September 11th, 2014 by Elijah Weber · No Comments
I want to take a moment and share an abstract of a paper that I’ll be presenting next week at the Western Michigan University Medical Humanities Conference. The paper is entitled “Taking Moral Distress Seriously.” If you’ll be in the Kalamazoo area next Thursday and Friday, this should be a really good conference, especially for anyone interested in bioethics.
Here’s the abstract. Feel free to comment, or post any questions you might have about either the forthcoming paper or the upcoming conference where I’ll be presenting it. Enjoy!
Taking Moral Distress Seriously
The problem of moral distress is an increasingly common, yet inadequately discussed phenomenon among health care practitioners. Consider the following example of moral distress. Suppose a patient with cystic fibrosis, currently hospitalized for complications related to her underlying condition, has repeatedly expressed that certain life-sustaining measures not be taken, should she come to need them. Despite this, her code status is not formally addressed, and she becomes unable to make decisions for herself. In the meantime, her surrogate decision-maker is asked about her code status, and he opts for full code. Thus, the patient’s code status obligates the medical team to provide interventions that they believe to be contrary to the patient’s wishes.
This is the sort of scenario that can lead to moral distress among health care practitioners. I define moral distress as a negative feeling state that one experiences whenever there is a disparity between what one takes oneself to be expected to do, and what one takes to be morally right. This suggests, among other things that moral distress may be a much more widespread phenomenon than is typically thought. In this paper, I explain why we should adopt this account of moral distress, and identify several advantages this account has over other accounts of moral distress.
I then consider the ethical significance of moral distress for health care decision-making, and argue that given its ethical significance, the moral distress that a treatment decision may create for the health care practitioners involved ought to be factored into treatment decisions where moral distress is likely to occur. It is not enough to simply acknowledge or create outlets for the expression of moral distress. The moral significance of moral distress demands that it be taken into account when treatment decisions are made. More specifically, the moral distress that an intervention creates for a medical team is a consideration that can count in favor of either providing or denying treatment. This is not to say that we ought to provide or deny treatment based solely or primarily on concerns about moral distress. Rather, it is to call for taking moral distress seriously, and treating it as comparable to other potential harms that a treatment decision may cause.
September 8th, 2014 by Elijah Weber · No Comments
Rage is an emotion that is frequently depicted in the national and international news. The civil unrest in Ferguson, Missouri and the ongoing conflict between Israel and Gaza are both recent examples. Further, we seem to think that rage is a morally problematic emotion. All things considered, the world would probably be a better place if no one ever felt or expressed rage. Any emotion that tends toward such destructive violence is something that, in my view at least, we should be suspicious about.
Recently, philosopher Antti Kauppinen has challenged some of my thinking on rage. You can check out his analysis, and some of our online discussion, here. In the meantime, I want to take some of Antti’s analysis as a jumping-off point for further discussion.
Antti characterizes warranted (or rational) rage in the following way:
“I’ll say that rage is warranted (or, as some might say, rational) when one really is deprived of something important one is entitled to, particularly when a pseudo-reasonable justification is offered for it, and, due to machinations of those benefiting from such deprivation, one cannot change the situation without a significant cost to oneself or others.”
Let’s suppose for now that Antti is right about this. Whatever moral concerns we might have about the violence that follows from our feelings of rage, let’s take for granted that it can be rational to experience rage at least some of the time. My question is whether the rationality of rage has any sort of time-constraints, a kind of expiration date on warranted rage. In other words, even if rage is sometimes warranted, can warranted rage become unwarranted when it drags on too long?
I ask this question, in part, because of my own reflections about the ongoing protests in Ferguson, Missouri. I cannot pretend to relate to the kinds of feelings about law enforcement that protestors there are expressing. However, I think we can rightly ask whether the violent protesting has carried on too long.
Even if rage was a warranted response to the shooting of Michael Brown, is rage still warranted today?
While I don’t yet have a good argument for this, I suspect that the answer to this question is no, and that an account of warranted rage should include a constraint on how long one can rationally be enraged about something.
On the other hand, perhaps my concerns about enduring or persistent rage are moral or prudential concerns, rather than concerns about rationality. If this is correct, then we can still raise concerns about long-term or persistent rage, but they will not be rational concerns of the sort Antti and I have been discussing.
