Moral distress has received much attention in the international nursing literature in recent years. In this article, we describe the evolution of the concept of moral distress among nursing theorists from its initial delineation by the philosopher Jameton to its subsequent deployment as an umbrella concept describing the impact of moral constraints on health professionals and the patients for whom they care. The article raises worries about the way in which the concept of moral distress has been portrayed in some (...) nursing research and expresses concern about the fact that research, so far, has been largely confined to determining the prevalence of experiences of moral distress among nurses. We conclude by proposing a reconsideration, possible reconstruction and multidisciplinary approach to understanding the experiences of all health professionals who have to make difficult moral judgements and decisions in complex situations. (shrink)

Following an extensive review of the moral intensity literature, this article reports the findings of two studies (one between-subjects, the other within-subject) that examined the effect of manipulated and perceived moral intensity on ethical judgment. In the between-subjects study participants judged actions taken in manipulated high moral intensity scenarios to be more unethical than the same actions taken in manipulated low moral intensity scenarios. Findings were mixed for the effect of perceived moral intensity. Both probable magnitude of consequences (a factor (...) consisting of magnitude of consequences, probability of effect, and temporal immediacy) and social consensus had a significant effect; proximity did not. In the within-subject study manipulated moral intensity had a significant effect on ethical judgment, but perceived moral intensity did not. Regression of ethical judgment on age, gender, major, and the three perceived moral intensity factors was significant between-subjects, but not within-subject. Ethical judgment was found to be a more robust predictor of intention than perceived moral intensity using a within-subject design. (shrink)

In 1991, Jones developed an issue-contingent model of ethical decision making in which moral intensity is posited to affect the four stages of Rest's 1986 model. Jones claimed that moral intensity, which is "the extent of issue-related moral imperative in a situation", consists of six characteristics: magnitude of consequences, social consensus, probability of effect, temporal immediacy, proximity, and concentration of effect. This article reports the findings of two studies that analyzed the factor structure of moral intensity, operationalized by a 12-item (...) Perceived Moral Intensity Scale adapted from the work of Sing-hapakdi et al. [1996, Journal of Business Research, 36, 245-255] and Frey [2000, Journal of Business Ethics, 26, 181-195]. The two items that were purported to measure CE were dropped due to their inability to effectively tap into the characteristic proposed by Jones. Factor analyses of the remaining 10 items supported a 3-factor structure, with the MC, PE, and TI items loading on the first factor, the PX items loading on the second factor, and the SC items loading on the third factor. These factors were labeled: Probable Magnitude of Consequences, Proximity, and Social Consensus. The authors conclude that moral intensity consists of three characteristics, rather than the six posited by Jones. (shrink)

Standard accounts on the nature of the firm are highly dependent on explanations by Coase, coupled with inputs from agency theory and shareholder theory. This paper carries out their critique in light of personalist and common good postulates. It shows how personalist and common good principles create a framework that not only accommodates business ethics better but also affords a more compelling understanding of business as a whole.

The factor structure of the Multidimensional Ethics Scale (MES; Reidenbach and Robin: 1988, Journal of Business Ethics 7, 871–879; 1990, Journal of Business Ethics 9, 639–653) was examined for the 8-item short form (N = 328) and the original 30-item pool (N = 260). The objectives of the study were: to verify the dimensionality of the MES; to increase the amount of true cross-scenario variance through the use of 18 scenarios varying in moral intensity (Jones: 1991, Academy of Management Review (...) 16, 366–395); and, to examine the items for measurement precision using item-response theory (IRT) methods. Results of confirmatory and exploratory factor analysis failed to conclusively support the hypothesized 3- (short form) or 5-factor (long form) structure; both instruments were instead dominated by a general factor. Item response theory analyses using Samejima’s (1969, Psychometrika Monograph Supplement 34, (4, Pt. 2)) graded response model revealed that many items in the 30-item pool performed very well, and suggested that a different collection of items be used to form a short-form version of the MES. Our proposed 10-item instrument includes more discriminating items than the 8-item version, and has the added advantage of including two items from each of the five ethical philosophies represented in the original 30-item pool. (shrink)

