Once a term used primarily by moral philosophers, “moral distress” is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? “Plight” encompasses not (...) only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of “efficiency,” is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals’ moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim. (shrink)

An important shift occurs in Martin Heidegger’s thinking one year after the publication of Being and Time , in the Appendix to the Metaphysical Foundations of Logic . The shift is from his project of fundamental ontology—which provides an existential analysis of human existence on an ontological level—to metontology . Metontology is a neologism that refers to the ontic sphere of human experience and to the regional ontologies that were excluded from Being and Time. It is within metontology, Heidegger states, (...) that “the question of ethics may be raised for the first time.” This paper makes explicit both Heidegger’s argument for metontology , and the relation between metontology and ethics. In examining what he means by “the art of existing,” the paper argues that there is an ethical dimension to Heidegger’s thinking that corresponds to a moderate form of moral particularism. In order to justify this position, a comparative analysis is made between Heidegger, Aristotle, and Bernard Williams. (shrink)

Volume 11, Issue 1, March 2019, Page 7-18.

The moral distress of psychologists working in psychiatric and mental health care settings was explored in an interdisciplinary, hermeneutic phenomenological study situated at the University of Alberta, Canada. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychologists described specific incidents in which they felt their integrity had been compromised by such factors as institutional and interinstitutional demands, team conflicts, and interdisciplinary disputes. They described dealing with the resulting moral distress by such means as (...) silence, taking a stance, acting secretively, sustaining themselves through work with clients, seeking support from colleagues, and exiting. Recognizing moral distress can lead to a significant shift in the way we perceive moral choices and understand the moral context of practice. (shrink)

The question, what measures to address the shortage of transplantable organs are ethically permissible? requires careful attention because, apart from its impact on medical practice, the stance we espouse here reflects our interpretations of human freedom and mortality. To raise the number of available organs, on utilitarian grounds, bioethicists and medical professionals increasingly support mandatory procurement. This view is at odds with the Catechism of the Catholic Church, according to which ‘[o]rgan donation after death is a noble and meritorious act’ (...) but ethically impermissible absent consent. Those who concur with this position, but would oppose conscription on independent philosophical grounds, have not yet found a voice in the Western tradition comparable in strength to the utilitarian basis of the policy’s support, for Kantian and Aristotelian ethics, too, lend themselves to a requirement that we make our organs available to others when they can no longer serve ourselves. One finds an ethical wedge against conscription in an unexpected philosophical locale: the ‘fundamental ontology’ of Heidegger’s Being and Time, where pertinent individual choices arc protectively over what happens post mortem. Heidegger’s perspective on this issue thus meshes, not with other philosophical voices, but with Catholic doctrine—a surprising convergence of atheistic and theistic approaches to our flourishing whose ground I address in the article’s conclusion. (shrink)

Studies about the influence of sound and ambient environments on understanding and the affects, prior to intentional acts of consciousness, are employed to rectify self-fragmentation exemplified in Heidegger and Augustine. Due to a visual bias that suppresses his auditory disposition in Being and Time, Heidegger gestures toward Dasein’s fulfillment in social-being yet also recoils from it. To ameliorate this impasse, his underdeveloped modification of existence is revisited by way of Augustine’s attunement to rhetoricity during his conversion experience. As a result (...) of embracing a shared ambient space, he brings care for others as oneself into the realm of “the with” and thereby verifies the significance of an auditory way of being-in-the-world to the formation of communities. (shrink)

