Introduction 1. Woman's Place in Man's Life Cycle 2. Images of Relationship 3. Concepts of Self and Morality 4. Crisis and Transition 5. Women's Rights and Women's Judgment 6. Visions of Maturity References Index of Study Participants General Index

In a Different Voice. Psychological Theory and Women’s Development. Cambridge, MA (Harvard University Press) 1982.

Symposium Review: 25th Anniversary of Moral Boundaries by Joan Tronto

Conclusions and Recommendations, are particularly interesting in view of the controversies aroused by the Warnock Report. Many of the recommendations contained here are similar to Warnock's (for example, concerning the legitimacy of AID children, the need for a licensing authority to supervise the work ofAID and IVF centres, etc), but others are at odds with the corresponding Warnock recommendations. In general, the authors place higher value on the family as an institution than did the Warnock Committee and display a much livelier awareness of the possible social dangers of the new techniques. One weakness of the book is that since its authors are approaching these topics from the standpoint of social scientists, their recommendations for legislative action which surely must be based on properly ethical considerations, not merely sociological ones seem devoid of any satisfactory rational support. For example, they concede that experimentation on human embryos is an objectionable practice, since 'the material acting as the subject of the experimentation is a human being at the beginning of its individual development' (p 178); but the practical recommendation which they make concerning this practice is disappointingly feeble:

https://jme.bmj.com/content/medethics/12/3/165.full.pdf

Ethics and the Limits of Philosophy

Preface Acknowledgments Introduction: How Cognitive Science Changes Ethics 1: Reason as Force: The Moral Law Folk Theory 2: Metaphoric Morality 3: The Metaphoric Basis of Moral Theory 4: Beyond Rules 5: The Impoverishment of Reason: Our Enlightenment Legacy 6: What's Wrong with the Objectivist Self 7: The Narrative Context of Self and Action 8: Moral Imagination 9: Living without Absolutes: Objectivity and the Conditions for Criticism 10: Preserving Our Best Enlightenment Moral Ideals Notes Index

Philosophical Applications of Cognitive Science.Moral Imagination: Implications of Cognitive Science for Ethics

I am delighted to announce the exciting news that we have received just under 900 abstracts for presentation in the scientific program of the VIth World Congress on Pain in Adelaide, April l-6, 1990. This 1s about a 50% increase in the number of abstracts submitted for the 1987 Congress in Hamburg and it represents by far the greatest number of scientific papers ever offered for the an IASP Congress. This surely reflects the healthy state of IASP and is also a very encouraging indlcator of the high level of activity in basic and clinical research in the field of pain throughout the world. Based upon our previous experience with the ratio of congress delegates to scientific abstracts, the Adelaide Congresses promises to be the largest world congress on pain we have so far held.

International association for the study of pain

Moral Distress in Healthcare Practice: The Situation of Nurses

When health practitioners' moral choices and actions are thwarted by constraints, they may respond with feelings of moral distress. In a Canadian hermeneutic phenomenological study, physicians, nurses, psychologists and non-professional aides were asked to identify care situations that they found morally distressing, and to elaborate on how moral concerns regarding the care of patients were raised and resolved. In this paper, we describe the experience of moral distress related by nurses working in mental healthcare settings who believed that lack of resources (such as time and staff) leads to dispiritedness, lack of respect, and absence of recognition (for both patients and staff) which severely diminished their ability to provide quality care. The metaphors of flashlight and hammer are used to elaborate nurses' possible responses to intolerable situations.

Unable to answer the call of our patients: mental health nurses' experience of moral distress.

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.

Moral distress and the contemporary plight of health professionals.

Traditional approaches to bioethics, that privilege impartiality and objectivity and that focus primarily on moral reasoning, are relatively silent on the moral habitability of healthcare environments. Nurses and others in "the trenches" of healthcare are increasingly voicing the need to address everyday ethical issues, interdisciplinary tensions, and systemic concerns, in addition to the ethics of high-profile medical cases. Attention to the institutional processes that shape and constrain ethical dialogue and practice is required. In this article, the call is made for a shift in thinking about ethics in healthcare.

The ethics of everyday practice: healthcare environments as moral communities.

The term compassion fatigue has come to be applied to a disengagement or lack of empathy on the part of care-giving professionals. Empathy and emotional investment have been seen as potentially costing the caregiver and putting them at risk. Compassion fatigue has been equated with burnout, secondary traumatic stress disorder, vicarious traumatization, secondary victimization or co-victimization, compassion stress, emotional contagion, and counter-transference. The results of a Canadian qualitative research project on nurses’ experience of compassion fatigue are presented. Nurses, self-identified as having compassion fatigue, described a change in their practice by which they began to shield and distance themselves from the suffering of patients and families. Time to help patients and families cope with suffering seemed unavailable, and many felt they were running on empty and, ultimately, impotent as nurses. Feelings of irritability, anger, and negativity arose, though participants described denying or i...

Wendy Austin

Papers

Moral Distress in Healthcare Practice: The Situation of Nurses

Unable to answer the call of our patients: mental health nurses' experience of moral distress.

Moral distress and the contemporary plight of health professionals.

The ethics of everyday practice: healthcare environments as moral communities.

Compassion Fatigue: The Experience of Nurses