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Added by: Chris Blake-TurnerAbstract:
Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating their values and responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life.Stramondo, Joseph A.. Tragic Choices: Disability, Triage, and Equity Amidst a Global Pandemic2021, The Journal of Philosophy of Disability. 1: 201–210.-
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Added by: Chris Blake-TurnerAbstract:
In this paper, I make three arguments regarding Crisis Standards of Care developed during the COVID-19 pandemic. First, I argue against the consideration of third person quality of life judgments that deprioritize disabled or chronically ill people on a basis other than their survival, even if protocols use the language of health to justify maintaining the supposedly higher well-being of non-disabled people. Second, while it may be unavoidable that some disabled people are deprioritized by triage protocols that must consider the likelihood that someone will survive intensive treatment, Crisis Standards of Care should not consider the amount or duration of treatment someone may need to survive. Finally, I argue that, rather than parsing who should be denied treatment to maximize lives saved, professional bioethicists should have put our energy into reducing the need for such choices at all by resisting the systemic injustices that drive the need for triage.Comment (from this Blueprint): Stramondo critiques triage protocols that were put into place, or at least proposed, during the COVID-19 pandemic. Stramondo argues that protocols that prioritize quality of life involve ableist commitments. While chance-of-survival protocols might do better here, he argues that they are also vulnerable to creeping ableism. Stramondo’s paper is valuable not only for its perspective on triage protocols, but also for highlighting some crucial theoretical contributions by philosophers of disability and by bioethicists. Stramondo also argues not to cede too much ground to fatalism in thinking about triage protocols; bioethicists should also, and perhaps primarily, resist the framing of triage as inevitable, rather than a product of various privileged interests.
Wiesler, Christine. Epistemic Oppression and Ableism in Bioethics2020, Hypatia. 35: 714–732.-
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Added by: Chris Blake-TurnerAbstract:
Disabled people face obstacles to participation in epistemic communities that would be beneficial for making sense of our experiences and are susceptible to epistemic oppression. Knowledge and skills grounded in disabled people's experiences are treated as unintelligible within an ableist hermeneutic, specifically, the dominant conception of disability as lack. My discussion will focus on a few types of epistemic oppression—willful hermeneutical ignorance, epistemic exploitation, and epistemic imperialism—as they manifest in some bioethicists’ claims about and interactions with disabled people. One of the problems with the epistemic phenomena with which I am concerned is that they direct our skepticism regarding claims and justifications in the wrong direction. When we ought to be asking dominantly situated epistemic agents to justify their knowledge claims, our attention is instead directed toward skepticism regarding the accounts of marginally situated agents who are actually in a better position to know. I conclude by discussing disabled knowers’ responses to epistemic oppression, including articulating the epistemic harm they have undergone as well as ways of creating resistant ways of knowing.Comment (from this Blueprint): Wieseler draws on resources developed by feminists and disability theorists to critique the practice of philosophical bioethics (bioethics done by philosophers). In particular, she argues that philosophical bioethics involves and perpetuates ableism. Among its many problems, this ableism is epistemically fraught. It interferes with disabled people’s ability to participate in various kinds of knowledge production. Wieseler uses a lot of technical terms—like epistemic exploitation, epistemic imperialism, and willful hermeneutical ignorance—but she explains everything clearly and the payoff is worthwhile. Wieseler uses these concepts to develop a powerful and thought-provoking critique of bioethical practice with respect to disability. The concepts are also useful in broader contexts, as we’ll see in section 3.
