Powerlessness and moral dilemma

Leviathan Press:

There are two sailors, A and B, who are shipwrecked. They both see a plank that can only support one person and try to swim to it. A swims to the plank first and climbs on it. When B arrives, he pushes A off the plank and lets himself climb on it when he is about to drown. In the end, A drowns and B is rescued by the search and rescue team. Should B be convicted of murder? The above is a thought experiment conceived by the ancient Greek scholar Carneades. There are many examples of moral dilemmas like this, such as the "Queen v. Dudley and Stephens" case, which is very famous in the Anglo-American legal system because a crew member was eaten in order to survive. Does moral behavior come from formal reasoning? Social intuitionists probably don't think so - in many cases, people often don't care about justice, law, human rights and abstract ethical values ​​when making moral judgments. In any case, we often face this kind of ethical dilemma. How to have some basic psychological construction and thinking framework may be a question that everyone should consider. "Do not look at what is not proper, do not listen to what is not proper, do not speak what is not proper" is a proverb that has been passed down for a long time (in Eastern civilization). This was inspired by the Japanese sculpture "Three Monkeys": three monkeys, one blindfolded, one covering his ears, and one covering his mouth. (Translator's note: This sentence from "The Analects of Confucius·Yan Yuan" was introduced to Japan around the 8th century, forming the "Three Monkeys" culture with Japanese characteristics) In the West, this sentence is often used to teach people not to look at things that violate the law and morality, but its original meaning is that people should always abandon evil thoughts and actions.

But what do we do when we find ourselves in a place where we can’t hide from “evil”? What do we do when we have to see, hear, or are powerless to turn away? What if our choice to speak out or confront evil poses a direct threat to ourselves or to the people and things we love?

When life forces us to choose between two "mistakes" or dilemmas, and either choice would betray the core values, obligations and commitments we firmly believe in, what should we do? How do we make these so-called "choices"? Or to go further, how do we coexist with these "mistakes"? Are they our own sins or are they set up by others?

The concept of “moral dilemma”

In 1984, philosopher Andrew Jameton first proposed the concept of "moral dilemma", which describes the situation in which nurses are unable to do what they think is right due to institutional and system limitations, especially when it comes to fundamental moral standards and ethical responsibilities.

In a world swept by the COVID-19 pandemic, the pressure of ethical dilemmas on today's medical workers and those who bear the brunt of public health events is unprecedented. But they are not alone. In 2020, the serious threat to global health and the strong shock to the social, political and economic development brought by the epidemic have forced many people to face some difficult moments of ethical dilemmas. Sometimes, if there is another choice, what was previously considered ethical may be different from the actions a person would instinctively choose and take.

Examples include:

Parents are faced with the dilemma of whether to send their children to school or not, and to teach them at home. Americans’ personal values ​​and beliefs conflict with state and national safety regulations (or the lack of them). Small businesses have to close their doors to cut losses despite their fiduciary duties to their employees and their families. Families need secure housing, but are unable to support it due to unemployment or other property problems, and have to sell their homes to make ends meet. People certainly want to spend more time with the elderly and with relatives and friends who live alone or are seriously ill, but these are not allowed due to quarantine requirements. We are trapped in social and cultural injustices and at the same time have a vague sense that nothing will change in the future. Our recognized “citizens” and “civic behavior” have undergone structural changes, but we have not allowed these values ​​to be respected at the individual and collective levels. The “other side” that opposes us on social and political issues has launched a life-and-death offensive, and we are powerless to do anything about it. In moral dilemmas, we often feel that we have no words to express our suffering, are restricted, are not valued, are not listened to, or are not understood. We become vulnerable to anger, disgust, fear, and frustration. Over time, these emotions fill our lives with anxiety, exhaustion, and despair. A sense of disillusionment creeps in, raising questions about who we are and what the world is all about. Research also shows that moral distress has lasting effects, such as burnout, exhaustion, numbness, disconnection, and decreased moral sensitivity (also known as compassion fatigue).

(journals.lww.com/ajnonline/Fulltext/2017/02001/Cultivating_Moral_Resilience.3.aspx)(journals.sagepub.com/doi/abs/10.1177/0969733019889400) In healthcare or social service settings, doctors are not the only ones who are troubled by moral dilemmas. Patients can also be negatively affected due to changes in the behavior or attitude of healthcare workers towards care. In our daily lives, this type of calcification can seriously damage interpersonal and doctor-patient relationships. In extreme forms, it can even lead to "normalization."

