Ethical non-naturalists often charge that their naturalist competitors cannot adequately explain the distinctive normativity of moral or more broadly practical concepts. I argue that the force of the charge is mitigated, because non-naturalism is ultimately committed to a kind of mysterianism about the metaphysics of practical norms that possesses limited explanatory power. I then show that focusing on comparative judgments about the explanatory power of various metaethical theories raises additional problems for the non-naturalist, and suggest grounds for optimism that a (...) naturalistic realist about practical normativity will ultimately be able to explain the distinctive normativity of practical norms. I then show that radical pluralism or particularism about the structure of normative ethics would complicate the naturalistic strategy that I defend. This suggests a perhaps surprising way in which the resolution of the debate between ethical naturalists and non-naturalists may rest in part on the answers to substantive normative questions. (shrink)

This is a short review of Moral Particularism, ed. Brad Hooker and Margaret Little (Oxford University Press, 2002).

It is widely held, even among nonnaturalists, that the moral supervenes on the natural. This is to say that for any two metaphysically possible worlds w and w′, and for any entities x in w and y in w′, any isomorphism between x and y that preserves the natural properties preserves the moral properties. In this paper, I put forward a conceivability argument against moral supervenience, assuming non-naturalism. First, I argue that though utilitarianism may be true, and the trolley driver (...) is permitted to kill the one to save the five, there is a conceivable scenario that is just like our world in all natural respects, yet at which deontology is true, and the trolly driver is not permitted to kill the one to save the five. I then argue that in the special case of morality, it is possible to infer from the conceivability of such a scenario to its possibility. It follows that supervenience is false. (shrink)

In the last three decades, considerable theoretical and empirical research has been undertaken on the topic of moral distress among health professionals. Understood as a psychological and emotional response to the experience of moral wrongdoing, there is evidence to suggest that—if unaddressed—it contributes to staff demoralization, desensitization and burnout and, ultimately, to lower standards of patient safety and quality of care. However, more recently, the concept of moral distress has been subjected to important criticisms. Specifically, some authors argue that the (...) standard account of moral distress elucidated by Jameton :542–551, 1984) does not refer to a discrete phenomenon and/or that it is not sufficiently broad and that this makes measuring its prevalence among health professionals, and other groups of workers, difficult if not impossible. In this paper, we defend the standard account of moral distress. We understand it as a concept that draws attention to the social, political and contextual determinants of moral agency and brings the emotional landscape of the moral realm to the fore. Given the increasing pressure on health professionals worldwide to meet efficiency, financial and corporate targets and reported adverse effects of these for the quality and safety of patient care, we believe that further empirical research that deploys the standard account moral distress is timely and important. (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)

Aims: The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress. Background: Moral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon. Design: Systematic literature (...) review and narrative synthesis (November 2015–March 2016). Data sources: Ovid MEDLINE® In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO® 1967–Present, CINAHL® Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education Abstracts. Review methods: Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis. Results: In all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity. Conclusion: We suggest the combination of (1) the experience of a moral event, (2) the experience of ‘psychological distress’ and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress. (shrink)

Actions can be moral or immoral, surely, but can also be prudent or imprudent, rude or polite, sportsmanlike or unsportsmanlike, and so on. The fact that diverse methods of evaluating action exist seems to give rise to a further question: what distinguishes moral evaluation in particular? In this article, my concern is methodological. I argue that any account of the distinctiveness of morality cannot be prior to substantive inquiry into the content of moral reasons, requirements, and concerns. The genuine distinctiveness (...) of morality will become clear only after we have determined what those very reasons, requirements, and concerns really are. (shrink)

This article uses a particular view of the basic emotions in order to develop and defend an account of paradigmatic emotion-linked evaluative properties. The view is that felt emotions are constituted by an awareness that one is about to behave in a certain way. This view provides support for a fitting-attitude account of certain evaluative properties. But the relevant sense of fittingness is not to be understood in terms of reasons. The account therefore sidesteps the well-known Wrong Kind of Reasons (...) problem. Throughout the article, a contrast is made with the rational sentimentalism of Justin D’Arms and Daniel Jacobson. (shrink)

Ethical non-naturalists often charge that their naturalist competitors cannot adequately explain the distinctive normativity of moral or more broadly practical concepts. I argue that the force of the charge is mitigated, because non-naturalism is ultimately committed to a kind of mysterianism about the metaphysics of practical norms that possesses limited explanatory power. I then show that focusing on comparative judgments about the explanatory power of various metaethical theories raises additional problems for the non-naturalist, and suggest grounds for optimism that a (...) naturalistic realist about practical normativity will ultimately be able to explain the distinctive normativity of practical norms. I then show that radical pluralism or particularism about the structure of normative ethics would complicate the naturalistic strategy that I defend. This suggests a perhaps surprising way in which the resolution of the debate between ethical naturalists and non-naturalists may rest in part on the answers to substantive normative questions. (shrink)

