Philosophy Department, Binghamton University, Binghamton, NY, 13902, USA.
Med Health Care Philos. 2020 Jun;23(2):165-177. doi: 10.1007/s11019-020-09942-7.
Nurses and other medical practitioners often experience moral distress: they feel an anguished sense of responsibility for what they take to be their own moral failures, even when those failures were unavoidable. However, in such cases other people do not tend to think it is right to hold them responsible. This is an interesting mismatch of reactions. It might seem that the mismatch should be remedied by assuring the practitioner that they are not responsible, but I argue that this denies something important that the phenomenon of moral distress tells us. In fact, both the practitioners' tendencies to hold themselves responsible and other people's reluctance to hold the practitioners responsible get something right. The practitioners may be right that they are responsible in the sense of having failed to meet a binding moral requirement, even when the requirement was impossible to meet. This makes moral distress a fitting response because it correctly represents their own action as a wrongdoing. However, others may meanwhile be right that the practitioners are not responsible in the sense of being culpable and blameworthy. To blame others, or oneself, for certain failures, including those that are unavoidable, would be unfair. My claim depends on distinguishing between the fittingness and the fairness of holding someone (including oneself) responsible for moral failure. Having drawn the distinction, I suggest that moral distress should be addressed in a way that both recognizes it as a fitting response and avoids the unfairness of blame.
他们对自己认为的道德失败感到痛苦和内疚，即使这些失败是不可避免的。然而，在这种情况下，其他人往往不认为应该让他们承担责任。这是一种有趣的反应不匹配。似乎可以通过向从业者保证他们没有责任来纠正这种不匹配，但我认为，这否认了道德困境现象告诉我们的一些重要的东西。事实上，从业者倾向于对自己负责，而其他人则不愿意让从业者负责，这两者都有一定的道理。从业者可能有理由认为自己在没有履行有约束力的道德要求方面是有责任的，即使这种要求是不可能履行的。这使得道德困境成为一种恰当的反应，因为它正确地将他们的行为视为一种不当行为。然而，与此同时，其他人可能有理由认为从业者在应受指责和应受责备的意义上没有责任。对某些失败（包括不可避免的失败）进行指责或自责是不公平的。我的主张取决于区分对某人（包括自己）因道德失败而承担责任的适当性和公平性。在进行了区分之后，我建议以一种既能认识到它是一种恰当的反应，又能避免指责的不公平性的方式来处理道德困境。