Draws from Latina feminism, existential phenomenology, and race theory to explore the concept of selfhood. This original study intertwining Latina feminism, existential phenomenology, and race theory offers a new philosophical approach to understanding selfhood and identity. Focusing on writings by Gloría Anzaldúa, María Lugones, and Linda Martín Alcoff, Mariana Ortega articulates a phenomenology that introduces a conception of selfhood as both multiple and singular. Her Latina feminist phenomenological approach can account for identities belonging simultaneously to different worlds, including immigrants, exiles, (...) and inhabitants of borderlands. Ortega’s project forges new directions not only in Latina feminist thinking on such issues as borders, mestizaje, marginality, resistance, and identity politics, but also connects this analysis to the existential phenomenology of Martin Heidegger and to such concepts as being-in-the-world, authenticity, and intersubjectivity. The pairing of the personal and the political in Ortega’s work is illustrative of the primacy of lived experience in the development of theoretical understandings of who we are. In addition to bringing to light central metaphysical issues regarding the temporality and continuity of the self, Ortega models a practice of philosophy that draws from work in other disciplines and that recognizes the important contributions of Latina feminists and other theorists of color to philosophical pursuits. Mariana Ortega is Professor of Philosophy at John Carroll University and coeditor (with Linda Martín Alcoff) of Constructing the Nation: A Race and Nationalism Reader, also published by SUNY Press. (shrink)

This paper offers a nexus of terms – mortality, limits, contingency and vulnerability – painting a picture of human life as marked by limitation and finitude. I suggest that limitations of possibility, capacity, and resource are deep features of human life, but not only restrict it. Limits are also the conditions of possibility for human life and as such have productive, normative, and creative powers that not only delimit life but also scaffold growth and transformation within it. The paper takes (...) a less known interpretation of the term ‘ephēmeros', to mean ‘of the day', rather than ‘short-lived' and suggests that as ephemeral, human life is contingent and mutable, subject to events beyond our control. However, virtue can still be exercised – indeed, can be exuberantly displayed – when we respond to contingent events marked by adversity. (shrink)

The confusion surrounding Heidegger's account of death in Being and Time has led to severe criticisms, some of which dismiss his analysis as incoherent and obtuse. I argue that Heidegger's critics err by equating Heidegger's concept of death with our ordinary concept. As I show, Heidegger's concept of death is not the same as the ordinary meaning of the term, namely, the event that ends life. But nor does this concept merely denote the finitude of Dasein's possibilities or the groundlessness (...) of existence, as William Blattner and Hubert Dreyfus have suggested. Rather, I argue, the concept of death has to be understood both as temporal finitude and as finitude of possibility. I show how this reading addresses the criticisms directed at Heidegger's death analysis as well as solving textual problems generated by more limited interpretations of the concept. (shrink)

In recent years there has been growing attention paid to a kind of human action or activity which does not issue from a process of reflection and deliberation and which is described as, e.g., ‘engaged coping’, ‘unreflective action’, and ‘flow’. Hubert Dreyfus, one of its key proponents, has developed a phenomenology of expertise which he has applied to ethics in order to account for ‘everyday ongoing ethical coping’ or ‘ethical expertise’. This article addresses the shortcomings of this approach by examining (...) the pre-reflective ethical know-how individuals first develop and on which all later forms of ethical expertise are dependent. In the first section an account is given of the ‘ethical second nature’ which every individual develops from childhood onwards and which forms the basis of pre-reflective ethical know-how. The acquisition of an ethical second nature early on opens up the very domain of ‘the ethical’ for us in the first place and is constitutive of our sensitivity to it. The second section turns to pre-reflective ethical know-how and whether it is conceptual in nature. Just as sensorimotor understanding forms the basis of our reflective perceptual concepts, pre-reflective ethical know-how is similarly proto-conceptual and is the source of our reflective ethical and moral concepts. Finally, the third section examines the process whereby ethical second nature and pre-reflective ethical know-how are actually acquired, namely, through immersion in an ‘ethical world’. This world consists of both the web of ethical meanings and significances which has evolved in a particular society or community as well as its members whose actions and interactions continually reproduce that web. (shrink)

