In this paper it is argued that moral distress is an emotional response to an ethical dilemma, and that to date, the literature has largely failed to address the fundamental questions that need to be answered in response to this emotional response. Firstly, does moral distress accurately identify a wrong being done to patients? Secondly, if it does, can nurses carry out this ‘wrong doing’, but not be responsible for the consequences of their actions? A narrative that reflects the emotional (...) nature of moral distress is presented, with the aim of providing some answers to these questions. (shrink)

Whom I call ‘epistemic reductionists’ in this article are critics of the notion of ‘moral luck’ that maintain that all supposed cases of moral luck are illusory; they are in fact cases of what I describe as a special form of epistemic luck, the only difference lying in what we get to know about someone, rather than in what (s)he deserves in terms of praise or blame. I argue that epistemic reductionists are mistaken. They implausibly separate judgements of character from (...) judgements concerning acts, and they assume a conception of character that is untenable both from a common sense perspective and with a view to findings from social psychology. I use especially the example of Scobie, the protagonist of Graham Greene’s novel The Heart of the Matter , to show that moral luck is real—that there are cases of moral luck that cannot be reduced to epistemic luck. The reality of moral luck, in this example at least, lies in its impact on character and personal and moral identity. (shrink)

Humanitarian health care practitioners working outside familiar settings, and without familiar supports, encounter ethical challenges both familiar and distinct. The ethical guidance they rely upon ought to reflect this. Using data from empirical studies, we explore the strengths and weaknesses of two ethical models that could serve as resources for understanding ethical challenges in humanitarian health care: clinical ethics and public health ethics. The qualitative interviews demonstrate the degree to which traditional teaching and values of clinical health ethics seem insufficient (...) for addressing all the realities of health care practice during humanitarian missions. They equally suggest that greater good orientations of public health ethics can thwart the best intentions of health care professionals wanting to attend to the interests of individual patients. Even though neither is complete on its own for helping guide health professionals on field missions, taken together these models have much to offer. At the same time, the narratives of the humanitarian health care workers illustrate how some of the crucial differences between public health ethics and clinical ethics generate tensions in humanitarian health practice. We offer an analysis of some of the complexities this creates for humanitarian health care ethics, and consider ways of adjudicating between the two models. (shrink)

Moral luck – which seems to appear when circumstances beyond a person’s control influence our moral attributions of praise and blame – is troubling in that modern moral theory has supposed morality to be immune to luck. In business, moral luck commonly influences our moral judgments, many of which have economic consequences that cannot be reversed. The possibility that the chance intervention of luck could influence the way in which we assign moral accountability in business ethics is unsettling. This paper (...) argues that if we cannot explain moral luck away, we should give consideration to moral risk in our moral judgments and the associated assignment of economic rewards regarding episodes in which moral luck plays a role. (shrink)

Infertility can be an agonizing experience, especially for women. And, much of the agony has to do with luck: with how unlucky one is in being infertile, and in how much luck is involved in determining whether one can weather the storm of infertility and perhaps have a child in the end. We argue that bad luck associated with being infertile is often bad moral luck for women. The infertile woman often blames herself or is blamed by others for what (...) is happening to her, even when she cannot control or prevent what is happening to her. She has simply had bad luck. We focus on the self-blame of infertile women and show how it stems from pro-natalism that targets women. We also argue that overall for women, regret is a better moral response to infertility than self-blame. (shrink)

The ‘standard interpretation’ of John Taurek’s argument in ‘Should the Numbers Count?’ imputes two theses to him: first, ‘numbers scepticism’, or scepticism about the moral force of an appeal to the mere number of individuals saved in conflict cases; and second, the ‘equal greatest chances’ principle of rescue, which requires that every individual has an equal chance of being rescued. The standard interpretation is criticized here on a number of grounds. First, whilst Taurek clearly believes that equal chances are all-important, (...) he actually argues for a position weaker than the equal greatest chances principle. Second, the argument Taurek gives for the importance of equal chances ought to commit him to being more hospitable to the significance of numbers than he seems to be. Third, and as a result, Taurek should not have dismissed the significance of numbers but embraced a form of pluralism instead. Fourth, this result should be welcomed, because pluralism is more plausible than either the equal greatest chances principle or the saving the greater number principle. (shrink)

Issue Title: Moral Luck, Social Networking Sites, and Trust on the Web I argue that the problem of 'moral luck' is an unjustly neglected topic within Computer Ethics. This is unfortunate given that the very nature of computer technology, its 'logical malleability', leads to ever greater levels of complexity, unreliability and uncertainty. The ever widening contexts of application in turn lead to greater scope for the operation of chance and the phenomenon of moral luck. Moral luck bears down most heavily (...) on notions of professional responsibility, the identification and attribution of responsibility. It is immunity from luck that conventionally marks out moral value from other kinds of values such as instrumental, technical, and use value. The paper describes the nature of moral luck and its erosion of the scope of responsibility and agency. Moral luck poses a challenge to the kinds of theoretical approaches often deployed in Computer Ethics when analyzing moral questions arising from the design and implementation of information and communication technologies. The paper considers the impact on consequentialism; virtue ethics; and duty ethics. In addressing cases of moral luck within Computer Ethics, I argue that it is important to recognise the ways in which different types of moral systems are vulnerable, or resistant, to moral luck. Different resolutions are possible depending on the moral framework adopted. Equally, resolution of cases will depend on fundamental moral assumptions. The problem of moral luck in Computer Ethics should prompt us to new ways of looking at risk, accountability and responsibility.[PUBLICATION ABSTRACT]. (shrink)