On the traditional view, moral distress arises only in cases where an individual believes she knows the morally right thing to do but fails to perform that action due to various constraints. We seek to motivate a broader understanding of moral distress. We begin by presenting six types of distress that fall outside the bounds of the traditional definition and explaining why they should be recognized as forms of moral distress. We then propose and defend a new and more expansive (...) definition of moral distress and examine how it can enable the development of a taxonomy of moral distress. (shrink)

Integrity looks dangerous. Passionate willpower, focused devotion and driving self-belief nestle all-too-closely to extremism, narcissism and intolerant hubris. How can integrity skirt such perils? This question opens the perennial issue of whether devout, driven devotees can guard themselves from antisocial extremes. Current proposals to inoculate integrity from moral danger hone in on integrity’s reflective side. I argue that this epistemic approach disarms integrity’s dangers only by stripping it of everything that initially made it worthwhile. Instead, I argue that integrity contains (...) substantive moral principles serving to surgically target the dangers the trait would otherwise pose. The person of integrity avoids extremism not by questioning whether her values are right, but by recognizing that in a social world whether her values are right is not the only factor that bears on how she should act. Normatively, the proposed account allows integrity to retain its intuitive allures of willpower, direction and unified character. Descriptively, it explains the surprising capacity for principled compromise displayed by canonical figures of integrity. Ultimately, integrity empowers us to be fit for society, even as we are true to ourselves. (shrink)

Some versions of moral naturalism are faulted for implausibly denying that moral obligations and prescriptions entail categorical reasons for action. Categorical reasons for action are normative reasons that exist and apply to agents independently of whatever desires they have. I argue that several defenses of moral naturalism against this charge are unsuccessful. To be a tenable meta-ethical theory, moral naturalism must accommodate the proposition that, necessarily, if anyone morally ought to do something, then s/he has a categorical reason to do (...) it. Versions of moral naturalism that deny this claim would, if widely believed, disable some crucial practical uses of moral concepts. In particular, if the existence of normative reasons for action is taken to be dependent on agents’ desires, it would breed profound skepticism about the legitimacy of evaluating others’ actions from a moral point of view. Also, it would raise doubts about whether people ought to correct their own behavior in light of moral considerations. Following Richard Joyce, I take these consequences to indicate that the concept of a categorical reason is a “non-negotiable” part of moral concepts. (shrink)

I present an overview of emotion theories, organised around the question of emotion causation. I argue that theories of emotion causation should ideally address the problems of elicitation, intensity, and differentiation. Each of these problems can be divided into a subquestion that asks about the relation between stimuli and emotions (i.e., the functional level of process description, cf. Marr, 1982) and a subquestion that asks about the mechanism and representations that intervene (i.e., the algorithmic level of process description). The overview (...) reveals that theories of emotion causation sometimes differ with regard to the kind of process that they hold responsible for emotion causation. More precisely, they hold different assumptions regarding the conditions under which the process is supposed to operate (optimal versus suboptimal), the format of the representations involved (propositional versus perceptual), and the object or input of the central process (stimulus versus responses/experience). Further, the overview reveals that theories of emotion causation sometimes differ with regard to the level of process description that they focus on. Finally, the overview brings to light several similarities among the theories discussed. (shrink)

In this paper I consider the routine moral burden of occupying a professional role and having to negotiate tensions between the normative expectations attached to that role and one's own personal moral compass. Using an example to introduce this central issue I then seek to explore it through a discussion of the tensions between, and spaces between, ‘identifying’ with one's role and ‘separating’ oneself from one's role. I suggest that ethical integrity at work is revealed through the successful negotiation of (...) these tensions, but that such negotiation depends upon the power and other resources available to individual professionals. Finally I argue that this discussion of ‘the ethics of role occupation’ has important implication for ‘the ethics of role construction’ and adds weight to concerns about the potential moral costs of managerialism. (shrink)

Moral distress has received much attention in the international nursing literature in recent years. In this article, we describe the evolution of the concept of moral distress among nursing theorists from its initial delineation by the philosopher Jameton to its subsequent deployment as an umbrella concept describing the impact of moral constraints on health professionals and the patients for whom they care. The article raises worries about the way in which the concept of moral distress has been portrayed in some (...) nursing research and expresses concern about the fact that research, so far, has been largely confined to determining the prevalence of experiences of moral distress among nurses. We conclude by proposing a reconsideration, possible reconstruction and multidisciplinary approach to understanding the experiences of all health professionals who have to make difficult moral judgements and decisions in complex situations. (shrink)