Taylor, Sunaura. Beasts of Burden: Animal and Disability Liberation2017, The New Press.-
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Added by: Chris Blake-TurnerPublisher’s Note:
How much of what we understand of ourselves as “human” depends on our physical and mental abilities—how we move (or cannot move) in and interact with the world? And how much of our definition of “human” depends on its difference from “animal”? Drawing on her own experiences as a disabled person, a disability activist, and an animal advocate, author Sunaura Taylor persuades us to think deeply, and sometimes uncomfortably, about what divides the human from the animal, the disabled from the nondisabled—and what it might mean to break down those divisions, to claim the animal and the vulnerable in ourselves, in a process she calls “cripping animal ethics.” Beasts of Burden suggests that issues of disability and animal justice—which have heretofore primarily been presented in opposition—are in fact deeply entangled. Fusing philosophy, memoir, science, and the radical truths these disciplines can bring—whether about factory farming, disability oppression, or our assumptions of human superiority over animals—Taylor draws attention to new worlds of experience and empathy that can open up important avenues of solidarity across species and ability. Beasts of Burden is a wonderfully engaging and elegantly written work, both philosophical and personal, by a brilliant new voice.Comment (from this Blueprint): In this excerpt from her book, Beasts of Burden, Taylor resists the way that animals and intellectual disabled people are often framed in terms of one another. She argues that this does a disservice to both groups. Animals are not voiceless, as they are often constructed. And their comparison to disabled people in the (in)famous argument from marginal cases should not be accepted. Perhaps most importantly, the argument opens for discussion the worth of disabled people’s lives. But this is not something that should be open for discussion, especially given the marginalization of disabled people.
Wilson, Yolonda, et al.. Intersectionality in Clinical Medicine: The Need for a Conceptual Framework2019, The American Journal of Bioethics. 19(2): 8–19.-
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Added by: Chris Blake-TurnerAbstract:
Intersectionality has become a significant intellectual approach for those thinking about the ways that race, gender, and other social identities converge in order to create unique forms of oppression. Although the initial work on intersectionality addressed the unique position of black women relative to both black men and white women, the concept has since been expanded to address a range of social identities. Here we consider how to apply some of the theoretical tools provided by intersectionality to the clinical context. We begin with a brief discussion of intersectionality and how it might be useful in a clinical context. We then discuss two clinical scenarios that highlight how we think considering intersectionality could lead to more successful patient–clinician interactions. Finally, we extrapolate general strategies for applying intersectionality to the clinical context before considering objections and replies.Comment (from this Blueprint): Wilson et al. argue that intersectionality is an important concept in clinical practice. They clarify the concept and distinguish their call for intersectionality from nearby claims. For instance, they argue that intersectionality goes beyond mere cultural competence that healthcare providers are already trained in, at least to some degree. Their paper is anchored around two fictionalized case studies, which they use to make vivid and explain their central claims. They end by responding to objections, including the very idea of intersectionality itself.
Ray, Keisha. It’s Time for a Black Bioethics2021, The American Journal of Bioethics. 21(2): 38–40.-
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Added by: Chris Blake-TurnerAbstract:
There are some long-standing social issues that imperil Black Americans' relationship with health and healthcare. These issues include racial disparities in health outcomes (Barr 2014), provider bias and racism lessening their access to quality care (Sabin et al. 2009), disproportionate police killings (DeGue, Fowler, and Calkins 2016), and white supremacy and racism which encourage poor health (Williams and Mohammed 2013). Bioethics, comprised of humanities, legal, science, and medical scholars committed to ethical reasoning is prima facie well suited to address these problems and influence solutions in the form of policy and education. Bioethics, however, so far has shown only a minimal commitment to Black racial justice.Comment (from this Blueprint): In this short, seminal piece, Keisha Ray argues that bioethics needs to address issues of health and well-being of Black individuals. She applies Beauchamp and Childress’s famous four principles of bioethics to a particular issue: the disproportionate maternal mortality rate of Black women in the United States. Ray argues bioethics must incorporate the lens of Black bioethics, if the discipline is to remain relevant.
