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PubMed2001

Is gratitude a moral affect?

Gratitude is conceptualized as a moral affect that is analogous to other moral emotions such as empathy and guilt. Gratitude has 3 functions that can be conceptualized as morally relevant: (a) a moral barometer function (i.e., it is a response to the perception that one has been the beneficiary of another person's moral actions); (b) a moral motive function (i.e., it motivates the grateful person to behave prosocially toward the benefactor and other people); and (c) a moral reinforcer function (i.e., when expressed, it encourages benefactors to behave morally in the future). The personality and social factors that are associated with gratitude are also consistent with a conceptualization of gratitude as an affect that is relevant to people's cognitions and behaviors in the moral domain.

Affect↗
PubMed1999

Acute care nurses' experiences of moral certainty.

Moral certainty is a common, vivid experience for many nurses, but it may be a mixed blessing. From one perspective moral certainty provides comfort for the ethical decision-maker and may prompt necessary action which would have been impossible without it. From another perspective, moral certainty stifles dialogue and in-depth discussion of moral issues. Despite the fact that moral certainty is ubiquitous in health care, few research studies have explored both the positive and negative aspects of this complex and sometimes troubling concept. A qualitative design was used to describe the experiences of 20 acute care nurses with moral certainty. They were interviewed and the interviews analysed using Colaizzi's method for qualitative data analysis. These nurses' primary responses to moral certainty were 'speaking up', 'standing up' and 'refusing to participate'. Their experiences with moral certainty, responses to it, reasons for responding as they did, and clinical prompts are described. The author concluded that moral certainty may have positive and negative aspects. Making an effort to hear alternative views is suggested.

Adult↗
PubMed2001

Development and evaluation of a moral distress scale.

AIM OF THE STUDY: This methodological research developed and evaluated the moral distress scale from 1994 to 1997. BACKGROUND/RATIONALE: Although nurses confront moral questions in their practice daily, few instruments are available to measure moral concepts. The methodological design used a convenience sample consisted of 214 nurses from several Unites States hospitals. The framework guiding the development of the moral distress scale (MDS) included Jameton's conceptualization of moral distress, House and Rizzo's role conflict theory, and Rokeach's value theory. Items for the MDS were developed from research on the moral problems that nurses confront in hospital practice. The MDS consists of 32 items in a 7-point Likert format; a higher score reflects a higher level of normal distress. RESULTS: Mean scores on each item ranged from 3.9 to 5.5, indicating moderately high levels of moral distress. The item with the highest mean score (M=5.47) was working where the number of staff is so low that care is inadequate. Factor analysis yielded three factors: individual responsibility, not in the patient's best interest, and deception. No demographic or professional variables were related to moral distress. Fifteen percent of the nurses had resigned a position in the past because of moral distress. CONCLUSION: The results support the reliability and validity of the MDS.

Adult↗
PubMed2003

Changes in the components of moral reasoning during students' medical education: a pilot study.

INTRODUCTION: Many authors are concerned by students' moral reasoning not developing normally during medical education. AIM: This study is concerned with how the components of student' moral reasoning are affected by their medical studies. METHODS: Ninety-two medical students were tested on entry into first year and on finishing third year, to determine evolutionary changes in their moral reasoning. Changes in their use of arguments specific to each stage of moral development were measured. RESULTS: Significant changes were observed in the weighted global score (-18.14 +/- 59.17, P = 2.8%). Changes in global score correlated with changes in stages of moral reasoning. The multivariate structure of moral reasoning was reorganised into two principal components, which, respectively, explained almost 82% (first year) and 72% (third year) of the total variability in scores. Moral reasoning stages characterized by law-and-order and social-contract/legalistic orientations proved important for explaining the variability in students' moral reasoning at the start of medical training, while instrumental-relativist and interpersonal-concordance orientations explained variability post third year. CONCLUSIONS: Students restructure their handling of ethical questions by using arguments with more instrumental-relativist and interpersonal-concordance orientations, rather than those of the more desirable law-and-order or social-contract/legalistic type. To assess better the skills required for moral reasoning, a more sophisticated approach is needed than that of a simple measure of improvement/stagnation/deterioration.