Whenever psychologists, neuroscientists, or philosophers draw conclusions about moral judgments in general from a small selected sample, they assume that moral judgments are unified by some common and peculiar feature that enables generalizations and makes morality worthy of study as a unified field. We assess this assumption by considering the six main candidates for a unifying feature: content, phenomenology, force, form, function, and brain mechanisms. We conclude that moral judgment is not unified on any of these levels and that moral (...) science should adopt a more fine-grained taxonomic approach that studies carefully defined groups of moral judgments. (shrink)

It is a platitude that morality is normative, but a substantive and interesting question whether morality is normative in a robust and important way; and although it is often assumed that morality is indeed robustly normative, that view is by no means uncontroversial, and a compelling argument for it is conspicuously lacking. In this paper, I provide such an argument. I argue, based on plausible claims about the relationship between moral wrongs and moral criticizability, and the relationship between criticizability and (...) normative reasons, that moral facts necessarily confer normative reasons upon moral agents. (shrink)

Abstract Studying a concept as complex as moral distress is an ongoing challenge for those engaged in empirical ethics research. Qualitative studies of nurses have illuminated the experience of moral distress and widened the contours of the concept, particularly in the area of root causes. This work has led to the current understanding that moral distress can arise from clinical situations, factors internal to the individual professional, and factors present in unit cultures, the institution, and the larger health care environment. (...) Corley et al. ( 2001 ) was the first to publish a quantitative measure of moral distress, and her scale has been adapted for use by others, including studies of other disciplines (Hamric and Blackhall 2007 ; Schwenzer and Wang 2006 ). Other scholars have proposed variations on Jameton’s core definition (Sporrong et al. 2006 , 2007 ), developing measures for related concepts such as moral sensitivity (Lutzen et al. 2006 ), ethics stress (Raines 2000 ), and stress of conscience (Glasberg et al. 2006 ). The lack of consistency and consensus on the definition of moral distress considerably complicates efforts to study it. Increased attention by researchers in disciplines other than nursing has taken different forms, some problematic. Cultural differences in the role of the nurse and understanding of actions that represent threats to moral integrity also challenge efforts to build a cohesive research-based understanding of the concept. In this paper, research efforts to date are reviewed. The importance of capturing root causes of moral distress in instruments, particularly those at unit and system levels, to allow for interventions to be appropriately targeted is highlighted. In addition, the issue of studying moral distress and interaction over time with moral residue is discussed. Promising recent work is described along with the potential these approaches open for research that can lead to interventions to decrease moral distress. Finally, opportunities for future research and study are identified, and recommendations for moving the research agenda forward are offered. Content Type Journal Article Pages 1-11 DOI 10.1007/s10730-012-9177-x Authors Ann B. Hamric, School of Nursing, Virginia Commonwealth University, P.O. Box 980567, Richmond, VA 23298-0567, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

This paper explores the idea—rife in various recent theories in moral education—that virtue ethicists, psychologists, and educators interested in the cultivation of character should pool their resources in order to launch wide-ranging initiatives in virtue development. I uncover the roots of this idea and maintain that the reason why the desired cooperation has not yet come about lies primarily in psychology's failure to deliver the required empirical evidence about the ingredients of a morally good life. I trace the origin of (...) this failure to certain mistaken assumptions made by psychologists—in particular to their conflation of the “is–ought distinction” with the “fact–value distinction”—leading to an unreasonable fear of normativity. I suggest how, by overcoming this fear and entering the field of factual moral values , psychologists could make a lasting contribution to the development of virtue. 2012 APA, all rights reserved). (shrink)

1. Presumably the point of, say, inculcating a moral outlook lies in a concern with how people live. It may seem that the very idea of a moral outlook makes room for, and requires, the existence of moral theory, conceived as a discipline which seeks to formulate acceptable principles of conduct. It is then natural to think of ethics as a branch of philosophy related to moral theory, so conceived, rather as the philosophy of science is related to science. On (...) this view, the primary topic of ethics is the concept of right conduct, and the nature and justification of principles of behaviour. If there is a place for an interest in the concept of virtue, it is a secondary place. Virtue is a disposition to behave rightly; the nature of virtue is explained, as it were, from the outside in. (shrink)

