Constraints in Albertus Magnus's Theory of Action Colleen McCluskey Many medieval accounts of action focus upon the interaction between intellect and will in order to explain how human action comes about. What moves agents to act are their desires for certain goals, their deliberations about their goals, and what it will take to accomplish (...) those goals and satisfy their desires. Thus, many medieval philosophers explain human action by referring to the operations of intellect or reason, which accounts for the deliberative aspect, and the will, which accounts for the desiderative aspect. This is not to say that medieval accounts ignored other influences on action such as passions or sensory desires, but that they tended to focus on the intellect and the will. The account of action developed by Albert the Great early in his career is a notable variation on this basic model. 1 Albert examined the nature of action in a number of texts written over the course of his long career, including De homine, De anima, and his commentaries on the Sentences and Nicomachean Ethics. In De homine, which is an early work, he agrees that intellect and will play important roles in the execution of action, but he argues that both the performance of an action and its freedom involve a third capacity that he calls "liberum arbitrium." Albert modified his views of action significantly in his later works, but I shall argue that this early view retains something of philosophical interest and importance.In the medieval philosophical tradition of the Latin West, beginning with Augustine in the fourth and fifth centuries and continuing well into the thirteenth century, philosophers used the term "liberum arbitrium," often translated [End Page 491] as "free choice" or "free decision," as a technical term for that power or capacity in virtue of which human beings act freely. 2 In the first half of the thirteenth century, many philosophers identified liberum arbitrium either with the will, or with both intellect and will. In De homine, Albert insists that it is a separate capacity. According to his account, liberum arbitrium is the human capacity for choice and also helps to explain the freedom of those choices. Although Albert ultimately characterizes an act of choosing as an inclination in favor of a particular course of action, a certain cognitive ability plays an important role in his account. Part of what makes human freedom possible is the ability to judge secundum rationem honesti. Literally this phrase means "in accordance with the concept of what has worth." I shall argue that this capacity consists of the ability to evaluate choices in light of one's immediate, intermediate, or ultimate objectives and to forgo lesser goods for the sake of a greater good. It would appear that an ability of this sort is a function of the intellect, since judgments about how to accomplish one's goals and which goods are the better ones require the exercise of certain abstract cognitive skills. But Albert holds that the intellect is determined and concludes that while the intellect is a necessary condition for free action, the constraints placed upon it prevent it from contributing substantially to the freedom of an action. Since the ability to judge secundum rationem honesti plays an integral role in bringing about a free action, Albert cannot argue that this ability is a function of the intellect. Although the will has the requisite freedom, it is an appetitive capacity, not a cognitive one. Therefore, it too is unable to fulfill this role. Given these commitments, it would seem natural for Albert to locate this ability in an independent power.As natural as it may appear, this position is bound to strike many philosophers as implausible and unnecessary. One could argue that the constraints placed upon the intellect need not restrict it in any significant way. I do not plan to defend Albert's account against this objection. Rather, first, I shall [End Page 492] examine Albert's view of... (shrink)

Colleen Glenney Boggs puts animal representation at the center of the making of the liberal American subject. Concentrating on the formative and disruptive presence of animals in the writings of Frederick Douglass, Edgar Allan Poe, and Emily Dickinson, Boggs argues that animals are critical to the ways in which Americans enact their humanity and regulate subjects in the biopolitical state. Biopower, or a politics that extends its reach to life, thrives on the strategic ambivalence between who is considered human (...) and what is judged as animal. It generates a space of indeterminacy in which animal representations intervene to define and challenge the parameters of subjectivity. The renegotiation of the species line produces a tension that is never fully regulated. Therefore, as both figures of radical alterity and the embodiment of biopolitics, animals are simultaneously exceptional and exemplary to the biopolitical state. An original contribution to animal studies, American studies, critical race theory, and posthumanist inquiry, Boggs thrillingly reinterprets a long and highly contentious human-animal history. (shrink)

The purpose of this study was to assess student perceptions of self-plagiarism. Students at three university campuses offering graduate and undergraduate classes in a residential and online format were queried; 284 students responded. Overwhelmingly, students perceived they owned their own previous published works and over half reported they believed self-plagiarism should not be considered an academic honesty offense. Most faculty members did not provide information about self-plagiarism to their students. Only about one-fourth of the students reported recycling parts of an (...) assignment in the past. Students who took online courses were more likely to have been educated about self-plagiarism than those who took residential courses. Understanding students’ perceptions about academic honesty offenses such as plagiarism can help institutions develop effective policies and interventions. (shrink)

My critical commentary focuses on Victor Tadros’ analysis of accountability for violations of the (revised) laws of armed conflict (LOAC) that he lays out (Tadr.

