Philosophers often call emotions appropriate or inappropriate. What is meant by such talk? In one sense, explicated in this paper, to call an emotion appropriate is to say that the emotion is fitting: it accurately presents its object as having certain evaluative features. For instance, envy might be thought appropriate when one's rival has something good which one lacks. But someone might grant that a circumstance has these features, yet deny that envy is appropriate, on the grounds that it is (...) wrong to be envious. These two senses of `appropriate' have much less in common than philosophers have supposed. Indeed, the distinction between propriety and correctness is crucial to understanding the distinctive role of the emotions in ethics. We argue here that an emotion can be fitting despite being wrong to feel, and that various philosophical arguments are guilty of a systematic error which we term the moralistic fallacy. (shrink)

The doyen of living English philosophers, by these reflections, took hold of and changed the outlook of a good many other philosophers, if not quite enough. He did so, essentially, by assuming that talk of freedom and responsibility is talk not of facts or truths, in a certain sense, but of our attitudes. His more explicit concern was to look again at the question of whether determinism and freedom are consistent with one another -- by shifting attention to certain personal (...) rather than moral attitudes, first of all gratitude and resentment. In the end, he arrived at a kind of Compatibilist or, as he says, Optimist conclusion. That is no doubt a recommendation but not the largest recommendation of this splendidly rich piece of philosophy. (shrink)

It is sometimes said that certain hard moral choices constitute tragic moral dilemmas in which no available course of action is justifiable, and so the agent is blameworthy whatever she chooses. This paper criticizes a certain approach to the debate about moral dilemmas and considers the metaethical implications of the criticisms. The approach in question has been taken by many advocates as well as opponents of moral dilemmas who believe that analysing the emotional response of the agent is the key (...) to the debate about moral dilemmas. The metaethical position this approach is most naturally associated with is sentimentalism. Sentimentalists claim that evaluation, and in particular moral evaluation, crucially depends on human sentiment. This paper is not concerned with the question whether moral dilemmas exist, but rather with emotion-based arguments used on both sides of the debate. The first aim of the paper is to show that emotion-based arguments by friends or foes of moral dilemmas cannot garner support from sentimentalism. The second aim is to show that this constitutes a serious problem for sentimentalism. (shrink)

Much research is currently being conducted on health care practitioners' experiences of moral distress, especially the experience of nurses. What moral distress is, however, is not always clearly delineated and there is some debate as to how it should be defined. This article aims to help to clarify moral distress. My methodology consists primarily of a conceptual analysis, with especial focus on Andrew Jameton's influential description of moral distress. I will identify and aim to resolve two sources of confusion about (...) moral distress: the compound nature of a narrow definition of distress which stipulates a particular cause, i.e. moral constraint, and the distinction drawn between moral dilemma and moral distress, which implies that the two are mutually exclusive. In light of these concerns, I argue that the definition of moral distress should be revised so that moral constraint should not be a necessary condition of moral distress, and that moral conflict should be included as a potential cause of distress. Ultimately, I claim that moral distress should be understood as a specific psychological response to morally challenging situations such as those of moral constraint or moral conflict, or both. (shrink)

As professionals, nurses are engaged in a moral endeavour, and thus confront many challenges in making the right decision and taking the right action. When nurses cannot do what they think is right, they experience moral distress that leaves a moral residue. This article proposes a theory of moral distress and a research agenda to develop a better understanding of moral distress, how to prevent it, and, when it cannot be prevented, how to manage it.

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)

Philosophers often call emotions appropriate or inappropriate. What is meant by such talk? In one sense, explicated in this paper, to call an emotion appropriate is to say that the emotion is fitting: it accurately presents its object as having certain evaluative features. For instance, envy might be thought appropriate when one’s rival has something good which one lacks. But someone might grant that a circumstance has these features, yet deny that envy is appropriate, on the grounds that it is (...) wrong to be envious. These two senses of ‘appropriate’ have much less in common than philosophers have supposed. Indeed, the distinction between propriety and correctness is crucial to understanding the distinctive role of the emotions in ethics. We argue here that an emotion can be fitting despite being wrong to feel, and that various philosophical arguments are guilty of a systematic error which we term the moralistic fallacy. (shrink)

This paper outlines and defends a notion of ‘tragic-remorse’. This moral emotion properly accompanies those actions that involve unavoidable moral wrongdoing in general and dirty hands scenarios in particular. Tragic-remorse differs both phenomenologically and conceptually from regret, agent-regret and remorse. By recognising the existence of tragic-remorse, we are better able to account for our complex moral reality which at times makes it necessary for good persons to act in ways that although justified leave the agent with a moral stain and (...) a particular emotional response. (shrink)