Adult↗
PubMed2001

Regulating moral dissent in an open society: The Dutch experience with pragmatic tolerance.

In pluralistic modern societies, moral dissent will, to an increasing extent, be an inescapable fact in our lives. Moral dissent, however, involves various serious dangers: escalation of conflicts, the use of violence, flourishing of radical extremism and even civil war. There are basically two ways in which these threats can be addressed: coercive enforcement of consensus or tolerance. First, we could try to eliminate moral dissent by using more dictatorial forms of consensus formation, like propaganda, indoctrination and terror. This, however, would endanger or even destroy the open society. Therefore, from a moral point of view, tolerance appears to be the more desirable antidote to the unwanted effects of moral dissent. This paper aims to contribute to the discussions about the regulation of moral dissent and the formation of moral consensus by analyzing one of the most important and idiosyncratic elements of the Dutch way of handling these issues: pragmatic tolerance. First, some general thoughts are developed about moral consensus, moral dissent and tolerance as a means of regulating dissent. In addition, the characteristic Dutch policy of pragmatic tolerance is described. Finally, some of the pros and cons of pragmatic tolerance are analyzed from an ethical perspective.

Attitude to Health↗
PubMed2001

The impossibility of a morality internal to medicine.

After distinguishing two different meanings of the notion of a 'morality internal to medicine' and considering a hypothetical case of a society that relied on its surgeons to 'eunuchize' priest/cantors to permit them to play an important religious/cultural role, this paper examines three reasons why morality cannot be derived from reflection on the ends of the practice of medicine: (1) there exist many medical roles and these have different ends or purposes, (2) even within any given medical role, there exists multiple, sometimes conflicting ends, and, most critically, (3) the ends of any practice such as medicine must come from outside the practice, that is, from the basic ends or purposes of human living. The paper concludes by considering whether these ends external to medicine are universally part of the moral reality or whether they are socially constructed. The paper argues that, even if various cultural accounts of the common, universal morality are 'socially constructed,' they may, nevertheless, be reflections, however, imperfect, of a more universal common morality that should be thought of as real. Therefore, the morality of medicine must come from a more fundamental morality external to medicine. That external morality will be socially constructed, but may nevertheless reflect an underlying common morality.

Ethics, Clinical↗
PubMed1976

A re-examination of widowhood and morale.

Previous research has suggested widowed status to be associated with lower morale or life satisfaction. The effects of marital status on morale relative to five covariates (health, income, age, family interaction, and employment status) were examined with 232 widowed and 363 married women aged 45-74, drawn in a multistage stratified area probability sample of Los Angeles County. Analysis of covariance was utilized with a six-item, factor analyzed measure of morale. Parallel analyses were performed for each of three ethnic groups (blacks, Mexican-American, and white) to examine specific ethnic patterns. In the total sample, poor health was associated with significantly lower morale among widowed than among married women. The analysis with age showed the widowed group catching up and surpassing their married peers on morale at higher ages. Controlling for income and employment status eliminated differences between the marital status groups on morale scores. Higher family interaction was positively associated with morale in both groups, but married women were consistently higher on morale regardless of level of interaction. Most ethnic differences were not significant, but family interaction appeared to be crucial among Mexican-American widows. The findings suggest that lower morale scores found among the widowed may be partly attributable to other factors commonly associated with this status and not due to the role of widowhood per se.

Age Factors↗
PubMed2001

The moral foundation of the clinical duties of care: needs, duties and human rights.