On this view, we can challenge the ongoing rage of protestors in places like Ferguson, but we must do so from moral and prudential points-of view. For example, we might say “you’re right to be enraged about this, but the ongoing violence should stop because it’s causing undue harm to others” or “even if you’re rightly enraged, continuing to protest violently won’t serve your long-term goals.”
But that’s quite different from claiming “your rage is no longer rational, because it’s gone on too long.” It’s one thing to say that an emotion is being immorally or imprudently expressed, and quite another to say that having the emotion is, itself, irrational.
I confess that I do not yet know the answer to this question. However, the way that we answer it clearly bears on both the way we think about events like Ferguson, Missouri, and the sorts of deliberative strategies we pursue in trying to resolve the conflicts that produce them. Thus, what seems like a theoretical problem in the philosophy of emotions turns out to have significant, real-world implications. For philosopher and non-philosopher alike, this is a question worth pursuing.
Tags: Philosophy of the Emotions · Social Ethics
August 21st, 2014 by Elijah Weber · No Comments
Recently, I’ve been reviewing some medical ethics cases that involve patients who lack decisional capacity. In these cases, the patient has been declared incompetent, and there is a question about whether a particular course of action is consistent with what they would have chosen for themselves. What has been especially striking about these cases is that despite the finding that the patients involved are incompetent, they have expressed preferences about what sorts of medical interventions they do and do not want.
This is a great example of the way that theoretical and practical ethics can come apart. When determining whether a patient is competent to make decisions for themselves, patients must demonstrate that their capacities exceed a certain threshold. If they demonstrate that their capacities fall below this threshold, they are considered not competent to make decisions for themselves. Evaluations of competency treat autonomy as a threshold capacity. If one performs below the requisite threshold, one is regarded as lacking the capacity for autonomy, and one’s expressed wishes are not taken to have moral authority.
However, most moral philosophers know that autonomy is not a threshold capacity. Instead, the capacity for autonomy falls along a spectrum. A ten year old, for example, has a greater capacity for autonomy than a newborn, even though neither would exceed the threshold for being competent to make their own medical decisions. Young children, as well as persons with certain psychological impairments, can still assert and express their values, desires, and preferences, even where they do not meet the threshold for being competent to make their own decisions.
This distinction has significant, but not often recognized ethical implications for medical practice. Even where a patient fails to meet the necessary threshold for autonomous decision-making, we shouldn’t thereby regard their expressed wishes as uninformative with regard to what they would have chosen for themselves. It is one thing to declare a patient incapable of making their own decisions, and quite another to completely disregard what they now claim to want.
The expressed wishes of incompetent persons should not have the same moral authority as the expressed wishes of competent persons, but it doesn’t follow that they should have no moral authority at all. The expressed wishes of incompetent persons can sometimes still tell us something about what the patient values, desires, and cares about, which is useful information when attempting to determine whether a particular medical intervention is contrary to what the patient would have chosen for themselves, were they able to do so.
This leaves medical practitioners with a very difficult problem. If incompetent persons retain some measure of autonomy, despite their incompetence, to what extent should their expressed wishes be respected? How can we respect patient autonomy without granting decision-making power? We’ll talk about how to deal with this problem next time. Until then, feel free to leave a comment to get the discussion started.
August 19th, 2014 by Elijah Weber · No Comments
This week, I was scheduled to talk to the incoming class of graduate students at Bowling Green State University about how to get involved in the greater philosophical community. This is a pretty important thing to do. These days, the academic job market is incredibly competitive. Publications among graduate students are no longer unique, and there are plenty of people out there who have won awards for their teaching.
In short, anything you can do to set yourself apart from other job candidates is probably a good idea. One strategy for setting yourself apart is participating in the greater philosophical community. This can have direct benefits, but it can also facilitate other things that are indirectly beneficial for you. And some of it is kind of fun, which always helps.
There are a lot of ways that a graduate student can do this, so what I’m going to do here is just briefly identify some easy options, with the hope that some of our new grads might comment or post follow-up questions.