The claim that democratic politics is the art of compromise is a platitude but we seem allergic to compromise in politics when it happens. This essay explores this paradox. Taking my cue from Machiavelli’s claim that there exists a rift between a morally admirable and a virtuous political life, I argue that: a ‘compromising disposition’ is an ambiguous virtue—something which is politically expedient but not necessarily morally admirable; whilst uncongenial to moral integrity, a ‘compromising disposition’ constitutes an essential aspect of (...) political integrity. In so doing, I question certain moralistic assumptions which fuel contemporary vilifications of compromise—that, in theory, democratic politics should be inhospitable to compromise and that political integrity should be akin to moral integrity—and which are shared by Walzer’s Dirty Hands thesis which professes to be sensitive to the realities of politics. These assumptions displace the complex realities of politics and misconstrue the standards of political excellence; they unsatisfactorily idealize political integrity and the messy context in which democratic politicians operate—a context characterized by a plurality of incompatible traditions, each with its own values and principles. Whilst commitment to a set of principles stemming from one’s tradition or pre-election promises implies commitment to realize these, leading a virtuous political life amidst such a grubby domain often requires abandoning some of these. An innocent, all-or-nothing pursuit of one’s principles in politics might prompt political disaster or defeat: an uncompromising disposition entails the entire abandonment of any hope of realizing all of those principles. (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)

Using five different child–sacrifice cases, I argue that the relationship between the ethics of care and the ethics of justice is not that one is wholly right while the other is morally wrong or irrelevant, or that one somehow has priority over the other, or that one is supererogatory while the other is required, or that one is a role ethic while the other is a real ethic, or that they are equivalent. Instead, I propose that the ethics of justice (...) and care are simply descriptions of the virtues of justice and care, understood richly and broadly. Each prescribes perceptions, values, self–conceptions, etc. as well as actions and passions in every sphere of human life. Like other actual (rather than idealized) virtues, justice and care sometimes conflict with each other. They demand incompatible actions, passions, perceptions, etc. The available options in conflict situations feel both right and wrong because they are admirably immoral acts and/or dirty hands acts. I argue that these conflicts do not undermine the primacy, practicality or consistency of morality. (shrink)

Should those who get dirty hands be punished? There is strong disagreement among even those who support the existence of such scenarios. The problem arises because the paradoxical nature of dirty hands - doing wrong to do right - renders the standard normative justifications for punishment unfit for purpose. The Consequentialist, Retributivist and Communicative approaches cannot accommodate the idea that an action can be right, all things considered, but nevertheless also a categorical wrong. This paper argues that punishment is indeed (...) appropriate for those who dirty their hands and that there are three normative justifications that can be used to support this claim. These are the justifications from ‘Catharsis’, ‘Recognition of Evil Suffered’ and ‘Causal Responsibility’. Together they provide the sui generis justifications for punishing dirty hands. (shrink)

This paper outlines and defends a notion of tragic-remorse. This moral emotion properly accompanies those actions that involve unavoidable moral wrongdoing in general and dirty hands scenarios in particular. Tragic-remorse differs both phenomenologically and conceptually from regret, agent-regret and remorse. By recognising the existence of tragic-remorse, we are better able to account for our complex moral reality which at times makes it necessary for good persons to act in ways that although justified leave the agent with a moral stain and (...) a particular emotional response. (shrink)

H.L.A. Hart’s lost and found essay ‘Discretion’ has provided new insight into the issue of how legal systems can cope with indeterminacy in the law. The so-called ‘open texture’ of law calls for the exercise of judicial discretion, which, I argue, renders judges susceptible to the problem of dirty hands. To show this, I frame the problem as being open to an array of appropriate emotional responses, namely, various senses of guilt. With these responses in mind, I revise an example (...) from Michael Walzer’s original analysis in a way that highlights purely personal sacrifices in solutions to dirty hands situations. I then turn to an account of moral emotions in legal decision-making and show how judges—in failing to advance all interests—might be left with a unique sense of guilt. With an application of this account to Hart’s legal positivism, it can be seen that a judge’s hands are often dirtied in resolving borderline cases. If discretion leaves judges in situations where they must do wrong in order to do right, Hart’s endorsement of a closure view of wrongdoing will lead to difficulties in how he can explain the presence of moral remainders in jurisprudence. (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)

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)

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)