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Nursing ethics in end-of-life care is often framed in reference to dramatic moral dilemmas and resulting moral distress that nurses experience in practice. While important, this framing obscures the moral significance of nurses’ everyday practice. The purpose of this study was to explore nurses’ moral experiences of palliative and end-of-life care, including situations that are enriching. The research question was: What are the moral experiences of nurses engaged in ethically meaningful situations in end-of-life care? Semi-structured interviews were conducted with five nurses from across Canada who practice in settings where palliative and/or end-of-life care are an important part of their role. Informed by interpretive description and a theoretical scaffold about nurses’ moral practice, a descriptive and thematic analysis of the data was performed. The participants described ethical challenges relating to patient autonomy, futility, prognostication, and navigating requests for medical assistance in dying. Experiences that were ethically enriching involved situations where the nurse, patient, and family worked together to create a peaceful and dignified death. Taken together, the participants’ narratives revealed them as morally engaged in their everyday practice, where such moral engagement is both reflective and relational. This study expands understanding about how nurses’ stories of end-of-life care reveal their capacity for moral sensitivity. This study also contributes to the articulation of a theoretical lens for examining the moral dimensions of nursing work. By explicating the relational dimensions of ethically meaningful experiences, including relationships with wider structures that facilitate and constrain the possibility for ethical action, this theoretical lens can support researchers to think creatively about palliative and end-of-life nursing from an explicitly ethical perspective.

In this thesis, I propose an argument against the possibility of moral dilemmas, which I construe as situations in which moral wrongdoing is inescapable. The first chapter addresses some terminological matters and attempts to sort out the main issues of contention between proponents and opponents of moral dilemmas. The second chapter lays out my argument, which I dub the "Argument from Action-Guidingness," against proponents of moral dilemmas. Negative moral judgments of the sort "X is wrong" typically carry with them the implication that X ought not to be done. If judgments of wrongness always have this action-guiding force, then moral dilemmas, which say that all courses of action available to the agent are morally wrong, threaten morality with incoherence. To avoid this problem, proponents of dilemmas will be forced to abandon the action-guiding implications of negative moral judgments when dilemmas arise. But this move is not without its own difficulties, which I elucidate. The final chapter identifies flaws in two prominent arguments in favor of dilemmas: the argument from moral distress and the argument from incommensurable values. The latter half of the chapter examines Sayre-McCord's "fairness argument" against dilemmas, and contrasts it with the argument from action-guidingness. / Master of Arts

These three papers examine "productive failure" as a viable learning design to improve problem solving skills using open-ended problems. Productive failure, a teaching method, is based on the premise of unsuccessful learning performance in solving for complex problems with little to no support while yielding productive learning for subsequent problems. Kapur (2008) argues that hidden efficacies of learning exist in failure in which learners potentially learn through experimentation from their exploration and struggle in solving complex problems in a way that learners must first try and solve complex, novel problems on their own, but ultimately will fail to reach a solution. We have limited understanding if this type of design would be effective on complex problems with multiple solutions since previous studies on productive failure focused on problems with a canonical solution. In the three papers, I examine the extent to which students learn how to solve moral dilemmas in productive failure (PF) compared to lecture and practice (LP) and to what extent instruction in PF helps students learn skills in transferable problem solving. One paper describes a pilot study that was conducted with 21 second-year dental hygiene students. In the randomized-controlled study, analysis did not show significant differences on moral reasoning (p = .06) and transfer of knowledge (p = .58) between PF and LP instructional method. However, the effect size on students' posttest scores was high (d = .76) which as a result of the educational intervention, suggests that PF students demonstrated acquisition of new thinking and approached the complex problem in a more sophisticated moral way of thinking. To replicate these findings, the results from the pilot study were used to make adjustments in instructional and research design for a full-scale study. The second study on 77 second-year dental hygiene students from four dental hygiene programs further shows that PF students gained a deeper conceptual understanding and were better prepared for subsequent problems. PF students, I found, demonstrated greater shifts from simplistic thinking to post conventional thinking compared to LP students. Although PF students performed similarly when compared to LP students on their posttest scores in the moral responses, LP students scored lower than their pretest problem and the difference between pretest and posttest scores in LP School had a moderate effect in a negative direction (d= -.64). Findings in both studies suggest that productive failure design has the potential to help students reach a deeper conceptual understanding when they 1) analyze their own failure; 2) use the learned concept to build upon their own prior knowledge; and 3) repair existing mental models to successfully solve complex problems. As such, continued exploration of various instructional approaches like productive failure is still needed as alternatives to lecture and practice for developing problem solving skills.

