Caring for older persons is both rewarding and consuming. Work with older people in Finland has been shown to be more burdensome than in the other Nordic countries. The aim of this study was to try out a Finnish version of the Stress of Conscience Questionnaire (SCQ) and explore stress of conscience in staff caring for older persons in Finland. The data were collected from the nursing staff (n = 350) working with older people in health (...) centre wards, municipal and private nursing homes, and municipal and private dementia care units in Finland. It emerged clearly from the results that Finnish nursing staff mostly felt that they did not have enough time to provide good care to patients, and this gave them a troubled conscience. They also felt that the demanding work taxed their energy, a consequence being that they could not give their own families and loved ones the attention they would have liked. (shrink)

The present study aimed at investigating the relationship between environmental and individual factors and Stress of Conscience among nursing staff in psychiatric in-patient care. A questionnaire involving six different instruments measuring Stress of Conscience, the ward atmosphere, the psychosocial work environment, Perceived Stress, Moral Sensitivity, and Mastery was answered by 93 nursing staff at 12 psychiatric in-patient wards in Sweden. The findings showed that Sense of Moral Burden, Mastery, Control at Work and Angry and Aggressive (...) Behavior were related to Stress of Conscience. We conclude that Mastery and Control at Work seemed to work as protective factors, while Sense of Moral Burden and perceptions of Angry and Aggressive Behavior made the nursing staff more vulnerable to Stress of Conscience. Future research should investigate whether measures to increase the level of perceived control and being part of decision making will decrease the level of Stress of Conscience among the staff. (shrink)

Background Healthcare workers frequently face ethically demanding situations in their work, potentially leading to stress of conscience. Long-term work intensification (more and more effort demanded year after year), organizational change and COVID-19 may be risk factors concerning stress of conscience. Aims The main aim was to investigate the relationship between long-term work intensification and stress of conscience among the personnel in a healthcare organization. Organizational change management was considered a mediator and COVID-19-related work (...) class='Hi'>stress a moderator in the association between work intensification and stress of conscience. Research design, participants and context A total of 211 healthcare district employees participated in a longitudinal survey using questionnaires collected in 2019 (major organizational change in the planning stage) and 2021 (organizational change completed). Ethical considerations The study was implemented according to the guidelines of the Finnish National Board on Research Integrity. The Finnish instructions were that no review by an ethics committee was necessary because participation was voluntary, informed consent was requested, participants were assured that they were free to withdraw from the longitudinal study at any time and no health data were collected. Findings Long-term work intensification was associated with more severe stress of conscience. Long-term work intensification was partially mediated through change management to stress of conscience. High COVID-19 stress strengthened the association between long-term work intensification and stress of conscience. Conclusions Long-term work intensification must be addressed to reduce stress of conscience in healthcare, otherwise the healthcare system will be vulnerable to changes and crisis. Extra resources for personnel and management should be allocated because of work intensification during organizational change and health crises like the COVID-19 pandemic to alleviate stress of conscience. (shrink)

Background: Nurses frequently face ethically demanding situations in their work, and these may lead to stress of conscience. Working life is currently accelerating and job demands are intensifying. These intensified job demands include (1) work intensification, (2) intensified job-related planning demands, (3) intensified career-related planning demands, and (4) intensified learning demands. At the same time, many healthcare organizations are implementing major organizational changes that have an influence on personnel. Aim: The aim of the study was to investigate the (...) association between intensified job demands and stress of conscience, and whether their association is moderated by organizational change experiences among nurses. Experiences of organizational change may expose employees to stress of conscience or serve as a buffer because employees appraise, involve, and cope with changes differently. Research design: Questionnaires measuring stress of conscience, intensified job demands, and organizational change experiences were completed by nurses (n = 511) in a healthcare district undergoing a major organizational change. Ethical considerations: Throughout, the study procedures were implemented according to the guidelines of the Finnish National Board on Research Integrity and the 1964 Helsinki Declaration and its later amendments. According to the Finnish regulations, because participation was voluntary, informed consent was requested, and participants were advised of their right to withdraw from the study at will. No permission from an ethics committee was necessary. Findings: Work intensification and personal worry considering organizational change were associated with more severe stress of conscience among nurses. Nurses’ experiences of managements’ competent handling of organizational change buffered the association between work intensification and stress of conscience. Conclusions: During organizational changes, management may alleviate nurses’ stress of conscience by proper communication and support procedures. (shrink)

The aim of this observational longitudinal cohort study was to describe relationships over time between degrees of stress of conscience, perceptions of conscience, burnout scores and assessments of person-centred climate and social support among healthcare personnel working in municipal care of older people. This study was performed among registered nurses and nurse assistants (n = 488). Data were collected on two occasions. Results show that perceiving one’s conscience as a burden, having feelings of emotional exhaustion and (...) depersonalization and noticing disturbing conflicts between co-workers were positively associated with stress of conscience. No significant changes were observed during the year under study, but degrees of stress of conscience and burnout scores were higher than in previous studies, suggesting that downsizing and increased workloads can negatively affect healthcare personnel. Following and expressing one’s conscience in one’s work, and perceiving social support from superiors are of importance in buffering the effects of stress of conscience. (shrink)

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item (...) instrument for assessing stressful situations and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts. (shrink)

Background In long-term care, registered nurses and other care providers often experience tensions between ideals and realities in the delivery of services, which can result in stress of conscience. Burnout, low quality of care and a tendency to leave the profession are perceived as consequences. Objectives This study aimed to identify the socio-demographic and work-related factors associated with a high level of stress of conscience, particularly between nursing occupations. Research design A cross-sectional survey was conducted among (...) care providers who worked in Norwegian nursing homes and home care services in the spring of 2021. The sample consisted of 950 registered nurses and 1143 other care providers. Data were collected online using the Stress of Conscience Questionnaire (SCQ). Ethical considerations Participation was voluntary and based on consent. The study was approved by the Norwegian Center for Research Data. Results Registered nurses were nearly twice as likely to report high levels of stress of conscience compared to other care providers in long-term care. In addition, being a female, living alone, caring for their own children, working in an institution (versus home based), working >75% time, working shifts, not having scheduled meetings for ethical reflection and working in municipalities with a higher population density were factors associated with a high level of SCQ score. Discussion Knowledge of factors that increase the risk of high SCQ scores in registered nurses provides opportunities for prevention. Managers in long-term care should pay more attention to how work is distributed between the occupational groups and should facilitate real opportunities for ethical reflection. Conclusions The results of this study show that registered nurses have particular exposure to high levels of stress of conscience compared to other care providers in long-term care. Particular attention should be paid to registered nurses working in nursing homes. (shrink)

Every day situations arising in health care contain ethical issues influencing care providers' conscience. How and to what extent conscience is influenced may differ according to how conscience is perceived. This study aimed to explore the relationship between perceptions of conscience and stress of conscience among care providers working in municipal housing for elderly people. A total of 166 care providers were approached, of which 146 (50 registered nurses and 96 nurses' aides/enrolled nurses) completed (...) a questionnaire containing the Perceptions of Conscience Questionnaire and the Stress of Conscience Questionnaire. A multivariate canonical correlation analysis was conducted. The first two functions emerging from the analysis themselves explained a noteworthy amount of the shared variance (25.6% and 17.8%). These two dimensions of the relationship were interpreted either as having to deaden one's conscience relating to external demands in order to be able to collaborate with coworkers, or as having to deaden one's conscience relating to internal demands in order to uphold one's identity as a `good' health care professional. (shrink)

The Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ) have previously been developed and validated within the ‘Stress of Conscience Study’. The aim was to revalidate these two questionnaires, including two additional, theoretically and empirically significant items, on a sample of healthcare personnel working in direct contact with patients. The sample consisted of 503 healthcare personnel. To test variation and distribution among the answers, descriptive statistics, item analysis and principal component analysis (...) (PCA) were used to examine the underlying factor structure of the questionnaires. Support for adding the new item to the PCQ was found. No support was found for adding the new item to the SCQ. Both questionnaires can be regarded as valid for Swedish settings but can be improved by rephrasing some of the PCQ items and by adding items about private life to the SCQ. (shrink)

