School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.
Nurs Ethics. 2024 Feb;31(1):17-27. doi: 10.1177/09697330231174532. Epub 2023 Jun 9.
In many high-income countries, an initial response to the severe impact of Covid-19 on residential care was to shield residents from outside contacts. As the pandemic progressed, these measures have been increasingly questioned, given their detrimental impact on residents' health and well-being and their dubious effectiveness. Many authorities have been hesitant in adapting visiting policies, often leaving nursing homes to act on their own safety and liability considerations. Against this backdrop, this article discusses the appropriateness of viewing the continuation of the practice of shielding as a moral failure. This is affirmed and specified in four dimensions: and (in MacIntyre's sense). is discussed in the context of prudent versus proportionate choices. As to , it will be shown that the continued practice of shielding no longer met the requirements of an (inherently moral) practice, as external goods such as security thinking and structural deficiencies prevented the pursuit of internal goods focusing on residents' interests and welfare, which in many places has led to a loss of trust in these facilities. This specification of moral failure also allows a novel perspective on moral distress, which can be understood as the expression of the psychological impact of moral failure on moral agents. Conclusions are formulated about how pandemic events can be understood as character challenges for healthcare professionals within residential care, aimed at preserving the internal goods of residential care even under difficult circumstances, which is understood as a manifestation of moral resilience. Finally, the importance of moral and civic education of healthcare students is emphasized to facilitate students' early identification as trusted members of a profession and a caring society, in order to reduce experiences of moral failure or improve the way to deal with it effectively.
在许多高收入国家，最初应对新冠疫情对养老院的严重影响的措施是将居民与外界隔离。随着大流行的发展，这些措施因其对居民健康和福祉的不利影响及其可疑的有效性而越来越受到质疑。许多当局在调整探视政策方面犹豫不决，往往让养老院自行考虑安全和责任问题。在此背景下，本文讨论了将继续隔离视为道德失败的合理性。这在四个维度上得到了肯定和具体说明： （在麦金泰尔的意义上）和 。审慎与相称性选择的背景下讨论了 。至于 ，将表明继续隔离的做法不再符合（内在道德）实践的要求，因为安全思维和结构性缺陷等外部利益因素阻碍了对以居民利益和福利为重点的内在利益的追求，这在许多地方导致了对这些设施的信任丧失。这种对道德失败的具体说明也为道德困境提供了一个新的视角，道德困境可以理解为道德失败对道德代理人的心理影响的表现。最后，强调了对医疗保健专业学生进行道德和公民教育的重要性，以促进学生尽早被视为值得信赖的专业人士和关爱社会的一员，从而减少道德失败的体验或改善有效应对道德失败的方式。
