Purpose (1) To explore the role of native voice and effects of voice loss on self-concept and identity, and survey the state of assistive voice technology; (2) to establish the moral case for developing personalized voice technology. Methods This narrative review examines published literature on the human significance of voice, the impact of voice loss on self-concept and identity, and the strengths and limitations of current voice technology. Based on the impact of voice loss on self and identity, and voice technology limitations, the moral case for personalized voice technology is developed. Results Given the richness of information conveyed by voice, loss of voice constrains expression of the self, but the full impact is poorly understood. Augmentative and alternative communication (AAC) devices facilitate communication but, despite advances in this field, voice output cannot yet express the unique nuances of individual voice. The ethical principles of autonomy, beneficence and equality of opportunity establish the moral responsibility to invest in accessible, cost-effective, personalized voice technology. Conclusions Although further research is needed to elucidate the full effects of voice loss on self-concept, identity and social functioning, current understanding of the profoundly negative impact of voice loss establishes the moral case for developing personalized voice technology. Implications for Rehabilitation Rehabilitation of voice-disordered patients should facilitate self-expression, interpersonal connectedness and social/occupational participation. Proactive questioning about the psychological and social experiences of patients with voice loss is a valuable entry point for rehabilitation planning. Personalized voice technology would enhance sense of self, communicative participation and autonomy and promote shared healthcare decision-making. Further research is needed to identify the best strategies to preserve and strengthen identity and sense of self.
This narrative symposium illuminates the problem of clinician moral distress. NIB editorial staff and narrative symposium editors, Cynda Rushton, PhD, RN, FAAN and Renee Boss, MD, MHS, developed a call for stories, which was sent to several list serves and posted on Narrative Inquiry in Bioethics' website. The request for personal stories from inter-professional healthcare providers asked them to: identify specific clinical situations that give rise to moral distress; discuss the sources of this distress; reflect on how they experienced moral distress-physically, psychologically, socially, or spiritually; assess how they managed their situations; and offer suggestions for avoiding future problems of a similar nature. Twelve stories are found in the print version of the journal and an additional eight supplemental stories are published online only through Project MUSE. The clinicians describe a wide range of experiences with patients, other clinicians, and their own professional and personal identities. Embedded in each of the narratives are deeply felt emotions that accompany their experiences of moral distress. Katherine Brown-Saltzman (a nurse), Alisa Carse (a philosopher), Zhanna Bagdasarov and Shane Connelly (industrial-organizational psychologists), and Nancy Berlinger (a bioethicist) provided commentaries.
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