Recent medical and bioethics literature shows a growing concern for practitioners’ emotional experience and the ethical environment in the workplace. Moral distress, in particular, is often said to result from the difficult decisions made and the troubling situations regularly encountered in health care contexts. It has been identified as a leading cause of professional dissatisfaction and burnout, which, in turn, contribute to inadequate attention and increased pain for patients. Given the natural desire to avoid these negative effects, it seems to (...) most authors that systematic efforts should be made to drastically reduce moral distress, if not altogether eliminate it from the lives of vulnerable practitioners. Such efforts, however, may be problematic, as moral distress is not adequately understood, nor is there agreement among the leading accounts regarding how to conceptualize the experience. With this article I make clear what a robust account of moral distress should be able to explain and how the most common notions in the existing literature leave significant explanatory gaps. I present several cases of interest and, with careful reflection upon their distinguishing features, I establish important desiderata for an explanatorily satisfying account. With these fundamental demands left unsatisfied by the leading accounts, we see the persisting need for a conception of moral distress that can capture and delimit the range of cases of interest. (shrink)

Both through his own work and that of his students, Franz Clemens Brentano had an often underappreciated influence on the course of 20 th - and 21 st -century philosophy. _The Routledge Handbook of Franz Brentano and the Brentano School_ offers full coverage of Brentano’s philosophy and his influence. It contains 38 brand-new essays from an international team of experts that offer a comprehensive view of Brentano’s central research areas—philosophy of mind, metaphysics, and value theory—as well as of the principal (...) figures shaped by Brentano’s school of thought. A General Introduction serves as an overview of Brentano and the contents of the volume and three separate bibliographies point students and researchers on to further avenues of inquiry. Systematic and detailed, _The Routledge Handbook of Franz Brentano and the Brentano School_ provides readers with a valuable reference to Brentano’s work, and to his lasting importance in the history of philosophy and in contemporary debates. (shrink)

Many recent critical discussions of anthropocentrism have focused on Bryan Norton's ‘convergence hypothesis': the claim that both anthropocentric and nonanthropocentric ethics will recommend the same environmentally responsible behaviours and policies. I argue that even if we grant the truth of Norton's convergence hypothesis, there are still good reasons to worry about anthropocentric ethics. Ethics legitimately raises questions about how to feel, not just about which actions to take or which policies to adopt. From the point of view of norms for (...) feeling, anthropocentrism has very different practical implications from nonanthropocentrism; it undermines some of the common attitudes – love, respect, awe – that people think it appropriate to take toward the natural world. (shrink)

In this chapter I explore what painful art can tell us about the nature and importance of human welfare. My goal is not so much to defend a new solution to the paradox of tragedy, as it is to explore the implications of the kinds of solutions that I find attractive. Both nonhedonic compensatory theories and constitutive theories explain why people seek out painful art, but they have troublesome implications. On some narrow theories of well-being, they imply that painful art (...) is bad for us. Accordingly, we may rightly wonder if it rational for people to watch melodramas or to listen to love songs. One might think that we should generally avoid unpleasant works of art. This implication flirts with absurdity. I show how it can be avoided by making a distinction between well-being and worth. (shrink)

Documented ethical violations and empirical research have demonstrated that, despite professional standards and formal training in ethical principles, some psychotherapists engage in unethical behaviors that compromise the welfare of clients. It appears that competing values and interests that emerge in the therapeutic endeavor can interfere with therapists' considerations of ethical standards and their willingness to act ethically. Expanding current models of ethical decision making, this article offers a hermeneutic model that recognizes that in addition to moral reasoning, the context of (...) the therapeutic relationship and the therapist's subjective responses are fundamental considerations in the interpretation and application of ethical interventions. Implications for understanding and training of ethics in psychotherapy in this broader context are explored. (shrink)

Drawing on recent cognitive theories of the emotions, this article develops an account of critical reflection as requiring emotional flexibility and involving the ability to envisage alternative reasons for action. The focus on the role of emotions in critical reflection, and in agents' resistance to reflection, suggests the need to move beyond an introspective to a more social and relational conception of the process of reflection. It also casts new light on the intractable problem of explaining how oppressive socialisation impairs (...) the capacity for autonomy. (shrink)

