This article on the potential for patient online records access (ORA) to increase the likelihood of nocebo effects is timely, 1 given the recent introduction of full prospective records access for primary care patients in England. 2 Blease provides a convincing overview of the evidence for the nocebo effect and examines the complex interplay with health inequities. The article proposes two mechanisms for ORA augmenting nocebo effects through: (A) patients reading about possible negative outcomes of treatments and (B) a negative (...) clinician tone or less supportive content in the notes diminishing patient trust and setting up negative expectations. Blease notes a small percentage of those who had used ORA at least once during the previous year in one study reported feeling more worried about their medications, 3 and that those with mental health diagnoses were significantly more prone to this than those without such diagnoses.shrink)

This study is about the interaction of scientific expertise and local knowledge in the context of a contested issue: the quality and quantity of safe drinking water available to some residents in one Canadian community. The authors articulate the boundary work in which scientific and technological expertise and discourse are played out against local knowledge and water needs to prevent the construction of a water main extension that would provide a group of residents with the same water that others in (...) the community already access. The authors draw on an extensive database constructed during a three-year ethnographic study of one community; the data base includes the transcript of a public meeting, newspaper clippings, interviews, and communications between residents and town council. The authors show not only that scientists and residents differ in their assessment of water quality and quantity but also that there is a penchant for undercutting residents in their attempts to make themselves heard in the political process. (shrink)

This paper is a counter to the view that names are always predicates with the same extension as a metalinguistic predicate with the form “is a thing called “N”” (the Predicate View). The Predicate View is in opposition to the Referential View of names. In this paper, I undermine one argument for the Predicate View. The Predicate View’s adherents take examples of uses of names that have the surface appearance of a predicate and generalise from these to treat uses of (...) names that do not have the surface appearance of a predicate. They show that the Predicate View can provide a unified account of these two uses and assume that the Referential account cannot. I propose an alternative view of names, the Polysemy View. This view allows one to resist the pressure to generalise from the cases with the surface appearance of predicates to all uses of names while nevertheless providing connections between the uses. On the Polysemy View names are not, in their core use, metalinguistic predicates. Names are predominantly referring expressions but they also freelance as metalinguistic predicates on occasion. They have a double life. This double life is possible because of the pragmatic and conventional connections between the two aspects of that life. My main aim in this paper is to show that the Predicate View is not the only view that can give a good account of apparently predicative uses of names. In addition, I offer some inconclusive reasons to prefer the Polysemy View over the Predicate View. My paper assumes a background framework that the Predicate and Referentialist Views share and I do not attempt to justify that framework. I ignore many other views of names (notably descriptivist views and relevance theoretic views) in order to focus on the debate between these two opponents. (shrink)

The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment have conducted visits and written reports criticising the surgical castration of sex offenders in the Czech Republic and Germany. They claim that surgical castration is degrading treatment and have called for an immediate end to this practice. The Czech and German governments have published rebuttals of these criticisms. The rebuttals cite evidence about clinical effectiveness and point out this is an intervention that must be requested (...) by the sex offender and cannot occur without informed consent. This article considers a number of relevant arguments that are not discussed in these reports but which are central to how we might assess this practice. First, the article discusses the possible ways in which sex offenders could be coerced into castration and whether this is a decisive moral problem. Then, it considers a number of issues relevant to determining whether sex offenders are harmed by physical castration. The article concludes by arguing that sex offenders should not be coerced into castration, be that via threats or offers, but that there is no reason to think that this is occurring in the Czech Republic or Germany. In some cases, castration might be useful for reconfiguring a life that has gone badly awry and where there is no coercion, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment are mistaken about this being degrading treatment. (shrink)

Psychedelic-Assisted Psychotherapy is being investigated as a treatment for a range of psychiatric illnesses. Current research suggests that the kinds of subjective experiences induced by psychedelic compounds play key roles in producing therapeutic outcomes. To date, most knowledge of therapeutic psychedelic experiences are derived from psychometric assessments with scales such as the Mystical Experience Questionnaire. While these approaches are insightful, more nuanced and detailed descriptions of psychedelic-induced changes to subjective experience are required. Drawing on recent advancements in qualitative methods arising (...) from the interdisciplinary field of phenomenological psychopathology, we propose a systematic and comprehensive investigation into how Psychedelic-Assisted Psychotherapy alters subjective experience. This research program aims to characterise the nature of therapeutic psychedelic experiences by drawing on concepts from philosophical phenomenology. Such characterisations should, moreover, contribute to our understanding of the mechanisms of psychedelic therapy, the role of integration therapy, and related philosophical debates. (shrink)