Although organizational and situational factors have been found to predict burnout, not everyone employed at the same workplace develops it, suggesting that becoming burnt out is a complex, multifaceted phenomenon. The aim of this study was to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among two groups of health care personnel from the same workplaces, one group on sick leave owing to medically assessed burnout (n = 20) and one group who (...) showed no indications of burnout (n = 20). The results showed that higher levels of stress of conscience, a perception of conscience as a burden, having to deaden one’s conscience in order to keep working in health care and perceiving a lack of support characterized the burnout group. Lower levels of stress of conscience, looking on life with forbearance, a perception of conscience as an asset and perceiving support from organizations and those around them (social support) characterized the non-burnout group. (shrink)

Background: Troubled conscience among nurses and other healthcare workers represents a significant contributor to healthcare worker moral distress, burnout and attrition. While research in this area has examined critical care in hospitals, less knowledge has been obtained from long-term care contexts such as nursing homes, despite widely recognised challenges with regard to vulnerable patients, increasing workload and maintaining workforce sustainability among nurses. Objective: The aim of this study was to illuminate and interpret the meaning of the lived experience of (...) troubled conscience among registered nurses (RNs) working in nursing homes. Research design: This qualitative research employed narrative interviews with eight nurses to obtain essential meanings of their lived experiences of troubled conscience. The interview texts were analysed using a phenomenological hermeneutic approach. Ethical considerations: Participation was voluntary, informed and was conducted with written consent. The Norwegian Centre for Research Data approved the data processing of personal data. Findings: The analysis uncovered two themes: (1) troubled conscience means abandoning ideals, with the subthemes: failing dependent patients; being disloyal to colleagues; being inadequate in the performance of work tasks and (2) troubled conscience means facing realities, with the subthemes: accepting being part of the system; responding to barriers. Discussion: Troubled conscience meant experiencing continuous and simmering tension between one’s ideals and realities and feeling a drive to preserve accountability and one’s moral integrity. Endangered ideals were often under cross-pressure and included humanistic values, professional values, working life values and the values of the organisation. Conclusion: Nurses’ troubled conscience refers to a struggle, but also a force that plays out at various levels and arenas in long-term care. Openness and dialogue about how professional values and the welfare state’s intentions can be realised within the given framework are important for individual nurses’ occupational health as well as the quality of care provided to patients. (shrink)

Research on ethical dilemmas in health care has become increasingly salient during the last two decades resulting in confusion about the concept of moral distress. The aim of the present paper is to provide an overview and a comparative analysis of the theoretical understandings of moral distress and related concepts. The focus is on five concepts: moral distress, moral stress, stress of conscience, moral sensitivity and ethical climate. It is suggested that moral distress connects mainly to a (...) psychological perspective; stress of conscience more to a theological–philosophical standpoint; and moral stress mostly to a physiological perspective. Further analysis indicates that these thoughts can be linked to the concepts of moral sensitivity and ethical climate through a relationship to moral agency. Moral agency comprises a moral awareness of moral problems and moral responsibility for others. It is suggested that moral distress may serve as a positive catalyst in exercising moral agency. An interdisciplinary approach in research and practice broadens our understanding of moral distress and its impact on health care personnel and patient care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 65.3 (2004) 455-474 [Access article in PDF] "Conscience the Ground of Consciousness": The Moral Epistemology of Coleridge's Aids to Reflection Jeffrey Hipolito Everett Community College. It will hardly come as a shock to the readers of this journal that Kant has been the philosophical gatekeeper of all those who have come after him and that the scale of his achievement was recognized (...) even by his immediate peers and the generation which followed them.1 It may be rather more surprising that Samuel Taylor Coleridge belongs among the most interesting members of that second generation, comparable to Fichte, Schelling, Schopenhauer, and Hegel in the originality of his response—not because of the Biographia Literaria (1817), the book for which he is now most famous, but because of the stream of work that followed the publication of the revised Friend (1818). Though the Collected Coleridge project has made available a mass of previously unpublished material, which in turn has stimulated a great deal of interesting research, one must still agree with Elinor Shaffer's recent assessment that "we have no accurate or adequate conception of the late Coleridge from 1819 to his death in 1834."2 Shaffer's range of dates is not accidental, indicating that the revised [End Page 455] Friend (and, more specifically, the break with Schelling) marks the beginning of the "late" Coleridge. In the "Essays on Method" that were a part of the revised Friend (1818) Coleridge effectively freed himself of Schelling's Idealism, which is so notoriously crucial to philosophical chapters of the Biographia, by moving away from the latter's metaphysics of the Absolute towards a metaphysics grounded in an ongoing and in principle unending exploration of "inquiry" itself.3 Though it did not appear until 1825, Aids to Reflection was the first book published by Coleridge following the revised Friend. It was his most popular and influential work during the nineteenth century, but it has been read almost exclusively in strictly theological terms. The implicit contention that the "middle" Coleridge of the Biographia was philosophical and that the "late," post-Biographia Coleridge turned to theology as a refuge from the Biographia's failure was ratified by Thomas McFarland's classic argument concerning the late Coleridge's "trinitarian resolution" to the problems that the middle Coleridge could not solve.4 One pernicious effect of this view (which is more nuanced than I have presented it here) is that until fairly recently it was still possible to describe Aids to Reflection as simply "an effort to argue away the terrifying import of The Ancient Mariner, which would lead us, since it jars our moral feelings, to hatred of God."5I argue in this essay that although Aids to Reflection employs theological vocabulary it is more than—indeed, cannot rightly be considered—an exercise in dogmatic Christian apologetics. More specifically, I will show that the book includes a vigorous engagement with Kant's moral philosophy not primarily by undercutting the metaphysical basis of the critical project's architectonic, though this is an ancillary effect, but by putting pressure on the model of judgment that underlies Kantian ethics.The importance of Kant to Coleridge's intellectual development is not a secret. Coleridge himself describes the way Kant "took possession of me as [End Page 456] with a giant's hand," though he confesses he "could never believe it was possible for him to have meant no more by his Noumenon, or THING IN ITSELF, than his mere words express" and that he even "entertained doubts likewise, whether in his own mind, he even laid all the stress, which he appears to do on the moral postulates."6 Kant's impact on Coleridge was primarily due to his status as a logician and a moral philosopher. Thus Coleridge contends in a letter of 1820 that "Kant will demonstrate to you, that this [Christian] Faith is... grounded on Postulates authorized & substantiated solely by the Moral Being,"7 and adds in another letter five years later that he... (shrink)

BackgroundPublic Safety Personnel are routinely exposed to human suffering and need to make quick, morally challenging decisions. Such decisions can affect their psychological wellbeing. Participating in or observing an event or situation that conflicts with personal values can potentially lead to the development of moral injury. Common stressors associated with moral injury include betrayal, inability to prevent death or harm, and ethical dilemmas. Potentially psychologically traumatic event exposures and post-traumatic stress disorder can be comorbid with moral injury; however, moral (...) injury extends beyond fear to include spiritual, cognitive, emotional or existential struggles, which can produce feelings of severe shame, guilt, and anger.ObjectiveThis scoping review was designed to identify the extant empirical research regarding the construct of moral injury, its associated constructs, and how it relates to moral distress in firefighters, paramedics, and police officers.MethodsA systematic literature search of peer-reviewed research was conducted using databases MEDLINE, EMBASE, APA PsychInfo, CINHAL PLUS, Web of Science, SCOPUS, and Google Scholar. Included studies were selected based on the inclusion criteria before being manually extracted and independently screened by two reviewers.ResultsThe initial database search returned 777 articles, 506 of which remained after removal of duplicates. Following review of titles, abstracts, and full texts, 32 studies were included in the current review. Participants in the articles were primarily police officers, with fewer articles focusing on paramedics and firefighters. There were two studies that included mixed populations. Most studies were qualitative and focused on four topics: values, ethical decision-making, organizational betrayal, and spirituality.ConclusionPublic safety organizations appear to recognize the experience of moral distress or moral injury among public safety personnel that results from disconnects between personal core values, formal and informal organizational values, vocational duties, and expectations. Further research is needed to better understand moral distress or moral injury specific to public safety personnel and inform training and treatment in support of public safety personnel mental health. (shrink)

There are widely differing accounts of Augustine's place in the early history of the notion of conscience. While some regard his contribution as groundbreaking, others consider that he only stressed interiority more than earlier authors. Starting with a contrast with Jerome, the present article aims at clarifying Augustine's specific contribution and the place of conscience in his moral thought.