Thesis advisor: Lisa Sowle Cahill / The existence of moral and tragic dilemmas is highly debated within philosophy. Tragic dilemmas are a special kind of moral dilemma that involve great tragedy. Traditionally, philosophy tends to deny dilemmas because obligations cannot truly conflict and an ethical system must always guide agents in deliberation. For the most part, Christian theology dismisses the possibility of moral dilemmas. A highly influential theological rejection comes from Aquinas. Philosopher Bernard Williams famously challenged traditional ideas, worrying that a focus on reason to the exclusion of feelings has prevented ethicists from recognizing important aspects of the moral life, including the existence of moral and tragic dilemmas. This omission renders ethics unable to capture moral experience, and what good is ethics if it doesn’t speak to the moral life as we experience it? This presents a challenge for theology as well. This dissertation takes seriously Williams’s concerns and investigates the possibility of tragic dilemmas within a Christian context. I develop a defense of tragic dilemmas within a Christian virtue framework using feminist insights. I argue that in a tragic dilemma an agent deliberates on, with sufficient knowledge, an issue that involves non-negotiable moral requirements in line with Christian obligations to protect human life and the vulnerable. A tragic dilemma causes great harm and can “mar” the agent’s life. The agent is morally responsible for the harm caused and/or the obligation not acted upon. However, culpability is mitigated due to the constraints of the situation as long as the agent acts with “repugnance of the will.” When involvement in a tragic dilemma produces emotional harm this has the power to undermine character because, as I argue, passions and the moral life are inextricably related. In turn, the agent’s life is “marred.” In light of this, Christian healing is necessary after involvement in a tragic dilemma. In the first half of this dissertation, I investigate moral dilemmas in general. In Chapter 1, I layout the major philosophical debates surrounding moral dilemmas and I highlight touchstones, questions, ambiguities, and problems to bring to theology—issues around logic, autonomy, the nature of moral requirements, blame, restitution, and what constitutes a tragic dilemma. In Chapter 2, I assess the theological response to moral dilemmas vis-à-vis Aquinas. Although Aquinas explicitly denies the possibility for moral dilemmas that are not the agent’s fault, I find new points of contact between Aquinas and moral dilemma theorists. In light of this, there is space for the possibility of moral dilemmas in a Christian virtue context, but this understanding is beyond the boundaries set-up by Aquinas. In the second half of the dissertation, I move to discuss tragic dilemmas, specifically. In Chapter 3, I use Christian thought and feminist insights to develop my definition of tragic dilemmas. As real-life cases of moral injury from war show, tragic dilemmas can cause emotional harm. In Chapter 4, I offer Christian strategies for healing from tragic dilemmas. Because we are social beings and because society often bears some blame for the occurrence of tragic dilemmas, healing must also happen in, with, and among the community member. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Theology.