It is often argued that the rule of law is only instrumentally morally valuable, valuable when and to the extent that a legal system is used to purse morally valuable ends. In this paper, I defend Lon Fuller’s view that the rule of law has conditional non-instrumental as well as instrumental moral value. I argue, along Fullerian lines, that the rule of law is conditionally non-instrumentally valuable in virtue of the way a legal system structures political relationships. The rule of (...) law specifies a set of requirements which lawmakers must respect if they are to govern legally. As such, the rule of law restricts the illegal or extra-legal use of power. When a society rules by law, there are clear rules articulating the behavior appropriate for citizens and officials. Such rules ideally determine the particular contours political relationships will take. When the requirements of the rule of law are respected, the political relationships structured by the legal system constitutively express the moral values of reciprocity and respect for autonomy. The rule of law is instrumentally valuable, I argue, because in practice the rule of law limits the kind of injustice which governments pursue. There is in practice a deeper connection between ruling by law and the pursuit of moral ends than advocates of the standard view recognize. The next part of this paper outlines Lon Fuller’s conception of the rule of law and his explanation of its moral value. The third.. (shrink)

Thomism is a philosophical movement based on the writings of Thomas Aquinas. This chapter begins by explaining the historical context within which Thomism originated and some of the general issues arising in Thomistic discussions, and then considers the two main approaches to Thomistic ethics: eudaimonism and natural law. It concludes with an application of Thomistic ideas to a current discussion of justice and practical rationality, specifically Alasdair MacIntyre's treatment of Aquinas in his book, Whose Justice? Which Rationality?

I discuss why one critical aspect of the process of political reconciliation involves the restoration of mutual respect for the rule of law and suggest that psychological research on post-traumatic stress disorder (PTSD) provides valuable resources for understanding how successfully to restore such mutual respect.

One of the central moral challenges facing numerous political communities today is political reconciliation. In the aftermath of repression, conflict, and injustice, communities confront the task of repairing damaged relationships among citizens and between citizens and officials. In A Moral Theory of Political Reconciliation, I develop a theory of what this process entails and of its moral significance. My central claim is that political relationships are damaged when and to the extent that they fail to express reciprocity and respect for (...) agency. Failures of reciprocity and respect for agency are how relationships go wrong during extended periods of repression and conflict, and it is in cultivating these two values in relations among citizens and officials that relationships are repaired. I am very grateful for the thoughtful, incisive, and stimulating comments provided by Cindy Holder, Tracy Isaacs, and Alice MacLachlan. In this reply to their commentaries, I first provide a brief background of the motivation for my project and an overview of the main theses that I defend over the course of my book. I then turn to three kinds of concerns raised by Holder, Isaacs, and MacLachlan. The first urges me to rethink the restriction of my analysis of political reconciliation to contexts of transition. The second challenges the particular way that I conceptualize the demands of reciprocity and respect for agency in political relationships. The final set turns to my analysis of the processes that can facilitate reconciliation. (shrink)

In Our Moral Fate, Allen Buchanan defends an account of moral change that is grounded in evolutionary biology. His account offers resources for explaining the possibility of both moral progress and moral regression, where progress and regression are a function of moral inclusion and moral exclusion, respectively. In my commentary, I first offer a brief summary of Buchanan’s argument. I then examine Buchanan’s account from the perspective of transitional justice. Transitional justice provides confirming evidence for some of Buchanan’s substantive claims (...) and challenges the validity of others. I end with a discussion of power and time. Power plays a central role in Buchanan’s account of niche construction, but the locus of power is unspecified. Time scales for moral change are profoundly different for the timeline of transitional justice versus the timeline of evolutionary biology. My discussion of power and time raises questions the nature of the normative guidance Buchanan’s account offers in the short term. (shrink)

In their article “Racial Justice Requires Ending the War on Drugs,” Earp, Lewis, and Hart argue for the end of our War on Drugs in order to alleviate our reliance on mass incarceration, harm...

Abstract Medical futility is commonly understood as treatment that would not provide for any meaningful benefit for the patient. While the medical facts will help to determine what is medically appropriate, it is often difficult for patients, families, surrogate decision-makers and healthcare providers to navigate these difficult situations. Often communication breaks down between those involved or reaches an impasse. This paper presents a set of practical strategies for dealing with cases of perceived medical futility at a major cancer center. Content (...) Type Journal Article Pages 1-8 DOI 10.1007/s10730-011-9168-3 Authors Colleen M. Gallagher, Section for Integrated Ethics in Cancer Care, Unit 1430, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX 77230-1402, USA Ryan F. Holmes, St. Louis University, St. Louis, MO, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)