Pseudo-appeals to conscience stress that the dictates of conscience are always either morally obligatory or at least not morally wrong. These appeals are untenable. They result in an indefensible moral relativism. They should be abandoned.

This book surveys the major thinking about Christian ethics as found in books published or distributed in the United States from the mid-sixties to the end of the seventies. In the first half of the book, Professor Long updates the analysis he first expounded in 1967 in his widely praised study, A Survey of Christian Ethics. Part one examines the literature dealing with moral reasoning, thinking about laws and codes, and ethics done in terms of situations and relationships. Part two (...) examines published work that stress the importance of institutions, politics in operational terms, and efforts to think of Christian fidelity as expressed in special communities outside or opposed to the civic mainstream. In part three Professor Long examines works concerned with the nature and function of the moral agent, covering such topics as attention to virtue and character, the nature and role of conscience, and thinking about the implications of moral development theory. Part four describes three new frameworks for doing ethics that have been developed during the last fifteen years: vocational ethics and policy studies; liberation theology; and comparative religious ethics. (shrink)

The book is divided into three parts. The first criticizes in some detail the various naturalistic theories as they appear in philosophy and the sciences. Thus Professor Vivas reckons with the interest theory of Santayana and R. B. Perry, the postulational theory of Charner Perry, the instrumentalist theory of Dewey, the linguistic theory of Stevenson, and again, the cultural relativity of the anthropologists and the genetic account of conscience in Freud. Once these are demolished, the second part looks for (...) the generic structure of the moral experience as focussed in the process of resolving a moral perplexity. Professor Vivas stresses the role of a hierarchically organized system of values espoused by the self which constitutes the person, and repeatedly insists on the objective or "ontic" status of the values. The person is regarded as an axiological not a psychological category; and it is only through resolving moral perplexities that a man finds out, by creating, what he is. The creative element prevents moral decision from being simply self-expression. In fact, the ethical stage, as distinguished from the moral, is characterized by the overthrow of a man's dominant values: "when we repudiate our constitutive values altogether and forge an entirely new personality, a naked, empty self must do the choosing, and how this process is possible is not at all obvious". The third part presents the rise of the ethical attitude in this second birth. Its essence lies in the absolute sanctity of the person, and Professor Vivas sees this as the answer to the conflict of values in our time. (shrink)

This book surveys the major thinking about Christian ethics as found in books published or distributed in the United States from the mid-sixties to the end of the seventies. In the first half of the book, Professor Long updates the analysis he first expounded in 1967 in his widely praised study, A Survey of Christian Ethics. Part one examines the literature dealing with moral reasoning, thinking about laws and codes, and ethics done in terms of situations and relationships. Part two (...) examines published work that stress the importance of institutions, politics in operational terms, and efforts to think of Christian fidelity as expressed in special communities outside or opposed to the civic mainstream. In part three Professor Long examines works concerned with the nature and function of the moral agent, covering such topics as attention to virtue and character, the nature and role of conscience, and thinking about the implications of moral development theory. Part four describes three new frameworks for doing ethics that have been developed during the last fifteen years: vocational ethics and policy studies; liberation theology; and comparative religious ethics. (shrink)

This article indicates the light that an epistemology like Newman’s, with its stress on the convergence of probabilities, the experience of conscience, and the presence of grace, can shed on the problem of faith and reason. The longstanding controversy over this problem between evidentialists and fideists has found new echoes in recent disputes between foundationalists and nonfoundationalists. It is necessary to distinguish between different aspects of the approach to faith—-the metaphysical, the historical, the religious, and the theological—-each with (...) its own logic and distinct style of epistemology. Examination of these aspects indicates that neither evidentialism nor fideism, neither foundationalism nor nonfoundationalism, does justice to the complexity of the matter. Faith arises out of a process in which human reason, in a large and comprehensive sense, is involved at every step of the way. Faith is not above or beyond reason, even though it depends for its origin and existence upon the grace of God. (shrink)

Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare (...) context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration. (shrink)

The great critic Peter Viereck, in a volume that both reproduces an earlier effort and presents an entirely new work on the intersection of history and literature, offers a biting critique of the American desire for normalcy that leads to a culture of the surrender of personality. In contrast to this voluntary thought control process is the unadjusted person. Cast in the mold of great individualists from Thomas More to Friedrich Nietzsche, such a person responds to fundamental values of (...) class='Hi'>conscience rather than conformity built exclusively on ego gratification and icon worship. Viereck's book is a stinging critique of the liberal presumption of a monopoly in critical thought. He argues to the contrary, that most varieties of liberal expression offer little else than the common platitude dressed up as critique. In such a cultural environment, conservatism is the skeleton in the liberal closet. The virtue of conservatism is that in its very stress on liberty as dependent on tradition and law, it permits the human being an opportunity to test all transient things by the touchstone of all lasting ideas. Unadjusted Man cuts deep and in many directions: against left totalitarian regimes of Europe and right wannabes like McCarthyism in America. For Viereck, the art of conserving is not an embrace of utopias to come or empires that were, but retaining the sense of individuality over against the senselessness of the "massman." Civil liberties in this approach are a right to non-conspiratorial dissent informed by fundamental values. The new material is presented unabashedly--without an attempt to rewrite personal history, and with an admission that not every prediction made in the original edition has come to fruition. That said, the underlying themes of the original are not so much repeated as expanded upon. For those seeking a work in the classic mold of conservatism, rather than the strident reactionary views that have come to dominate much of the conservative dialogue, this will be a special book, a special entrance to the mind of a great figure in American culture wars of present as well as past. (shrink)

Walter S. Athearn's "An Introduction to the Study of the Mind" delves into the essence and functions of the human mind, exploring its immaterial, unitary, self-active, self-conscious, and abiding attributes. Athearn emphasizes the mind's immortality and constancy despite bodily changes, underscoring the importance of effective study habits and emotional management for cognitive efficiency. The work highlights the significant impact of early experiences on mental development and stresses the need for balanced growth in knowledge, appreciation, and conduct to prevent mental disorders. (...) Through insightful examples and practical guidance, Athearn provides a comprehensive framework for understanding the mind's role in shaping individual destiny and the importance of listening to the voice of conscience. (shrink)

Five registered nurses were interviewed as part of a comprehensive investigation by five researchers into the narratives of five enrolled nurses (study 1, published in Nursing Ethics 2004), five registered nurses (study 2) and 10 patients (study 3) describing their experiences in an acute care ward at one university hospital in Sweden. The project was developed at the Centre for Nursing Science at Ö rebro University Hospital. The ward in question was opened in 1997 and provides care for a period (...) of up to three days, during which time a decision has to be made regarding further care elsewhere or a return home. The registered nurses were interviewed concerning their experience of being in ethically difficult care situations in their work. Interpretation of the theme ‘ethical problems’ was left to the interviewees to reflect upon. A phenomenological hermeneutic method (inspired by the French philosopher Paul Ricoeur) was used in all three studies. The most prominent feature revealed was the enormous responsibility present. When discussing their responsibility, their working environment and their own reactions such as stress and conscience, the registered nurses focused on the patients and the possible negative consequences for them, and showed what was at stake for the patients themselves. The nurses demonstrated both directly and indirectly what they consider to be good nursing practices. They therefore demand very high standards of themselves in their interactions with their patients. They create demands on themselves that they believe to be identical to those expected by patients. (shrink)

Abstract Studying a concept as complex as moral distress is an ongoing challenge for those engaged in empirical ethics research. Qualitative studies of nurses have illuminated the experience of moral distress and widened the contours of the concept, particularly in the area of root causes. This work has led to the current understanding that moral distress can arise from clinical situations, factors internal to the individual professional, and factors present in unit cultures, the institution, and the larger health care environment. (...) Corley et al. ( 2001 ) was the first to publish a quantitative measure of moral distress, and her scale has been adapted for use by others, including studies of other disciplines (Hamric and Blackhall 2007 ; Schwenzer and Wang 2006 ). Other scholars have proposed variations on Jameton’s core definition (Sporrong et al. 2006 , 2007 ), developing measures for related concepts such as moral sensitivity (Lutzen et al. 2006 ), ethics stress (Raines 2000 ), and stress of conscience (Glasberg et al. 2006 ). The lack of consistency and consensus on the definition of moral distress considerably complicates efforts to study it. Increased attention by researchers in disciplines other than nursing has taken different forms, some problematic. Cultural differences in the role of the nurse and understanding of actions that represent threats to moral integrity also challenge efforts to build a cohesive research-based understanding of the concept. In this paper, research efforts to date are reviewed. The importance of capturing root causes of moral distress in instruments, particularly those at unit and system levels, to allow for interventions to be appropriately targeted is highlighted. In addition, the issue of studying moral distress and interaction over time with moral residue is discussed. Promising recent work is described along with the potential these approaches open for research that can lead to interventions to decrease moral distress. Finally, opportunities for future research and study are identified, and recommendations for moving the research agenda forward are offered. Content Type Journal Article Pages 1-11 DOI 10.1007/s10730-012-9177-x Authors Ann B. Hamric, School of Nursing, Virginia Commonwealth University, P.O. Box 980567, Richmond, VA 23298-0567, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