We address Steel’s Programme to identify a ‘preferred’ universe of set theory and the best axioms extending ZFC by using his multiverse axioms MV and the ‘core hypothesis’. In the first part, we examine the evidential framework for MV, in particular the use of large cardinals and of ‘worlds’ obtained through forcing to ‘represent’ alternative extensions of ZFC. In the second part, we address the existence and the possible features of the core of MV_T (where T is ZFC+Large Cardinals). In (...) the last part, we discuss the hypothesis that the core is Ultimate-L, and examine whether and how, based on this fact, the Core Universist can justify V=Ultimate-L as the best (and ultimate) extension of ZFC. To this end, we take into account several strategies, and assess their prospects in the light of MV’s evidential framework. (shrink)

The Question of the Self Perhaps the clearest access to the question of the self in Dogen lies in the fascicle of Shobogenzo entitled "Genjo-koan. ...

The ArgumentIt has long been apparent that in the nineteenth century, mathematics in France and England developed along different lines. The differences, which might well be labelled stylistic, are most easy to see on the foundational level. At first this may seem surprising because it is such a fundamental area, but, upon reflection, it is to be expected. Ultimately discussions about the foundations of mathematics turn on views about what mathematics is, and this is a question which is answered by (...) a variety of different groups including mathematicians, students, curricular planners, parents, etc. Mathematical practice rests on some kind of mixture of the answers to this fundamental question which come from these diverse groups. Comparing the cultural matrices which supported mathematics in France and Britain in the first decades of the nineteenth century sheds light on the real though often subtle differences in the ways the subject was pursued in the two countries. (shrink)

This article briefly outlines some of the key problems with the way in which the moral realm has traditionally been understood and analysed. I propose two alternative views of what is morally interesting and applicable to nursing practice and I indicate that instability has its upsides. I begin with a moral tale – a 'Good Samaritan' story – which raises fairly usual questions about the nature of morality but also the more philosophically fundamental question about the relationship between subjectivity and (...) moral agency. I then consider this relationship from the perspectives of two twentieth century philosophers: Emmanuel Levinas and Michel Foucault. Levinas' basic point is that the experience of ethical subjectivity is made possible through others: the demand to respond to the existence of others is the basic social structure that precedes individual freedom. If Levinas posits intersubjectivity as a fundamental or primitive feature of the moral realm, Foucault poses an even more basic question: how have moral subjects and relations of obligation been constituted? The aim of ethical inquiry, for Foucault, is to describe the network of discourses, institutions, relations, and practices through which certain kinds of subjects are constituted and constitute themselves, e.g. as a kind of person who can act morally. Finally, I consider some recent research in philosophy of nursing which illustrates how Levinasian and/or Foucauldian perspectives can deepen understanding of nurses' moral practices, specifically, the work of Norwegian public health nurses, Canadian pediatric nurses, and Irish midwives. I suggest that in spite of the instability of morality in general and the particular ethical challenges that face nurses, there are grounds for hope and possible strategies for living in unstable times. (shrink)

Stambaugh (philosophy, City U. of New York) elucidates one of the central themes in the work of German philosopher Martin Heidegger (1889-1976), based on her talks with him, and on her extensive study of his works, several of which she has ...

This paper is the introduction to the Special Issue with a selection of papers presented at the 21st IESE International Symposium on Ethics, Business and Society, held in Barcelona, Spain, in July 2021. The Symposium focused on the future of work and how to promote dignity and human flourishing. This editorial introduction emphasizes how work has been studied over the centuries and how new directions have been considered in recent times. We suggest that dignity and human flourishing are particularly relevant (...) in the current context and for the future of work. Finally, the papers that make up this special issue are introduced and summarized. (shrink)