At the heart of moral dilemmas is powerlessness, the feeling that we must passively or actively compromise or give up something we value because of external factors beyond our control.

How moral dilemmas live with us

Humans are not very good at detecting and responding to threats. Just as with physical threats, psychological and existential threats, or “soul” threats (such as threats to our integrity), can activate the human nervous system, shifting it from a calm and measured state to survival mode. The most primitive part of the brain, the reptilian brain, is always on high alert, constantly scanning the environment for other potential threats, and the body is always ready to respond.

(www.ncbi.nlm.nih.gov/pmc/articles/PMC4406946/)

When this happens, a flood of stress chemicals is released, causing physical, emotional, and cognitive changes. Our heart rate and blood pressure rise, and our muscles tighten. All nonessential functions become dormant. Negative emotions are activated. The proper expression and communication of feelings or needs can become painful and exhausting. Our attention shrinks, becoming increasingly focused on potential threats. Our empathy weakens, interfering with our prosocial behavior and relying more on instinctual, defensive default patterns of thinking and behavior.

(www.sciencedirect.com/topics/social-sciences/prosocial-behavior)

Typically, we take spontaneous actions to cope with and manage this stress in one of three ways: fight (trying to regain control by neutralizing the source of the threat or demonstrating greater power); flight (getting out of the situation by giving up, or mitigating the conflict in a moral dilemma); and freeze (inaction or paralysis; numbing ourselves by “getting through it”; and distraction, denial, or complete detachment from the cause of the dilemma).

Repeatedly experiencing moral dilemmas without ever intervening creates a persistent disorder that accumulates in a very specific sense, in our organizations. In other words, even after any crisis is over, it leaves behind a “moral residue” or “moral stain” (also called the “creeping effect”) that persists in our lives. Like a clogged artery, this moral occlusion can threaten our lives.

Developing moral resilience

Resilience usually refers to the ability to recover or adapt from stress, adversity and trauma; it allows these changes and challenges to promote our lives rather than harm them, and to strengthen our spirits rather than weaken them. This kind of resilience allows us to see that after difficulties, we are not necessarily left with scars all over our bodies, and challenges are only temporary.

Although moral resilience is still a nascent concept, it is related to psychological resilience, but the two are distinct in three ways. Cynda Hylton Rushton, a leading figure in the field of clinical ethics and professor of nursing and pediatrics at the Johns Hopkins University School of Nursing, believes that "moral resilience addresses the moral aspects of human experience, the moral complexity of decisions, obligations, and relationships, and the inevitable moral challenges that trigger conscience, confusion, and moral dilemmas."

Because the moral domain is so closely connected to all aspects of human nature (biologically, psychologically, cognitively, spiritually, and relationally), cultivating moral resilience can benefit us as a whole person as well as on many specific levels.

2021 continues to present itself to us as a challenger. If you also feel that you are struggling in a moral dilemma and want to desperately hold on to your own persistence, the following methods may help you develop moral resilience.

Autonomy: Learning the Art of Self-Management

Autonomy is the present-centered understanding that while we may not be able to control all situations or outcomes, we can always be in control of our body, mind, and spirit. This is about learning how to remain graceful in difficult situations, and we can start by turning our attention inward or training our inner awareness. Inner awareness can help us notice the deeper consciousness hidden beneath the surface, which may contribute to our feelings, thoughts, and actions.

In our inward search, we do not try to eliminate unpleasant emotions or judge them as wrong or weak. We allow them space to tell us what new things we do not know about. We observe and wonder what moral values, obligations or responsibilities we are not fulfilling, how these emotions describe our relationship to the dilemma, and whether there are other ways for us to fulfill these values.

Doing so allows us to regain the inner peace and insight that is so important for maintaining our “window of tolerance” and is key to autonomy. This way, we can always make conscious choices, no matter how difficult, to live out our core values, make principled choices, and take wise, ethical actions. Two ways to explore this inner space are mindfulness practice and titration.

Self-awareness: “To be true to yourself”

Rushton believes that moral resilience is based on a sense of moral responsibility. "When we are in a situation that is contrary to moral justice, a sense of moral responsibility can constantly remind us who we are and what we believe in." This vigilance or desire for morality requires us to fundamentally realize what values, responsibilities and missions truly constitute the core of our morality. It means that we must constantly reflect on ourselves, otherwise there is a risk of complacency and loss of moral sensitivity. At the same time, we are unwilling to become dogmatic and arbitrary.