We argue, contrary to epistemological orthodoxy, that knowledge is not purely epistemic—that knowledge is not simply a matter of truth‐related factors (evidence, reliability, etc.). We do this by arguing for a pragmatic condition on knowledge, KA: if a subject knows that p, then she is rational to act as if p. KA, together with fallibilism, entails that knowledge is not purely epistemic. We support KA by appealing to the role of knowledge‐citations in defending and criticizing actions, and by giving a (...) principled argument for KA, based on the inference rule KB: if a subject knows that A is the best thing she can do, she is rational to do A. In the second half of the paper, we consider and reject the two most promising objections to our case for KA, one based on the Gricean notion of conversational implicature and the other based on a contextualist maneuver. (shrink)

Illness creates a range of negative emotions in patients including anxiety, fear, powerlessness, and vulnerability. There is much debate on the ‘therapeutic’ or ‘helping’ nurse–patient relationship. However, despite the current agenda regarding patient-centred care, the literature concerning the development of good interpersonal responses and the view that a satisfactory nursing ethics should focus on persons and character traits rather than actions, nursing ethics is dominated by the traditional obligation, act-centred theories such as consequentialism and deontology. I critically examine these theories (...) and the role of duty-based notions in both general ethics and nursing practice. Because of well-established flaws, I conclude that obligation-based moral theories are incomplete and inadequate for nursing practice. I examine the work of Hursthouse on virtue ethics’ action guidance and the v-rules. I argue that the moral virtues and a strong (action-guiding) version of virtue ethics provide a plausible and viable alternative for nursing practice. I develop an account of a virtue-based helping relationship and a virtue-based approach to nursing. The latter is characterized by three features: (1) exercising the moral virtues such as compassion; (2) using judgement; and (3) using moral wisdom, understood to include at least moral perception, moral sensitivity, and moral imagination. Merits and problems of the virtue-based approach are examined. I relate the work of MacIntyre to nursing and I conceive nursing as a practice: nurses who exercise the virtues and seek the internal goods help to sustain the practice of nursing and thus prevent the marginalization of the virtues. The strong practice-based version of virtue ethics proposed is context-dependent, particularist, and relational. Several areas for future philosophical inquiry and empirical nursing research are suggested to develop this account yet further. (shrink)

This paper is a contribution to the debate about eudaimonism started by Kashdan, Biswas-Diener, King, and Waterman in a previous issue of The Journal of Positive Psychology. We point out that one thing that is missing from this debate is an understanding of the problems with subjective theories of well-being that motivate a turn to objective theories. A better understanding of the rationale for objective theories helps us to see what is needed from a theory of well-being. We then argue (...) that a suitably modified subjective theory can provide what is needed and that this is the theory that ought to be favored by psychologists. Keywords: well-being; happiness; hedonism; eudaimonia; subjective well-being; theory; values.. (shrink)

To explain an intentional action one must exhibit the agent’s reasons. Donald Davidson famously argued that the only clear way to understand action explanation is to hold that reasons are causes. Davidson’s discussion conflated two issues: whether reasons are causes and whether reasons causally explain intentional action. Contemporary work on explanation and normativity help disentangle these issues and ground an argument that intentional action explanations cannot be a species of causal explanation. Interestingly, this conclusion is consistent with Davidson’s conclusion that (...) reasons are causes. In other words, reasons are causes, but rationalizing explanations are not causal explanations. Key Words: action theory • explanation • causal explanation • rationality • Donald Davidson. (shrink)

Discussion of moral explanation has reached animpasse, with proponents of contemporaryethical naturalism upholding the explanatoryintegrity of moral facts and properties, andopponents – including both anti-realists andnon-naturalistic realists – insisting thatsuch robustly explanatory pretensions as moraltheory has be explained away. I propose thatthe key to solving the problem lies in thequestion whether instances of moral propertiesare causally efficacious. It is argued that,given the truth of contemporary ethicalnaturalism, moral properties are causallyefficacious if the properties of the specialsciences are. Certain objections are rebuttedinvolving (...) the nature of causation, on the onehand, and putative special features of themoral realm, on the other. (shrink)

Discussion of moral explanation has reached an impasse, with proponents of contemporary ethical naturalism upholding the explanatory integrity of moral facts and properties, and opponents--including both antirealists and non-naturalistic realists--insisting that such robustly explanatory pretensions as moral theory has be explained away. I propose that the key to solving the problem lies in the question whether instances of moral properties are causally efficacious. It is argued that, given the truth of contemporary ethical naturalism, moral properties are causally efficacious if the (...) properties of the special sciences are. (shrink)