I denna studie uppmärksammas lärares resonemang om bedömning i etik med fokus på moraliska dilemman. Studiens empiriska data består av fyra kvalitativa semistrukturerade intervjuer med lärare som arbetar som So-lärare i skolåren 4-6. Resultatet från analysen presenteras utifrån tre olika delar. Den första delen behandlar lärares syn på etik och bedömning av ett moralisk dilemma. Den andra delen visar att lärarna har olika uppfattningar när det kommer till bedömning av ett moraliskt dilemma där elevsvaret går emot skolans värdegrund. Den tredje delen uppmärksammar de svårigheter lärarna ställs inför när de bedömer elevers etiska förmågor. De resonerar om elevers resonemangsförmåga samt vad som egentligen kan godtas som ett etiskt begrepp. / This study draws attention to how teachers reason when assessing moral dilemmas. The study's empirical data consist of four qualitative semi-structured interviews with teachers working with pupils in primary school years 4-6. The result from the analysis is presented in three parts. The first part is about teachers' view of ethics and the assessment of moral dilemmas. The second part shows that the teacher have slightly different perceptions when it comes to assessing a moral dilemma where the pupil argues against the value of the school. The third part draws attention to the difficulties the teachers experince when assessing the pupils' ethical knowledge. They argue about how developing a reasoning must be for certain grade and what they can accept as an ethical concept.

Submitted by MAYRA MARQUES DA SILVA GUALTIERI KAPPANN null (mayragualtieri@hotmail.com) on 2016-03-24T00:47:24Z No. of bitstreams: 1 TESE ÉTICA, JUSTIÇA E DEMOCRACIA EM SALA DE AULA - Texto completo - Mayra M S Gualtieri-Kappann.pdf: 1904768 bytes, checksum: db56dc7cf7943334fafa8b2d4f2c3388 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-03-24T13:59:51Z (GMT) No. of bitstreams: 1 gualtierikappann_mms_dr_mar.pdf: 1904768 bytes, checksum: db56dc7cf7943334fafa8b2d4f2c3388 (MD5) / Made available in DSpace on 2016-03-24T13:59:51Z (GMT). No. of bitstreams: 1 gualtierikappann_mms_dr_mar.pdf: 1904768 bytes, checksum: db56dc7cf7943334fafa8b2d4f2c3388 (MD5) Previous issue date: 2016-02-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Partindo da preocupação sobre uma melhor compreensão do desenvolvimento do agente ético na educação e na busca por novas estratégias e recursos pedagógicos para intervenções eficazes nas escolas, esta pesquisa buscou conhecer a realidade do ensino da Ética nas escolas brasileiras, mais especificamente nas do estado de São Paulo, a partir da perspectiva dos documentos oficiais e de diretores, coordenadores e professores em exercício e também desenvolver, apresentar, testar e avaliar junto a professores um novo método de discussão de dilemas morais para a educação. Para tanto, realizamos um estudo quanti-qualitativo sobre as noções de ética, justiça e democracia em sala de aula, experimentando nossa proposta de discussão com professores do Ensino Médio de uma escola estadual de uma cidade do interior de São Paulo e o submetemos às suas análises críticas a respeito de sua estruturação, conteúdo, aplicação e critérios de viabilidade e eficácia para a aplicação nos contextos educacionais brasileiros e a uma avaliação psicométrica de seus possíveis efeitos. Foi realizada também uma avaliação qualitativa do conteúdo das discussões. Participaram da pesquisa a diretora da escola, dois coordenadores pedagógicos e quinze professores. A pesquisa envolveu, além de um estudo documental e bibliográfico, duas fases de realização. Na primeira fase, os instrumentos utilizados foram uma entrevista semidirigida coletiva com a diretora e os coordenadores pedagógicos e um Grupo Focal com os professores acerca de questões sobre ética e educação, além de uma pré-testagem com MJT_xt (Moral Judgment Test - extended version) com este grupo. Após isto, foi realizada junto aos professores uma intervenção com cinco discussões de dilemas utilizando a nova metodologia. A avaliação psicométrica foi realizada através de uma nova e comparativa testagem com o MJT_xt. A avaliação qualitativa do método utilizou como instrumento a Técnica do Grupo Focal. A avaliação qualitativa do conteúdo das discussões e argumentos utilizou a Técnica de Análise de Conteúdo e Categorias Temáticas de Bardin e a teoria de Kohlberg para suas análises. Concluímos que o método se mostrou eficaz no sentido de exercitar a reflexão, a crítica e um retorno ao diálogo no espaço escolar. Percebemos que há uma carência de uma formação escolar que privilegie a formação integral do ser