Thomistic ethics has sometimes been accused of being excessively rationalistic, impersonal, and a priori. This study attempts to provide textual support from Aquinas for an interpretation which stresses the primacy of conscience, individual responsibility, and the central importance of the virtue of prudence. The doctrine seems timely and suggestive, but the author's decision to write in scholastic jargon limits the effectiveness of this book for the uninitiated.--D. D. O.

This study reinterprets the core concept of bao 報 (reciprocity or recompense) within the Confucian tradition through the lens of yili zhi bian 義利之辨 (debate of righteousness and profit). It examines the relevant discourses of Confucius, Mencius, Xunzi, Zhou Dunyi, Zhu Xi, and Wang Yangming. By analyzing these discussions, the paper elucidates the transformations in the meaning of bao embedded in the moral principles and views on righteousness in Confucian thought. Furthermore, it systematizes the notion of “virtue” (dexing 德性) into (...) three categories: great virtue (dadexing 大德性), non-virtue (feidexing 非德性), and theological virtue (chaodexing 超德性), thereby uncovering the multidimensional implications of bao. Confucius and Mencius emphasized the primacy of moral principles, advocating for the pursuit of legitimate profit (li 利) grounded in righteousness (yi 義). They further concretized the ethical significance of bao by asserting that “requite kindness with kindness; requite resentment with justice.” Xunzi, on the other hand, stressed the regulation of human nature through ritual propriety and postnatal education, proposing that profit should be harmoniously controlled through righteousness. The Neo-Confucian scholars of the Song and Ming dynasties advanced the yili zhi bian to a metaphysical level. In particular, Wang Yangming sought to reconcile righteousness and profit by grounding them in inner conscience and virtue through his doctrine of the “unity of knowledge and action” (zhixing heyi 知行合一). Consequently, the concept of bao evolved beyond mere reciprocity or transactional exchange, emerging as a principle of moral cultivation and ethical practice. This reinterpretation offers a foundation for moral reasoning in the face of contemporary ethical uncertainties, providing a basis for strengthening the moral fabric of modern society while fostering individual moral self-cultivation. (shrink)

Heidegger’s Being and Time has been accused of espousing empty decisionism and relativism. I argue, first, that in fact Being and Time’s stress on the situated character of human judgment is supplemented by a very Kantian account of being human that defi nes appropriate behavior towards all entities possessing a certain character. Its analysis of conscience and guilt attempts to uncover the existential basis for the distinction Kant draws between the phenomenal and the noumenal aspects of the self. (...) Building on this analysis, I claim, Being and Time reaffirms the second version of Kant’s categorical imperative, which states that humanity should never be treated merely as a means, but always also as an end in itself. In the second part of the paper, however, I argue that this proximity to Kant is part of the problem with Being and Time, that some of this work’s shortcomings and dangers in relation to ethics rest precisely in its very Kantian view of what makes an entity worthy of moral concern, and what is owed to others in virtue of their being such worthy entities. As a consequence of this view, not only are all nonhuman animals excluded from moral concern, but, strangely, the intrinsic value of human well-being is itself threatened. (shrink)

Heidegger’s Being and Time has been accused of espousing empty decisionism and relativism. I argue, first, that in fact Being and Time’s stress on the situated character of human judgment is supplemented by a very Kantian account of being human that defi nes appropriate behavior towards all entities possessing a certain character. Its analysis of conscience and guilt attempts to uncover the existential basis for the distinction Kant draws between the phenomenal and the noumenal aspects of the self. (...) Building on this analysis, I claim, Being and Time reaffirms the second version of Kant’s categorical imperative, which states that humanity should never be treated merely as a means, but always also as an end in itself. In the second part of the paper, however, I argue that this proximity to Kant is part of the problem with Being and Time, that some of this work’s shortcomings and dangers in relation to ethics rest precisely in its very Kantian view of what makes an entity worthy of moral concern, and what is owed to others in virtue of their being such worthy entities. As a consequence of this view, not only are all nonhuman animals excluded from moral concern, but, strangely, the intrinsic value of human well-being is itself threatened. (shrink)

This article considers the ways in which a series of artworks by French artist Jean-Baptiste Greuze focus on the father’s ethical education of his male children, reading these as a close visualization of the pedagogical theories of Rousseau. Through paintings that contemplate family life, religious sentiment, filial piety, obedience versus disobedience, illness, and death, Greuze’s images of male youth coalesce with the ethics promoted in Rousseau’s novel Emile—stressing in particular the compassion and good conscience that a boy should develop (...) under the guidance of his father to become a man of virtue. In so doing, the artist responds to some of the key historic issues and social beliefs affecting male youth during his era: the necessity of apprenticed boys to leave home; an idealization of country living and farming as the best occupation for the adult male; and an overwhelming concern, widespread during this heightened period of warfare and unrest preceding the French Revolution, that young men go astray when they become soldiers. (shrink)

A dialogical approach to understanding Islamic ethics rejects objectivist methods in favor of a conversational model in which participants accept each other as rational moral agents. Hans-Georg Gadamer asserts the importance of agreement upon a subject matter through conversation as a means to gaining insight into other persons and cultures, and Jürgen Habermas stresses the importance of fairness in dialogue. Using human rights as a subject matter for engaging in dialogue with Islamic scholars, Muslim perspectives on issues such as democracy, (...) toleration, and freedom of conscience emerge. A capabilities approach to human rights, such as that developed by Martha Nussbaum, enables the coexistence of multiple religious ethical visions while insisting upon the need to protect and nurture essential human abilities. (shrink)

Van der Poel’s book is a relatively comprehensive essay in ethics or, more properly, moral theology, providing outlines of a theological anthropology necessary for understanding man as a moral agent, a suggested process for determining the value of human actions, a consideration of conscience, and a discussion of virtue and vice. Van der Poel lays great stress on man’s historicity and the conditioned nature of moral laws and principles. He likewise attacks a naive dualism and proposes a view (...) of man influenced to considerable extent by contemporary existential phenomenology. The thought of Merleau-Ponty is quite strongly reflected in the anthropology proposed. Perhaps the most original section of the work is the one dealing with the evaluation of man’s moral acts. Van der Poel sharply distinguishes between the "material result" or physical activity and the agent’s intention and maintains that the "human reality" of the act is an interpenetration of these two aspects and that its moral worth is ultimately to be judged by "its impact upon the well-being of the individual and the human society." This view seems to have some kinship with utilitarian ethics, for it seems to make the final criterion of moral activity rest in its consequences. The comments of Paul Ramsey concerning the function of an "exception-making criterion" seem applicable to Van der Poel’s analysis of moral activity, and his way of describing human acts seems open to the same kind of criticism that Eric D'Arcy applied to the extreme utilitarianism of J. J. C. Smart in his Moral Acts: An Essay in their Evaluation.—W. E. M. (shrink)

This paper addresses the question of whether the interest liberal societies have in producing liberal citizens gives liberal societies the right to regulate the affairs of illiberal groups. It claims that attempts by Rawls and Galston to make liberalism more “pluralism friendly” by reducing the demands for liberal citizenship fail, and it explores arguments by Amy Gutmann, Susan Moller Okin, Eamonn Callan and Will Kymlicka that support a stronger interest in regulating the socialization practices of illiberal groups. The main conclusion (...) of the article is that we must seek for a context-sensitive balance between the need to produce liberal citizens and other liberal values such as freedom of conscience. (shrink)

In an era of confessional conflict, the conscience served as a powerful mediator between God and man, directing and judging moral actions. This work aims to convey the breadth of the conscience's jurisdiction, analyzing its impact upon a variety of important aspects of early modern society: political allegiance the genre of "advice to princes" religious conformity slavery the regulation of sexual behavior gender roles and the intellectual methods of scientists.