The Platonic view that art is incapable of providing us with knowledge is sufficiently widely held as to merit a serious attempt at refutation. Once it is acknowledged that there are alternative forms of knowledge other than propositional, then it is possible to establish the truth of the claim that the knowledge which art affords has a value on a par with that provided by other disciplines. Art, it is argued, has a unique potential to provide imaginative insights by reference (...) to which we may understand what it is like to experience and to feel, in ways very different from those with which we may be familiar. It is shown to be instrumental in enabling us to refine our moral concepts as well as in determining what is salient from the moral point of view. As a powerful tool in the education of the emotions, artworks have the power to increase our moral sensitivity and to sharpen our perception of what is required of us inways that are otherwise unobtainable. (shrink)

Are there normative reasons for love? More specifically, is it possible to rationally justify love? Or can we at best provide explanations for why we love? In Part I of this entry, I discuss the nature of love, theories of emotion, and what it takes to justify an attitude. In Part II, I provide an overview of the various positions one might take on the rational justification of love. I focus on the debate between defenders of the no-reasons view and (...) the reasons view. Along the way, I discuss the significance of falling in love, the problem of trading up, and the notion of irreplaceability. I evaluate attempts to justify love based on the intrinsic and the relational properties of the beloved. (shrink)

This paper constitutes a defence of an affective account of emotion. I begin by outlining the case for thinking that emotions are just feelings. I also suggest that emotional feelings are not reducible to other kinds of feelings, but rather form a distinct class of feeling state. I then consider a number of common objections that have been raised against affective accounts of emotion, including: (1) the objection that emotion cannot always consist only of feeling because some emotions - for (...) example, indignation and regret - necessarily have a cognitive component (say, the perception of a lost opportunity in the case of regret); (2) the objection that emotion cannot consist only of feeling because in order to explain how emotions have intentional objects we will have to recognise that emotion consists of cognition; and (3) the objection that emotion cannot consist only of feeling because emotion, but not feeling, can be variously assessed or evaluated. However, I demonstrate how an affective account of emotion might be successfully defended against all of the objections that are cited. (shrink)

Recent thinking within philosophy of mind about the ways cognition can extend has yet to be integrated with philosophical theories of emotion, which give cognition a central role. We carve out new ground at the intersection of these areas and, in doing so, defend what we call the extended emotion thesis: the claim that some emotions can extend beyond skin and skull to parts of the external world.

Claims that emotions are or can be rational, and crucially enabling of rationality, are now fairly common, also outside of philosophy, but with considerable diversity both in their assumptions about emotions and their conceptions of rationality. Three main trends are worth picking out, both in themselves and for the potential tensions between them: accounts that defend a case for the rationality of emotions A) by assimilating emotions closely to beliefs or judgements; B) in terms of the very features that traditional (...) views of emotions as irrational/a-rational emphasized; C) by arguing that emotions exhibit a more sui generis kind of rationality, often one based on a narrative or dramaturgic “inner logic”. (shrink)

In this article we discuss generosity, a virtue that has received little attention in relation to nursing practice. We make a distinction between material generosity and generosity of spirit. The moral imagination is central to our analysis of generosity of spirit. We discuss data taken from a team meeting and identify the components of generosity, for example, the role of the moral imagination in interrupting value judgements, protecting the identity of the chronically ill patient through use of the psychosocial format, (...) and displaying empathetic maturity. The talk of the team enables us to understand and make visible the link between generosity, moral imagination and identity construction. The topic of generosity, although contextualized in a UK setting, has relevance to other cultural contexts. (shrink)

This article reports a study exploring the meaning of the complex phenomenon of moral responsibility in nursing practice. Each of three focus groups with a total of 14 student nurses were conducted twice to gather their views on moral responsibility in nursing practice. The data were analysed by qualitative thematic content analysis. Moral responsibility was interpreted as a relational way of being, which involved guidance by one’s inner compass composed of ideals, values and knowledge that translate into a striving to (...) do good. It was concluded that, if student nurses are to continue striving to do good in a way that respects themselves and other people, it is important that they do not feel forced to compromise their values. Instead they should be given space and encouragement in their endeavours to do good in a relational way that advances nursing as a moral practice. (shrink)