Two aspects of mothering—using drugs during pregnancy and giving up the rearing of one's children—are the focus of this analysis of 58 addicted Chicana mothers who spent their adolescent years in barrio gangs. From a traditional stance, such women were doubly deviant, since they violated gender-role prescriptions by joining a barrio gang and by becoming involved in heroin and street life. Half of these women added to this deviance by using heroin during pregnancy, and 40 percent relinquished at least one (...) of their children. This article explores what distinguishes these classically “bad mothers” from addicts who maintain some degree of conventionality in their mothering. We found that Mexican gender-role traditionalism is not the only influence on these women. Many came from cholo or underclass families with a tradition of street involvement. In addition, their involvement in gang and heroin worlds may influence their behavior as mothers. We found that women who used drugs during pregnancy were more likely than abstainers to be cholas and to reject traditional gender-role values. However, those who gave up their children were more likely than those who kept their children to be from traditional families. We discuss the implications of these findings for research on deviance and the underclass among Hispanic women. (shrink)

Aim: The aim of this review is to examine the ways in which the concept of moral distress has been delineated and deployed in the argument-based nursing ethics literature. It adds to what we already know about moral distress from reviews of the qualitative and quantitative research. Data sources: CINAHL, PubMed, Web of Knowledge, EMBASE, Academic Search Complete, PsycInfo, Philosophers’ Index and Socindex. Review methods: A total of 20 argument-based articles published between January 1984 and December 2013 were analysed. Results: (...) We found that like the empirical literature, most authors in this review draw on Jameton’s original definition and describe moral distress in psychological–emotional–physiological terms. They also agree that moral distress is linked to the presence of some kind of constraint on nurses’ moral agency, and that it is best understood as a two-staged process that can intensify over time. There is also consensus that moral distress has an important normative meaning, although different views concerning the normative meaning of moral distress are expressed. Finally, the authors generally agree that moral distress arises from a number of different sources and that it (mostly) affects negatively on nurses’ personal and professional lives and, ultimately, harms patients. However, despite this consensus, many authors take issue with the way in which moral distress is conceptualized and operationalized. Moreover, while some worry that identifying nurses as a group of health professionals whose voices are ignored or marginalized might disempower nurses and encourage them to avoid their moral responsibilities, others take situations involving moral distress as indicative of more fundamental, structural inequities at the heart of contemporary healthcare provision. Conclusion: We conclude that research on moral distress in nursing is timely and important because it highlights the specifically moral labour of nurses. However, we suggest that significant concerns about the conceptual fuzziness and operationalization of moral distress also flag the need to proceed with caution. (shrink)

This paper addresses the progressive, feminist critique of same-sex marriage as articulated by Claudia Card. Although agreeing with Card that the institution of marriage as we know it is profoundly morally flawed in its origins and effects, Callahan disagrees with Card's suggestion that queer activists in the United States should not be working for the inclusion of same-sex couples in the institution.

The aim of this paper is to present artificial intelligence (AI) as an organ with a role in the production of judicial truth, expanding its objects, changing its procedures and reshaping the distribution of agencies within the judicial organism. To this end, it builds on Michel Foucault’s work on the procedures of truth production and the three subject forms involved: operator, spectator and object. This is then complemented by the general organological perspective proposed by Bernard Stiegler. On the basis of (...) both, we will demonstrate two realities: first, that AI is shifting truth production from the individual to the profile, and second, that the types of associations that AI is forming have the potential to curtail human agency in the production of judicial truth. (shrink)

For many of us, entry into motherhood involves an ambiguous visibility and intelligibility, where our acceptance into mainstream spaces as mothers entails a loss of lesbian difference. Mann explores this loss using the work of two philosophers of lesbian difference, Monique Wittig and Judith Butler. She argues that the figure of the lesbian mother is deployed on a broad cultural scale to reinvigorate and renaturaUze the myth of the happy, natural, heterosexual mother.