Scholarly inquiry into medical ethics should inform and guide those involved in making challenging ethical decisions.1 It should strive to be integral to the work of health care professionals and health care institutions2 and clinical relevance seems essential for this to happen. To acknowledge the importance of clinical relevance for medical ethics, the Journal of Medical Ethics has introduced a regular Clinical Ethics section at the beginning of each issue. Papers that we think are likely to be of particular interest (...) and relevance to clinicians will be placed in this section of the journal. One way in which a paper can be framed for a more clinical audience is by organising it around a scenario that healthcare professions might face. The paper published in this issue’s Clinical Ethics section considers a dilemma about whether an egg donor should be contacted to help diagnose a condition that the resulting child might have.3 While egg donation has become more common, the complexities presented by this scenario might appear removed from those which most health professionals face. However, the way in which genomics is becoming incorporated into healthcare means that the issues this scenario raises are relevant to all healthcare professionals. The spread of genomics into practice means that the …. (shrink)

The Peri ide^on is the only work in which Aristotle systematically sets out and criticizes arguments for the existence of Platonic forms. Gail Fine presents the first full-length treatment in English of this important but neglected work. She asks how, and how well, Aristotle understands Plato's theory of forms, and why and with what justification he favors an alternative metaphysical scheme. She examines the significance of the Peri ide^on for some central questions about Plato's theory of forms--whether, for example, (...) there are forms corresponding to every property or only to some, and if only to some, then to which ones; whether forms are universals, particulars or both; and whether they are meanings, properties or both. Fine also provides a general discussion of Plato's theory of forms, and of our evidence about the Peri ide^on and its date, scope, and aims. While she pays careful attention to the details of the text, she also relates it to contemporary philosophical concerns. The book will be valuable for anyone interested in metaphysics ancient or modern. (shrink)

A report by the Nuffield Council on Bioethics, contrary to the Declaration of Helsinki, permits most important research initiatives in developing countries.The Ethics of Research Related to Health Care in Developing Countries by the Nuffield Council on Bioethics makes a number of innovative recommendations that depart from codes such as the Declaration of Helsinki. It recommends that standards of care might be relativised to the standard of that nation. It recommends that very good reasons need to be given for not (...) giving post-trial access to medications but recognises that there may be justifiable instances of this. It is the view of the authors that these and other recommendations of the report are sensible pieces of advice given the complexities of the developing world. (shrink)

Psychedelic-assisted Psychotherapy combines the use of psychedelic compounds, such as psilocybin, with psychotherapy. PAP has shown some promise as a novel treatment for Major Depressive Disorder, and empirical research suggests that its efficacy turns on the altered states induced by psychedelic compounds. In this paper we draw on the literature of phenomenology to explain the therapeutic potential of psychedelic experiences. Svenaeus characterises mental illness as a form of suffering that entails three distinct but related experiences of alienation or “unhomelike being-in-the-world”: (...) illness suffering, which relates to embodiment; existential suffering, which relates to self-narratives, and political suffering, which relates to social relationships. Ratcliffe further characterises the experience of MDD in phenomenological terms as a loss of pre-intentional possibility that manifests as excessive noematic feeling in the experience of embodiment, restrictive narratives in the construction of self, and disconnectedness in experience of the social world. We contend that PAP ameliorates the suffering associated with MDD by inducing and consolidating a state of broadened pre-intentional possibility—one that entails sudden, profound and enduring changes in embodiment, self-narratives, and social experience. We argue further that this phenomenological account is consistent with a bio-psycho-social model of mental health and illness, and we frame it as an argument supporting the plausibility of recent claims about treatment success. This helps to justify ongoing future empirical research in this setting. (shrink)