At a historic dialogue convened at the University of Richmond, Virginia, Baptist and secular humanist scholars in theology, history, philosophy, and the social sciences, came together to define shared concerns and common values. The dialogue focused on major areas of concern: academic freedom; social, political, and religious tolerance; biblical scholarship; separation of church and state; the social agenda of the Christian Coalition and the Southern Baptist Convention; the danger of militant fundamentalism; freedom of conscience and the historic and current (...) role of American Baptists; as well as the plight of pluralistic democracy. (shrink)

The recent confirmation of the constitutionality of the Obama administration’s Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether or not (...) to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties. (shrink)

The second essay of Nietzsche's Genealogy of Morality (GM) offers a naturalistic and developmental account of the emergence of conscience, a faculty uniquely responsive to remembering and honoring obligations. This article attempts to solve an interpretive puzzle that is invited by the second essay's explanation of nonmoral obligation, prior to the capacity to feel guilt. Ostensibly, Nietzsche argues that the conscience and our concept of obligation originated within contractual (“creditor-debtor”) relations, when creditors punished delinquent debtors (GM II:5). However, (...) this interpretation, which I call the contractualist reading, is incoherent and subject to an insoluble bootstrapping problem. I argue instead that Nietzsche provides two accounts of nonmoral obligation in the second essay, and that the conscience originated in the morality of custom to track rule prohibitions (“I will nots” [GM II:3]), which Nietzsche conceives of as involuntary or reciprocal obligations that, unlike contractual debts, do not require the making of promises. (shrink)

Background: Limited knowledge of the experiences of conflicts of conscience found in nursing literature. Objectives: To explore the individual experiences of a conflict of conscience for neonatal nurses in Alberta. Research design: Interpretive description was selected to help situate the findings in a meaningful clinical context. Participants and research context: Five interviews with neonatal nurses working in Neonatal Intensive Care Units throughout Alberta. Ethical consideration: Ethics approval from the Health Research Ethics Board at the University of Alberta. Findings: (...) Three common themes emerged from the interviews: the unforgettable conflict with pain and suffering, finding the nurse’s voice, and the unique proximity of nurses. Discussion and conclusion: The nurses described a conflict of conscience when the neonate in their care experienced undermanaged pain and unnecessary suffering. During these experiences, they felt guilty, sad, hopeless, and powerless when they were unable to follow their conscience. Informal ways to follow their conscience were employed before declaration of conscientious objection was considered. This study highlights the vital importance of respecting a conflict of conscience to maintain the moral integrity of neonatal nurses and exposes the complexities of conscientious objection. (shrink)

A presente investigação busca ressaltar a contribuição heideggeriana para a questão da alteridade, contrapondo-se às interpretações que enfatizam o "solipsismo existencial" do Dasein resoluto como o sintoma de que Heideggerteria desconsiderado esse problema em sua analítica existencial. Para tanto, discute-se o movimento argumentativo pelo qual Heidegger, partindo da análise do encontro do outro na cotidianidade mediana, chega até o problema do reconhecimento da alteridade que todo Dasein já traz em si mesmo. Segundo a interpretação aqui proposta, a chave para uma (...) possível leitura ética da analítica existencial se encontra na articulação entre as análises fenomenológicas da angústia e do chamado da consciência, pois é justamente nelas que se revela o estranho apelo de uma alteridade que já habita cada um, e que tem de ser pensada como a condição ontológica do reconhecimento de si e do outro enquanto singularidade própria, isto é, como alteridade.By critically departing from current interpretations that stress the "existential solipsism" of the resolute Dasein, the present investigation emphasizes the Heideggerian contribution to the question of otherness. I discuss the main `existentials' through which Heidegger, starting with the question of the encounter of the other in the everyday world, reaches the crucial point where he acknowledges that otherness is already rooted in each Dasein. According to this interpretation, the key to uncover the ethical dimension of Heidegger's existential analytic is to be found in the theoretical articulation established between the phenomenological analysis of anguish and the phenomenological analysis of the call of conscience. This is the locus where Heidegger rends manifest that the resolute Daseinalready carries within itself the strange appeal of otherness, considered as the existential condition for the acknowledgment of the other in his own singularity, that is, as otherness. (shrink)