Self-awareness is a dance of conscious experience that requires us to humbly, carefully, and courageously explore our feelings, thoughts, and desires, an attitude I like to call "compassionate sincerity." We must also be clear and transparent, that is, we are willing to admit when our beliefs may be biased, distorted, short-sighted, or incorrect; at the same time, we must be open to possible changes, revisions, or unexpected results. The ability to be self-aware provides us with space to hold our heads high, open our eyes, relax our shoulders, and strengthen our beliefs, and find possibilities for resolving moral dilemmas at the lowest personal cost.

Self-expression: making choices and contributions with moral purity and competence

There are many ways to express yourself, but when it comes to moral resilience, two methods are particularly effective: developing moral competence and speaking clearly and confidently.

Moral competence involves what Rushton calls moral embodiment, which is our desire to ensure that the truths and beliefs we hold are reflected in our behavior, so that we can demonstrate that we are living out the values ​​we hold. We accumulate and cultivate a moral vocabulary, imagination, attitudes, coherent character, and a vibrant moral posture that immerses us in the "moral" world while being patient, open, and tolerant of the values, needs, hopes, and fears of others.

Speaking clearly and confidently is about expressing our concerns in a way that resonates with others who are also in the same situation. Rather than viewing the moral dilemma as an outcome in itself, it is about seeing it as the beginning of a broader, more substantive conversation about the dynamics of the situation. Speaking clearly and confidently is also about knowing when to excuse ourselves from a situation, system, or relationship, either temporarily or permanently, because the situation may sometimes cause irreparable damage to our moral sense.

Creating meaning: Don’t demand meaning, create meaning

Creating meaning is the process by which we perceive, know, and make sense of our interactions with life, our relationships, and ourselves. It provides us with a way to organize our memories and shape our sense of experience. Meaning also helps reconcile inconsistencies in our values, beliefs, and expectations, as well as our attitudes toward life. This is particularly important in times of moral adversity.

Pointless suffering is a key issue in moral resilience. We often say to ourselves, “Why should I keep ‘doing this’ if nothing can change?” or “I’ve done everything in my power to change, but it’s never enough.” Or “I’m fighting this broken system that’s inherently flawed.” These feelings of discontent can provoke experiences of deep negativity and despair, or they can lay the foundation for further principled action.

One way to create meaning is to reconsider situations that may not have been obvious or that you may have previously dismissed. Think about whether you have overlooked or misunderstood any information. Has your discontent obscured any information? Can you look at the situation more nuanced and from more subjective perspectives?

Furthermore, think about how this situation requires us to grow. Are there any new discoveries and insights about ourselves, others, and life? What are your core strengths? Which weaknesses are rearing their ugly heads? Which values, responsibilities, or moral standards have remained relevant, and which have changed? How do all these meanings coexist with us?

A common mistake when creating meaning is to think that there is a lesson to be learned or a “story to tell us.” It is not. Creating meaning is not about trying to grow happiness in the soil of pain, nor is it necessarily about teaching us to be cautious about reality. Creating meaning is simply about helping us expand our thinking and feeling about moral dilemmas, so that we can act with integrity and principle at all times and move forward.

Connectedness: Staying connected with others

Staying connected to the world is a fact of life. Recent neuroscience research shows that our obsession with relationships is hard-wired: when we talk to other people, mirror neurons in the brain light up to mimic the emotions and behaviors that other people are conveying. Matthew Lieberman, director of the Social Cognitive Neuroscience Laboratory at the University of California, Los Angeles, believes that people's need for relationships is even more basic than food and shelter, and it is the main driving force of people's behavior.

(newsroom.ucla.edu/releases/we-are-hard-wired-to-be-social-248746)

Allowing people we trust to participate and interact with them is an absolute necessity in the process of developing moral resilience. Notice the word “trust” here; it’s key. Sharing challenges, difficult emotions, and frustrations with others makes us feel vulnerable. Moral dilemmas are not a time to test the waters with people we cannot count on to be present, to listen, to show empathy, to express compassion, to offer us compassionate sincerity, and to plant seeds of hope. Feelings of loneliness and despair can be greatly alleviated by knowing that we are not alone in our moral dilemmas.

When we don’t have control, that’s when we want it the most, and when we’re in a moral dilemma, it can be a real feeling of being out of control. When our experience of powerlessness, hopelessness, and helplessness shifts toward a possible, principled choice, it helps mitigate the impact of moral dilemmas and fosters moral resilience.

By Michele DeMarco

Translated by Xixi

Proofreading/Rabbit's Light Footsteps

Original article/elemental.medium.com/that-powerlessness-you-feel-is-called-moral-distress-291795756fff

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