This article explores the development of a novel biomedical research organism, and its potential to remake the species and spaces of translational medicine. The humanized mouse is a complex experimental object in which mice, rendered immunodeficient through genetic alteration, are engrafted with human stem cells in the hope of reconstituting a human immune system for biomedical research and drug testing. These chimeric organisms have yet to garner the same commentary from social scientists as other human–animal hybrid forms. Yet, they are (...) rapidly being positioned as central to translational medicine in immunological research and pharmaceutical development. This article explores the complex relations between species and spaces they seek to enact. Humanizing mice simultaneously moves these animal forms towards the intimate geographies of corporeal equivalence with humans and the expansive geographies of translational research. These multiple trajectories are achieved by the way humanized mice function as both uncertain ‘epistemic things’ and as expansive ‘collaborative things’, articulating mouse genetics with other research, notably stem cell science. In the context of post-genomics, their indeterminacy is critical to their collaborative value; their expansive potential follows as much from their biological openness as from specific expectations. Yet, these new research organisms have both accumulative and disruptive capacities, for there are patterns of interference between these trajectories, remaking boundaries between experimental practices and clinical contexts. (shrink)

“Women and the Law in Irigarayan Theory” by Gail Schwab is a reading of French feminist philosopher Luce Irigaray's writings on law together with texts of American feminist jurisprudence. The first part of the article summarizes many of the conflicts surrounding the concept of equality in American feminist legal thought and attempts to move beyond them with the Irigarayan principle of equivalence or equivalent rights. The second part of the article deals more generally with the symbolic changes that will (...) be necessary in order to change the law, and with the cultural evolution that changes in the law can bring about, and more specifically with two areas of Irigarayan legal theory that are central to cultural change and evolution: the concept of female identity or virginity, and the relationship to the mother. In the conclusion, a new utopian vision of what law might be‐the cultural mediation for an evolved intersubjectivity‐is developed through Irigaray's most recent texts. (shrink)

This article analyzes how the family policing/regulation system utilizes disorientation as a tool to implement successive stages of surveillance, coercion, and control and to tear apart Black families while capturing children in the foster system. Through specific examples based on both the author’s own experiences and those she has witnessed in her work, the process of how families are targeted and ensnared in the family policing/regulation system becomes visible.

:This article describes the well-developed and long-standing medical ethics teaching programs in both of New Zealand’s medical schools at the University of Otago and the University of Auckland. The programs reflect the awareness that has been increasing as to the important role that ethics education plays in contributing to the “professionalism” and “professional development” in medical curricula.

An interview with Gail Weiss concerning her interests and influences, especially the body and embodiment.

Change is inevitable, and increasingly rapid and continuous in healthcare as organizations strive to adapt, improve and innovate. Organizational change challenges healthcare providers because it restructures how and when patient care delivery is provided, changing ways in which nurses must carry out their work. The aim of this doctoral study was to explore frontline nurses’ experiences of living with rapid and continuous organizational change. A critical hermeneutic approach was utilized. Participants described feeling voiceless, powerless and apolitical amidst rapid and continuous (...) organizational changes which fuelled apathy, cynicism and disengagement from the organization. However, critical analysis of the data showed that nurses actively engaged with power, voice and politics through resistant and transgressive behaviours in micro‐ethical moments of practice. There is a need to reconceptualize the concepts of voice, power and politics in nursing as there is dissonance between nurses’ beliefs about these concepts and what they are enacting in practice. Recognizing their enactment of power, voice and political agency at the micro‐level may empower nurses. Empowerment would mitigate the high levels of reports of powerlessness experienced in practice during organizational changes. (shrink)

Meno's Paradox from Socrates to Sextus Gail Fine. sense that they consider the issues it raises; and they argue, against its conclusion, that inquiry is possible. Like Plato and Aristotle, they also explain what makes inquiry possible; and they do ...

Access to human biospecimens is widely regarded as essential to the progress of medical research, and in particular, to the success of “personalized medicine.” Understanding the influence of genetic variation on human health and disease requires that researchers conduct genetic and other studies on thousands of human specimens. Over the past decade, human “biobanks” — vast collections of human biospecimens — have proliferated both in the United States and internationally. These biobanks are subject to a heterogeneous mix of standards that (...) govern the collection and use of biospecimens. (shrink)

In much the same way that genomic technologies are changing the complexion of biomedical research, the issues they generate are changing the agenda of IRBs and research ethics. Many of the biggest challenges facing traditional research ethics today — privacy and confidentiality of research subjects; ownership, control, and sharing of research data; return of results and incidental findings; the relevance of group interests and harms; the scope of informed consent; and the relative importance of the therapeutic misconception — have become (...) important policy issues over the last 20 years because of the ways they have been magnified by genomic research efforts. Research that examines the ethical, legal, and social implications of human genomics research has become a burgeoning international field of scholarship over the last 20 years, thanks in part to its support first by the genome research funding bodies in the U.S. and then by national science agencies in other countries. (shrink)