continent. 2.1 (2012): 29–35. Translated by Vincent W.J. van Gerven Oei from Jeroen Mettes. "Politieke Poëzie: Enige aantekeningen, Poëtica bij N30 (versie 2006)." In Weerstandbeleid: Nieuwe kritiek . Amsterdam: De wereldbibliotheek, 2011. Published with permission of Uitgeverij Wereldbibliotheek, Amsterdam. L’égalité veut d’autres lois . —Eugène Pottier The modern poem does not have form but consistency (that is sensed), no content but a problem (that is developed). Consistency + problem = composition. The problem of modern poetry is capitalism. Capitalism—which has no (...) image: the unrepresentable Idea of “everything.” The problem is that a poem cannot be justified. There is no excuse for it. Political poetry— pure poetry—has to be problematic, though not in a mannerist way. Yes, its problem is first its own problem—poetry’s existence in the same world as the newspaper—but therefore also always everybody’s problem (the problem of any world at all). The cult of the sublime points at a suspect desire for transcendence, nostalgia for paradise lost (the womb?). Melancholia of the post-. But a problem neither sorrows nor mourns, it is alive, and the fact that it is alive is the problem—the problem for death (rigidity, the status quo). Our symbols and ideologies do not hide any god: symbolic = state; imaginary = human; real = money. Problem: the possibility of communal speech (poetry) in the absence of a “we.” Or: what is a “we” that is not a collective subject (or in any case is not a volonté générale )? What is a universal history that is not a History? This work was started in the shade of the anti-globalization protests at the end of November 1999. I considered N30 to be the closure of the nineties, of my adolescence, and of the a seemingly total extinction of social desire. From the beginning I was skeptical about the alterglobalization movement as the avant-garde of a new politics, but something was happening . Maybe this event did not show that, as the slogan would have it, “another world” is possible, but for me it indicated that such possibility was at least still possible. That naked possibility is carrying forward. And if the fundamental tone of this work sounds more desperate than utopian, this is not caused by the catastrophic sequence that since 1999 has plunged us ever deeper into the right-wing nightmare—a nightmare that this work also gives an account for—but because my hope as yet remains empty. Composition . Composition is no design, but the production of an autonomous block of affects (i.e. a POEM), rhythmically subtracted from the language of a community. A poem does something. Is something. New Sentence . Choosing the non sequitur as compositional unit has the advantage that an abstract composition is subjected to the stress of concrete, social references. Where there is a sentence, there is always a world. (This does not hold necessarily for words on their own.) And where sentences collide, something akin to a textual civil war takes place. It is not about “undermining” whatever, or de-scribing the raging global civil war, but about writing social (or even: ontological) antagonism -- including all its catastrophic and utopian possibilities. Minor resistance. Why would poetry be the no protest zone par excellence? It is nothing but protest, not simply qua “content,” but in its most fundamental essence: rhythm. Rhythm is resistance against language, time, and space, and the basis of (what we will continue to call) autonomy. Rhythm starts with the anti-rhythmic caesura as Hölderlin remarked about Sophocles, a disruption of the quotidian drone. The destruction of everything that is dead inside of us. The noise of the avant-garde has never been the representation of the noise of (post)modernity (from the television or shopping mall), but the sober noise of the systematic exchange of an unbearable worldview. The poet does not describe, but looks for a way out: There is a Grain of Sand in Lambeth that Satan cannot find Nor can his Watch Fiends find it, tis translucent & has many Angles But he who finds it will find Oothoons palace, for within Opening into Beulah every angle is a lovely heaven William Blake was not mad. And there has always been only one poetry: the poetry of paradise. The principle is that there is something in art (the essentially creative element) that is disgusted by that which, unlike art, does not aim for the supreme. Wonder is not supreme, tranquility is not supreme, beauty is not supreme. Even amusement is not supreme! The supreme is supremely open, “das Einfache,/ Das Schwer zu machen ist” 1 : paradise. That is abstract. Literally. For me it is not about a concrete imagination, an idyll or utopia. There is no doubt a need for that, but it is not so much the supposed lack of imagination or ideals (human rights are ideals), but a fundamental lack of desire (human rights are no desires) that we suffer from, and from which we do not need to remove Nietzsche’s label of “nihilism.” “We.” George Oppen: “ Of Being Numerous asks the question whether or not we can deal with humanity as something which actually exists.” What is less actual than humanity? Nowadays it appears as a lifeless ideology of cynical power politics. Or as what makes one think. It is a shame to be human. The event is the caesura that defines rhythm. Writing toward the event is not the description of the event, but marking an abstract and intense space in which the event may unfold and keep itself. It is a task. “Remember that thou blesseth the day on which I seized thee, because such is thy obligation.” The event is a contraction (or a series of contractions) with its own rhythm and unique qualities. It is more than an explosion or demonstration. But at the same time less. The endless repetition of images and stories in the media points to a fear for the indeterminate and indeterminable void of the event. In the end there is nothing to see. We do not live in disaster’s shade or miracle’s light, but rather in the rhythm, which is contracted time, having little to do with omnipresent representations. For this book I did not intend a rhythm of evental representations (a narrative rhythm), but a rhythm which would be an event itself , because it draws the border between artwork and history. My desire for a direct engagement with the “extra-textual reality” has nothing to do with the representation of “rumor in the streets.” (What has less street cred than representation?) Naturally, a poem is no historical event and does not change anything. But a poem is a part of history that wants to be repeated forever, constructed in such a way that it is worthy of repetition. It is a part of desire (composition) made consistent (durable). The “historical event” flares up and burns down, and has to burn down to be effective. The leftovers are images and stories (representations), History—no event. The artwork—that is the ambition— remains event (though monumental and inefficient/inoperable). (No wonder that a historical singularity, a revolution, reminds us of a work of art; the resurrection yearns for a judgment, an affirmation; everything depends on it.) Hence the title does not summarize the book, let alone contract its “content” into a quasi-transcendental signifier. The title is juxtaposed to the book, like everything else inside the book, and in that relation it precisely forms a part of it. The ideal work is an open whole, lacking nothing but to which everything may be added. I have been interested in this “everything,” the world, or as I said above: capitalism. “Everything” is not the space for “wonder”—a code word, a shibboleth for petty bourgeois imagination (I recognize myself in the strangest things, a speaking dog, a canal, a pond standing straight—oh my god). No. The world is a social world, not YOUR world, poet. Power is number one. I will call “Dutch,” or “shitty,” whatever denies this power. That hurts, but this pain is an expression of the desire in the world to write another world, or as Blanchot says, “the other of all worlds” 2 : the world. Not as what “is there,” but rather as that which urges for an escape from what “is.” This is a testament of how radical reality has become, for me—or rather, a writing body—in a having-been-written. I am not interested in the problem of “meaning” as misunderstood by literary scholarsi: “order” in “chaos,” “symbolization.” Bullshit. What is there, hop, hope, now: the meaning of the taste in my mouth. Bullshit. I am not interested in the frustration of interpretation; I am writing for readers who do not want to interpret. I do not know how many “professional readers” will hear the music of a paragraph like: Sun. Sushi. Volvo. I hope more than I would think. There is a suggestion (or rather, an actual production) of speed and infinitive owing to the absence of plosives, i.e. articulations such as /k/, /t/, or /p/. Can you hear the slick suaveness? Driving car dark, vocal chiaroscuro of the word “sushi.” The unstressed /i/ stands in the middle of dark vowels and thus acquires its own special out of focus , like a momentary flash or brilliance—an obscure light. It is not about recognizing a story, but about avoiding any story whatsoever: the car disappears in the glow, cars and raw fish have nothing in common except their articulation in a language that brings them together, blurring them. A world appears in its disappearance. For a moment, light is a metaphor for language, though it cannot be reduced to tenor. It is not necessary to be a linguist or philosopher to hear this—a “difficult” poem all too often becomes an allegory of its own impenetrable being-language. The only demand: leave your hermeneutical fetish at home. This was no interpretation. Most shit has been stolen etcetera. That is no longer interesting. You cannot shoot the body with information and let your lawyers reclaim the bullets. So every sentence has been stolen. Also the ones “out” “of” “my” “head.” Why would I be allowed to steal from myself and not from others? Man takes what he needs to move forward. Whatever he encounters, finds in front of him, “occurs” to him. The writer as text editor, or singing pirate. Nothing new here. Important difference with for example Sybren Polet’s 4 montage technique: anti-thematicism. Most of the time ferocious citation from whatever I was reading, listening to, ended up in, and so on. I wrote chapter 12 on my laptop while watching CNN. On the air instead of en plein air . I often employed search engines to generate material. Chapter 20 offers the purest example of this. Often I stop recognizing a particular citation after some time. It is not uncommon for a stolen sentence to conform itself to the paragraph in which it finds itself. Sometimes I nearly arbitrarily replace words. Arbitrariness as a guarantee for absolute democracy. It is a poetics of the non sequitur : a conclusion that does not follow from the premises, the strange element in the discourse. A discourse of strangers. No logical, narrative, thematic unity. There is unity in speed/flight. It has to be read linearly, but not necessarily (not preferably) from beginning to end. The shortest distance between two points is a straight line, but this line precedes every point. The middle, the acceleration, comes first. A point occurs where two lines cross. It has been written from up close, at the level of the tension between sentences. Nothing to be seen from a distance: no form except the exchange of form, no geometrical or mythical meaning. You have to get in, “groping toward a continuous present, a using everything a beginning again and again” (Stein). 