1. Conference Participation
Conferences are a great place to network, meet new people, and if you’re lucky, maybe get a famous philosopher to agree to look over some of your work. That last one is particularly important, since this is a first step to getting that famous philosopher to write you a letter. In fact, these sorts of letters are especially valuable when they come from a big name that isn’t affiliated with your university. It’s expected that faculty will write positive letters for their own graduate students. If you have a letter from someone outside your department, it tells the person reading the letter that you must be really good. Otherwise, the famous philosopher has no incentive to write a letter for you.
Here’s one caveat about conferences–if you’re going to go to one, try to get yourself onto the program in some capacity. If you don’t get a paper accepted, offer to be a commentator, or even a moderator. This allows you to acquire a line on your CV, in addition to allowing you the opportunity to network. If you’re going to go to a conference solely as an attendant, it should be because there is a particular person that you know will be there, and that you want to talk to about your work. You only have so much time, and listening to a bunch of talks will rarely be the best way to use that time.
Okay, one more caveat–if you’re going to conferences with the hope of networking, you have to talk to people. Because these are philosophers, most of the people you talk to will be socially awkward and uncomfortable. Doesn’t matter, keep talking to them. This is another reason it’s good to try to get yourself onto the program. If you said something interesting, it’s possible that others might try to talk to you, or at least give them something to say to you in response. The point is, conferences are a good place to network, but only if you actually do the legwork.
2. Pay attention to the Blogosphere
There are a lot of good blogs out there that you should keep an eye on. You should definitely read the Leiter Report. Although Leiter doesn’t have a very good reputation among some people, his blog is the most central location for what’s going on in academic philosophy. It’s also a great place to hear about conferences, calls for papers, and other opportunities to interact with other philosophers.
If you’re interested in ethics or political philosophy, it’s probably a good idea to read PEA Soup as well. Again, great place to hear about conferences, find CFP’s, etc. But it’s also a good place to interact directly with other philosophers, because PEA Soup hosts a lot of online discussion forums.
Here’s another caveat: Be really careful about your posts to these blog sites. You want to seem like an intelligent, thoughtful person who is making positive contributions to a philosophical discussion. You don’t want to ask a silly question, or come off like a jerk. Be polite, be well-informed, and engage with the ongoing discussion. Remember, at some point a hiring committee may be Googling your name. You don’t want them to find a series of angry, ignorant blog posts.
3. Register with Philosophy Listservs
There are a couple of good Listservs for philosophy out there, and you should take a few minutes to register with them. I like Philosophy Updates and Philosop. Most of what they send you will be stuff that you immediately delete. But you will also get a lot of useful notifications about CFP’s and conferences. A good bit of participating in the greater philosophical community is knowing how to gather information about opportunities.
Those are just a few suggestions for ways that new graduate students can participate in the greater philosophical community. Comments and questions are welcome and encouraged.
August 4th, 2014 by Elijah Weber · No Comments
Currently, the city of Toledo, Ohio is experiencing a serious water crisis. One of their main sources of municipal water supply, Lake Erie, is currently experiencing algae blooms that are causing a buildup of dangerous toxins around the intake area for the city’s water. As of today, 400,000 people in the greater Toledo area have no access to clean, potable water.
This is clearly a social and political problem of some significance. But it may also be a moral problem. It’s sometimes argued that persons have a positive right to water, such that others are obligated to ensure that they have access to this resource. An argument for this position goes roughly like this.
1. If a public resource is essential for one’s survival, then one has a right to that resource.
2. Water is a public resource that is essential for one’s survival.
3. Therefore, everyone has a right to water.
The second premise of this argument is difficult to dispute, so we should focus our attention on the first premise. The most plausible example in support of this premise is clean, breathable air. Clearly, clean air is a public resource required for survival, and many people find it plausible to say that everyone has a right to clean air as a result.
In fact, we take fairly significant steps to ensure that everyone’s air is clean enough for them to breathe it safely. We place limits on industry, impose fines and other penalties for exceeding emission limits, and invest in the development of technology that will make our air safer to breathe.
This suggests that not only is there a right to clean air, but a positive right to clean air. This means that not only must we not interfere with others’ ability to have clean air, we are also obligated to take steps to ensure that everyone has access to clean air.
