Diversity Reading List

Abstract:
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.

Introduction: One might suppose that if political theorists are by now clear about anything at all, they should be clear about the problem of political obligation and the solution to it most commonly offered, the doctrine of consent. The greatest modern political theorists took up this problem and formulated this answer. The resulting theories are deeply imbedded in our American political tradition; as a consequence we are al- ready taught a sort of rudimentary consent theory in high school. And yet I want to suggest that we are not even now clear on what "the problem of political obligation" is, what sorts of "answers" are appropriate to it, what the con- sent answer really says, or whether it is a satis- factory answer. This essay is designed to point up the extent of our confusion, to explore some of the ground anew as best it can, and to invite further effort by others. That such effort is worthwhile, that such political theory is still worth considering and that it can be made genuinely relevant to our world, are the assump- tions on which this essay rests and the larger message it is meant to convey

Introduction: [The doctrine of "hypothetical consent"] teaches that your obligation depends not on any actual act of consenting, past or present, by yourself or your fellow-citizens, but on the character of the government. If it is a good, just government doing what a government should, then you must obey it; if it is a tyrannical, unjust government trying to do what no government may, then you have no such obligation. Or to put it another way, your obligation depends not on whether you have consented but on whether the government is such that you ought to consent to it, whether its actions are in accord with the authority a hypothetical group of rational men in a hypothetical state of nature would have (had) to give to any government they were founding. Having shown how this formulation emerges from Locke's and Tussman's ideas, I want now to defend it as a valid response to what troubles us about political obligation, and as a response more consonant than most with the moral realities of human decisions about obedience and resistance. At the same time the discussion should also demonstrate how many different or even conflicting things that one might want to call "consent" continue to be relevant - a fact which may help to explain the tenacity of traditional consent theory in the face of its manifest difficulties. Such a defense and demonstration, with detailed attention to such decisions, are difficult; the discussion from here on will be more speculative, and will raise more questions than it answers.

Abstract:
In this article, I argue that (1) transgender adolescents should have the legal right to access puberty-blocking treatment (PBT) without parental approval, and (2) the state has a role to play in publicizing information about gender dysphoria. Not only are transgender children harmed psychologically and physically via lack of access to PBT, but PBT is the established standard of care. Given that we generally think that parental authority should not go so far as to (1) severally and permanently harm a child and (2) prevent a child from access to standard physical care, then it follows that parental authority should not encompass denying gender-dysphoric children access to PBT. Moreover, transgender children without supportive parents cannot be helped without access to health care clinics and counseling to facilitate the transition. Hence there is an additional duty of the state to help facilitate sharing this information with vulnerable teens.

Content: Purdy offers a strong argument against overriding the decisions of pregnant women and tries to reconcile the significance of the dependence of the fetus on the mother with the mother's right to control her own body.