The UK Medical Research Council, in order to further its mission of maintaining and improving human health, supports a substantial number of clinical trials on a wide variety of medical questions; some of these trials involve the use of placebos as controls or to maintain blinding. Before providing support, proposed trials are carefully reviewed to assess scientific quality, and to determine whether a placebo is required and is ethical — in addition to ethics review by independent Research Ethics Committees. Some (...) questions such as the choice of placebos in trials in developing countries, in surgical trials and those involving alternative medicine require consideration of additional, specific issues. Involvement of consumers in MRC work has been increasing and includes the establishment of a Consumer Liaison Group; members of this group comment on patient information leaflets for clinical trials, helping to improve patient understanding of trials and ensuring topics like placebo use are explained clearly. Views differ on the value of placebos in clinical care and on their mechanism of action; continuing research is helping to clarify the issues. (shrink)

A developmental study of free-classification behavior within the age range of 3-1/2 to 19 years indicates that categorical responses, which are characteristic of adult behavior, increase with age while overgeneralized responses, classifications including noncategorical instances, decrease with age. Overdiscriminated responses which are incomplete categorical classifications increase from 3-1/2 to 6 years and then decrease to 19 years of age. These results are discussed within a two-stage theory of conceptual development (Kendler, 1971).

Before women could become visible as philosophers, they had first to become visible as rational autonomous thinkers. A social and ethical position holding that chastity was the most important virtue for women, and that rationality and chastity were incompatible, was a significant impediment to accepting women's capacity for philosophical thought. Thus one of the first tasks for women was to confront this belief and argue for their rationality in the face of a self-referential dilemma.

This paper proposes an introduction to the Kierkegaardian relation between freedom and truth. In order to do this, mainly paying attention to his Philosophical Fragments, it begins with the Socratic problem of acquiring truth. After this, it focuses on truth as the fruit of God’s free love, whence emerges the topic of freedom. Finally, this theme leads to the Kierkegaardian account of becoming, and specifically to the relation between possibility and reality. Throughout this exposition, the central concept that articulates this (...) itinerary is the “instant”, understanding it as the point of convergence between the eternal and the temporal, stressing the paradox therein. (shrink)

The controversy over the so-called Ashley Treatment (AT), a series of medical procedures that inhibited both growth and sexual development in the body of a profoundly intellectually impaired girl, usually centers either on Ashley’s rights, including a right to an intact, unaltered body, or on Ashley’s parents’ rights to make decisions for her. The claim made by her parents, that the procedure would improve their ability to care for her, is often dismissed as inappropriate or, at best, irrelevant. We argue, (...) however, that caregiving is a central issue in the controversy, as Ashley’s need for caregiving is a defining characteristic of her life. In this article, we analyze the ethics of the Ashley Treatment within the context of family caregiving. Through the physical and emotional work of caregiving, families participate in the formation and maintenance of personal identity, a process that Hilde Lindemann recently called “holding.” We argue that, in an intellectually disabled person such as Ashley, who depends on her family for every aspect of her care, the family’s contribution to identity is an essential source of personhood. We believe that the treatment can be justified if it is indeed an instance of appropriate family “holding” for Ashley. (shrink)

Advance care planning (ACP) is a process that seeks to elicit patients’ goals, values, and preferences for future medical care. While most commonly employed in adult patients, pediatric ACP is becoming a standard of practice for adolescent and young adult patients with potentially life-limiting illnesses. The majority of research has focused on patients and their families; little attention has been paid to the perspectives of healthcare providers (HCPs) regarding their perspectives on the process and its potential benefits and limitations. Focus (...) groups were conducted with 15 physicians as part of a larger study of adolescent and young adult ACP in hematopoietic stem cell transplant (HSCT) patients. This study identified two categories important to the utility of ACP in pediatric HSCT patients; (1) the temporal context of ACP and decision making and (2) the limitations of pediatric ACP, with subcategories identified as (a) embodied and witnessed knowing, (b) the impact of clinical cascades—when the treatment of one organ system creates complications in another system that needs to be treated—and a creation of a “new normal” following complications of illness and its treatment in the pediatric intensive care unit (PICU), (c) the balancing of adolescents’ autonomy with their capacity to make informed medical decisions, and (d) the epistemological frames that differ between HCP and patients and their families. These findings support ACP in adolescent and young adult HSCT patients, with a number of implications for practice as this process becomes more common. (shrink)