Suppose for a moment that this is an accurate account of one’s right to water. Has the City of Toledo wronged it’s citizens by failing to ensure that they have access to safe, potable water? Is this merely a case of bad governance, or a serious moral harm? If so, what does Toledo owe it’s citizens in return?
Post a comment, and let’s see what people think.
Tags: Applied Ethics · Social Ethics
July 28th, 2014 by Elijah Weber · No Comments
Last February, Baltimore Ravens running back Ray Rice was caught on video physically assaulting his fiance, to the point that she was rendered unconscious. Rice has now completed legal proceedings related to this incident, and the NFL recently announced their own disciplinary action. Rice received a suspension of 2 regular season games.
This decision was understandably met with shock, derision, and outrage from both the world of sports and the court of public opinion. It has been widely agreed that Rice’s punishment is much too lenient, especially in light of other recent suspensions that have been handed out for things like using performance-enhancing drugs or driving under the influence.
If a player can be suspended for four games for things like inadvertently taking a medication that contained a banned substance, it only seems fitting that something like domestic violence ought to receive a harsher punishment.
I won’t comment on the egregious nature of Rice’s actions, nor the inadequacy of the NFL’s response. Domestic violence is a serious social issue, far more so than something like performance-enhancing drugs or recreational marijuana use by players.
Instead, I want to note something important about the public response to the NFL’s decision in this case. Our actions, whether as individuals or representatives of institutions, often express our values. For example, when I make a decision to spend my time with family, rather than working on my research, I’m making a statement about my values. Time with family is, for me, more important than getting another article published.
Court decisions, institutional policies, even individual actions say something about what we care about. And in the case of the NFL’s decision about Ray Rice, the public backlash is due to a conflict between society’s values and what the NFL’s action expresses about those values.
A two game suspension for domestic violence expresses a value hierarchy where things like PED’s and marijuana use are more serious than violently assaulting another person. These are not the values that, socially, we endorse.
Hopefully, when the times comes, we will all have the wherewithal to express our disagreement with the values expressed by the NFL in this case, and change the channel on America’s most popular professional sports league.
Tags: Applied Ethics · Ethics and Sports · Social Ethics
July 23rd, 2014 by Elijah Weber · No Comments
Nothing brings out bad behavior in others quite like air travel. I was reminded of this on a recent flight back from San Diego. As we were leaving the plane, there was a man attempting to retrieve his bag from an overhead compartment that was in the rear of the plane, many rows back from his current seat. Rather than simply waiting until the plane was empty, he was attempting to move against the flow of humanity exiting the plane, in order that he might retrieve his belongings more quickly.
As you might imagine, this involved awkwardly passing the other passengers in the much-too-narrow aisle, often with a great deal of shoving on his part. Apparently, there was some concern that his bag might leave the plane without him, or perhaps be stolen by another passenger. Either that, or he was simply a very rude person that couldn’t be bothered to wait his turn.
This incident, while both annoying and largely unnecessary, got me thinking about a challenging distinction in moral philosophy–the distinction between propriety and ethics. It’s pretty clear, at least intuitively, that these are not the same sort of thing. “Don’t murder,” isn’t on par with “don’t eat your salad with a dinner fork,” for example.
However, both are systems of norms that govern our interpersonal interactions, and both are quite important to the functionality of social groups. So while ethics and propriety don’t seem like the same sort of thing, there is an important sense in which they are the same sort of thing.
Philosophers have often puzzled over how to account for this For example, some have suggested that while rules of propriety apply only to those who care about following them, morality applies to everyone. This is a good first pass, but it doesn’t fully do the trick. Some might hold that propriety applies equally to all members of a social group, irrespective of their concerns about it, while others might claim that morality applies only to those who care about doing the right thing.
My point here is somewhat different. It seems that at least some of the time, rules of propriety are themselves also rules of morality. Take the airline passenger example above. What this man was doing was clearly improper. In fact, it was quite rude. But it also had a distinctively moral connotation. His actions expressed an attitude of superiority over others, as though his concerns took precedent over the wishes or preferences of others. One might think that for this reason, his impatience wasn’t just improper, but also immoral.