Heideggerian philosophy is frequently chosen as a philosophical framing, and/or a hermeneutic analytical structure in qualitative nursing research. As Heideggerian philosophy is dense, there is merit in the development of scholarly resources that help to explain discrete Heideggerian concepts and to uncover their relevance to contemporary human experience. This paper uses a meta-synthesis methodology to pool and synthesise findings from 29 phenomenological research reports on Being-with in the nurse–patient relationship. We firstly considered and secured the most relevant Heideggerian elements to (...) nurse–patient Being-with. Under these deductive codes, we then inductively developed sub-themes that seemed to explain the multifaceted nature of Being-with, through a secondary analysis and synthesis of published data from 417 patient, carer and nurse participants. Dasein-with was enhanced when nurses had first-hand experience with a phenomenon. Nurses moved between the inauthentic they-mode, and the authentic self-mode. Through circumspection, technology and people were encountered environmentally feeding into nursing attention, assessment and communication. Nursing as a social arrangement was expressed through either leaping-in care or leaping-ahead care. There was a place for both inauthentic and authentic discourse that nurses wove through the ontic everydayness of nursing tasks. (shrink)

Prior research on student question-asking has primarily been conducted from a cognitive, epistemological standpoint. In contrast, we present a hermeneutic-phenomenological investigation that emphasizes the moral-practical context in which question-asking functions as a situated way of being in the midst of practice. More particularly, we present a hermeneutic study of student question-asking in a graduate seminar on design theory. The study offers a unique moral-practical perspective on this commonly studied phenomenon. Our analysis yielded four themes regarding the moral-practical intricacies of question-asking (...) in this setting, with a particular focus on time-related constraints on participation, various types of background understanding, and value-laden expectations that participants encountered in this complex ecology of practice. (shrink)

The Dreyfus account of seven stages of learning is considered in the context of the Dreyfus account of five stages of skill development. The two new stages, Mastery and Practical Wisdom, make more explicit certain themes implicit in the five‐stage account. In this way Dreyfus encourages a more reflexive approach. The themes now more explicit are, in part, derived from Aristotle on phronesis, but are also influenced by Heidegger and Foucault on cultural dimensions of meaning and value. The paper considers (...) whether Dreyfus’ revised account tends towards a relativism of different worlds of meaning, disclosed through personal commitment. A more reflexive account of phronesis, it is suggested, needs to clarify the potentiality of phronesis for co‐ordination as it promotes patterns of unity in difference and difference in unity. (shrink)

Technology is fundamental to and embedded in the way practice is conceptualized and institutionalized in social service work. Many scholars assume and expect that good practices of care are achieved with the correct application of theory produced by rigorous scientific research. However, there are significant critiques of this viewpoint. We examine the work of Donald Schön and Martin Heidegger and agree with these authors' suggestions that technical rationality and modern technology are not the way to achieve good practice in the (...) human services. At the same time, we are not convinced that the alternatives offered by Schön and Heidegger provide what good practice requires. We draw on Aristotle's account of the intellectual virtues and make the case for phronesis and praxis as other possibilities for inspiring new kinds of social welfare practice in the twenty-first century. (shrink)

Heidegger’s 1927 call to provide “a special hermeneutic of empathy” is linked with his later commitment at the Zollikon Seminars to engage explicitly with issues in psychodynamic therapy with psychiatrists. The task of providing a special hermeneutic of empathy is one that Heidegger assigns in Being and Time, but on which he does not deliver. Inspired by the assignment, this article applies the distinctions of Heidegger’s Daseinanalysis to human interrelations. This article generates a Heideggerian account of empathy as a multi-dimensional (...) process that delimits and illuminates the field of possibilities of authentic human relationships. The multiple dimensions of empathy include affectedness (Befindlichkeit), understanding of possibility, interpretation, and speech, the latter including listening. The result is a reconstruction of a Heideggerian account of empathic human relations in the sense that it goes beyond what Heidegger explicitly says to what the Heideggerian method of inquiry can contribute to understanding and implementing the process of empathy. In particular, a two-by-two matrix is built and engaged in detail, cross referencing the four possibilities of authentic and inauthentic relationships with the individual and the other. A specifically Heideggerian analysis of the multi-dimensional process of empathy is the result. The clinical relevance of Heidegger’s work is made explicit as empathy is positioned as the foundation of clinical practice as exemplified in psychodynamic psychotherapy. (shrink)