Judith Andre

Bioethicists appearing in the media have been accused of "shooting from the hip" (Rachels, 1991). The criticism is sometimes justified. We identify some reasons our interactions with the press can have bad results and suggest remedies. In particular we describe a target (fostering better public dialogue), obstacles to hitting the target (such as intrinsic and accidental defects in our knowledge) and suggest some practical ways to surmont those obstacles (including seeking out ways to write or speak at length, rather than in sound bites). We make use of our own research into the way journalists quote bioethicists. We end by suggesting that the profession as a whole look into this question more fully.

As feminist theory explicates its fundamental principles – justice for the oppressed – it can lose its essential focus on the situation of women. One example is the inattention to nurses within feminist bioethics. Nurses deserve attention because most are women, but also because their lack of power is paradigmatic of patriarchy. Those examining ethics consultations should discuss whether nurses are allowed to request them. But feminists also need to imagine ways in which nurses can be heard when, for instance, their worklives are “redesigned.” Doing so would also allow attention to other classes of the disempowered.

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care

Hope as a virtue is an acquired disposition, shaped by reflection; as a civic virtue it must serve the good of the community. Ernst Bloch and Lord Buddha offer help in constructing such a virtue. Using a taxonomy developed by Darren Webb I distinguish open hope from goal-oriented hope, and use each thinker to develop the former. Bloch and Buddha are very different (and notoriously obscure; I do not attempt an exegesis). But they share a metaphysics of change, foundational for making any sense of hope.Buddhism would seem to repudiate hope; it is a source of suffering (i.e., pain in living with reality). Seen more deeply, however, Buddhism offers material for a carefully limited virtue of hope: the habits of noticing good and acknowledging transience. This disposition, acquired through Buddhist practice among other ways, shields one against despair. The habit also frees up energy that would otherwise be wasted. Ernst Bloch gives us insight into how to use that energy, teaching us to value the yearning implicit throughout culture. Open hope becomes a civic virtue when it concerns civic matters; it can be threatened by hyperbolic discourse in political life.

During medical training students and residents reconstruct their view of the world. Patients become bodies; both the faults and the virtues of the medical profession become exaggerated. This reconstruction has moral relevance: it is in part a moral blindness. The pain of medical training, together with its narrowness, contributes substantially to these faulty reconstructions. Possible improvements include teaching more social science, selecting chief residents and faculty for their attitudes, helping students acquire communication skills, and helping them deal with their own pain. Most importantly, clearer moral vision requires time and scope for reflection.