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At least 199 records · Page 11Linked to original sources
PubMed2005

"We are white coats whirling round"--moral distress in Swedish pharmacies.

OBJECTIVE: The extended role of pharmacists has made pharmacy practice more complex and increased the moral responsibility of pharmacy staff. Consequently, ethics has become an important part of their daily work. In health care, ethical dilemmas have been shown to cause distress, usually referred to as "moral distress". Moral distress among hospital personnel has been well described and discussed in numerous studies. There are very few similar studies in pharmacy settings. This article reports on the results of an investigation concerning whether and in what situations moral distress is present in pharmacy practice. METHOD: A questionnaire derived from focus group data, covering ethically troubling situations in pharmacy settings, was distributed to all staff of three pharmacies in Sweden. RESULTS: The results show that moral distress is experienced in the day-to-day pharmacy practice, and that it is in many ways connected to care providing. For example, prioritizing between customers was reported as very stressful. Younger personnel reported higher moral distress than their older colleagues did. However, there were no differences between pharmacies. A lack of support structures, such as meetings where ethical issues can be discussed, was reported by all the participating pharmacies. CONCLUSION: It is reasonable to assume that moral distress is even more present in pharmacy practice than in other health care areas as it is, in general, much more sensitive and exposed to the modern, demanding customer. The meeting with the customer is on a more neutral ground than in, for example, a hospital setting. Although there are ethical codes for pharmacists, they are not enough. Moral distress is experienced anyway; general codes and personal coping strategies must be supplemented with support from the management and work organization. There is a need to look more closely at specific factors related to the degree and extension of moral distress, going beyond individual coping strategies.

Attitude of Health Personnel↗
PubMed1993

Moral reasoning in social context.

Scholarly thinking about morality has been deeply affected by the confrontation with practical moral problems epitomized by bioethics. Attention to social context is increasingly seen as vital to sound moral reasoning. The dominant model in bioethics assumes that moral reasoning proceeds downward, from fundamental principles to specific cases. This top-down model, deductivism, is flawed both as a description of moral reasoning, and as a prescription for how moral reasoning should be done. In recent years, another model known as casuistry and based on case-centered moral reasoning has emerged to challenge deductivism. Casuistry suggests new lines of empirical and conceptual research into the history of moral disputes and the practice of moral reasoning and debate.

Advisory Committees↗
PubMed2001

Scientific vs. clinical-based knowledge in psychology: a concealed moral conflict.

Psychology and the other mental health professions are bitterly divided between the proponents of scientific vs. clinical-based knowledge. Though these two groups agree on little related to assessment, treatment or outcome evaluation, they share a belief in the moral neutrality of the knowledge they do possess. It is argued here that this moral neutrality is a myth, and that it is exactly the unacknowledged and incompatible moral positions inherent in clinical and research practices that are at the center of this controversy. The nature of moral problems, the fundamental moral value positions prevalent in our culture, and the specific moral values associated with each side of this schism are explored. While these moral differences may not all be resolved by being recognized and discussed, the process of dialogue can not but help us bridge the current chasm. To this end it is recommended that psychologists and other mental health professionals adopt a "truth-in-moral-packaging" rule that requires both clinicians and scientific researchers to define openly and clearly the moral objectives that infuse their work.

Attitude↗
PubMedDate not supplied

Listening to nurses' moral voices: building a quality health care environment.

In this paper we describe a research project in nursing ethics aimed at exploring the meaning of ethics for nurses providing direct care with clients. This was a practice-based project in which participants who were staff nurses, nurses in advanced practice, and students in nursing were asked to tell us (or describe to us) how they thought about ethics in their practice, and what ethical practice meant to them. We then undertook to analyze, describe and understand the enactment of ethical practice, the opportunities for and barriers to such enactment, as well as the resources nurses need for ethical practice. We drew out implications of these findings for nursing leaders. We identified practice realities that create a climate for ethical or moral distress, and the way in which nurses attempt to maintain their moral agency. Practice realities included nurses' ethical concerns about policies guiding care; the financial, human and temporal resources available for care; and the power and conflicting loyalties nurses encounter inproviding good care. Maintaining moral agency involved use of a variety of ethical resources and the identification of resources needed to provide good care, as well as the processes used to enact moral agency. Nurse leaders are also moral agents. Important implications of these findings for nursing leaders are that they need moral courage to be self-reflective, to name their own moral distress, and to act so that their nursing staff are able to be moral agents. Nurse leaders need to be the moral compass for nurses, using their power as a positive force to promote, provide and sustain quality practice environments for safe, competent and ethical practice.