humano e não somente sua formação teórica ou técnica. De modo geral, não parece haver uma formação dos professores voltada para práticas pedagógicas que incluam a dimensão ética nas práticas docentes, nem uma estruturação democrática das escolas que privilegie esta vivência no meio escolar. Nossa proposta é que os cursos de formação de professores atentem, desde a graduação, para a necessidade de considerar a dimensão ética e a epistemológica como de igual importância para a formação dos educadores, a fim de que o professor chegue à sala de aula como um prático reflexivo que ajude a formar novos agentes reflexivos e práticos em suas áreas específicas de conhecimento e de ação coletiva. No vasto universo de necessidades da educação, acreditamos que novas e aprofundadas pesquisas devam ser realizadas e os educadores encorajados a pensar e a avaliar juntos novas estratégias para a construção de uma educação emancipadora do ser humano, em que nosso modo de discurso expresse também nosso modo de educar. / Starting from the concern about a better understanding of the development of ethical agent in education and in the search for new strategies and teaching resources for effective interventions in schools, this research aimed to know the reality of the ethics education in Brazilian schools, specifically in the state of São Paulo, from the perspective of official documents and directors, coordinators and teachers in exercise and also develop, introduce, test and evaluate with teachers a new method of moral dilemmas discussion for education. To this end, we conducted a quantitative and qualitative study on the notions of ethics, justice and democracy in the classroom, experiencing our proposal for discussion with high school teachers of a public school in a city in São Paulo state and submit to their critical analysis about its structure, content, application and feasibility and efficacy criteria for the application in the Brazilian educational contexts and to a psychometric assessment of their possible effects. It also carried out a qualitative assessment of the content of the discussions. The participants were the school principal, two coordinators and fifteen teachers. The research involved, as well as a documentary and bibliographical study, two phases of realization. In the first phase, the instruments used were a collective semistructured interview with the director and educational coordinators and focus groups with teachers on issues of ethics and education, as well as a pre-test with MJT_xt (Moral Judgment Test - extended version) with this group. After this, was done with teachers an intervention with five dilemmas discussions using the new methodology. The psychometric assessment was carried out through a new and comparative testing with MJT_xt. The qualitative assessment of the method used as an instrument of the Technical Focus Group. The qualitative assessment of the content of the discussions and arguments used the Content Analysis Technique and Thematic categories of Bardin and Kohlberg's theory to their analysis. We conclude that the method has proved effective to exercise reflection, criticism and a return to the dialogue at school. We realize that there is a lack of an education that favors the integral formation of the human being and not just a theoretical or technical training. Overall, it seems not to have a formation teachers dedicated to pedagogical practices that include the ethical dimension in teaching practices, nor a democratic structure of schools that favors this experience at school. Our proposal is that the teacher training courses, consider, from the undergraduate, to the need to consider the ethical dimension and the epistemological as its equal importance to the training of teachers, so that the teacher could comes to the classroom as a reflective practice that helps form new reflective and practical agents in their specific areas of expertise and collective action. In the vast universe of educational needs, we believe that new and further research should be conducted and educators encouraged to think and evaluate together new strategies for the construction of an emancipating education of the human being, when our discourse so also expresses our way to educate.