Representing a new generation of theorists reaffirming the radical dimensions of art, Gail Day launches a bold critique of late twentieth-century art theory and its often reductive analysis of cultural objects. Exploring core debates in discourses on art, from the New Left to theories of "critical postmodernism" and beyond, Day counters the belief that recent tendencies in art fail to be adequately critical. She also challenges the political inertia that results from these conclusions. Day organizes her defense around critics (...) who have engaged substantively with emancipatory thought and social process: T. J. Clark, Manfredo Tafuri, Fredric Jameson, Benjamin H. D. Buchloh, and Hal Foster, among others. She maps the tension between radical dialectics and left nihilism and assesses the interpretation and internalization of negation in art theory. Chapters confront the claim that exchange and equivalence have subsumed the use value of cultural objects—and with it critical distance— and interrogate the proposition of completed nihilism and the metropolis put forward in the politics of Italian operaismo. Day covers the debates on symbol and allegory waged within the context of 1980s art and their relation to the writings of Walter Benjamin and Paul de Man. She also examines common conceptions of mediation, totality, negation, and the politics of anticipation. A necessary unsettling of received wisdoms, _Dialectical Passions_ recasts emancipatory reflection in aesthetics, art, and architecture. (shrink)

Plato on Knowledge and Forms brings together a set of connected essays by Gail Fine, in her main area of research since the late 1970s: Plato's metaphysics and epistemology. She discusses central issues in Plato's metaphysics and epistemology, issues concerning the nature and extent of knowledge, and its relation to perception, sensibles, and forms; and issues concerning the nature of forms, such as whether they are universals or particulars, separate or immanent, and whether they are causes. A specially written (...) introduction draws together the themes of the volume, which will reward the attention of anyone interested in Plato or in ancient metaphysics and epistemology. (shrink)

While the UK Home Office’s proposals to preventively detain people with what it has called dangerous severe personality disorder have been subjected to debate and criticism the deeply troubling jurisprudential issues in these proposals have not yet entered into public debate in a way that their seriousness deserves.1 It is good that a commentator as well known as Professor Szasz is speaking out on this issue.Professor Szasz focuses upon a crucial question by calling into question the medicalisation of terms like (...) dangerousness and mental illness.2 There is a great temptation for legislators and the public to treat these terms as if they are purely scientific terms and to think of risk assessment as a precise science. I don’t share Professor’s Szasz’s worry about how psychiatry is using these terms but I think there are some important questions about how these concepts function in the public sphere.This issue is important enough to justify the use of some rhetorical claims because such claims can serve to bring out what are neglected and important issues. In raising the following objections I am not attempting to refute the message that is in Szasz’s article or to say that he is not making an important point but rather to attempt to sharpen the issues and to suggest ways that we can respond to Professor Szasz’s challenge.Psychiatry has progressed in a number of ways since Professor Szasz wrote The Myth of Mental Illness.3 The science is much better, we have much better medications, and psychiatrists are acutely aware of the tension between treating their patient and their obligations to the public interest.So when Professor Szasz says: “Psychiatrists offer to relieve the disturbed person of the burden of coping …. (shrink)

The Social Value Judgments consultation document reveals NICE’s failure to understand its role in healthcare prioritisationThe National Institute for Health and Clinical Excellence has published a draft guideline, Social Value Judgments: Guidelines for the Institute and its Advisory Bodies , which outlines the ethical framework that will guide its decision making in the future.1 NICE guidance has a profound effect upon the delivery of health care within the National Health Service so it is crucial that an overarching guideline such as (...) this is suited to the task that it needs to perform. In this paper we argue that NICE has misunderstood the way in which its advice fits into prioritisation decisions. This misunderstanding is amplified by its views about the ethical principles that should apply to prioritisation and, in particular, its failure to appreciate the role of fair processes in prioritisation.The national and international standing of NICE means that the definitive version of Social Value Judgments: Guidelines for the Institute and its Advisory Bodies is likely to have influence beyond the institute itself. There is much to welcome about the document, not least the acknowledgement that there are important ethical dimensions to NICE’s decision making. Indeed, the significance of the document lies in the fact that NICE is attempting to create an explicit ethical framework for funding decisions.There is, however, much that is of concern. Although John Harris has made some important points about the NICE position on age and sex,2 there are other important problems that need to be discussed. First, there appears to be confusion over the nature of the funding decisions taken by NICE and, as a result, the role of its guideline. It is of vital importance that professionals and public alike understand the precise nature of …. (shrink)

