J Clin Ethics. 2024 Fall;35(3):169-179. doi: 10.1086/730869.
AbstractMoral 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.
摘要道德困境传统上被定义为一种情况，即一个人知道正确的做法，但外部限制使得几乎不可能采取正确的行动方针。许多减轻道德困境的干预措施都集中在使医疗工作者在面对不利环境时更有弹性或更勇敢。虽然这些“美德培养”的反应可能对个人有价值，但我想指出，在组织环境中，培养美德充其量只是处理道德困境的一种不完整策略。这些方法的个人主义特征忽略了组织的政策如何可能导致许多道德困境。我将认为，如果我们将美德传统的资源转换到组织层面，它们仍然可以在解决医疗保健环境中的道德困境方面发挥有价值的理论作用。医院或医疗机构的政策可以被视为有道德的，在多大程度上它们促进了该组织的医学目标。那么，组织的美德伦理就可以阐明医疗保健组织中的道德困境问题。如果组织的政策导致其成员遭受道德困境，那么该政策很可能会阻碍组织履行提供优质医疗保健的使命。组织应该对道德困境做出反应，并寻求减轻甚至消除道德困境的方法。
