Distresse moral de médicos relacionado à incerteza moral frente às diretivas antecipadas de vontade

Moral-uncertainty-distress (MUD) é o distresse moral relacionado ao conflito sobre qual melhor decisão em situações moralmente complexas. Propomos identificar a relação entre percepção do médico sobre as Diretivas Antecipadas de Vontade (DAV) e MUD, assim como o impacto na tomada de decisão. Neste estudo qualitativo, realizou-se entrevistas semiestruturadas com oito médicos de um hospital em Curitiba-PR tendo por base uma DAV verídica e, posteriormente, submetidas ao método de análise de conteúdo por categorização de Bardin. A primeira categoria identificada, DAV como elementos de conflito moral, revelou atitudes paternalistas por parte dos entrevistados, assim como insegurança por incertezas prognósticas, questionamento das DAV considerando motivações prévias do paciente e pouco conhecimento sobre as DAV. O reconhecimento das DAV como instrumentos de exercício da autonomia do paciente constituiu a segunda categoria encontrada. Apesar da identificação das DAV como ferramentas de autonomia, outros aspectos se mostraram moralmente desafiadores para os médicos entrevistados, sendo potencial fonte de MUD e impactando a tomada de decisão.

Moral distress in midwifery practice: A concept analysis

Research suggests that the incidence of moral distress experienced by health professionals is significant and increasing, yet the concept lacks clarity and remains largely misunderstood. Currently, there is limited understanding of moral distress in the context of midwifery practice. The term moral distress was first used to label the psychological distress experienced following complex ethical decision-making and moral constraint in nursing. The term is now used across multiple health professions including midwifery, nursing, pharmacy and medicine, yet is used cautiously due to confusion regarding its theoretical and contextual basis. The aim of this study is to understand the concept of moral distress in the context of midwifery practice, describing the attributes, antecedents and consequences. This concept analysis uses Rodgers’ evolutionary framework and is the first stage of a sequential mixed-methods study. A literature search was conducted using multiple databases resulting in eight articles for review. Data were analysed using NVivo12©. Three core attributes were identified: moral actions and inactions, conflicting needs and negative feelings/emotions. The antecedents of clinical situations, moral awareness, uncertainty and constraint were identified. Consequences of moral distress include adverse personal professional and organisational outcomes. A model case depicting these aspects is presented. A midwifery focused definition of moral distress is offered as ‘a psychological suffering following clinical situations of moral uncertainty and/or constraint, which result in an experience of personal powerlessness where the midwife perceives an inability to preserve all competing moral commitments’. This concept analysis affirms the presence of moral distress in midwifery practice and provides evidence to move towards a consistent definition of moral distress.

Climate Change, Uncertainty and Policy

While the foundations of climate science and ethics are well established, fine-grained climate predictions, as well as policy-decisions, are beset with uncertainties. This chapter maps climate uncertainties and classifies them as to their ground, extent and location. A typology of uncertainty is presented, centered along the axes of scientific and moral uncertainty. This typology is illustrated with paradigmatic examples of uncertainty in climate science, climate ethics and climate economics. Subsequently, the chapter discusses the IPCC’s preferred way of representing uncertainties and evaluates its strengths and weaknesses from a risk management perspective. Three general strategies for decision-makers to cope with climate uncertainty are outlined, the usefulness of which largely depends on whether or not decision-makers find themselves in a context of deep uncertainty. The chapter concludes by offering two recommendations to ease the work of policymakers, faced with the various uncertainties engrained in climate discourse.

Educational potential of the book by A. A. Magometov “They fought for the Motherland” (Vladikavkaz, 2020, 438 p.)

The relevance of the study is caused by the need for moral and patriotic education of students, who, in the process of revising the value orientations and ideological foundations characteristic of modern society, at the time of active socialization, experience a certain confusion and spiritual and moral uncertainty. In the modern world, under the influence of global ideological and cultural transformations, young people, as more amenable to the slogan of “bread and circuses”, are alienated from the traditional values of humanism, patriotism, citizenship, and the history of their people, becoming “Ivans who do not remember their kinship”. In these conditions, the appeal to the heroic pages of their people, acquaintance with the biographies of the participants of the Great Patriotic War-students and teachers of the North Ossetian State University named after K. L. Khetagurov, should be recognized as an effective form of moral and patriotic education of student youth. The purpose of the work is to substantiate the methods, forms and technologies of spiritual, moral, patriotic and multicultural education of students based on the material of the book by A. A. Magometov “They fought for the Motherland». The methodological basis of the research consists of the theories and practices of spiritual, moral and patriotic education of students, axiological and activity approaches that consider the dominant values of the individual as the activity basis of its socialization, cultural approach that combines the cultures of different peoples into a single cultural palette, the theory of internal and basic culture of the individual and the concept of the development of multicultural education. The research methods used are theoretical (study, comparison and analysis), empirical: observation, study of the experience of patriotic education, psychological diagnosis, systematization of the results obtained.