Vaughan-Lee, Emmanuel. Marie’s Dictionary2014, Self-Produced. 10min. USA.-
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Added by: Sonja Dobroski and Quentin PharrAbstract:
This short documentary tells the story of Marie Wilcox, the last fluent speaker of the Wukchumni language, and the dictionary she created to keep her language alive. For Ms. Wilcox, the Wukchumni language has become her life. She has spent more than twenty years working on the dictionary and continues to refine and update the text. Through her hard work and dedication, she has created a document that will support the revitalization of the Wukchumni language for decades to come. Along with her daughter, Jennifer Malone, she travels to conferences throughout California and meets other tribes who struggle with language loss. Ms. Wilcox’s tribe, the Wukchumni, is not recognized by the federal government. It is part of the broader Yokuts tribal group native to Central California. Before European contact, as many as 50,000 Yokuts lived in the region, but those numbers have steadily diminished. Today, it is estimated that fewer than 200 Wukchumni remain.Comment:
available in this Blueprint
Various Contributors. Indigenous Land Stewardship: Tending Nature2021, KCET. 57min. USA.-
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Added by: Sonja Dobroski and Quentin PharrAbstract:
This "Tending Nature" special features multiple perspectives and voices from Indigenous communities across California who are striving to keep the practices of their heritage alive. From coming-of-age rituals, seasonal food harvests, basket weaving and jewelry making, the documentary shares how traditional practices can be protected and maintained as a way of life for future generations.Comment:
available in this Blueprint
Powys Whyte, Kyle, Cuomo, Chris. Ethics of Caring in Environmental Ethics: Indigenous and Feminist Philosophies2016, In The Oxford Handbok of Environmental Ethics, Stephen Gardiner and Allen Thompson (eds.), OUP-
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Added by: Sonja Dobroski and Quentin PharrAbstract:
Indigenous ethics and feminist care ethics offer a range of related ideas and tools for environmental ethics. These ethics delve into deep connections and moral commitments between nonhumans and humans to guide ethical forms of environmental decision making and environmental science. Indigenous and feminist movements such as the Mother Earth Water Walk and the Green Belt Movement are ongoing examples of the effectiveness of on-the-ground environmental care ethics. Indigenous ethics highlight attentive caring for the intertwined needs of humans and nonhumans within interdependent communities. Feminist environmental care ethics emphasize the importance of empowering communities to care for themselves and the social and ecological communities in which their lives and interests are interwoven. The gendered, feminist, historical, and anticolonial dimensions of care ethics, indigenous ethics, and other related approaches provide rich ground for rethinking and reclaiming the nature and depth of diverse relationships as the fabric of social and ecological being.Comment:
available in this Blueprint
Kimmerer, Robin Wall. Braiding Sweetgrass: Indigenous Wisdom, Scientific Knowledge, and the Teaching of Plants2015, Milkweed Editions.-
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Added by: Sonja Dobroski and Quentin PharrPublisher’s Note:
As a botanist, Robin Wall Kimmerer has been trained to ask questions of nature with the tools of science. As a member of the Citizen Potawatomi Nation, she embraces the notion that plants and animals are our oldest teachers. In Braiding Sweetgrass, Kimmerer brings these lenses of knowledge together to show that the awakening of a wider ecological consciousness requires the acknowledgment and celebration of our reciprocal relationship with the rest of the living world. For only when we can hear the languages of other beings are we capable of understanding the generosity of the earth, and learning to give our own gifts in return.Comment:
available in this Blueprint
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Peter, Elizabeth, Liaschenko, Joan. Moral Distress Reexamined: A Feminist Interpretation of Nurses’ Identities, Relationships, and Responsibilites
2013, The Journal of Bioethical Inquiry. 10: 337–345.
Comment (from this Blueprint): Moral distress is, roughly, when a healthcare worker is institutionally constrained to act against their best moral judgement. A typical example is a nurse being prevented from giving care they deem morally required because they are hierarchically constrained by the orders of a physician. Moral distress has been much discussed in nursing ethics, but is almost entirely absent from broader bioethics syllabi and conversations. This paper examines moral distress through a lens of feminist care ethics. In doing so, it draws lessons that apply very broadly throughout professional ethics.