Can any being worthy of worship make others worship it? I think not. By way of an analogy to love, I argue that it is perfectly coherent to think that one could be made to worship. However, forcing someone to worship violates their autonomy, not because worship must be freely given, but because forced worship would be inauthentic—much like love earned through potions. For this reason, I argue that one cannot be made to worship properly; forced worship would be unfitting. (...) My principal claim is that no being worthy of worship could exercise the power to make others worship it, since the act of making another worship would necessarily make one unworthy of worship. (shrink)

The problem of undermedication of pain in health care is widely recognized and acknowledged; however, there is an obvious lack of exploration of this problem from an ethical perspective. When undermedication is raised as a moral concern, the underlying premise is that a patient may experience harm or not benefit from ineffective pain management practices. I will argue that the harm is of a particular type, that is, moral negligence. My intention is to increase nurses’ awareness of both the type (...) of moral harm they are causing, and their professional and moral duties to provide appropriate medication, more particularly to avoid undermedication. I hope that this heightened awareness will be incorporated into practice. As a nurse, I chose to focus on nursing for this article, but my claims are applicable to other health professions, such as medicine. (shrink)

Consequentialism has trouble explaining why hypocrisy is a term of moral condem-nation, largely because hypocrites often try to deceive others about their own selfishness through the useof words or deeds which themselves have good consequences. We argue that consequentialist attempts to deal with the problem by separating the evaluation of agent and action, or by the directevaluation of dispositions, or by focusing on long-term consequences such as reliability and erosion of trust, all prove inadequate to the challenge. We go on (...) to argue, however, that a version of consequentialism which values the fulfilment of desires, rather than mental states, is able to explain why hypocrisy is generally wrong, and indeed can do so better than its Kantian rivals. (shrink)

The subject of this article is moral agency in nursing, studied by the use of an applied philosophical method. It draws upon nurses’ accounts of how they see intrinsic value in their work and believe that they make a difference to patients in terms that leave their patients feeling better. The analysis is based on the philosophy of Iris Murdoch to reveal how nurses’ accounts demonstrated that they hold a view of themselves and their professional practice that is intrinsically linked (...) to, and dependent upon, their capacity to see good in the work they do. (shrink)

The bulk of the literature on the relationship between art and morality is principally concerned with an aesthetic question: Do moral flaws with works of art constitute aesthetic flaws?1 Much less attention has been paid to the ways in which artworks can be morally flawed. There are at least three promising contenders that concern aesthetic education: Artworks can be morally flawed by endorsing immorality, corrupting audiences, and encouraging responses that are bad to have. When it comes to works of fiction, (...) the third suggestion requires what Allan Hazlett calls response moralism—the position that audience reactions to artworks can be morally bad.2 Here, I will put aside issues of aesthetic.. (shrink)

Moral emotions shape the effectiveness of culturally diverse teams. However, these emotions, which are integral to determining ethically responsive patient care and team relationships, typically go unrecognised. The contribution of emotions to moral deliberation is subjugated within the technorational environment of healthcare decision‐making. Contemporary healthcare organisations rely on a multicultural workforce charged with the ethical care of vulnerable people. Limited extant literature examines the role of moral emotions in ethical decision‐making among culturally diverse healthcare teams. Moral emotions are evident in (...) ethnocentric moral perspectives that construct some colleagues' practices as ‘other’. This article examines how moral emotions are evoked when cultural dissonance influences nurses' moral perceptions. We use a qualitative investigation of teamwork within culturally diverse healthcare organisations. We use Haidt's () account of moral emotions to examine practice‐based accounts of 36 internationally educated and 17 New Zealand educated nurses practising in New Zealand. The study provides evidence that moral emotions are frequently elicited by communication and care practices considered ‘foreign’. The main implication is that although safe practice in healthcare organisations is reliant on highly functioning teams, collaboration is challenged by interprofessional power relations of contested culturally shaped values. We address practice‐based strategies that enable engagement with moral emotions to enhance effective teamwork. (shrink)

