It is known that people have been getting distressed for a long‐time and healthcare workers, like the military, seem to fit criteria for being at particular risk. Fairly recently a term of art, moral distress, has been added to types of distress at work, though not restricted to work, they can suffer. There are recognized scales that measure psychological distress such as the General Health Questionnaire and the Kessler scales but moral distress it is claimed is different warranting its own (...) scale. This seems to be because of both the intensity and nature of moral problems encountered at work that is so powerful and so destructive of moral agency and integrity. This paper will focus on how, if at all, moral distress is different by examining the idea of moral normativity. Moral normativity is understood as roughly the sort of thing that all rational persons would endorse regardless of his interests, having an “automatic reason giving force” and is likely to also require an overriding force. Specifically, it will examine how this force of moral claims seems to be needed for moral distress to be so destructive of healthcare professional's moral agency and integrity. This is related to the idea of warrantedness of the reaction of distress. Even if morality had such a strong normativity, one can still ask is distress the correct or warranted reaction? It seems plausible that if distress is a correct response for it to be both moral and warranted it needs a strong account of moral normativity. The idea of a distinct form of distress as moral distress may be true in theory but is too contested both ontologically and epistemologically for a useful practice of measurement at present. (shrink)

People can have or lack ‘integrity’. But can public institutions? It is common to speak of the ‘integrity’ of such institutions: in popular discourse, legal decisions, law and regulations, and also increasingly, political theory, and proximate disciplines. Such integrity is often said to be at risk of being ‘subverted,’ ‘corroded,’ and ‘corrupted,’ by both forces within and without. Furthermore, the implication is that this is a very worrying thing. The integrity of our institutions, at least, needs to be preserved, supported, (...) and defended; against money, politics, power, and populists. However, despite such common usage, the concept itself has attracted little theoretical reflection. What can it mean, if anything sensible, for an institution itself – instead of a person (or even say, a body, process, territory or a bridge) – to have ‘integrity’? And, why might it be so important? This is the subject of this paper. It puts forward a substantive moral conception of institutional integrity as the robust disposition of an institution to pursue its purpose efficiently, within the constraints of legitimacy, consistent with its commitments. It argues that it is important because it provides the strongest grounding for a ‘duty of support’ owed by citizens to the institution. The strength of such support owed also gives content to a scalar dimension of the institution’s normative legitimacy, that is, the ‘strength’ (or weakness) of such legitimacy. Further, it illustrates how such a conception of institutional integrity will helpfully advance the current debate regarding institutional corruption. (shrink)