Abstract: Is it morally permissible for me to have children? 1A decision to procreate is surely one of the most significant decisions a person can make. So it would seem that it ought not to be made without some moral soul-searching. There are many reasons why one might hesitate to bring children into this world if one is concerned about their welfare. Some are rather general, like the deteriorating environment or the prospect of poverty. Others have a narrower focus, like continuing civil war in Ireland, or the lack of essential social support for childrearing persons in the United States. Still others may be relevant only to individuals at risk of passing harmful diseases to their offspring. There are many causes of misery in this world, and most of them are unrelated to genetic disease. In the general scheme of things, human misery is most efficiently reduced by concentrating on noxious social and political arrangements. Nonetheless, we shouldn't ignore preventable harm just because it is confined to a relatively small corner of life. So the question arises: can it be wrong to have a child because of genetic risk factors?2Unsurprisingly, most of the debate about this issue has focused on prenatal screening and abortion: much useful information about a given fetus can be made available by recourse to prenatal testing. This fact has meant that moral questions about reproduction have become entwined with abortion politics, to the detriment of both. The abortion connection has made it especially difficult to think about whether it is wrong to Prevent a child from coming into being since doing so might involve what many people see as wrongful killing; yet there is no necessary link between the two. Clearly, the existence of genetically compromised children can be prevented not only by aborting already existing fetuses but also by preventing conception in the first place. Worse yet, many discussions simply assume a particular view of abortion, without any recognition of other possible positions and the difference they make in how people understand the issues. For example, those who object to aborting fetuses with genetic problems often argue that doing so would undermine our conviction that all humans are in some important senseequal.3 However, this position rests on the assumption that conception marks the point at which humans are endowed with a right to life. So aborting fetuses with genetic problems looks morally the same as killing "imperfect" people without their consent. This position raises two separate issues. One pertains to the legitimacy of different views on abortion. Despite the conviction of many abortion activists to the contrary, I believe that ethically respectable views can be found on different sides of the debate, including one that sees fetuses as developing humans without any serious moral claim on continued life. There is no space here to address the details, and doing so would be once again to fall into the trap of letting the abortion question swallow up all others. Fortunately, this issue need not be resolved here. However, opponents of abortion need to face the fact that many thoughtful individuals do not see fetuses as moral persons. It follows that their reasoning process and hence the implications of their decisions are radically different from those envisioned by opponents of prenatal screening and abortion. So where the latter see genetic abortion as murdering people who just don't mea-sure up, the former see it as a way to prevent the development of persons who are more likely to live miserable lives. This is consistent with a worldview that values persons equally and holds that each deserves high quality life. Some of those who object to genetic abortion appear to be oblivious to these psychological and logical facts. It follows that the nightmare scenarios they paint for us are beside the point: many people simply do not share the assumptions that make them plausible. How are these points relevant to my discussion? My primary concern here is to argue that conception can sometimes be morally wrong on grounds of genetic risk, although this judgment will not apply to those who accept the moral legitimacy of abortion and are willing to employ pre-natal screening and selective abortion. If my case is solid, then those who oppose abortion must be especially careful not to conceive in certain cases, as they are, of course, free to follow their conscrence about abortion. Those like myself who do not see abortion as murder have more ways to prevent birth.

Publisher's Note: Controversies about abortion and women's reproductive technologies often seem to reflect personal experience, religious commitment, or emotional response. Laura M. Purdy believes, however, that coherent ethical principles are implicit in these controversies and that feminist bioethics can help clarify the conflicts of interest which often figure in human reproduction. As she defines the underlying issues, Purdy emphasizes the importance of taking women's interests fully into account. Reproducing Persons first explores the rights and duties connected with conception and pregnancy. Purdy asks whether conceiving a child or taking a pregnancy to term can ever be morally wrong. She challenges the thinking of those who feel the prospect of disability or serious genetic disease should not constrain conception or justify abortion. The essays next look at abortion from a variety of angles. One contends that killing fetuses is not murder; others emphasize the moral importance of access to abortion. Purdy considers the conflicting interests of women and men regarding abortion, and argues against requiring a husband's consent. The book concludes with a consideration of new reproductive technologies and arrangements, including the controversial issue of surrogacy, or contract pregnancy. Throughout, Purdy combines traditional utilitarianism with some of the most powerful insights of contemporary feminist ethics. Her provocative essays create guidelines for approaching new topics and inspire fresh thinking about old ones.

Abstract:
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.

Publisher's Note: The Blackwell Guide to Medical Ethics is a guide to the complex literature written on the increasingly dense topic of ethics in relation to the new technologies of medicine. Examines the key ethical issues and debates which have resulted from the rapid advances in biomedical technology Brings together the leading scholars from a wide range of disciplines, including philosophy, medicine, theology and law, to discuss these issues Tackles such topics as ending life, patient choice, selling body parts, resourcing and confidentiality Organized with a coherent structure that differentiates between the decisions of individuals and those of social policy

Summary: This paper develops the claim that indefinite detention (as used by the U.S. following the attacks on September 11, 2001) is justfied by an appeal to racialized fear. Roberts argues that the indefinite detention of suspected terrorists is both immoral and unjust--claiming that arguments in favor of it (such as the interest in interrogation, the consequentialist justification, and the preventative detention argument) fail to ground the permissibility of indefinite detention.