Daniel Tigard on Moral Distress in Medicine

Hi, I’m Steve Latham at the Yale Interdisciplinary
Center for Bioethics, and I am speaking now with Daniel Tigard. Daniel is teaching in our summer institute. Why don’t you tell us a little bit about your
educational background. So, my background is in Philosophy, my BA
was from the University of Washington in Seattle, and then I went to do my master’s at Brandeis
University, just outside of Boston. And then down to Tulane in New Orleans where
I just finished up my PhD on the issue of moral distress in medical practice. And, say a little bit more about moral distress
for those who might not be familiar with it. Yes, it’s typically addressed in the nursing
literature, though I do take it to be a broader phenomenon, it’s often associated with a lot
of undesirable effects, namely shortages of healthcare professionals. And what I wanted to do was provide an account
of what moral distress might be by invoking some theories about the moral emotions, and
then I also wanted to challenge some of the prevailing assumptions that moral distress
is purely a negative phenomenon, and so there I wanted to invoke some contemporary theories
about moral responsibility, and really investigate what it means for someone to experience moral
distress. Because it also seems to me that it’s not
just a bad thing, but it might also tell us something important about our character. So, what’s a paradigm case of someone undergoing
moral distress? Well, typically in the literature, we see
things like a healthcare practitioner who’s unable to do what they believe to be morally
right – it might be due to some sort of institutional constraint. So, it looks like they’re facing some sort
of moral conflict in the sense that they’re forced to do something they believe to be
wrong, and it’s this sort of phenomenon that causes a great deal of suffering. So, practitioners are often cited as losing
sleep at night and leaving the profession entirely because of this, and so I try to
walk a pretty fine line in my dissertation between saying — trying to recognize the
negative effects, while at the same time recognizing that the experience of moral distress itself
might indicate that we are morally sensitive creatures. That we have good enough character to be distressed
by these kinds of circumstances? Precisely, yes. So, what is happening next for you, academically,
in your career? So I’ve recently been accepted as a two-year
post-doctoral researcher at a German University by the name of Aachen, so the project that
I’ll be working on there for two years is also on moral responsibility with respect
to emerging technologies, so I have things in mind like autonomous weapons, social robots,
our use of big data in domains like healthcare and social media. What I have seen in a lot of very recent literature
is a concern for moral responsibility for emerging technology and often skepticism that
we can have anything like moral responsibility in these domains, and so it occurred to me
that some work needs to be done trying to carve out what that might mean to have anything
like moral agency with our use of technology, and how if at all we can have responsibility
when it comes to those domains. So, what are you teaching in our Summer Institute? Yeah, so I teach a seminar on responsibility
and moral conflicts, and so this does speak a lot to my dissertation with respect to establishing
what it means to be a morally responsible agent, and then we turn to kind of a range
of different sorts of conflicts, so we look at moral dilemmas, the problem of dirty hands,
and cases of moral luck, and it looks like all of these sorts of conflicts might somehow
undermine our status as morally responsible agents, so the question then is what do we
do, and to what extent are we still morally responsible for those actions in decisions
that we make in those really difficult decisions. That’s how I set up the course. Do you look at literature of moral emotions? Yes, so that kind of neo-David Hume literature
on the sentiments and their role in determining our responsibility practices. And how do you find the students? The students are wonderful! One of the things I really appreciate about
the students here – I mean they are coming from all different backgrounds in terms of
their academic fields, we get to interact with those who are coming from more philosophical
backgrounds, we’ve also got the more practically minded who are either in med school or are
already practicing medicine and want to think more about the ethics of their practice, of
course we’ve got law students, and so I just like the very dynamic interactions that we
have. And I like that they’re coming from all around
the world, so I get to connect with people from all around the world, and then develop
colleagues and really develop some meaningful relationships. I’m smiling because, I ask this question of
everyone, and everyone says exactly the same thing. It’s true! And it is just true. How about the colleagues that you have here? You’ve been working with people here? I have. So, one colleague that I’ve met here works
at a hospital down in Israel and since I’ve been living in Vienna, I’ve meaning to make
a trip down there to see him, and he’s recently invited me to speak on the issue of moral
distress to some of his colleagues at the hospital there, so that’s certainly something
I intend to take him up on. Then there’s also Olya Kudina who works in
areas that are very similar to my upcoming project on technology and the ethics in emerging
technology, so we’ve had some very fruitful discussions, and I can definitely imagine
those will continue beyond here. And she is located at Twente [University]
which is very close to Aachen, so you will be able to see each other. Yes, right across the border. In fact I understand she is organizing a conference,
an upcoming conference, so we’ll all be able to share some ideas that we’ve been talking
about here and carry those forward. Great! And so what brings you back? This is your second time teaching the program. Yeah, that’s right, second, and I hope to
continue that. So, why, what’s the big benefit for you? Yeah, there’s just such a positive, productive
atmosphere, I just feel like everyone here really wants to be here and everyone’s always
just consistently excited to interact with each other and so it’s inspiring! It really gets me to want to work more on
my own work, but also just engage with others and see what they are working on because I
find it personally enriching and inspiring. I have to agree because with my job, as with
lots of peoples’ jobs in Bioethics, if you’re a university bioethicist you are often the
only one, or maybe not the only one, but one of very few, and it’s very unusual to have
– in my case – thirty or so international colleagues who work in Bioethics to come through
in a couple of the summer months, it’s really an amazing kind of gang to get to be a part
of. And it’s terrific that we now have so many
people coming back year after year. It’s really becoming a solid community of
a lot of the really great, leading, mostly junior scholars in the area from around the
world, so it’s very exciting. It’s nice to establish those relationships
at this point in our careers because I see a lot of young scholars that are just going
in so many awesome directions, and so it’s going to be really fun to see where everyone
takes their careers, and so it’s nice to have these relationships established at this point. Well, congratulations, I know Aachen is very
recent, so that’s a wonderful opportunity you’ve got, congratulations on that. Thanks for sitting and being interviewed! I’m glad to be here! Thanks.

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