It has become fashionable to question attempts to derive internationally agreed duties of clinical care from more general theories of human rights. For example, some argue that such attempts risk moral abstraction through their neglect for the importance of culture and community in shaping moral consciousness and thus often unhelpful in the resolution of concrete moral dilemmas within medicine. Others denounce the importance of general moral principles altogether in bioethics and attempt to articulate what are claimed to be more practical approaches to resolving moral conflict. This paper challenges such arguments. It does so through arguing that: i) all humans everywhere have the same basic human needs; ii) the satisfaction of these needs varies with culture; iii) the imputation of moral duties on others entails respect for their right to basic need satisfaction, including the right to choose between presumptions about the duties and rights of patients which follow from these more general principles and v) problems of moral indeterminancy that arise from putting these principles into practice can be resolved through associated procedural policies of rational negotiation and compromise. The moral importance and practicality of respect for individual human rights within the practice of medicine is thus defended. Indeed, the paper concludes by arguing that without belief in human rights linked to a theory of basic human needs, communitarian theories of morality are incoherent.

Cultural Diversity↗
PubMedDate not supplied

Brazilian adolescents' prosocial moral judgment and behavior: relations to sympathy, perspective taking, gender-role orientation, and demographic characteristics.

The goal of this study was to examine demographic and individual difference variables that predict level of prosocial moral judgment and self-reported prosocial behavior and to test mediating or moderating relations among predictors. The relations of prosocial moral reasoning and self-reported prosocial behavior to perspective taking, sympathy, age, sociometric status, and gender-role orientation were examined with a sample of 149 Brazilian adolescents who completed a series of questionnaire measures. Prosocial moral judgment was expected to be predicted by both sympathy and perspective taking, whereas sympathy or prosocial moral judgment was expected to mediate the relations of femininity and perspective taking to prosocial behavior. Self-reported perspective taking and sympathy interacted when predicting prosocial moral judgment; adolescents who were high in either sympathy or perspective taking (or both) scored high in prosocial moral reasoning. A feminine orientation predicted sympathy and perspective taking, perspective taking predicted prosocial moral reasoning and sympathy, and sympathy had both direct and indirect paths (through moral judgment) to prosocial behavior. The findings generally were consistent with the contention that both the tendency to take others' perspectives and to sympathize are related to level of prosocial moral reasoning, which in turn motivates prosocial behavior. Moreover, patterns of correlations among variables were similar to those found in the United States.

Adolescent↗
PubMed1989

A longitudinal study of moral reasoning.

Several issues concerning Gilligan's model of moral orientations and Kohlberg's models of moral stages and moral orientations were examined in a longitudinal study with 233 subjects (from 78 families) who ranged in age from 5 to 63 years. They participated in 2 identical interviews separated by a 2-year interval. In each interview, they discussed hypothetical dilemmas and a personally generated real-life dilemma, which were scored for both moral stage and moral orientation (both Gilligan's and Kohlberg's typologies). Results revealed few violations of the stage sequence over the longitudinal interval, supporting Kohlberg's moral stage model. Sex differences were almost completely absent for both Gilligan's and Kohlberg's moral orientations, although there were clear developmental trends. Hypothetical and real-life dilemmas elicited different moral orientations, especially in terms of Kohlberg's typology. The interrelations between the 2 models of moral orientations were generally weak, indicating that they are not synonymous.

Adolescent↗
PubMedDate not supplied

Moral development and reproductive health decisions.

This article reviews the concepts of biomedical ethics, the justice perspective, and the care perspective of moral development and moral decision making; integrates key aspects of each to women's reproductive health nursing practice; and gives examples of application of these models to use as a framework for the assessment of moral development in guiding women in making reproductive health decisions. Emphasis is placed on the need for an integrated approach to assessment of the recognition of and response to what an individual identifies as a moral dilemma. Discussion of two different perspectives, justice and caring, is presented with application to women's health concerns. Nurses are encouraged to assess their moral development and appraisal of issues that constitute moral dilemmas and their ensuing decision making processes and those of clients. Techniques for obtaining information about moral reasoning are suggested. Rather than a traditional framework for the assessment of moral development, the uniqueness of individual women's experiences as they pertain to the case context is recommended to assess the client's appraisal of the circumstances of a perceived moral situation from the client's vantage point.

