Periodic Reporting for period 1 - MORE (Moral residue - epistemological ramifications, ethical implications and didactic opportunities)
Reporting period: 2022-09-01 to 2025-02-28
The overall aim of MORE is threefold: (1) to substantially advance the philosophical and phenomenological understanding of MR, as a concept and as an experience, (2) to empirically study the impact of literary narrative fiction (that is thematically related to MR) in altering concepts of self and others, and (3) to devise, and to empirically test the potential merits of a novel narrative method for medical ethics education that we believe can enable health care practitioners to learn to live with and through situations of MR and to accept that they are likely to fail morally in ways that they may not be able to avoid, without this acceptance compromising their sense of dignity as moral agents.
The project consists of three inter-related Work Packages. In WP1, we focus on the concept and phenomenon of MR from a philosophical perspective as well through conducting interviews with healthcare professionals about their own experiences of MR; we ask whether and how reading literary fiction narrating situations of MR can be helpful in navigating these experiences. WP2 investigates how aspects of a literary text enhance certain reading experiences that may evoke MR, and subsequently facilitate the awareness and acceptance of MR. WP3, which will start in 2025, will develop and test a novel program for medical ethics education.
The project consists of three inter-related Work Packages. In WP1, we focus on the concept and phenomenon of MR from a philosophical perspective as well through conducting interviews with healthcare professionals about their own experiences of MR; we ask whether and how reading literary fiction narrating situations of MR can be helpful in navigating these experiences. WP2 investigates how aspects of a literary text enhance certain reading experiences that may evoke MR, and subsequently facilitate the awareness and acceptance of MR. WP3, which will start in 2025, will develop and test a novel program for medical ethics education.
WP1, study 1: How can the concepts of unavoidable moral failure and MR be further developed and defended against objections, and what typology of MR and notion of acceptance of MR do they suggest?
Situations of MR invoke a number of philosophical considerations. First, they suggest that there is a tight connection between certain emotions and moral responsibility. Second, they suggest that we generally see these emotions as misplaced, or unfitting, when the relevant person was not at fault (i.e. when they did not fall short of fair or reasonable standards). But finally, and paradoxically, these situations suggest that we tend to see the relevant emotions as fitting–at least for us to feel towards ourselves–when the outcome resulted from our hands and so implicated our agency.
The upshot of our view is that we can really be responsible in situations of MR, in the limited sense that it can be fitting for us to hold ourselves responsible (i.e. even though we are not responsible in the sense that it would be fitting for others to hold us responsible). With this view in mind, we turn to the question of how we might nonetheless help people who are struggling with the emotions of MR–for instance, doctors and nurses who anguish over the patients they have lost or the otherwise bad outcomes that have resulted from their actions. Our view rules out, in most cases, what might strike one as the obvious option–namely, that we should help healthcare providers by diffusing their sense of responsibility in situations of MR. For since we hold that the emotions of MR can be fitting, we think it is generally inappropriate to try to eliminate or otherwise pathologize them, as this would be equivalent to trying to revise someone’s perfectly allowable values. Instead, we suggest that those who struggle with the emotions of MR might find some relief through acceptance, by which we mean a non-aggrandized living with and through the emotions of MR.
The philosophical part of WP1 has resulted in a book proposal, Holding Ourselves Responsible: When What Rightly Matters Doesn’t Really Matter (Authors: Cullin Brown and Lisa Tessman), which is currently under review by a top Publishing House.
WP1, study 2: What do medical literature and interviews with health care practitioners reveal about the experience of MR, and how must the conceptual model and typology be adjusted accordingly?
A paper, Varieties of Moral Distress (MD) - a critical and narrative review of different definitions and descriptions of MD in the healthcare literature, has been drafted and will be ready for submission by the end of 2024 (Lead author: Jan Helge Solbakk).
The first series of 3 interviews have been conducted in WP1 to collect MR-experiences from healthcare professionals. At present Janine de Snoo-Trimp and Albert C. Molewijk are in the phase of analyzing results and drafting the paper.
WP1, study 3: How do the selected texts from world literature narrate experiences of MR, and what further adjustments in the conceptual model and typology are necessary?
A MR-related fiction literature list from world literature narrating situations of MR has been devised. So far, the list entails about 60 titles. These selected texts are currently being analyzed for the kinds of MR-situations narrated.
In addition, reading experience interviews (interviews 2 and 3) with health care practitioners who have experienced MR are being conducted. The interviews are being conducted by Olivia Fialho.
WP2:
In the past, studies have suggested that narratives can impact readers’ self-concepts and assist them in understanding themselves. In this context, this project is interested in exploring whether and how narratives can help healthcare professionals recognize their vulnerability to Moral Residue (MR).
Nikoletta Alexandri and Frank Hakemulder have developed a scale designed to measure individuals' perceived susceptibility to MR. This scale is in the process of being validated and can be used in different experiments. Specifically, this project has conducted an experiment providing different narrative stimuli to healthcare workers to see whether the different narrative stimuli can impact the level to which healthcare professionals may realize their susceptibility to MR. It compares three groups: the first group read a story and was told that the story is fiction, the second group read the same story but was told that the story was non-fiction, and the third group wasn’t exposed to any narrative. Currently, the data from this study are being analyzed. The analysis of this data will give important insights into whether and how a narrative can impact healthcare workers’ perceived susceptibility to MR, and it will be the stepping stone for future experiments to explore whether and how narratives can support healthcare professionals in recognizing and navigating MR.