5 In Dutch, experimental poetry has been mainly dense: a small rectangular form filled with a maximum amount of poetic possibility. But at the moment the poem starts to relax, the anecdotical content seems to increase. This is what is called “epic”: long, narrative. I believe that an epic is more than that, in fact something completely different. An epic is “a poem including history,” 6 a long poem tied up with the life of community, that as a whole does not need to be narrative. The American poets of the twentieth century (Pound, Williams, Zukofsky, Oppen, Olson, Silliman) have put the epic back on the map by interpreting the poem itself as a map, and writing it as navigation. They have invented the experimental epic, a genre that has generated little original following in “our” poetry. N30 is the middle part—“always start in the middle”—of a trilogy, the contours of which remain as of yet unclear, although each episode investigates one of the three “ecstasies of time”—past, present, future—concerning society X. N30 concerns itself with the PRESENT: not with the description of actual facts but of the rhythm and the intense depth in which facts appear to us. Where are we? We are camping in the desert. Sometimes we are looking at the stars. As opposed to maximum density and minimal tension (a characteristic of most (post-)experimental lyricism), I have sought a minimal density and maximum tension in this book, considered as a long non-narrative prose poem. On the one hand, the minimal density is obtained by the inherent formlessness of prose, on the other hand by the conscious refusal of any active (formal, non-rhythmic) synthesis: the poem tells nothing, shows nothing, has no theme. I did not seek maximum tension either by loading the quotidian with epiphanic radioactivity (“wonder,” confirmation from above), or by means of the intensity of the linguistic structure. I want an abstract tension, but social in its abstraction, in other words, not neutralized by and subjected to Form. Instead of form (transcendent): composition (immanent). The concept is series. Ideal: every unit is necessary for the efficacy of the others and the whole, their relation is purely linear, i.e. non-hierarchic, non-syllogistic, non-discursive, non-narrative. Sentence related to sentence like paragraph to paragraph and chapter to chapter; the whole means nothing and represents nothing. Inside the sentence: syntax (Chomsky’s tree, a type of parallel circuit), outside: parataxis (coordination, an asyntactic line through language and world). I consider duration—the energy of duration (rhythm)—to be the fundament of a poem, the temporal inclination to delimit a “space.” Being as consistency, its consistency. A spatial part of time is not merely a metaphor for an inevitable trajectory, an inescapable time, something like “our time.” Not merely—because rhythm comes from language and is not projected onto it; the poem derives from the world like a scent and a color and a life from a flower. A series, a sequence: nothing potential, but truly infinite—the movement of an infinitude. The infinite series = everything minus totality. That means that there is no container—no Form, no Self, no Image, no Structure, not even a Fragment—just “the prose of the world.” No representation, but also no staging of the impossibility of representation (the postmodern sublime). These are no fragments, no image of a fragmented world or personality, no cautious incantations around the Void. It does not exist. It is a movement. Buying bread, a flock of birds, a bomb falling—they do not depict or represent anything, not literally, not metaphorically. There is an Idea, which is however nothing more than a rhythm, in the same way that capitalism is nothing more than a pure function. Parataxis: the white space between two sentences stresses, which is nevertheless always there, also between words, even between letters: the out of focus of idle talk, the gutter, the irreducible Mallarméan mist which renders even the seemingly most transparent text legible. The white space suggests a neutral medium for free signification, a substance of language. A non sequitur is an element from a foreign discourse, which stresses the white space as space, and problematizes freedom for supra-sentential signification. I start by withdrawing material, leaving the initiative to the sentences. In general a word presupposes less often a discourse than a sentence. What discourse is presupposed by “dog”? We could think of several, but why would we? It is more probable that, when faced with the naked word, we think of its naked (dictionary) meaning, of its denotative signified. By means of two simple interventions we may also write the word as sentence: Dog. In no way this suggests the discourse from which this sentence originates, but in any case we’re presupposing one. This is shown by questions like: “Whose dog? Who’s a dog? What kind of dog?” Etc. (Sentences are question marks.) A sentence implies/is a microcosm—a subject, a verb, an object, and so on. Even an incomplete or ungrammatical sentence does so. My main fascination while writing this book is the worldly and social aspect of language, an aspect that often becomes invisible, or rather, transparent in narrativity—the stretching of sentences into stories. Narrativity organizes a new discourse and a new world, and places a sometimes all too dispersing relation of transparence in between. The conventional novel is the brothel of being. I do not intend to prohibit brothels, and I have certainly not intended to write an anti-novel (THIS IS A POEM), but I do consider narrativity (in general, in poetry, in the news, in daily life) to be ontologically secondary with regard to an immediate being in the world through sentences, also if the latter have been withdrawn from a narrative or otherwise externally structured discourse (which in that case would therefore be chronologically primary ). Naturally, two or more sentences are always in danger of telling stories or arguing, just like the world is always in danger of becoming an objective representation, facing us, strangers. That is why need to wage war—against representation and against the interface, against interaction. AGAINST THE “READER.” To the extent that a sentence is worldly, writing is a condensed global war, and in so far as there is ultimately only one world and one open continuum of languages, it is a global civil war. Nice subject for an epic. The elaboration of a singular problem—prose as the outside of poetry, the form of the novel as purely prosodic composition scheme—“expresses” the universal problem: capitalism as Idea of the world vs. poetry as language of an (im)possible community. The paragraphs are blocks of rhythmically contracted social material. By choosing the sentence as the basic compositional component, an abstract whole may contain social sounds, without telling a story or showing an image. Composition is subrepresentative —a rhythmic, passive synthesis, or rather: a synthesis of syntheses. I never write large blocks of prose in one sitting, because there is no obvious organizational vector —plot, theme, conscience—outside the inherent qualities of the material itself. Usually I write down one sentence, sometimes two, but rarely more than three. Those sentences are usually placed in the text which I am editing at the time. In fact, there is no original composition, new chapters split off from chapters which became too long during the editing process. (Revision mainly consists of adding and inserting, displacing and dividing; only during the last phase, when the text has gained enough consistency, there may be subtraction to tighten the composition; each chapter requires a season of daily revision). This constant revision, accompanied by a continuous influx of collective background noise (to speak with Van Bastelaere), 7 makes every chapter a block condensed (“historical” and “personal”) time. The block itself is a-personal and a-historic; it is ontologically autonomous. If there is such a thing as a spirit of the times, I do not try to offer an image of it, but rather to cancel something of it by erecting a monument of its own excrement within its own boundaries. Tuning and dis-tuning , “in de taal der neerslachtigen een eigen geluid doen klinken,” 8 in other words, desiring in an Elysian way. In this sense I have intended to be able to write a political poetry. The ultimate political poem is the epic, “the tale of the tribe.” I consider N30 to be a prolegomenon to a future epic (of which it in the end will form a part a structural moment, as introduction-in-the-middle), an extended pile on top of an epic as narrative, a question of the tribe and question of its history. I was burdened by too much satire, too much bullshit. But: satire willy-nilly = the only justifiable satire. Against the abstract universalism of the market (“globalism”): concrete disgust, a positive way of saying “No.” Moreover, disgust is a specifically total attitude, which ultimately concerns the world as a whole. I hate this or that, but I am disgusted by EVERYTHING (when I am disgusted), and so it appears that satire is in fact related to the epic, in so far as it concerns society, the cosmos, history. Maybe it is no coincidence that the Dutch literary canon knows no great poet of disgust; what could be more fearful to us than society, the cosmos, and history? The T-tendency (T from Tollens 9 ) clearly points into the direction of the small, friendly, ironic, melancholic, acquiescent, wondrous, and so on. The anti-political, anti-cosmic, anti-historical. (Why am I so philosophical? To scare away the Dutchies.) And most of all: the “poetical” (the pseudo-mysticism from the backyard). Yes, the N in N30 also stands for the Netherlands (just like 30 indicates the number of chapters). I was not in Seattle, I do not live in Iraq. But is not the whole world bleeding to death on Dutch paving stones? Let’s hope that we mowed away something with this total satire, also “in myself.” The arrogant stupidity that definitely thinks to know the essence of freedom (the free development of esthetic needs inside the void), that cannot take anything serious, only believes in the disciplined bestiality of the individual (“norms and values”) and the mere functioning of a social factory which finds no justification whatsoever outside its functioning (“get to work”)… Who knows. A certain aimed destruction leaves grooves and craters, mapping out a next adventure. Pound’s periplum : sailing while mapping the coasts. Immanent orientation. The terrain changes with the map, history changes with the poem. Maps never merely organize the chaos, transcendent schemes imposed on a formless Ding-an-sich . They organize from within, surfing. But they are most of all routes back into the chaos or forward to paradise (final identity of chaos and paradise; Schlegel: “ Nur diejenige Verworrenheit ist ein Chaos aus der eine Welt entspringen kann ”10). A poem is not only a piece of history, it is also a flight from history. Maps give chaos to the form of reality , open escape routes, break through representations, make us shivery and dazed. Paradise is immanent to a fleeting desire. History is the history of labor—this is Adam’s curse—and the poet works too: For to articulate sweet sounds together Is to work harder than all these, and yet Be thought an idler by the noisy set Of bankers, school masters, and clergymen The martyrs call the world 11 But: the poet works in paradise. The paradox of the artwork, the work that is no work, the piece of history that cannot be reduced to History—this is explained by The Space of Literature , a virtual space, an autonomous rhythm, not outside, but in the midst of the noise, a piece of paradise in hell, a postcard from the vale of tears addressed to paradise, to X. Political poetry means: a poetry that dares to think about itself, about its language and about its world and about the problematic relation between both, which is this relation as problem. A poetry that thinks at all, articulates its problem. It has nothing to do with journalism or morality or debate, let alone the law or the state. It has nothing to do with “criticism” if this means the replacement of incorrect representations by other, more correct representations. It has something to do with ethics in the sense of learning to live. It has something to do with the community and the language of the community (whichever that may be) and the role of the poet regarding the community. It concerns justice without judgement or measure. In the end the just word is just a word , to paraphrase Godard: it is from a future that is unimaginable. It Is no rational engagement, but an aversion against everything that obstructs life, and love for everything what is worthy of having been loved. The world is engaged with me, not the other way round. First Exodus, then Sinai. A desire does not start with an agenda. To answer the question whether I am really so naive as to want to change the world: “We only want the world.” Justice is the world appealing to us to liberate it from all possible chains, from each organization and inequality, to be it, smooth, equal, under a clear sky—a desert and a people in a desert. That moment between Egypt and the Law. It is not a revolution, but the sky above the revolution. Poetry = the science of escape. There is no art that we already know. The weakness of modernistic epic poetry seems to me to be the unwillingness to completely abandon narrative as a structural principle, in favor of a composition “around” or from an event. The China Cantos and Adams Cantos are the low point, and the Pisan Cantos the high point of Pound’s poetry. Two types of research: archival representation of the past vs. ontology of the present (which virtually presupposes the entire history). Presupposing an event means that it is impossible for the poet to stage his own absence, but in no way makes the work personal. An event is the unknown, the new invading into the business as usual, so also the personal. The question heading this research is not: “Who am I?” but “What is happening?” The book is as little illegible as Mondrian’s work is invisible. Form is of interest only to the extent that it empowers liberation. Ron Silliman So no formalism, but what it means to live in this world and to have a future in it. I want something that holds together that’s not smooth. Bruce Andrews The past above, the future below and the present pouring down: the roar, the roar of the present, a speech— William Carlos Williams If my confreres wanted to write a work with all history in its maw, I wished, from the beginning to start all over again, attempting to know nothing but a will to create, and matter at hand. Ronald Johnson NOTES 1) “The easy thing/ that is difficult to make.” Bertold Brecht, Lob des Kommunismus . (All footnotes are the translator’s) 2) Maurice Blanchot, The Space of Literature , trans. Ann Smock. Lincoln/London: University of Nebraska Press (1989), 75. 3) Mettes uses the word “Neerlandicus,” which refers to scholars of Dutch language and literature. 4) Dutch poet. 5) Gertrude Stein. “Composition as Explanation.” A Stein Reader . Ed. Ulla E. Dydo. Evanston, IL: Northwestern University Press (1993), 495-503. 6) Ezra Pound. 7) Flemish poet. 8) “Resounding an original sound in the language of the despondent.” A. Roland Holst, De afspraak . 9) Dutch poet. 10) “Only such a confusion is a chaos which can give rise to a world.” 11) W.B. Yeats, “Adam’s Curse.&rdquo. (shrink)