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This doctoral thesis addresses the issue of moral dilemmas, specifically dilemmas of serious severity. These specific dilemmas are analyzed in an attempt to connect them to the thesis of Inescapable Moral Wrongdoing and the psychological trauma situation experienced by the agent in these situations. At first, examples of literature and philosophy that illustrate and explain each situation are presented. Such examples are Sophie s Choice, by William Styron, the dialogue between Socrates and Cephalus, in Book I of The Republic by Plato, and the case of the student of Sartre, in Existentialism is a Humanism. In a second moment, the study aims to carry out some important distinctions between types of moral dilemmas, namely: soluble, insoluble and symmetrical dilemmas. The main theories that deal with solution of moral dilemmas are exposed, divided in rationalist theories and "experientialist" theories. The former are analyzed so that it is shown that they do not accept genuine moral dilemmas, neither the thesis of the Inescapable Moral Wrongdoing, providing solutions for difficult moral dilemmas and even symmetrical, making use of principles of deontic logic, as the Kant Principle and the Agglomeration Principle. On the other hand, the theories of experientialist nature, which most interest this work, are those that accept the genuineness of moral dilemmas and admit the existence of the Inescapable Moral Wrongdoing. Therefore, some make use of the Remainder Thesis (TR), to which this work is affiliated. This theory states that in some specific moral dilemmas, even though the rational moral deliberation has been followed, the agent will suffer from feelings of regret, due to an emotional remainder concerning the duty that was not fulfilled or a violated value. Thus, according to the Remainder Thesis, the best explanation for this remainder and feelings of regret is the Inescapable Moral Wrongdoing theory. Therefore, the term "wrongdoing" is used in the sense of violating important moral values for the agent, and not in the sense of violating correct moral deliberation conclusions. To systematize the discussion, in a third moment, this study focuses on providing a definition capable of including the specific cases of moral dilemmas with inescapable moral wrongdoings (Definition of Moral Dilemmas with Inescapable Moral Wrongdoings - MDIMW). Moral dilemmas of serious severity are included in this definition, ones with a high moral cost to the agent, which are able to hurt the agent s moral sensibility and generate strong feelings of grief, which can lead to serious psychological trauma. The example of Sophie s Choice plays a crucial role in this discussion, while it fits the MDIMW. Finally, it is brought to the discussion the concept of "moral injury", recent term used in psychiatry to refer to situations of difficult moral choices usually faced by former war combatants. Certain serious moral choices faced by these agents would be able to generate "moral injury" to their moral codes, become risk factors for the manifestation of traumas and, in more serious cases, Post-Traumatic Stress Disorder (PTSD). Thus, analyzing the relationships between moral choices of serious severity, inescapable moral wrongdoings, trauma and the possibility of its overcoming, are the main objectives of this study. / A presente tese de doutorado aborda o tema dos dilemas morais, especificamente dilemas de séria gravidade. Estes dilemas específicos são analisados buscando-se conectar aos mesmos a tese do erro moral inevitável e à situação de trauma psicológico vivida pelo agente. Em um primeiro momento, expõem-se exemplos da literatura e da filosofia capazes de ilustrar e explicar tais situações. Tais exemplos são a Escolha de Sofia, de William Styron, o diálogo entre Sócrates e Céfalo, no livro I da República de Platão e o caso do aluno de Sartre, em O Existencialismo é um Humanismo. Em um segundo momento, o trabalho objetiva realizar algumas distinções importantes entre tipos de dilemas morais, a saber: solúveis, insolúveis e simétricos. São expostas as principais teorias que se ocupam da solução de dilemas morais, divididas entre teorias racionalistas e experiencialistas . As primeiras são analisadas para que fique demonstrado que não aceitam dilemas morais genuínos e, tampouco, a tese do erro moral inevitável, oferecendo soluções para dilemas morais difíceis e até mesmo simétricos, fazendo uso de princípios da lógica deôntica, como o Princípio de Kant e o Princípio de Aglomeração. Por outro lado, as teorias de cunho experiencialista, que mais interessam a este trabalho, são aquelas que aceitam a genuinidade dos dilemas morais e admitem a existência do erro moral inevitável. Para tanto, algumas fazem uso da Tese do Resquício (TR), à qual este trabalho se filia. Tal tese afirma que em alguns dilemas morais específicos, mesmo que a deliberação moral racional tenha sido seguida, o agente sofrerá de