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.

The central argument of this dissertation is that virtue ethics is overly individualistic. In response, I develop and defend a more relational, ecological account - what I call extended virtues. First, following Andy Clark, Kim Sterelny, and others, I argue that cognition and emotion can be embedded in, scaffolded by, or even extended to include various environmental resources. These arguments undermine default internalism about cognitive and affective processes. Next, I show how recent work in social and personality psychology similarly undermines individualism about the bearers of these cognitive and affective processes. Taken together, these arguments have significant but heretofore underappreciated implications for virtue ethics. After reviewing the literature which attempts to spell out the ethical implications of embedded, scaffolded, and extended cognition, I conclude that a more substantive engagement with virtue ethics is needed. I then show how plausible, mainstream theories of virtue assume default internalism and individualism, and are thus subject to charges of empirical inadequacy. Finally, I formulate my account of extended virtues in response to these shortcomings. I begin by making three explicit arguments for why an account of extended virtues is needed. I then develop two further arguments - the process argument and the bearer argument - which yield the conclusion that the processes relevant to, and the bearers of, moral and intellectual virtues can be embedded, scaffolded, or extended. After providing examples and filling in details about the hypotheses of embedded, scaffolded, and extended virtue, I propose that virtues are less like dispositions and more like relations. I conclude by suggesting that ecological metaphors such as stewardship are more fitting than traditional views of morality as inner strength.

This thesis analyses information disclosure in clinical practice from a legal, ethical and professional perspective. It examines therapeutic privilege, the duty of candour and the application of virtue ethics to truth-telling in nursing practice. I argue that each of these areas requires further clarity, articulation and application in order to assist the decision-making process of health care professionals and improve disclosure practices. In analysing these areas this thesis recognises the context of disclosure practices in relation to respect for patient autonomy and trust in the patient-health care professional relationship. The first published paper at the core of this thesis considers the status of therapeutic privilege in English law and concludes that further clarification is needed to establish its legitimacy. I argue that the shift in English law towards a disclosure standard judged by reference to the reasonable patient requires a doctrine of therapeutic privilege. There are strong ethical arguments in favour of information disclosure, particularly founded on respect for patient autonomy. As such, further clarification is needed to identify and define the grounds on which this exception exists, when the information can lawfully be withheld and how this exception extends to the rest of the health care team, particularly nurses. The second paper examines the ethical and practical considerations that underpin the disclosure of medical errors to patients. This provides a foundation for a discussion of how the law can best support a duty of candour. I argue for the introduction of a statutory duty of candour and analyse the current legal mechanisms and proposals for addressing this issue. The final paper argues that virtue ethics is a useful approach from which to explore decisions relating to information disclosure. Its explicit focus upon moral character, the role of emotion, intention and the importance of practical judgement are considered from the nurse's perspective. This thesis contributes to the dialogue on information disclosure on a number of levels. In terms of methodological approach, it recognises the importance of the synthesis of law and ethics in addressing issues in clinical practice. It uses an interdisciplinary approach, incorporating both legal and ethical perspectives, to examine the substantive questions as well as incorporating reference to empirical research to further underpin its normative claims. Moreover, this thesis considers the nursing perspective in relation to issues of information disclosure to explore the role of the nurse in decision-making regarding disclosure practices.

This dissertation describes a method for constructing a religious environmental ethic modeled on the spiritual practice of lectio divina, or devotional reading. Lectio divina is an explicitly religious way of reading, distinguished from other modes of reading not by what is read--even sacred scriptures can be read for mastery of content, for entertainment, etc.--but by how it is read. In lectio divina, the reader engages the text with a willingness to be transformed by an encounter with the sacred, mediated somehow by the text. This vulnerability is inherent in a religious reading, as is the intimacy implicit in the repeated engagement with the text that is central to the practice of lectio divina. The emphasis on vulnerability and intimacy marks this religious approach to environmental ethics as a form of virtue ethics. Consistent with the traditional insight conveyed by the two-books metaphor, whereby Christians believed God was revealed both in the Book of Scripture and the Book of Nature, I map the classic stages of lectio divina onto a reading not of scripture but of the natural world. Paying attention requires careful observation, the naming and description of relevant details, and awareness and articulation of emotional responses as one repeatedly visits natural settings. Pondering requires a willingness to enter deeply into the religious, scientific, and other sources that help us understand the natural world and our place within it, as well as a willingness to reflect critically upon those sources. Responding calls upon readers of nature to take definite actions that flow out of the previous stages of paying attention and pondering, utilizing knowledge born of familiarity to address environmental challenges while also protecting natural settings in which the unnamable sacred can be encountered. Surrendering involves acknowledging human limits of understanding, will, and action, and nonetheless finding rest and restoration by trusting in some force beyond the merely human. I illustrate this argument with interpretations of literary works by Terry Tempest Williams, thereby asserting the relevance of religiosity to human transformation and to efforts to imaginatively embody human-land relationships that further human and ecological flourishing.

