Mental Illness, Motivation and Moral Commitment

I present a dilemma which depressive behavioural pathology poses for both Humean and non-Humean theories of motivation and value. Although the dilemma shows that neither theory can be considered adequate in its standard form, I argue that if the Humean theory is modified so as to embrace a richer notion of satisfaction than it currently does, it can solve the problem which depression poses for it, and thus the dilemma can be avoided. Embracing a richer notion of satisfaction not only solves this problem, it also extends the scope of the Humean theory in a potentially dramatic way, by extending the explanatory reach of moral psychology to issues often thought to fall outside its scope, namely, issues in moral psychopathology.     

新生儿ICU护士道德困境研究进展

新生儿ICU护士由于工作环境与护理对象的特殊性,极易产生道德困境。目前有多种道德困境评估工具用以评估新生儿ICU护士道德困境,大多数新生儿ICU护士对道德困境认知清晰,道德困境水平较高;护士的权限、治疗和护理措施对患儿预后的影响、团队合作等情景是新生儿ICU护士道德困境的来源。道德困境使新生儿ICU护士产生了负面心理,降低了护士的工作积极性,不利于临床工作的开展,应重视新生儿ICU护士道德困境问题,采取措施以改善新生儿ICU护士道德困境,降低道德困境对新生儿ICU护士的负面影响。

     

ICU护士伦理气氛认知与道德困境的相关性研究

采用量性研究方法对ICU护士进行调查分析,了解ICU护士道德困境和伦理气氛认知的现状,并探讨两者之间的相关性。结果显示,ICU护士道德困境总分为43.00分(24.00, 67.00),伦理气氛认知得分为(3.44±0.38)分。相关性分析结果显示：道德困境总分与关怀型伦理气氛呈负相关(r=-0.131,P＜0.05),与功利型伦理气氛呈正相关(r=0.297,P＜0.01)。护理管理者在临床工作中可采取积极有效的措施塑造关怀型伦理气氛,避免或削弱功利型伦理气氛的形成, 从而降低道德困境的发生。

     

A Broader Understanding of Moral Distress

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.     

Techniques of Affirmation: Deviant Behavior,Moral Commitment,and Subcultural Identity

Previous studies have examined how individuals act in ways that are considered deviant by mainstream standards and how these individuals neutralize their actions to maintain a positive self concept. But little is known about how individuals who defy social norms by “not doing” socially accepted behaviors construct meaningful subcultural identities. We explore the overlap between “deviant behavior” and subcultural identity through a case study of an abstinence-based subculture called straightedge. Through an analysis of online, textual interaction among participants of an internet forum dedicated to the straightedge youth subculture and focused discussions with forum members, we develop the concept of techniques of affirmation to frame how participants' beliefs regarding abstinence from drugs, alcohol, and promiscuous sex are articulated in subcultural discourse. We identify five affirmation techniques through which straightedge youths remain steadfast to their ideals, beliefs and non-actions: (1) acknowledgment of responsibility, (2) acknowledgment of injury, (3) acknowledgment of the victim, (4) discounting condemners, and (5) reference to priority relationships. We suggest that people and groups who orient themselves to subcultural frames of reference are more likely to utilize techniques of affirmation as part of constructing a positive sense of self.     

Commitment and Partialism in the Ethics of Care

It is plausible to think that practices of caring are partly constituted by a caregiver's commitment to a cared‐for. However, discussions of caring often contain no explicit discussion of such commitments, and do not attempt to draw any philosophical conclusions from the nature of caring relations as committed. A discussion of caring practices that emphasizes the importance of commitment therefore has the potential to generate important new insights for our understanding of caring. This essay begins that project by arguing that a commitment‐centric conception of caring entails the truth of moral partialism. Although many care‐ethicists are sympathetic to partialism, the arguments in its defense remain controversial. As I show in this article, however, partialism is necessarily true given the committed nature of caring. This is because the concept of commitment is itself a necessarily partial one: to say that we are equally committed to everyone or everything is equivalent to saying that we are not committed to anything. Thus, when viewed as a species of commitment, it is part of the concept of caring that it requires us to put the needs of those we care for before the needs of those unknown to us.     

Moral Distress as a Symptom of Dirty Hands

The experience of ‘moral distress’ is an increasing focal point of contemporary medical and bioethics literature, yet it has received little attention in discussions intersecting with ethical theory. This is unfortunate, as it seems that the peculiar phenomenon may well help us to better understand a number of issues bearing both practical and theoretical significance. In this article, I provide a robust psychological profile of moral distress in order to shed a newfound light upon the longstanding problem of ‘dirty hands’. I argue that moral distress offers evidence of the existence of dirty hands situations. By examining moral distress and its relationship to cases of dirty hands, it appears that few of us are completely immune to susceptibility to these sorts of troubling experiences. With this concern in mind, I provide various recommendations to help alleviate our morally distressing personal and professional lives.