In this article, I defend luck at the expense of risk. Or, more precisely, I try to make a distinction that gives both concepts fair treatment. I start by making it clear that luck stands in opposition to control and not to causation. Both luck and risk are related to causal uncertainty. But it is warranted to talk about risk only when the uncertainty involved is brought under control, as it is in some familiar forms of fair gambling such as (...) dicing and roulette. Life is however not a fair gamble. We rarely have the kind of control over the preconditions of life that we have over the preconditions of say dicing. Luck therefore has profound influence on our lives and our health. This means that the standard conception of responsibility - that is, that we stand responsible only for consequences that we control - breaks down far more often than what is usually acknowledged. I therefore end the article by arguing that the standard conception of responsibility ought to be supplemented with a different conception that I have called "responsibility because of social involvement.". (shrink)

Should clinicians ask women to donate or even sell their eggs for stem cell research? Enucleated ova are crucial in somatic cell nuclear transfer technologies, but risky for women’s health. Until comparatively recently, very few commentators debated the ethical issues in egg donation and sale, concentrating on the embryo’s status. The unmasking of Hwang Woo Suk, who used over 2,200 ova in his fraudulent research, has finally brought the question of ova donation and sale into prominence. In this article we (...) offer an international comparison of recent responses to this crucial question and suggest that the levels of risk are too imprecise to enable women to give meaningful informed consent for egg extraction. What we do know of the risks also indicates that they are too high and that potential donors or sellers are not being fully informed of their extent, raising disturbing ethical issues concerning commodification, deception, coercion, and exploitation. (shrink)

The spectacular progress in assisted reproduction technology that has been witnessed for the past thirty years resulted in emerging new ethical dilemmas as well as the revision of some perennial ones. The paper aims at a feminist approach to oocyte and spare embryo donation for research. First, referring to different concepts of autonomy and informed consent, we discuss whether the decision to donate oocyte/embryo can truly be an autonomous choice of a female patient. Secondly, we argue the commonly adopted language (...) of gift is misleading and that calling for altruism could put female patients at risk of exploitation. Finally, we point out that the presence of gender stereotypes in the procreative area casts doubt whether even a more robust notion of informed consent manages to overcome this risk. (shrink)

Risk decisions often appear unsatisfactory after a calamity has taken place. This holds even when they are products of systematic risk analysis. Yet, if relevant considerations available to be known pre-accident were adequately taken into account and safety measures implemented accordingly, nobody seems morally blameworthy. In this paper, I advance a two-way argument. Firstly, I show how analysis of post-accident apologizing sheds new light on vexed tensions in ethical assessment of risk impositions. This amounts to exposing conflicting moral intuitions in (...) risk decisions, discussing problematic tenets in risk analysis as well as outlining three lines of arguments that destabilize the very notion of correct risk analysis. The analysis indicates that bringing different discussions of moral blameworthiness together facilitates resolving the tensions. It also calls for further and early-on collaboration between risk theorists and ethicists in order to carry these insights to risk analysis. Secondly, I argue that analysis of risk decisions, in part, reveals a discrepancy between the definitional work done on apology and what is required by ethics. Virtually every suggestion for the gold standard for apology involves moral blameworthiness as a necessary condition. I highlight different kinds of cases in which nobody is culpable, but an apology can be morally fitting or required. It would be nonsensical to say that, in these cases, one ought to apologize, but in a disingenuous manner. (shrink)

Humanitarian emergencies and natural disasters can overwhelm the capacity of local and national agencies to respond to the needs of affected populations. In such cases, international relief organizations are frequently involved in the provision of emergency assistance. Health care professionals play a key role in these interventions. This practice environment is significantly different from the context of health care delivery in the home countries of expatriate health care professionals. Clinicians who travel from a developed nation to a resource-poor setting where (...) a humanitarian crisis has occurred experience a shift of professional, social, cultural and regulatory environments. In this dissertation I examine the ethics of health care practice in humanitarian work. I evaluate the literature of global bioethics, global health ethics and the ethics of humanitarian assistance, and consider the contributions of various ethics frameworks and normative approaches. I also develop a set of questions to guide health care professionals as they address ethically complex issues arising in clinical practice during humanitarian crises. In the empirical component of this research program I use Interpretive Description methodology to examine the moral experience of health care professionals in humanitarian relief work, and clinician experiences of resources and constraints for addressing ethical issues in humanitarian settings. Building upon the inductively derived findings, I argue for strategies and approaches that humanitarian organizations, project teams, and health care professionals can adopt to respond to the ethics of this field of practice. I also provide a critical review of Interpretive Description methodology. The research presented in this dissertation makes an important contribution to the ethical analysis of health care practice in humanitarian work. (shrink)