Ethics, Nursing↗
PubMed1998

Codes and morals: is there a missing link? (The Nuremberg Code revisited).

Codes are a well known and popular but weak form of ethical regulation in medical practice. There is, however, a lack of research on the relations between moral judgments and ethical Codes, or on the possibility of morally justifying these Codes. Our analysis begins by showing, given the Nuremberg Code, how a typical reference to natural law has historically served as moral justification. We then indicate, following the analyses of H. T. Engelhardt, Jr., and A. MacIntyre, why such general moral justifications of codes must necessarily fail in a society of "moral strangers." Going beyond Engelhardt we argue, that after the genealogical suspicion in morals raised by Nietzsche, not even Engelhardt's "principle of permission" can be rationally justified in a strong sense--a problem of transcendental argumentation in morals already realized by I. Kant. Therefore, we propose to abandon the project of providing general justifications for moral judgements and to replace it with a hermeneutical analysis of ethical meanings in real-world situations, starting with the archetypal ethical situation, the encounter with the Other (E. Levinas).

Codes of Ethics↗
PubMed2004

Moral conflict, religiosity, and neuroticism in an outpatient sample.

Our sense of identity is inextricably connected to our sense of ourselves as moral beings. However, concerns about the rightness and wrongfulness of our own actions, and a range of emotions connected to moral worry, such as regret and remorse, rarely receive clinical attention. The present study sought to develop and operationalize the construct of moral concern or worry in a psychiatric outpatient sample and to investigate relationships between moral worry and age, gender, religiosity, and the tendency to worry in general. The Eysenck Personality Inventory, Duke Religiosity Scale, and a 20-item Worry Scale (containing eight moral worry items) were administered to 225 psychiatric outpatients. Data analysis included principal components analysis, repeated measures MANOVA to examine extent of worry among factor scales and interactions between age and sex, and multiple regression to identify significant correlates of each factor scale. Worry about moral issues emerged as a domain distinct from worry about practical matters. Although respondents reported more worry about practical matters than about moral concerns, worry about the former declined with age, whereas worry about the latter did not. Intrinsic religiosity was negatively correlated and neuroticism positively correlated with both scales. Because patients are concerned about the moral aspects of their character and behavior, this area deserves further research and consideration.

Adolescent↗
PubMed1989

Rethinking moral reasoning theory.

Many nursing studies on moral reasoning and ethics have used Kohlberg's theory of moral development. The body of knowledge that resulted from these studies indicated that nurses and nursing students had consistently lower than expected levels of moral reasoning. Educational offerings were developed to assist nurses to improve their moral reasoning. This article explores the cognitive-developmental theory of moral development as one way of determining the moral development of nurses. Since this theory of moral reasoning focuses on the rational thought of the individual and does not consider the impact of the environment, it is of limited applicability in nursing. A new theory of morality needs to be developed--a more holistic one that will include both universal principles and contextual tissues.

Cognition↗
PubMed1989

Values, moral reasoning, and ethics.

The purpose of this exchange was to explore the domains of values, moral reasoning, and ethics. Values and moral reasoning reflect the "is." Moral reasoning is the mental process that nurses set in motion to come to some decision of right or wrong in any moral dilemma. Values are motivational preferences or dispositions. Moral values are those preferences that are integral to any moral reasoning process. Ethics reflect the oughts. It is the art-science that critically evaluates the "is." As such, ethics identifies the norms or standards of behaviors that either are or can become the values that are implemented through moral reasoning. Nursing is just beginning to identify its moral values and reasoning. Nevertheless, nursing seems to be further along in the identification of the "is" than it is with the "ought." The further development of nursing ethics will be of great benefit to nurse researchers and educators. The greatest benefit will be, however, to the practicing nurse as she/he struggles with giving excellent nursing care consistent with a positive nursing ethic.

