Background: Medicine is full of value conflicts. Limited resources and legal regulations may place doctors in difficult ethical dilemmas and cause moral distress. Research on moral distress has so far been mainly studied in nurses. Objective: To describe whether Norwegian doctors experience stress related to ethical dilemmas and lack of resources, and to explore whether the doctors feel that they have good strategies for the resolution of ethical dilemmas. Design: Postal survey of a representative sample of 1497 Norwegian doctors in (...) 2004, presenting statements about different ethical dilemmas, values and goals at their workplace. Results: The response rate was 67%. 57% admitted that it is difficult to criticise a colleague for professional misconduct and 51% for ethical misconduct. 51% described sometimes having to act against own conscience as distressing. 66% of the doctors experienced distress related to long waiting lists for treatment and to impaired patient care due to time constraints. 55% reported that time spent on administration and documentation is distressing. Female doctors experienced more stress that their male colleagues. 44% reported that their workplace lacked strategies for dealing with ethical dilemmas. Conclusion: Lack of resources creates moral dilemmas for physicians. Moral distress varies with specialty and gender. Lack of strategies to solve ethical dilemmas and low tolerance for conflict and critique from colleagues may obstruct important and necessary ethical dialogues and lead to suboptimal solutions of difficult ethical problems. (shrink)

Islam gives legal precedence to purity of lineage and known parenthood of all children. In Islam treatment to infertility using IVF is permitted within validity of marriage contract with no genes mixing. The paper shows that the Qur’ān, the word of Allah, and science, the deeds of Allah are not in major conflicts in defining the start of human life. The Holy Qur’ān provides an elegant description of origin, developmental stages of intra-uterine life. The Hadith explains two positions one that (...) believes human embryo get ensouled at conception and the other after 40 days of conception. The paper aims to find that Islam confers moral respect to human embryo, but it also clarifies the absence of full human rights to a developing foetus. In Islam, human embryonic use is probably permissible for therapeutic and reproductive purpose keeping intact the principles of Shari’ah. (shrink)

The plethora of literature on moral distress has substantiated and refined the concept, provided data about clinicians’ (especially nurses’) experiences, and offered advice for coping. Fewer scholars have explored what makes moral distress _moral_. If we acknowledge that patient care can be distressing in the best of ethical circumstances, then differentiating distress and moral distress may refine the array of actions that are likely to ameliorate it. This article builds upon scholarship exploring the normative and conceptual dimensions of moral distress (...) and introduces a new tool to map moral distress from emotional source to corrective actions. The Moral Distress Map has proven useful in clinical teaching and ethics-related debriefings. (shrink)

The connection between shame, guilt and morality is the topic of many recent debates. A broad tendency consists in attributing a higher moral status and a greater moral relevance to guilt, a claim motivated by arguments that tap into various areas of morality and moral psychology. The Pro-social Argument has it that guilt is, contrary to shame, morally good since it promotes pro-social behaviour. Three other arguments claim that only guilt has the requisite connection to central moral concepts: the Responsibility (...) Argument appeals to the ties between guilt and responsibility, the Autonomy Argument to the heteronomy of shame and the Social Argument to shame's link with reputation. In this paper, we scrutinize these arguments and argue that they cannot support the conclusion that they try to establish. We conclude that a narrow focus on particular criteria and a misconception of shame and guilt have obscured the important roles shame plays in our moral lives. (shrink)

Forgiveness has been a central issue for humankind since ancient times; it emerged in theology, but in recent decades it has received significant attention from different disciplines, such as philosophy and psychology. More recently, forgiveness has received attention also from organizational and managerial studies, particularly, in studying how individuals respond to interpersonal offenses, or perceived harm and wrongdoing in the workplace. Forgiveness is a complex concept, as it can be understood as a family of related constructs and can be analyzed (...) at different levels. Even if social sciences have widely recognized that the nature of forgiveness can be both conditional and unconditional, the notions of conditionality and unconditionality have not yet received sufficient study, especially in organizational and managerial fields. In these fields, forgiveness has been predominantly studied under a psychological approach, looking for the conditions under which it may occur in the workplace. Unconditional forgiveness has received less attention: with a few exceptions, managerial and organizational literature has limited the conceptualization of forgiveness, weakening its scope and probably not catching a relevant part of forgiving experiences in the workplace. This article proposes to follow a more comprehensive approach to forgiveness in the workplace, according to the social sciences field, which can take into account both conditionality and unconditionality. It focuses on unconditional forgiveness according to Continental philosophy, in particular, to the thought of Jacque Derrida and Paul Ricoeur. Through their contributions, the unconditionality of forgiveness is deepened, and the implications of considering both conditional and unconditional forgiveness are discussed. (shrink)

