Moral sensitivity, moral distress and moral functioning

For this open issue of the Etikk i Praksis: Nordic Journal of Applied Ethics, we put together a broad mix of different articles tackling current important issues in the field.


Introduction
Moral sensitivity, moral distress and moral functioning Allen Alvarez, May Thorseth Moral beliefs and values motivate us to act in ways that align with these beliefs and values. We experience satisfaction when our actions align with our values and feel distressed when we cannot act according to them. Distress also occurs when circumstances prevent us from acting with integrity, that is, acting according to values we hold dear. A similar kind of distress is experienced when we are pushed to act in ways contrary to our values.
Since Andrew Jameton first used the term in 1984, moral distress has been described in the empirical and conceptual literature as the experience of troubling emotions (frustration, anger, feeling powerless, hopelessness) due to constrained moral agency. Interventions have been studied and tested (Morley et al. 2021) because of the negative health impact of moral distress on those who experience it. Reducing moral distress is important in healthcare because healthcare professionals who suffer from chronic moral distress tend to leave their roles to protect their health and wellbeing (Karakachian & Colbert 2019). The effectiveness of interventions in managing or reducing moral distress has become a growing research interest in healthcare ethics (Musto, Rodney & Vanderheide 2015).
While any form of suffering should be reduced, if not eliminated, we also need to consider the human function that gives rise to moral distress. We do not want to merely eliminate the symptom without understanding the cause. The attribute of moral sensitivity enables the moral agent to feel the alignment between actions and values. Misalignment would cause moral distress. Given this functional relationship between moral sensitivity and moral distress, it may not necessarily be bad to experience moral distress if it functions to signal that something is wrong with the moral environment that needs to be changed. Could moral distress be a sign of moral wellness (defined as having a well-functioning moral compass)? The distress felt could motivate moral action to address the cause of distress. Therefore, we need not merely aim to reduce moral distress beyond addressing the circumstances that gave rise to it. As De Villers and DeVon (2012) stated: Moral sensitivity fosters commitment to patients and the ability to use strategies in ethical decision-making. Nurses who have lost their ability to care may lack moral sensitivity and will not experience moral distress. Those who maintain high levels of sensitivity and competency are more likely to demonstrate moral courage and moral heroism and are able to take action resulting in moral comfort rather than moral distress.
Nevertheless, the functional relationship requires additional conceptual and empirical investigation to inform further work on testing intervention with respect to the appropriate goal we should aim for (Souvandjiev 2021;McAuley-Gonzalez 2018). Applied ethicists can play a role in increasing our understanding of this relationship.
For this open issue of the Etikk i Praksis: Nordic Journal of Applied Ethics, we put together a broad mix of different articles tackling current important issues in the field.
The issue opens with the article by Arseniy Kumankov "Nazism, Genocide and the Threat of The Global West. Russian Moral Justification of War in Ukraine". The article critically examines how the Russian invasion of Ukraine was preceded by several public actions that aimed to frame the military operation as necessary and inevitable. Kumankov examines how, during these events, the Russian authorities used moral language to justify the war and the use of force against Ukraine. This article looks at why Russian officials used moral language to justify the war, what arguments they used, and whether these arguments would be effective in the long term. It examines speeches by the Russian President and materials from the Russian Federation Security Council meeting to answer these questions. Kumankov concludes that Putin's lack of legitimacy led him to justify the war in moral terms, which the nature of Russian moral discourse allowed him to do, but that this justification strategy may not be stable or sustainable in the long term. The author analysed speeches by Putin and other senior officials to show that the conflict was initially presented as a moral clash with the West rather than just a political rivalry. This strategy was intended to give legitimacy to the decision to attack Ukraine. The author also reproduced and classified the arguments used to support the war, showing that the Great Patriotic War was employed as a framework to justify this war and maintain Russia's image as a victorious and moral state. Other reasons for the war included the perceived threat of the West to Russia's values, and the Nazi character of the Ukrainian regime. The effectiveness of this strategy is discussed and uses some statistical information to conclude that although initial support in Russia for the war appeared high, the author questions the depth of the moral grounding and commitment for this war in the long term.
A commentary by Jennifer Bailey accompanies this original article by Kumankov. Bailey uses a political science lens to examine the thesis and arguments presented to help readers broaden their thinking about the issue.
In the second article, "Socratic dialogue on responsible innovation -A methodological experiment in empirical ethics" by Bjørn K. Myskja and Alexander Myklebust, the authors describe an experiment in which the Socratic dialogue method was used to promote Responsible Research and Innovation (RRI) in an interdisciplinary life sciences research project. The authors present an approach to avoiding the imposition of predetermined norms in interdisciplinary research projects by engaging researchers in group discussions. The method, which is based on Svend Brinkmann's epistemic interviewing, was used in two research group sessions to facilitate reflection on the issue of responsibility in research and innovation. This approach differs from other empirical ethics methodologies in that it aims to develop knowledge through dialogue, and the facilitators are active participants in the discussions rather than just observers. Myskja and Myklebust discuss the potential of this method as a supplement to other approaches to RRI and argue that it can contribute to both knowledge production and reflexivity. The main focus of their article is on the methodology used to produce knowledge. The effectiveness of this approach will be determined when the central arguments are developed and integrated into academic papers. The authors believe that researchers have valuable knowledge based on their experiences that can be used to contribute to academic or public debates. They are not concerned with whether the participants are representative of their group or whether the data generated in the sessions is valid. Instead, the validity of the approach will be tested by its contribution to knowledge when the arguments are presented to a competent audience.