Beneficence↗
PubMed2005

Moral voices of politically engaged urban youth.

The relationship between reflection and action is an enduring question for those interested in promoting moral development among young people. Educators struggle to find effective methods for helping youth reason carefully about moral problems and also to show moral commitment in their everyday lives. One place where reflection and action come together is in youth activism, where young people engage in social action campaigns to improve their schools and communities. What are the moral concerns that urban youth raise when given the opportunity? How do these concerns get translated into action? Drawing on original and secondary sources, this chapter discusses four social action campaigns organized by youth in the San Francisco Bay Area, in which youth combined critical moral judgments with social action. The chapter is not an empirical study, but instead an effort to bring attention to the moral and ethical perspectives that politically engaged youth raise. These social action projects suggest that for youth living in low-income neighborhoods with limited resources, the capacity for critical moral reflection about one's surroundings is an important dimension of healthy development. Helping youth assess and transform their local environments represents a promising direction for moral education and youth development.

Adolescent↗
PubMed1996

Moral strangers and the health care market.

In order to reflect on the morality of the health care market this paper critiques some of H.T. Engelhardt's presuppositions. Engelhardt has created the vivid term 'moral stranger' and suggested that there can be a 'morality of moral strangers'. However his position relies either on certain necessary presuppositions which he leaves unmentioned or on presuppositions that are--in a strict sense--not moral ones. Engelhardt advocates the market economy as the guiding principle of health care, and claims that the market needs no moral presuppositions. But when the preconditions of a functioning market are examined it turns out that a functioning market requires property and ownership, and that property and ownership are moral institutions. Therefore the application of the idea of the market to health care undoubtedly has morally serious consequences: most important, the difference between commodities and human beings is obscured.

Coercion↗
PubMed2006

The dawn of science-based moral reasoning.

In 1998, Edward O. Wilson discussed the biological basis of morality, pointed out that the analysis of its material origins should enable us to fashion a wise ethical consensus, and predicted the dawn of science-based moral reasoning. This article testifies that his prediction was right. Morality, being based on altruism and collaboration, evolved as a socially advantageous biological phenomenon aimed at ensuring the survival of our species, which was structured in small groups at high risk of extinction for the 99.5% of its existence. In the last 0.5%, the advent of agriculture resulted in a demographic explosion that impaired human beings' moral discernment, because the socially detrimental consequences of immoral actions, which had been recognised and condemned promptly in small groups consisting of a few tens of members, were diluted among millions of untouched individuals, thereby becoming less easily recognisable. Nowadays, to test the supposed morality of individual actions and government policies, we should use reason or, in doubtful cases, mathematical modelling to determine their predictable effects on the survival of small theoretical communities. Unless we untenably claim that the unlikelihood of extinction of today's immense societies entitles us to overturn the meaning of morality, all actions and policies that would cause the extinction of small communities should be regarded as indisputably immoral. This article also presents some examples of science-based moral arguments showing the immorality of restrictions and bans on research with human embryonic stem cells and demonstrates that the old concept of the "naturalistic fallacy", which philosophers frequently invoke to dismiss any scientific approach to morality, is no longer tenable, because it increasingly emerges to be a proof of what may well be defined the "philosophical fallacy".

Biological Evolution↗
PubMed2006

The neural basis of implicit moral attitude--an IAT study using event-related fMRI.

Recent models of morality have suggested the importance of affect-based automatic moral attitudes in moral reasoning. However, previous investigations of moral reasoning have frequently relied upon explicit measures that are susceptible to voluntary control. To investigate participant's automatic moral attitudes, we used a morality Implicit Association Test (IAT). Participants rated the legality of visually depicted legal and illegal behaviors of two different intensity levels (e.g., high intensity illegal = interpersonal violence; low intensity illegal = vandalism) both when the target concept (e.g., illegal) was behaviorally paired with an associated attribute (e.g., bad; congruent condition) or an unassociated attribute (e.g., good; incongruent condition). Behaviorally, an IAT effect was shown; RTs were faster in the congruent rather than incongruent conditions. At the neural level, implicit moral attitude, as indexed by increased BOLD response as a function of stimulus intensity, was associated with increased activation in the right amygdala and the ventromedial orbitofrontal cortex. In addition, performance on incongruent trials relative to congruent trials was associated with increased activity in the right ventrolateral prefrontal cortex (BA 47), left subgenual cingulate gyrus (BA 25), bilateral premotor cortex (BA 6) and the left caudate. The functional contributions of these regions in moral reasoning are discussed.