sentimentos de pesar, devido a um resquício emocional relativo ao dever não cumprido ou valor violado. Dessa forma, partindo-se da Tese do Resquício, defende-se que a melhor explicação possível para este resquício e os sentimentos de pesar correlatos é a tese do erro moral inevitável. Assim, utiliza-se o termo erro no sentido de violar valores morais importantes para o agente e não no sentido de violar conclusões de deliberação moral corretas. Para sistematizar a discussão, em um terceiro momento, este trabalho se concentra em oferecer uma definição capaz de abarcar os casos específicos de dilemas morais com erros morais inevitáveis (Definição de Dilemas Morais com Erros Morais Inevitáveis DMEMI). São incluídos em tal definição dilemas morais de séria gravidade, com custo moral alto para o agente, capazes de ferir sua sensibilidade moral e gerar fortes sentimentos de pesar, capazes de levar a traumas psicológicos sérios. O exemplo da Escolha de Sofia desempenha papel crucial nessa discussão, ao encaixar-se em DMEMI. Por fim, é trazido à discussão o conceito de dano moral , termo recente utilizado pela psiquiatria para se referir a situações de escolhas morais difíceis enfrentadas geralmente por ex-combatentes de guerra. Determinadas escolhas morais graves enfrentadas por estes agentes seriam capazes de gerar danos morais aos seus códigos morais e serem fatores de risco para manifestação de traumas e, em casos mais sérios, de Transtorno de Estresse Pós-traumático (TEPT). Assim, analisar as relações entre escolhas morais de séria gravidade, erro moral inevitável, trauma e a possibilidade de sua superação, são os principais objetivos deste trabalho.

Society and technology are advancing, in which morality is being artificially implemented into machines, often known as artificial moral agency. Along with this implementation, knowledge about the underpinnings of morality, such as the neurocognitive and ethical basis are an important matter. Human moral judgment has been speculated to be a function for survival, as it favors altruism and prosocial behavior. The neural correlates of moral judgment stem from several structures of the human brain that control cognitive and affective functions such as decision making, cognitive control, theory of mind (ToM) and empathy. In relation to these, the ventromedial prefrontal cortex (vmPFC) has been widely linked to moral behavior such as ToM and moral judgment. The anterior cingulate cortex (ACC) has been linked to regulation of conflict and the dorsolateral prefrontal cortex (dlPFC) to remain cognitive control, which both have strong correlations to moral behavior. Damage to areas such as the vmPFC and ACC have demonstrated abnormal response to guilt, ToM, empathy, risky behavior as well as sociopathic tendencies, which emphasizes the importance of these structures for human morality. By investigating research in the fields of cognitive neuroscience, moral psychology and machine ethics, this thesis aims at seeking out the importance of cognitive neuroscience for the development of artificial moral agency and to furthermore discuss the necessity of emotions in artificial moral agents, which naturally lack the affective part of moral judgment. Lastly, this thesis will cover some of the main dilemmas with this integration and some future implications.

Morality has been a subject of study for centuries, though there is still much that is not understood about the factors that dictate moral decision making and moral identity. This study examines the relationship between the Big Five Personality traits (agreeableness, openness, neuroticism, conscientiousness, and extraversion) as well as empathy and moral decision making. However, we use a slightly different methodology than previous studies on morality and personality by incorporating more relevant moral dilemmas related to the ongoing COVID-19 pandemic in addition to the purely hypothetical dilemmas used in previous research (referred to as standard dilemmas). Additionally, rather than considering only the response to the dilemma as variable, this study also explored the relationship between these personality traits and the guilt felt by the decision made as well as how difficult participants felt it was for them to make the decision. The results suggest that there is a relationship between certain aspects of personality and the guilt felt by moral decisions as well as how difficult one finds making a decision. Additionally, the results imply that the relevance of the dilemma does significantly impact moral dilemma decisions and the feeling associated with such decisions.