Background: Empathy is of great importance in nursing, as it helps us to see and meet the needs of patients and hence to care for patients in an appropriate way. Therefore, it is of great importance that nursing students and nurses develop their ability to empathize. Objective: The study aimed at gaining knowledge on what characterizes undergraduate nursing students’ ability to empathize with patients during their first practice in a nursing home. In addition, the aim of the study was to (...) investigate what nursing students think is important with regard to upholding their ability to empathize with patients in a professional way. Research design: This research has a phenomenological and hermeneutic design, based on qualitative interviews. Participants and research context: A total of 11 undergraduate nursing students participated in interviews during or right after their first practice in a nursing home. Ethical considerations: Norwegian Social Science Data Services approved the study. Participants were informed that their participation was voluntary. The participants were also assured confidentiality, and they were informed that they could withdraw from the study at any time, without providing any reasons. Findings: What the findings show is that affective empathy is strong among undergraduate nursing students in their first practice. They think the emotions are important to be able to empathize, and they are afraid of becoming indifferent. At the same time, they are afraid that the feelings will hinder them from acting in a professional manner. Discussion: The findings are discussed in light of previous theories on empathy, and especially perspectives on empathy, emotions, and morality. Conclusion: Affective empathy seems to be strong among nursing students, and this may be of great importance to be sensitive to patients’ well-being. However, affective and cognitive empathy should be balanced if nurses will have to meet patients in a professional way. (shrink)

U radu kritički razmatram pokušaj inkorporiranja emocija kao motiva u okvire Kantove etike. U prvom dijelu rada to činim raspravljajući o distinkciji djelovanja iz dužnosti i djelovanja prema dužnosti te o Kantovu shvaćanju pojma moralne vrijednosti. U drugom dijelu teksta analiziram poznati argument kojim se ukazuje na to da Kantova teorija ne ostavlja prostor pristranim oblicima ponašanja. Na koncu nastojim pokazati da taj prigovor ne bi trebalo olako odbaciti te sugeriram da bi prihvatljiva etička teorija trebala omogućiti integraciju emocija u (...) svoju domenu.In this paper I critically examine the attempt of incorporation of emotions as motives into the framework of Kant’s ethics. In the first part of the paper I do this by discussing the distinction of acting from duty and acting in accordance with duty as well as Kant’s understanding of the notion of moral worth. In the second part of the paper I analyze the well-known objection that there is no place for partial forms of behavior in Kant’s ethics. I try to show that this objection should not be easily dismissed and suggest that the acceptable ethical theory should integrate emotions into its domain. (shrink)

A critical examination of contemporary nursing theory suggests that two distinct discourses coexist within this field. On the one hand, proponents of the ‘knowledge discourse’ argue that nurses should drop the ‘virtue script’ and focus on the scientific and technical aspects of their work. On the other hand, proponents of the ‘caring discourse’ promote a view of nursing that embodies humanistic qualities such as compassion, empathy and mutuality. In view of this, we suggest a way to reconcile both discourses despite (...) the fact that they appear to be at odds theoretically and practically. To that end, we argue that nursing theory must give a prominent role to the Aristotelian conception of virtue, and we offer an account that includes both character and intellectual virtues. This account allows for a focus on moral competence but also accommodates the demands for discipline‐specific knowledge. Our account incorporates the caring discourse by suggesting a way for individuals to cultivate the conditions within themselves that make ‘caring in nursing’ possible, while the knowledge discourse is accommodated via the acquisition of the intellectual virtues. The process for achieving both these ends is the same: an intention to consistently develop, hone and exercise certain character traits over time. (shrink)

Selon le «cognitivisme fort», toutes les raisons d’une action trouvent leurs sources dans des caractéristiques normatives par lesquelles l’individu motivé (explicitement ou implicitement) prend des objets comme avoir (ou manque), indépendamment de son attitude à l’égard de ces objets. L’objectif majeur de cet article est de contester les arguments du cognitivisme fort, en d’autres termes, de démontrer que toute attitude volitive donne aux individus des raisons pour entreprendre une action. À cette fin, l’argument principal consistera à procéder par le biais (...) de l’analyse du phénomène complexe de la préoccupation, pour en extrapoler une conclusion relative à la nature (incitative et normative) d’un phénomène mental plus fondamental encore : les désirs spécifiques. (shrink)