This is the first book that explains how you actually go about doing good bioethics. John McMillan develops an account of the nature of bioethics; he reveals how a number of methodological spectres have obstructed bioethics; and then he shows how moral reason can be brought to bear upon practical issues via an 'empirical, Socratic' approach.

The recent renaissance in research on psychedelic-assisted psychotherapy is showing great promise for the treatment of many psychiatric conditions. Interestingly, therapeutic outcomes for patients undergoing these treatments are predicted by the occurrence of a mystical experience—an experience characterised in part by a sense of profound meaning. This has led to hypotheses that psychedelic-assisted psychotherapy is therapeutic because it enhances perception of meaning, and consequently leads to a meaning response. The putative mechanism of action of psychedelics as meaning enhancers raises normative (...) ethical questions as to whether it can be justified to pharmacologically increase the perception of meaning in order to heal patients. Using the perspectives of hedonistic moral theories, this paper argues that if psychedelics operate as meaning enhancers, psychedelic-assisted psychotherapy can be ethically justified. An anti-hedonistic objection is presented by applying Robert Nozick’s Experience Machine thought experiment to the case of psychedelic-assisted psychotherapy. However, it is argued that this objection falls short for two reasons. First, even if pleasure and pain are not the only consequences which have moral value they are not morally irrelevant, therefore, therapeutic meaning enhancement can still be justified in cases of extreme suffering. Second, it is possible that psychedelic states of consciousness do not represent a false reality, hence their therapeutic meaning enhancement is not problematic according to Nozick’s standards. (shrink)

Biomedical science is usually framed for the public in terms of its “promise.” When a breakthrough results from scientific inquiry, that promise is translated into a hope for a cure. The “promise” of such advances in biomedical research can have a paradoxical effect. In the case of pediatric neuromuscular disease, rather than reducing suffering, the expectation of cure can be a burden—both physically and emotionally—for affected children and their families. If a family expects a cure, it is likely to do (...) everything possible to help the child live as long as possible, in the hope that the child will eventually receive it. I am not arguing that the appropriate response to the paradox of promise is to impede scientific progress. What is needed, however, is a broader conception of hope—one that values hope for a good day, a good quality of life, good relationships, or even a good death—alongside the hope for a cure. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Confessions of a Poisoner, Written by HerselfGail K. Hart (bio)Confessions of a Poisoner, Written by Herself. Translated and introduced by Raleigh Whitinger and Diana Spokiene. New York: MLA, 2009. xliii + 196 pp. $12.95.Confessions of a Poisoner is an epistolary, autobiographical novel, first published anonymously in German as Bekenntnisse einer Giftmischerin in 1803. Lurid accounts of sex, incest, murder, and other crimes contributed to its status as a (...) sensational document in its day, especially in light of the illicit activities of the Countess Charlotte Ursinus, who was arrested and prosecuted for multiple poisonings allegedly committed between 1779 and 1803. Readers were eager for details of the countess's affairs and crimes, and the novel can indeed be read as an account, perhaps her account, of a very busy life of iniquity.The book is extremely engaging, and absorbing because our autobiographical narrator has unusually acute insight into human affairs and human character. From early youth, she finds pleasure in the art of seeming and she is proud of the skill with which she reads those who have something to offer her. Indeed the book could double as a seminar in social manipulation as the narrator negotiates her culture's obstacles to women's self-fulfillment. One is often reminded of George Lillo's murderous Millwood from The London Merchant, who in 1731 made the observation:It is a general maxim among the knowing part of mankind that a woman without virtue, like a man without honor or honesty, is capable of any action, though never [End Page 68] so vile. And yet what pains will they not take, what arts not use, to seduce us from our innocence and make us contemptible and wicked, even in their own opinions?(I:3)The narrator of Poisoner, though she might agree with Millwood, sees her part in the vile actions as both determined and chosen. The early steps of corruption were abetted by passion (incited with some calculation by early lovers) but also by the education she received, which she describes as being more masculine than feminine. Her father's failure to guide and restrain her thirst for knowledge has apparently left her with the ambitions of a conquerer and the social duties of an aristocratic woman—and, as Countess Orsina would have it, where men use daggers, women use poison. Yet she also accepts responsibility for all that she has done, quite convinced that most of it was wrong. The moral philosophy of the piece is somewhat peculiar, but she strives in the space of the one long letter that makes up the book to give an honest account of her duplicitous deeds.This intriguing life story also has significant scholarly value, and the editors/translators, Raleigh Whitinger and Diana Spokiene, have appended an excellent introduction that examines the poisoner's confessions as a document of its time. Our narrator is both wise and well-educated, and she discourses frequently on contemporary literature and philosophy, inserting herself into a variety of cultural debates. For example, her opinions on the value of Richardson's novels for the education and protection of young woman—that Richardson's ideals of virtue are delusional and therefore dangerous—run counter to prevailing wisdom on what young ladies should read. Her struggles with Kant and critical philosophy, which, she claims, diminished her pulchritude, are also instructive. Additionally, the editors make a very convincing case for the authorship of Friederike Helene Unger, whose husband was the publisher, and whose other works bear certain strong resemblances to the prose and the ideas of Poisoner.All of this excitement and knowledge comes to us in a supremely lucid and readable translation. I rarely read fiction in translation without being regularly reminded in some way of the translator. One sees an odd word, puzzles out a sentence and thinks about how one might have done that differently—and one gets distracted. That is not the case with this text, and this is especially surprising because the original German is that "of an era both culturally and historically distant" (xxvii). Whitinger and Spokiene have done a superb job of resurrecting a forgotten German text, embedding it in... (shrink)