Attitude of Health Personnel↗
PubMed2001

An fMRI investigation of emotional engagement in moral judgment.

The long-standing rationalist tradition in moral psychology emphasizes the role of reason in moral judgment. A more recent trend places increased emphasis on emotion. Although both reason and emotion are likely to play important roles in moral judgment, relatively little is known about their neural correlates, the nature of their interaction, and the factors that modulate their respective behavioral influences in the context of moral judgment. In two functional magnetic resonance imaging (fMRI) studies using moral dilemmas as probes, we apply the methods of cognitive neuroscience to the study of moral judgment. We argue that moral dilemmas vary systematically in the extent to which they engage emotional processing and that these variations in emotional engagement influence moral judgment. These results may shed light on some puzzling patterns in moral judgment observed by contemporary philosophers.

Brain↗
PubMed1977

A comparison of four measures of moral reasoning.

Kohlberg's Moral Judgment Scale, Gilligan et al.'s Sexual Moral Judgment Scale, Maitland and Goldman's Objective Moral Judgment Scale, and Hogan's Maturity of Moral Judgment Scale, were examined for reliability and inter-scale relationships. All measures except the Objective Moral Judgment Scale had good reliabilities. The obtained relations between the Moral Judgment Scale and the Sexual Moral Judgment Scale replicated previous research. The Objective Moral Judgment Scale was not found to validly assess the Kohlberg stages. The Maturity of Moral Judgment Scale scores were strongly related to the subjects's classification on the Kohlberg stages, and the scale appears to offer a reliable, quickly scored, and valid index of mature thought, although the scale's continuous scores do not permit clear stage classification.

Adult↗
PubMed2002

Sex and racial differences in preference for a caring morality in a corporate environment that promotes diversity and equal opportunity.

This study investigated the caring moral perspective of managers in a corporation recognized as being a champion of promoting diversity and equal opportunity. Caring is described as a morality of responsibility and relationship, a sensitivity to the needs of persons. The study was based on the prediction that the attachment and caring shown elsewhere to be characteristic of the morality of females would be characteristic of all managers, regardless of sex or race in this kind of corporate environment. 121 male and female, African-American and Euro-American managers responded to a survey using three subscales of a Caring Morality Inventory: caring orientation, use of intuition and feeling to make a judgment, and concern with others in decision-making. Analysis showed female managers, regardless of race, scored significantly higher on the Caring Morality scale than the male managers, supporting other findings of sex differences in caring moral perspective and suggesting that working for a company actively promoting diversity and equal opportunity does not cancel out these differences. In addition, for this study it was assumed that, although African Americans, in general, may have been sensitized to lean more toward a caring morality, any racial differences in caring morality would be cancelled out by the fact that all of the managers work for the same prodiversity and, by assumption, more sensitive company. The Euro-American managers, regardless of sex, actually scored higher on the Caring Morality scale than did the African-American managers, with the difference being attributable solely to the greater tendency of the Euro-American managers to use intuition and feeling to make a judgment.

Adult↗
PubMed2003

Changes in students' moral development during medical school: a cohort study.

INTRODUCTION: The requirements of professionalism and the expected qualities of medical staff, including high moral character, motivate institutions to care about the ethical development of students during their medical education. We assessed progress in moral reasoning in a cohort of medical students over the first 3 years of their education. METHODS: We invited all 92 medical students enrolled at the University of Sherbrooke, Que., to complete a questionnaire on moral reasoning at the start of their first year of medical school and at the end of their third year. We used the French version of Kohlberg's Moral Judgment Interview. Responses to the questionnaire were coded by stage of moral development, and weighted average scores were assigned according to frequency of use of each stage. RESULTS: Of the 92 medical students, 54 completed the questionnaire in the fall of the first year and again at the end of their third year. The average age of the students at the end of the third year was 21 years, and 79% of the students included in the study were women. Over the 3-year period, the stage of moral development did not change substantially (i.e., by more than half a stage) for 39 (72%) of the students, shifted to a lower stage for 7 (13%) and shifted to a higher stage for 8 (15%). The overall mean change in stage was not significant (from mean 3.46 in year 1 to 3.48 in year 3, p = 0.86); however, the overall mean change in weighted average scores showed a significant decline in moral development (p = 0.028). INTERPRETATION: Temporal variations in students' scores show a levelling process of their moral reasoning. This finding prompts us to ask whether a hidden curriculum exists in the structure of medical education that inhibits rather than facilitates the development of moral reasoning.