Aim: The aim of this review is to examine the ways in which the concept of moral distress has been delineated and deployed in the argument-based nursing ethics literature. It adds to what we already know about moral distress from reviews of the qualitative and quantitative research. Data sources: CINAHL, PubMed, Web of Knowledge, EMBASE, Academic Search Complete, PsycInfo, Philosophers’ Index and Socindex. Review methods: A total of 20 argument-based articles published between January 1984 and December 2013 were analysed. Results: (...) We found that like the empirical literature, most authors in this review draw on Jameton’s original definition and describe moral distress in psychological–emotional–physiological terms. They also agree that moral distress is linked to the presence of some kind of constraint on nurses’ moral agency, and that it is best understood as a two-staged process that can intensify over time. There is also consensus that moral distress has an important normative meaning, although different views concerning the normative meaning of moral distress are expressed. Finally, the authors generally agree that moral distress arises from a number of different sources and that it (mostly) affects negatively on nurses’ personal and professional lives and, ultimately, harms patients. However, despite this consensus, many authors take issue with the way in which moral distress is conceptualized and operationalized. Moreover, while some worry that identifying nurses as a group of health professionals whose voices are ignored or marginalized might disempower nurses and encourage them to avoid their moral responsibilities, others take situations involving moral distress as indicative of more fundamental, structural inequities at the heart of contemporary healthcare provision. Conclusion: We conclude that research on moral distress in nursing is timely and important because it highlights the specifically moral labour of nurses. However, we suggest that significant concerns about the conceptual fuzziness and operationalization of moral distress also flag the need to proceed with caution. (shrink)

We argue, contrary to epistemological orthodoxy, that knowledge is not purely epistemic—that knowledge is not simply a matter of truth‐related factors (evidence, reliability, etc.). We do this by arguing for a pragmatic condition on knowledge, KA: if a subject knows that p, then she is rational to act as if p. KA, together with fallibilism, entails that knowledge is not purely epistemic. We support KA by appealing to the role of knowledge‐citations in defending and criticizing actions, and by giving a (...) principled argument for KA, based on the inference rule KB: if a subject knows that A is the best thing she can do, she is rational to do A. In the second half of the paper, we consider and reject the two most promising objections to our case for KA, one based on the Gricean notion of conversational implicature and the other based on a contextualist maneuver. (shrink)

Moral distress is one of the core topics of clinical ethics. Although there is a large and growing empirical literature on the psychological aspects of moral distress, scholars, and empirical investigators of moral distress have recently called for greater conceptual clarity. To meet this recognized need, we provide a philosophical taxonomy of the categories of what we call ethically significant moral distress: the judgment that one is not able, to differing degrees, to act on one’s moral knowledge about what one (...) ought to do. We begin by unpacking the philosophical components of Andrew Jameton’s original formulation from his landmark 1984 work and identify two key respects in which that formulation remains unclear: the origins of moral knowledge and impediments to acting on that moral knowledge. We then selectively review subsequent literature that shows that there is more than one concept of moral distress and that explores the origin of the values implicated in moral distress and impediments to acting on those values. This review sets the stage for identifying the elements of a philosophical taxonomy of ethically significant moral distress. The taxonomy uses these elements to create six categories of ethically significant moral distress: challenges to, threats to, and violations of professional integrity; and challenges to, threats to, and violations of individual integrity. We close with suggestions about how the proposed philosophical taxonomy of ethically significant moral distress sheds light on the concepts of moral residue and crescendo effect of moral distress and how the proposed taxonomy might usefully guide prevention of and future qualitative and quantitative empirical research on ethically significant moral distress. (shrink)

Moral stress is an increasingly significant concept in business ethics and the workplace environment. This study compares the impact of moral stress with other job stressors on three important employee variables—fatigue, job satisfaction, and turnover intentions—by utilizing survey data from 305 customer-contact employees of a financial institution’s call center. Statistical analysis on the interaction of moral stress and the three employee variables was performed while controlling for other types of job stress as well as demographic variables. The results reveal that (...) even after including the control variables in the statistical models, moral stress remains a statistically significant predictor of increased employee fatigue, decreased job satisfaction, and increased turnover intentions. Implications for future research and for organizations are discussed. (shrink)

My aim in this article is to argue that Philippa Foot fails to provide a convincing basis for moral evaluation in her bookNatural Goodness.Foot's proposal fails because her conception of natural goodness and defect in human beings either sanctions prescriptive claims that are clearly objectionable or else it inadvertently begs the question of what constitutes a good human life by tacitly appealing to an independent ethical standpoint to sanitize the theory's normative implications. Foot's appeal to natural facts about human goodness (...) is in this way singled out as an Achilles' heel that undermines her attempt to establish an independent framework for virtue ethics. This problem might seem to be one that is uniquely applicable to the bold naturalism of Foot's methodology; however, I claim that the problem is indicative of a more general problem for all contemporary articulations of virtue ethics. (shrink)