This symposium includes twelve personal narratives from healthcare interpreters who have navigated challenges while interpreting for patients and healthcare providers who do not share a common language. These stories are from trained professionals who speak a variety of spoken and sign languages. They describe what it is like to be a communication tool for a Patient-Physician relationship and the many ways this service takes a toll on their own physical and emotional health. They share the systemic dysfunction they have witnessed (...) first-hand, as well as the gratification they feel when patients and their physicians successfully communicate the nuances of the health situation. Four commentaries on these narratives are also included, authored by experts and scholars in the fields of medicine and bioethics, with particular interests in the moral distress of healthcare providers, medical communication, the intersection of policy and ethics, and the education of future interpreters. The goal of this symposium is to call attention to the experiences of healthcare interpreters and to enrich discussions of the ethical ramifications of communication between people who do not share a common language. (shrink)

This volume draws together a series of thirteen essays on ancient epistemology by Gail Fine. She discusses knowledge, belief, subjectivity, and scepticism in Plato, Aristotle, and the Pyrrhonian sceptics. They consider such questions as: is episteme knowledge? Is doxa belief? Do the ancientshave the notion of subjectivity? Do any of them countenance external world scepticism? Several essays compare these philosophers with one another, as well as with more recent discussions of knowledge, belief, subjectivity, and scepticism, asking how if at (...) all the ancient discussions of these topicsdiffer from more recent ones. In exploring these issues, the essays often make use of the distinction between concepts and conceptions, between an abstract account of something, and more determinate ways of filling it in. Together they compose a rich set of investigations, illuminating ancientperspectives on the central questions in epistemology. (shrink)

Neoliberalism has ushered in a rise in managerialism, technocracy and bureaucratisation in residential child care where economy, efficiency, and effectiveness have been prioritised over the moral imperative to care. One implication has been the commodification of children who are traded in a culture of procurement and commissioning compounded by a climate of austerity, and where moral regulation has been replaced by contractual regulation. The impact of this upon the care that children receive has raised concern. The impact upon frontline carers (...) of intractable moral challenges which this climate presents in their role of caring each day is less well understood. The naming of an experience can provide an important starting place to understanding and challenging it. This article draws upon the phenomenon of ‘moral distress’, which is well documented in the medical field, and considers the transferability of this phenomenon from nursing to residential child care. It proposes that moral distress discourse may provide a language to residential child care workers through which their experience of the betrayal of the moral fabric of their work may be articulated. (shrink)