Adult↗
PubMed2006

Separation-survivability--the elusive moral cut-off point?

Act 92 of 1996, the Choice on Termination of Pregnancy Act, seeks to promote female autonomy. The Act makes no reference to the nature of the abortus--implying its moral insignificance. Utilitarian arguments on the value of life strongly support this position. Utilitarians argue that neither belonging to the human species, nor possession of the potential to develop into a person, is a significant intrinsic characteristic in determining the value of life. For them the entrance requirement to any conception of moral significance is sentience--the ability to suffer. Full moral significance is only accorded to 'persons'. A person is someone who has attained a sufficient level of self-awareness to have an interest in the continuance of its existence. This develops some time after birth. 'Conservatives' argue for conception as the moral cut-off point after which termination is morally unacceptable; 'liberals' hold that there is no such prenatal point. Both of these notions are problematic, as is the notion of sentience. We argue that separation-survivability is the only morally acceptable cut-off point, based on four premises, viz. (i) a particular notion of potentiality; (ii) the inextricable, mutual relationship between human beings and their world (without either, the other cannot exist); (iii) the moral correspondence of the viable fetus and the neonate; and (iv) the moral unacceptability of infanticide. We support a graded position on the value of prenatal human life, and a 'moderate' stance on termination--that notwithstanding possessing some moral significance, other arguments may trump this up to the point of separation-survivability. This seriously problematises 'partial birth' abortion, and the utilitarian argument on the value of life.

Abortion, Legal↗
PubMed1989

[Development of a moral consciousness in medical schools].

In the conditions of developed socialism, changes in social consciousness are also reflected in one of its forms - the morals. The problems of moral education as an inseparable part of communist education is coming to the foreground. It plays its role in all the stages of the education system, having its unsubstitutable place also in the conditions of universities and technical colleges, the faculties of medicine not excluding. It is its task to form the personality of the student and graduate, to make them, among others, acquire the moral codex of a builder of communism (habits of moral behaviour in professional activities - medical ethics). Such crucial situations must be found that are of cardinal importance for the formation of the medical student's moral profile (transition from the secondary school to university, entering the clinic, meeting the patient, running health institutions, positive and negative influences in the health service). The student must live the moral situation, obtain the experience from moral acting on his own self and be an active participant in the events creating his moral qualities, primarily in collective conditions. We stress the necessity of engagement - mobilisation of students to all-round social activities, connection of the theoretical findings of marxist ethics with their particular problems and actual activities. A special accent is laid on the method of personal example, the moral example of the university teacher himself, in the first place his authority based on all the progressive components of his personality.(ABSTRACT TRUNCATED AT 250 WORDS)

Communism↗
PubMed1993

Metacognitive aspects of moral reasoning and behavior.

This study explored the notion that the development of moral reasoning and moral behavior may be linked to metacognition. The awareness of moral processes involved in moral reasoning and behavior was examined in 139 adolescents in three age groups. A number of significant moral metacognition-reasoning-behavior correlations were found. Intercorrelations for all dependent measures increased by age. A factor analysis revealed several components of moral metacognition (person, task, and strategy variables), and these were significantly related to increases in moral reasoning and behavior scores. More important, a contingency analysis supported the notion that specific types of metamoral knowledge (e.g., understanding the purpose, scope, and requirements of moral action) are related to high and low moral reasoning and behavior.

Adolescent↗