What do you make of this distinction? Are morality and propriety really as distinct as we seem to think? Are some rules of propriety also of moral significance? If so, how do we account for this? Post a comment, and let’s see if we can figure it out together.
Tags: Personal Ethics · Social Ethics
July 10th, 2014 by Elijah Weber · No Comments
My friend Josh Shepherd is blogging about agency, free will, and consciousness over at Flickers of Freedom, and one of his posts has inspired me to think a bit more about a related topic that has always interested me, but that doesn’t get much attention from philosophers that work on these sorts of questions.
The discussion over there is pretty technical, so I want to keep things simple over here. It seems pretty clear that given the nature of many of our contemporary moral issues, there’s a need to try to make sense of the notion of group agency. By group agency, all I mean to refer to is the notion that groups are things that can act, in roughly the same way that individuals can act.
Agency is a complicated notion. But there’s a common-sense, intuitive level where the idea of group agency sounds fairly plausible. For example, when corporations do things that are morally problematic, such as the Deepwater Horizon oil spill in 2010, it sounds pretty sensible to talk about the corporation as though it were an agent. We seem to be able to coherently say, for example, that BP caused the oil spill, and that they are responsible for cleaning it up as a result. These sorts of statements are fairly common, and they don’t obviously involve any sort of linguistic error or conceptual mistake.
However, as I’ve noted recently, things get difficult when we attempt to assign moral obligations where individual agents cannot be said to have caused the morally problematic outcome. For example, what exactly are we saying when we say that BP caused the Deepwater Horizon spill? Are we saying that the employees caused it? Surely that can’t be right. Many of BP’s employees had nothing to do with this event, while many others committed actions that contributed in some way to this event, but can’t reasonably be said to have caused it to occur.
The problem is this–our understanding of concepts like action, agency, and moral responsibility has traditionally been formulated in terms of individuals. It turns out that what we think about these concepts at the individual level doesn’t neatly transfer over to a discussion of these concepts as they pertain to groups. And yet, given the role these concepts play in our moral practice, along with the social need to apply our moral practices to groups, it seems really important that we retain these concepts at the group level.
A notion of group agency can be helpful here. If we can get clear about what it means for a group, such as a corporation like BP, to be an agent, we can perhaps begin to make sense of the idea that the group is morally responsible for their actions, and that they bear certain moral obligations as a result, even if the individuals that constitute the group are not morally responsible for any moral wrongdoing.
But this presupposes that our intuitions are correct, that it really does make sense to talk about groups in this way. What do others think about this? Do you share the intuition that it makes sense to talk about groups in the same way we talk about individual agents? If not, what do we do about group wrongdoing? Are we better of trying to identify individual agents who are morally responsible in these sorts of cases, or do we simply abandon the idea of group moral responsibility? Are there any other options? Share your thoughts, and let’s talk about it.
Tags: Moral Theory
July 7th, 2014 by Elijah Weber · No Comments
The World Cup is coming to a close soon, and by all accounts, soccer fans have largely enjoyed it. However, just prior to its start, there were national protests all over Brazil, part of a concerted effort to draw international attention to the fact that this World Cup has come at an extremely high cost for Brazil’s citizens.
Brazil’s economy is in shambles, and it stands in dire need of improvements in health care, education, and transportation infrastructure. While the Brazilian government spent billions of dollars building soccer stadiums, and will soon spend billions more on Olympic venues, a significant number of Brazil’s citizens engage in a daily struggle to simply survive.
Brazil’s World Cup raises a familiar problem in moral philosophy: What is the moral significance of actions that are not themselves morally wrong, but that indirectly contribute, though in causally negligible ways, to morally wrong actions or morally bad situations?
Lots of contemporary social issues are like this. For example, no one person is responsible for the negative effects of global climate change. In fact, even if huge numbers of people made drastic changes to their ways of life, very little would change at the level of global climate. There’s a sense in which no one is responsible for these effects, and no one person can do anything about it.
And yet, it’s nearly indisputable that human actions cause these effects. We all contribute to the effects of global climate change, but in a way that is both indirect and causally insignificant. The negative effects of global climate change create a morally bad situation that no individual is responsible for causing, and that no individual can do much about.