Background Supporting physicians in Intensive Care Units s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Such data would enhance understanding and guide the provision of better support for (...) ICU physicians. Methods An SSR adopts the Systematic Evidenced Based Approach to map prevailing accounts of caring for dying patients in ICUs. To enhance the transparency and reproducibility of this process, concurrent and independent use of tabulated summaries, thematic analysis and directed content analysis is adopted. Results Eight thousand three hundred fifty-eight abstracts were reviewed from four databases, 474 full-text articles were evaluated, 58 articles were included, and the Split Approach revealed six categories/themes centered around the Innate, Individual, Relational and Societal Rings of Personhood, conflicts in providing end of life care and coping mechanisms employed. Conclusion This SSR suggests that caring for dying patients in ICU impacts how physicians view their personhood. To resolve conflicts within individual concepts of personhood, physicians use prioritization, reframing and rely on accessible, personalized support from colleagues to steer coping strategies. An adapted form of the Ring Theory of Personhood is proposed to direct timely personalized, appropriate and holistic support. (shrink)

Transplant coordinators play a pivotal role in the process of obtaining consent for live or dead donation of organs. The objective of the project is to unveil emotional experiences and ethical conduct of transplant coordinators using a qualitative research methodology. Ten transplant coordinators who have worked for more than 20 years in this job were recruited by using a purposive sampling technique. The transplant coordinators spoke of negative feelings and moral distress with regard to futile care of family members of (...) deceased donors as well as of living donors. Transplant coordinators experience moral distress on a daily basis; being compelled to compromise their integrity causes moral distress and moral residue, hence, training and support should be offered to them. (shrink)

:In this essay, I consider a particular version of the thesis that the blameworthy deserve to suffer, namely, that they deserve to feel guilty to the proper degree. Two further theses have been thought to explicate and support the thesis, one that appeals to the non-instrumental goodness of the blameworthy receiving what they deserve, and the other that appeals to the idea that being blameworthy provides reason to promote the blameworthy receiving what they deserve. I call the first "Good-Guilt" and (...) the second "Reason-Guilt.” I begin by exploring what I take to be the strongest argument for Good-Guilt which gains force from a comparison of guilt and grief, and the strongest argument against. I conclude that Good-Guilt might be true, but that even if it is, the strongest argument in favor of it fails to support it in a way that provides reason for the thesis that the blameworthy deserve to feel guilty. I then consider the hypothesis that Reason-Guilt might be true and might be the more fundamental principle, supporting both Good-Guilt and Desert-Guilt. I argue that it does not succeed, however, and instead propose a different principle, according to which being blameworthy does not by itself provide reason for promoting that the blameworthy get what they deserve, but that being blameworthy systematically does so in conjunction with particular kinds of background circumstances. Finally, I conclude that Desert-Guilt might yet be true, but that it does not clearly gain support from either Good-Guilt or Reason-Guilt. (shrink)

This study examined the relationship between moral distress intensity, moral distress frequency and the ethical work environment, and explored the relationship of demographic characteristics to moral distress intensity and frequency. A group of 106 nurses from two large medical centers reported moderate levels of moral distress intensity, low levels of moral distress frequency, and a moderately positive ethical work environment. Moral distress intensity and ethical work environment were correlated with moral distress frequency. Age was negatively correlated with moral distress intensity, (...) whereas being African American was related to higher levels of moral distress intensity. The ethical work environment predicted moral distress intensity. These results reveal a difference between moral distress intensity and frequency and the importance of the environment to moral distress intensity. (shrink)

Obsessive–compulsive disorder is a debilitating mental health disorder that can easily become a treatment-resistant condition. Although effective therapies exist, only about half of the patients seem to benefit from them when we consider treatment refusal, dropout rates, and residual symptoms. Thus, providing effective augmentation to standard therapies could improve existing treatments. Group compassion-focused interventions have shown promise for reducing depression, anxiety, and avoidance related to various clinical problems, but this approach has never been evaluated for OCD individuals. However, cultivating compassion (...) for self and others seems crucial for OCD patients, given the accumulating research suggesting that fear of guilt, along with isolation and self-criticism, can strongly contribute to the development and maintenance of OCD. The primary aim of this pilot study was to evaluate the acceptability, tolerability, and effectiveness of an 8-week group compassion-focused intervention for reducing OCD symptoms, depression, fear of guilt and self-criticism, and increasing common humanity and compassionate self-reassuring skills in treatment-resistant OCD patients. Using a multiple baseline experimental design, the intervention was evaluated in a sample of OCD patients who had completed at least 6 months of CBT treatment for OCD, but who continued to suffer from significant symptoms. Participants were randomized to different baseline assessment lengths; they then received 8 weekly, 120-min group sessions of compassion-focused therapy for OCD, and then were tested again at post-treatment and at 1 month follow up. Despite the adverse external circumstances, by the end of treatment, all participants demonstrated reliable decreases in OCD symptoms, and these improvements were maintained at 4-week follow-up for seven of eight participants. The intervention was also associated with improvements in fear of guilt, self-criticism, and self-reassurance, but less consistent improvements in depression and common humanity. Participants reported high levels of acceptability of and satisfaction with the intervention. Results suggest that the intervention may be beneficial as either a stand-alone treatment or as an augmentation to other treatments. (shrink)