Pour contrer le scepticisme au sujet de la connaissance des valeurs, la plupart soutiennent avec John Rawls qu’une croyance comme celle qu’une action est bonne est justifiée dans la mesure où elle appartient à un ensemble de croyances cohérent, ayant atteint un équilibre réfléchi. Christine Tappolet s’inspire des travaux de Max Scheler et d’Alexius von Meinong pour défendre une conception opposée au cohérentisme. La connaissance des valeurs est affirmée dépendre de nos émotions, ces dernières étant conçues comme des perceptions des (...) valeurs. (shrink)

The Confucian understanding of emotions and their ethical importance confirms and exemplifies the contemporary Western renewed understanding of the nature of emotions. By virtue of a systematic conceptual analysis of Confucian ethics, one can see that, according to Confucians, the ethical significance of emotions, lies in that an ethical life is also emotional and virtues are inclinational. And a further exploration shows that the reason for the ethical significance is both that emotions are heavenly-endowed and that there exists a union (...) of emotions and reason in Confucian ethics. This will constitute a challenge to the so-called mainstream ethical theories which have been popularly engaged in seeking justifications for abstract moral rules. (shrink)

This paper argues that there is a dimension of human consciousness which allows for a pre-intentional and non-cognitive intuition of sensibility. A sensibility which allows for the vulnerability of the human other is by nature characterized by passivity and receptivity. Moreover, sensibility invokes the significance of relating to the human other in an affective way of being touched by his or her pain and suffering. This capacity of being distressed by the distress of another person opens up for ethical responsibility (...) and even in a fundamental sense is a presupposition for full-fledged clinical knowledge in medical care and health care. (shrink)

This paper analyses a situation where a patient's suffering provoked feelings of compassion in a student nurse, and distress at her patient's circumstances. The reported behaviour of qualified nurses within the situation suggests that they lacked compassion, had inadequate knowledge, and that they failed to understand their patient's plight. An account of the situation is followed by an exploration of the nature of moral agency, and understanding in nursing. Nurses' capacity for moral imagination is shown to be of crucial importance (...) to the care that patients receive. The extent of nurses' responsibility for their behaviour is considered, and in particular, the extent of nurses' responsibility during times when they experience strain. Argument leads to the conclusion that we are justified in holding nurses responsible for their behaviour in situations of patient care, although we must not judge a nurse's behaviour too hastily. Attention is drawn to the need for a moral climate to sustain those nurses who struggle to give good patient care, despite the strain that is ever present within today's world of health care. (shrink)

Medical errors are all too common. Ever since a report issued by the Institute of Medicine raised awareness of this unfortunate reality, an emerging theme has gained prominence in the literature on medical error. Fears of blame and punishment, it is often claimed, allow errors to remain undisclosed. Accordingly, modern healthcare must shift away from blame towards a culture of safety in order to effectively reduce the occurrence of error. Against this shift, I argue that it would serve the medical (...) community well to retain notions of individual responsibility and blame in healthcare settings. In particular, expressions of moral emotions—such as guilt, regret and remorse—appear to play an important role in the process of disclosing harmful errors to patients and families. While such self-blaming responses can have negative psychological effects on the individual practitioner, those who take the blame are in the best position to offer apologies and show that mistakes are being taken seriously, thereby allowing harmed patients and families to move forward in the wake of medical error. (shrink)

Clinical ethics consultations are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult's endpoint runs the risk of overemphasizing the conflict's resolution at the expense of the consult's process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, lingering (...) sequelae: moral distress or negative moral emotions. The problem, succinctly named, is that such consults have insufficient “closure” for patients, families, and providers. To promote closure, and avoid the ills of moral distress and the moral emotions, I argue that CECs need to prioritize assisted conversation between the different stakeholders in these conflicts, what is often referred to as “bioethics mediation.”. (shrink)