These features, referred to by philosopher Stephen Gardiner as the “fragmentation of agency,” make it difficult to support definitive moral claims about what ought to be done. For example, some might say “you should get a hybrid car to reduce emissions, because climate change has morally bad effects.” But it’s not unreasonable to say that since my driving a hybrid car will make no measurable difference to global climate change, but be much more expensive for me, really what I should do is NOT buy a hybrid car.
Further, it’s not as though I’m responsible for the negative effects of climate change, such that I’m obligated to purchase a hybrid car. These effects are the result of billions of morally permissible actions that have almost no causal significance in themselves. In the absence of any causal powers, it’s very difficult to make the case that such actions can give rise to moral obligations.
Traditional ways of thinking about morality are ill-suited for addressing contemporary social issues of this kind. Some have argued that what’s required is a “new” way of thinking about morality. But it’s not yet clear what that new way might look like, nor how we integrate it into our current moral thinking.
As I watched portions of the World Cup, and thought about the protests in Brazil that preceded it, I found myself wondering if doing so amounted to the same sort of problem. Is there something morally bad about watching the World Cup, knowing the social circumstances surrounding it? Am I contributing, however indirectly or insignificantly, to problems of social justice in places like Brazil?
Or, like climate change, is this another example of the limitations of our traditional ways of thinking about the moral aspects of contemporary social issues?
What do others think of these sorts of questions? Do we need a “new” way of thinking about morality? What would that new way look like? Are these contemporary social issues as morally significant as they seem? Post a comment and let’s talk about it.
Tags: Applied Ethics · Social Ethics
May 21st, 2014 by Elijah Weber · No Comments
In general, it’s thought that for a person to give informed consent to a medical procedure, they must understand certain things about it. Understanding of risks, benefits, alternatives, and facts about what the procedure will actually involve are relevant considerations when evaluating whether a person’s consent is fully informed.
This requirement can be more difficult to satisfy than one might think. In many cases, a medical procedure has lots of potential risks, side effects, etc., but many of these are exceedingly rare or uncommon. If we interpret the understanding requirement as a requirement that the patient be told everything about the procedure in question, there’s a concern that this requirement is unduly burdensome, or worse, that it can’t be met at all.
To deal with this problem, the understanding requirement is sometimes interpreted as a requirement that the patient be told all information that might make a difference to what they decide. This requires a judgment call on the part of the person seeking the patient’s consent, but it provides some measure of leeway with regard to what degree of informational disclosure is adequate for informed consent.
The thought here is that if a bit of information would make no difference to what the patient decides to do, failing to disclose it doesn’t undermine the person’s ability to give informed consent.
Here’s where this way of thinking about informed consent is of contemporary interest. Recently, a lawsuit was filed by former NFL players, charging the NFL with providing painkillers and anti-inflammatory drugs to injured players, without informing them about the risks of using them. Many players used these drugs to excess, became addicted, and suffered numerous negative consequences as a result.
However, when these sorts of lawsuits are filed, players not involved in them frequently claim that had they been told about the risks involved in playing with a concussion, a serious knee injury, taking painkillers to be able to play, etc., they would have played anyway. So while team doctors clearly did fail to provide certain information typically thought to be relevant to informed consent in this case, there’s also a sense in which the withholding of this information made no difference to what players decided to do.
Evaluating cases of past consent are difficult, because standards for informed consent, as well as documentation requirements, are much higher than they used to be. That said, there’s a general theoretical question here regarding whether withholding information that would have made no difference to what a person decides undermines their ability to give informed consent.
One might think that if a piece of information would have made no difference, withholding it does not undermine informed consent, because the patient would have opted for the same course of action.
On the other hand, one might claim that certain information is required for informed consent, irrespective of whether it would have made a difference to one’s decision. On this view, there’s a difference between choosing a course of action without knowledge of the risks involved, and choosing that same course of action in full view of the risks.
What do you think? If a piece of information would have made no difference to what a person decided about their care, can that person legitimately claim that they were denied the opportunity to give informed consent? Post a comment and let’s try to figure it out together.