Certain philosophers have argued in favour of recognising a right to freedom of conscience that includes a defeasible right of individuals to live in accordance with their perceived moral duties. This right requires the government to exempt people from general laws or regulations that prevent them from acting consistently with their perceived moral duties. The importance of protecting individuals’ integrity is sometimes invoked in favour of accommodating conscience. I argue that personal integrity is valuable since autonomy, identity and (...) self-respect are all dependent on the preservation of personal integrity. I respond to two objections, one pressed by Andrew Koppelman and the other by Richard Arneson, to the claim that personal integrity is valuable, and to a further argument by Arneson to the effect that it is unfair to others claiming accommodations to exempt those with conscience-based claims. (shrink)

The issue of conscience and authority has long been on the agenda of moral philosophy. In particular, the views of John Locke and Thomas Hobbes came to the fore when there was freedom of religion and conscience. Their views continue to influence the moral philosophers of today's world. In terms of organizing and maintaining individual and social relationships, different perspectives from past to present have been made possible by taking into account the common life practices. In today's world, (...) the social configurations that have changed compared to the past and the problems arising from the encounter of different ethnic and social groups have caused re-emergence of solidarity in a common theme. The concept of cultural relativism, which is one of these common themes, refers to the evaluation of exposed judgments within the internal dynamics of culture. On the other hand, shaping of universal human rights and social solidarity on an intercultural ground makes the existence of an additional theme inevitable in terms of harmony and sustainability: conscience. Conscience is related to the commonization of the common living commitments and being in solidarity in sustaining social relations. Predicating the relations to be formed on the basis of conscience upon an essentialist foundation does not run parallel to the continuous reshaping of solidarity in practical life. In the absence of essentialist truths, and outside the original ethnic relativity, a new and sustainable togetherness starts to be shaped within these practices. Therefore, one of the themes that will spring to mind will be the values education. There are studies that include the answers given to the questions that come to mind about the theoretical possibilities of this and the determination and interpretation of the values already positioned in the practical structures. (shrink)

Conscience can err. Yet erroneous conscience still seems binding in that it is likely to be morally wrong to ignore the call of conscience. Meanwhile, it seems equally wrong to act according to such a wrong judgment of conscience. The moral dilemma of erroneous conscience poses a challenge to any coherent theory of conscience. In light of this, I will examine Aquinas’s reflections on the psychological mechanism of erroneous conscience and reconstruct a sophisticated (...) explanation of the obligatory force of erroneous conscience, in which the conscientious integrity of the agent is intimately integrated with the sovereignty of divine law. Next, I will appeal to Aquinas’s distinction between the judgment of conscience (iudicium consentiae) and that of free decision (iudicium liberi arbitrii) to show that the judgments pertaining to conscience are purely cognitive rather than affective. This analysis will also help specify in what sense we can tolerate conscience’s wrong judgments. (shrink)

Does a pharmacist have a right to refuse to fill certain prescriptions? In this paper, I examine cases in which an employee might refuse to do something that is part of his or her job description. I will argue that in some of these cases, an employee does have a right of refusal and in other cases an employee does not. In those cases where the employee does not have a right of refusal, I argue that the refusals are just (...) cause for termination of employment. I argue that there are moral principles that support the different outcomes in the cases under consideration. I turn to pharmacy cases at the end of the paper and argue that they are analogous to cases where an employee does not have a right of refusal and thus fall under the principle that refusing to fill birth control prescriptions constitutes just cause for termination. (shrink)

Moral moments -- The neurotic and the penitent -- True, false, and feigned penance -- Fame without conscience -- Cain and conscience -- Feminine paradoxes -- Sincere hypocrisy -- The poetical consience -- Envoi : spiritual sophistry.

ObjectiveLong-term isolation, including lockdowns and quarantines, may have a distressing effect on anyone experiencing it. Adolescent brain architecture is very sensitive to environmental adversities, and the mental health development of adolescents may be particularly vulnerable during the pandemic era. In order to better understand the triggers for perceived adolescent stress during the COVID-19 lockdown, the present study aimed to assess the effects of social well-being and changes in time use during the lockdown, as well as the family COVID experience (...) of adolescents.MethodsThe sample for this study comprised n = 3,440 adolescents. Bayesian correlations between PSS, health and well-being variables were assessed. PSS was then modeled as an outcome variable in a series of nested Bayesian multilevel regression models.ResultsThe negative impact of the COVID-19 lockdown was more apparent in girls. PSS was moderately correlated with adolescent health and well-being. The strongest predictor of higher level of PSS was frequent feeling of loneliness. On the contrary, lower level of PSS was most associated with having someone to talk to.ConclusionLong-term social isolation of adolescents could be harmful to their mental health. Psychological coping strategies to prevent the consequences of social isolation and development of mental health problems should be promoted on the individual, family, and even community level. (shrink)

First of all - about the connections of culture and religion. This question is one of those who, in the recent past, was subjected to all kinds of distortions. Consequently, our contemporary Ukrainian society needs a true meeting of religion and culture. The attempt of Marxism to create a new humanism, which completely rejects religion and is based only on atheism, and even that which was given a militant character, proved to be insolvent. Even now we understand that it is (...) impossible to build a culture denying the close connection between religion and culture. (shrink)

The widespread emergence of innumerable technologies within health care has complicated the choices facing caregivers and their patients. The escalation of knowledge and technical innovation has been accompanied by an erosion of moral and ethical consensus among health providers that is reflected in the abandonment of the Hippocratic Oath as the immutable bedrock of medical ethics. Ethical conflicts arise when the values of health professionals collide with the expressed wishes of patients or the dictates of regulatory bodies and administrators. Increasing (...) attempts by groups outside of the medical profession to limit freedom of conscience for health providers has raised concern and consternation among some health professionals. The personal and professional impact of health professionals surrendering freedom of conscience and participating in actions they deem malevolent or unethical has not been adequately studied and may not be inconsequential when considering the recognized impact of other circumstances of coerced complicity. We argue that the distinction between the two ways that freedom of conscience is exercised (avoiding a perceived evil and seeking a perceived good) provides a rational basis for a principled limitation of this fundamental freedom. (shrink)

The dominant approach to conscience in contemporary bioethics presumes that conscience functions to promote personal moral integrity, and therefore presumes that the relevant values are inherently personal. This approach fails to demonstrate when and why claims of conscience should be taken seriously by others. I draw on Hannah Arendt’s deliberative model of conscience and Cheshire Calhoun’s social model of integrity to develop an alternative relational view of conscience—one that demonstrates that the relevant values are social (...) as well as personal. I show how the goal of improving ethical practice over time constrains which conscience claims should be taken seriously by others. (shrink)