Situations of MR invoke a number of philosophical considerations. First, they suggest that there is a tight connection between certain emotions and moral responsibility. Second, they suggest that we generally see these emotions as misplaced, or unfitting, when the relevant person was not at fault (i.e. when they did not fall short of fair or reasonable standards). But finally, and paradoxically, these situations suggest that we tend to see the relevant emotions as fitting–at least for us to feel towards ourselves–when the outcome resulted from our hands and so implicated our agency.
The upshot of our view is that we can really be responsible in situations of MR, in the limited sense that it can be fitting for us to hold ourselves responsible (i.e. even though we are not responsible in the sense that it would be fitting for others to hold us responsible). With this view in mind, we turn to the question of how we might nonetheless help people who are struggling with the emotions of MR–for instance, doctors and nurses who anguish over the patients they have lost or the otherwise bad outcomes that have resulted from their actions. Our view rules out, in most cases, what might strike one as the obvious option–namely, that we should help healthcare providers by diffusing their sense of responsibility in situations of MR. For since we hold that the emotions of MR can be fitting, we think it is generally inappropriate to try to eliminate or otherwise pathologize them, as this would be equivalent to trying to revise someone’s perfectly allowable values. Instead, we suggest that those who struggle with the emotions of MR might find some relief through acceptance, by which we mean a non-aggrandized living with and through the emotions of MR.
The philosophical part of WP1 has resulted in a book proposal, Holding Ourselves Responsible: When What Rightly Matters Doesn’t Really Matter (Authors: Cullin Brown and Lisa Tessman), which is currently under review by a top Publishing House.
WP1, study 2: What do medical literature and interviews with health care practitioners reveal about the experience of MR, and how must the conceptual model and typology be adjusted accordingly?
A paper, Varieties of Moral Distress (MD) - a critical and narrative review of different definitions and descriptions of MD in the healthcare literature, has been drafted and will be ready for submission by the end of 2024 (Lead author: Jan Helge Solbakk).
The first series of 3 interviews have been conducted in WP1 to collect MR-experiences from healthcare professionals. At present Janine de Snoo-Trimp and Albert C. Molewijk are in the phase of analyzing results and drafting the paper.
WP1, study 3: How do the selected texts from world literature narrate experiences of MR, and what further adjustments in the conceptual model and typology are necessary?
A MR-related fiction literature list from world literature narrating situations of MR has been devised. So far, the list entails about 60 titles. These selected texts are currently being analyzed for the kinds of MR-situations narrated.
In addition, reading experience interviews (interviews 2 and 3) with health care practitioners who have experienced MR are being conducted. The interviews are being conducted by Olivia Fialho.
WP2:
In the past, studies have suggested that narratives can impact readers’ self-concepts and assist them in understanding themselves. In this context, this project is interested in exploring whether and how narratives can help healthcare professionals recognize their vulnerability to Moral Residue (MR).
Nikoletta Alexandri and Frank Hakemulder have developed a scale designed to measure individuals' perceived susceptibility to MR. This scale is in the process of being validated and can be used in different experiments. Specifically, this project has conducted an experiment providing different narrative stimuli to healthcare workers to see whether the different narrative stimuli can impact the level to which healthcare professionals may realize their susceptibility to MR. It compares three groups: the first group read a story and was told that the story is fiction, the second group read the same story but was told that the story was non-fiction, and the third group wasn’t exposed to any narrative. Currently, the data from this study are being analyzed. The analysis of this data will give important insights into whether and how a narrative can impact healthcare workers’ perceived susceptibility to MR, and it will be the stepping stone for future experiments to explore whether and how narratives can support healthcare professionals in recognizing and navigating MR.
WP1:
Although adjacent to the project aims, Brown and Tessman’s account of moral responsibility makes novel contributions to two enduring philosophical problems. First, it provides an account of moral responsibility that would not be undermined by the truth of determinism/the absence of libertarian free will, largely by refining and expanding upon the account that Peter Strawson gave in “Freedom and Resentment” (1962). And second, it provides an account of how normative properties (e.g. “being blameworthy”) might be said to exist/obtain within a naturalistic worldview by combining broadly Humean insights about the nature of value and reasons with contemporary work on emotion theory and response-dependent properties.
WP2:
The scale of perceived susceptibility to MR represents a novel advancement in this field. While numerous scales have been created to measure moral distress, this is the first scale specifically designed to address the phenomenon of MR.
Although adjacent to the project aims, Brown and Tessman’s account of moral responsibility makes novel contributions to two enduring philosophical problems. First, it provides an account of moral responsibility that would not be undermined by the truth of determinism/the absence of libertarian free will, largely by refining and expanding upon the account that Peter Strawson gave in “Freedom and Resentment” (1962). And second, it provides an account of how normative properties (e.g. “being blameworthy”) might be said to exist/obtain within a naturalistic worldview by combining broadly Humean insights about the nature of value and reasons with contemporary work on emotion theory and response-dependent properties.
WP2:
The scale of perceived susceptibility to MR represents a novel advancement in this field. While numerous scales have been created to measure moral distress, this is the first scale specifically designed to address the phenomenon of MR.