Jay Carlson

Moral distress is traditionally defined as situations where one knows the right thing to do but external constraints make it nearly impossible to pursue the right course of action. Many interventions to mitigate moral distress focus on making healthcare workers more resilient or courageous in the face of adverse circumstances. While these “virtue cultivation” responses might be valuable traits for individuals, I want to argue that cultivating virtue is at best an incomplete strategy for dealing with moral distress in an organizational setting. The individualistic character of these approaches ignores how an organization’s policies may be contributing to many morally distressing situations. I will argue that resources from the virtue tradition can still play a valuable theoretical role in addressing moral distress in healthcare settings if we transpose them to the organizational level. The policies of a hospital or healthcare institution can be seen as virtuous to the degree that they further the organization’s goals of medicine. Organizational virtue ethics can then illuminate the issue of moral distress in healthcare organizations. If an organization’s policies contribute to its members suffering from moral distress, then that policy may well inhibit the organization from carrying out its mission of providing excellent healthcare. Organizations should respond to moral distress and seek ways to mitigate if not eliminate it.

The conciliationist and steadfast approaches have dominated the conversation in the epistemology of disagreement. In this paper, drawing on Jennifer Lackey’s justificationist approach and the casuistry paradigm in medical ethics, I will develop a more contextual epistemology of political disagreement. On this account, a given political disagreement’s scope, domain, genealogy, and consequence can be helpful for determining whether we should respond to that disagreement at the level of our confidence, beliefs, or with policy. Though some may argue that responding with policy is a practical consideration instead of an epistemic matter, I argue that even policy responses to disagreements have an epistemic dimension to them that we should not ignore.

In this paper, I will discuss the relevance of epistemology of disagreement to political disagreement. The two major positions in the epistemology of disagreement literature are the steadfast and the conciliationist approaches: while the conciliationist says that disagreement with one’s epistemic equals should compel one to epistemically “split the difference” with those peers, the steadfast approach claims that one can maintain one’s antecedent position even in the face of such peer disagreement. Martin Ebeling applies a conciliationist approach to democratic deliberations, arguing that deliberative participants ought to pursue full epistemic conciliation when disagreeing with their peers on political questions. I argue that this epistemic “splitting the difference” could make participants vulnerable to certain cognitive biases. We might avoid these biases by paying more attention to the deliberative environment in which disagreement takes place.