While extensive scholarship has been dedicated to the emotional experiences of transplant patients, little is known about the emotional experiences of transplant co‐ordinators. Semi‐structured face‐to‐face interviews conducted with ten transplant co‐ordinators who have worked for more than 20 years in this job. The transplant co‐ordinators spoke of negative feelings and moral distress with regard to futile care of deceased donor family members as well as of living donors. Transplant co‐ordinators experience intense negative feelings, emotional pain, and moral distress on a (...) daily basis. Transplant co‐ordinators play a pivotal role in the process of obtaining consent for live or dead donation of organ; however, their well‐being and job satisfaction are impaired by contradictions between their moral values and the tasks they are instructed to perform. The study exposes the silent emotional suffering of transplant co‐ordinators; main findings show that the transplant co‐ordinators are torn between contradictory expectations and a gap between values and praxis. It is recommended to offer them training and support for the sake of their retention. (shrink)

The concept of moral distress comes from nursing ethics, and was initially defined as ‘…when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. There is a large body of literature associated with moral distress, yet multiple definitions now exist, significantly limiting its usefulness. We undertook a systematic review of the argument-based bioethics literature on this topic as the basis for a critical appraisal, identifying 55 papers for analysis. (...) We found that moral distress is most frequently framed around individual experiences of distress in relation to local practices and constraints, and understood in terms of power relations and workplace hierarchies. This understanding is directly derived from, and often still seen as specific to, nursing. Frequently the perspective of the morally distressed individual is privileged. Understandings of moral distress have evolved towards an ‘occupational health approach’, with the assumption that moral distress should be measured and prevented. Counter-perspectives were identified, highlighting conceptual problems. Based on our review, we propose a redefinition of moral distress: ‘Ethical unease or disquiet resulting from a situation where a clinician believes they have contributed to avoidable patient or community harm through their involvement in an action, inaction or decision that conflicts with their own values’. This definition is specific enough for research use, anchored in clinicians’ professional responsibilities and concerns about harms to patients, framed relationally rather than hierarchically, and amenable to multiple perspectives on any given morally distressing situation. (shrink)

This paper examines the psychology of existential guilt with Martin Heidegger and Rollo May’s conceptualizations as the point of departure. The concept of existential guilt describes preconditions for responsibility and accountability in life choices and the relationship to the potential given in the life of a human. It might also be used as a starting point to examine an individual’s relationship to the potential offered in their life and life context and, in this way, the hitherto unlived life of an (...) individual. The following questions are discussed in contexts of identity development, perfectionism, and current cultural shifts in conceptualizations of selfhood: How can humans relate to the fact that only limited parts of who they might be can ever be actualized? Moreover, how can they relate to the fundamental ambiguity and “groundlessness” in the contexts of life where choices are made? There are striking parallels between the role of exploration in the Eriksonian approaches to healthy identity development and the ontological groundlessness that stands out as a premise for existential guilt. There are also parallels between identity fore-closure and normative identity styles and “falling” into das Man in the existential framework. Perfectionistic ideals easily become an objectivization – and closure – of possible alternatives and choices. In contemporary theories of constructions of selfhood, the dangers of alienation from the community on the one hand and escape into what might become totalitarian collectivism on the other is pointed out. The contextualization of personal responsibility offered through the concept of existential guilt might address both dangers. It provides a perspective on how personal responsibility is embedded in contexts of human relationships, relationships to nature, and the finitude, freedom, uncertainties, and suffering that is given through human existence. Existential guilt can wake sorrow and regret over opportunities overlooked and lost. However, most of all, it can be seen as a drive toward repair in the relationship toward both oneself and the other. It takes the form of receptivity, an openness to a life not yet lived, and creative use of imagination. (shrink)

Nurse researchers engaged in qualitative interviews with patients and spouses in healthcare may often experience being in unforeseen ethical dilemmas. Researchers are guided by the bioethical principles of justice, beneficence, non-maleficence, respect for human rights and respect for autonomy through the entire research process. However, these principles are not sufficient to prepare researchers for unanticipated ethical dilemmas related to qualitative research interviews. We describe and discuss ethically challenging and difficult moments embedded in two cases from our own phenomenological interview studies. (...) We argue that qualitative interviews involve navigation between being guided by bioethics as a researcher, being a therapist/nurse and being a fellow human being or even a friend. The researchers’ premises to react to unexpected situations and act in a sound ethical manner must be enhanced, and there is a need for an increased focus on the researchers’ ethical preparation and to continually address and discuss cases from their own interviews. (shrink)