The third article by María-Jesús Úriz, Juan-Jesús Viscarret, and Alberto Ballestero, titled "Ethical challenges of social work in Spain during Covid-19", the authors tell a story of the experience of social workers in Spain during the pandemic. In 2020, during the initial surge of COVID-19 in Spain, social work professionals faced significant ethical dilemmas. This article delves into the primary challenges encountered in the field, as the pandemic not only impacted healthcare but also had far-reaching effects on social work. Throughout this period, social workers grappled with profound ethical concerns encompassing breaches of confidentiality, equitable allocation of limited resources, the absence of personal and emotional connections with service users, the struggles of remote and isolated work, uncertainties regarding the reliability of information handled, and the complexities of accurate diagnoses. To gain a comprehensive understanding, an international research team led by Dr. Sara Banks collaborated with the International Federation of Social Workers on a broader project. The study involved collecting data through an online questionnaire targeted at social workers from different countries. In this article, we focus on the analysis of results specifically related to the primary ethical challenges faced by social workers in Spain. The research group identified two distinct categories of ethical challenges, each explored in separate sections. The first section addresses direct interactions with users, highlighting concerns such as the absence of emotional support, reliability and appropriate use of technology, adherence to professional standards, maintaining confidentiality, vulnerability and fair resource distribution. The second section concentrates on ethical challenges encountered within social organizations on a daily basis, encompassing aspects such as e-social work and coordination difficulties, managing pressure within social bodies, and adapting to changes in intervention methodologies.
The fourth article by Annamari Vitikainen entitled "LGBTIQ+ Prioritization in Refugee Admissions -The Case of Norway", the author delves into the normative foundations behind Norway's recent (2020) policy that places emphasis on admitting LGBTIQ+ refugees. The aim is to examine the compatibility of this policy with the vulnerability selection criteria outlined by the United Nations High Commissioner for Refugees (UNHCR) and to evaluate its independent justifications. While the article argues that the Norwegian policy aligns with the UNHCR criteria when appropriately interpreted, Vitikainen also emphasizes that it does not derive exclusive support from these criteria alone. To form a comprehensive understanding, she considers a range of broader moral principles that shape refugee admissions, encompassing both state-based and refugeecentered rationales for resettlement. By drawing on the specific challenges and dynamics associated with the resettlement and integration of LGBTIQ+ refugees, the article's analysis offers cautious endorsement for the Norwegian policy of prioritizing this vulnerable group. However, it also highlights certain limitations inherent in such an approach, particularly regarding the agency of the refugees themselves. Throughout the article, Vitikainen underscores the importance of amplifying the voices of refugees in the selection and resettlement processes. This entails recognizing cases where the default position of prioritizing LGBTIQ+ individuals may be superseded by their own interests in seeking resettlement elsewhere. The article aims to contribute to the ongoing dialogue surrounding the prioritization of LGBTIQ+ refugees, shedding light on the normative considerations that inform Norway's policy while advocating for a comprehensive and inclusive approach to refugee admissions.
And finally, in the fifth article "Stakeholder Inclusion as the Research Council of Norway's Silver Bullet" by Matthias Solli, the author delves into an important concept known as responsible research and innovation (RRI) and its implications within a public funding system. Using a fascinating case study from Norway, the author uncovers how the Research Council of Norway has embraced the idea of stakeholder inclusion. They believe that by involving various stakeholders in a transdisciplinary project, they can ensure its success and secure further funding for its development. However, there are potential risks associated with this approach. Through careful analysis of this case, the author unveils a concept called "4E Waste" -waste that occurs when a project with great potential to benefit society and tackle significant challenges ultimately falls short. To understand this waste, the author breaks it down into four types: Economic Waste, Eidetic Waste, Ecological Waste and Ethical Waste. Through this exploration of responsible research and innovation, the author attempts to shed light on the importance of avoiding these different types of waste. By doing so, the author believes that we can maximize the value and impact of projects, ensuring they deliver tangible benefits to society while addressing the pressing challenges we face today.
It is our wish that the new articles included in this issue will help stimulate deeper thinking in the various topics discussed by the authors. We encourage you to explore other complex ethical challenges. We seek articles that employ ethical theories and principles to analyze and evaluate different facets of society, ranging from politics and science to technology and the economy. We are particularly intrigued by the ethical ramifications of emerging issues like artificial intelligence, genetic engineering, climate change, and the politics of disinformation. We welcome submissions from diverse disciplines and perspectives, encompassing philosophy, sociology, law and public policy.

Call for papers
We would like to invite submissions for the Fall 2023 Special issue on environmental (food and water) ethics. The deadline for submission to this special issue is 1 August 2023.