In this thesis I distinguish between two conceptions of naturalism that have been offered as possible starting points for a virtue based ethics. The first version of naturalism is characterized by Philippa Foot’s project in Natural Goodness. The second version of naturalism can be found, in various forms, among the works of John McDowell, Martha Nussbaum, and Rosalind Hursthouse. I argue that neither naturalistic approach is entirely successful on its own, but that we can fruitfully carve a path between both approaches that points the way to a positive ethical account. I then conclude with a brief sketch of what such a positive account of a virtue ethics may look like.

This thesis provides one component of a greater defense of Christian ethical relativism, or the notion that what is a morally allowable action for one Christian may be wrong for another and both could be correct in their assertions. This essay does not develop such a Christian relativism, but merely defends the idea that a relativistic view could be developed in an academically rigorous manner and may be able to explain the diversity of Christian ethical traditions in a simpler manner than that offered by the ethical absolutist. As such, the thesis argues that a relativistic view ought to be developed.

<p>This dissertation begins a conversation between "apocalyptic" interpretations of the Apostle Paul and the contemporary revival in "virtue ethics." It argues that the human actor's place in Pauline theology has long been captive to theological concerns foreign to Paul and that we can discern in Paul a classical account of human action that Alasdair MacIntyre's work helps to recover. Such an account of agency helps ground an apocalyptic reading of Paul by recovering the centrality of the church and its day-to-day Christic practices, specifically, but not exclusively, the Eucharist. To demonstrate this we first offer a critique of some contemporary accounts of agency in Paul in light of MacIntyre's work. Three exegetical chapters then establish a "MacIntyrian" re-reading of central parts of the letter to the Romans. A concluding chapter offers theological syntheses and prospects for future research.</p> / Dissertation

Thesis (M.A.)--University of Central Florida, 2009. / Adviser: Nancy Stanlick. Includes bibliographical references (p. 54-58).

Changes in health care delivery practices are impacting the provision of care in all venues. Occupational therapists working in hospital settings strive to meet professional mandates for occupation-based practice within a medical-model system. Ethical practice is another aspect of service provision vulnerable to contextual influences. The aims of the two studies reported here were to explore occupational therapists’ experiences with occupation-based practice, and with ethical issues, in hospital settings. Grounded theory methods were employed for both studies. Data were collected via individual, semi-structured interviews with 22 participants for the first study. For the second study, nine participants participated in individual, semi-structured interviews, journaling, and follow up interviews. Data analysis resulted in four emergent themes for each study. The main themes of the first study were Occupation-based practice expresses professional identity; Occupation-based practice is more effective; Occupation-based practice can be challenging in the clinic; and, Occupation-based practice takes creativity to adapt. The four themes of the second study were Anything less would be unethical: Key issues; I trust my gut: Affective dimension of ethical practice; Ethical practice is expected but challenging; and, It takes a village. Occupational therapists negotiate challenges inherent in contemporary hospital-based practice to provide occupation-based services and to practice ethically. Occupation-based practice is perceived to be more effective than biomedical approaches to intervention. Therapists must employ creative strategies to overcome challenges presented by medical-model service delivery contexts in order to provide occupation-based interventions. In comparison to other health care professionals working in adult rehabilitation practice, occupational therapists experience both common and unique ethical issues. A discovery of this study was that occupational therapists also experience ethical tensions related to team members’ and families’ sometimes subtle, and less frequently explicit, requests to falsify recommendations in documentation. Experiences with ethical issues include an inherent affective component in the form of moral distress and a strong sense of caring. The impact of systemic/organizational and relational forces is a reality that contemporary occupational therapists must negotiate in order to provide occupation-based and ethical practice.

Recent years have seen an increasing interest in the application of virtue ethics in business as opposed to consequentialist or deontogical ethics. However the focus has often been on virtues at the individual as opposed to the organizational level of analysis.It is proposed that the organisational virtues intermediate individual (leadership) and group level constructs (organisational citizenship behaviours, corporate citizenship) to foster intrinsic motivation through a focus on eudemonia (measured as affective commitment). The overall aim of this study is to test this hypothesis using the Chun (2005) scale of organisational virtues ('Virtue Ethical Character Scale'). In the conceptualisation of the organisational virtues I draw from the Aristotelian virtue ethics tradition as reinterpreted by Alasdair MacIntyre.The study is in the main quantitative using SPSS and AMOS, vs. 16 and it is based on a sample of 643 questionnaires drawn from eight different organisations, including two law firms, the headquarters of an international timeshare company, four hotels and a dairy company. All the organisations are based in the UK, except the timeshare company which is based in Cork, Ireland.The survey questionnaire used for the collection of quantitative data is composed of measurement scales representing each construct which were available in the literature and whose validity and reliability were also tested.The outcome of the study is a structured equation model linking the various constructs in the hypothesised manner, which is then applied in a series of case studies involving the organisations surveyed. The model shows particularly strong path coefficients between transformational leadership behaviours and the organisational virtues, and the organisational virtues and affective commitment. Findings from semi-structured and informal qualitative interviews conducted at the organisations are used to help interpret the results.