Adult↗
PubMed1997

The impact of political violence on moral reasoning in children.

OBJECTIVE: The moral development of three groups of children, who had been subjected to varying degrees of political violence and economic advantage, was examined in an attempt to determine if group membership or gender influenced the level of moral reasoning or orientation. METHOD: Ninety-three 8- to 13-year-old Israeli Jewish and Bedouin school children, and Palestinian West Bank school children were asked various moral reasoning questions based on an animal fable involving a moral dilemma under three (hypothetical, role-taking, political) conditions. RESULTS: Results indicate that mutuality solutions to moral dilemmas were given more frequently by Israeli Jewish children than Israeli Bedouin or Palestinian children as the questions shifted from abstract to real-life situations. No significant gender differences were found between Jewish children and Bedouin children in hypothetical issues; however, violence and limited resources were found to affect moral judgment in real-life situations for boys, but not for girls. CONCLUSIONS: These findings supported the hypothesis that moral reasoning in children is significantly linked to real-life situations and resources. The results were discussed in terms of their relevance to future researchers and the manner in which children interpret moral questions.

Adolescent↗
PubMed2003

Disgust sensitivity and meat consumption: a test of an emotivist account of moral vegetarianism.

Emotivist perspectives on moral reasoning hold that emotional reactions precede propositional reasoning. Published findings indicate that, compared with health vegetarians, those who avoid meat on moral grounds are more disgusted by meat [Psychol. Sci. 8 (1997) 67]. If, as per emotivist perspectives, such disgust precedes moral rationales for meat avoidance, then the personality trait of disgust sensitivity should generally be inversely related to meat eating. We surveyed 945 adults regarding meat consumption, reasons for meat avoidance, and disgust sensitivity. Contrary to the emotivist prediction, (a) meat consumption was positively correlated with disgust sensitivity, and (b) individuals who reported avoiding meat for moral reasons were not more sensitive to disgust than those who avoided meat for other reasons. We conclude that moral vegetarianism conforms to traditional explanations of moral reasoning, i.e. moral vegetarians' disgust reactions to meat are caused by, rather than causal of, their moral beliefs.

Adolescent↗
PubMed2001

Is there a moral duty to die?

In recent years, there has been a great deal of philosophical discussion about the alleged moral right to die. If there is such a moral right, then it would seem to imply a moral duty of others to not interfere with the exercise of the right. And this might have important implications for public policy insofar as public policy ought to track what is morally right. But is there a moral duty to die? If so, under what conditions, if any, ought one to have such a duty, and why? In this paper, I distinguish between different moral grounds for the putative moral duty to die: deontological, intuitionist, and contractarian. Subsequently, I argue in support of Paul Menzel's theory of health care distribution. More precisely, I concur with his claim that there is a moral duty to die inexpensively in health care contexts. Then I provide and defend a philosophical analysis of the conditions in which such a duty could exist.

Capital Punishment↗
PubMed2003

A moral framework for multicultural education in healthcare.

The goal of this paper is two-fold. First, I begin by reviewing several of the major points of emphasis among health educators as they begin to incorporate multicultural issues into healthcare education. I then consider the role of moral relativism, which is currently being endorsed by some health educators, as the foundation for resolving cross-cultural conflicts in healthcare. I argue that moral relativism is ultimately inconsistent with the stated goals in multicultural curricular proposals and fails to provide an effective framework for considering moral conflicts in cross-cultural settings. Instead, I propose that those methods seeking to establish a common morality, built upon mutually shared values, offer the most promising means of resolving cross-cultural conflicts. This leads to my second goal, to compare recent work in moral pragmatism with what is now widely known in bioethics as moral "principlism." I argue that while proponents of principlism and pragmatism each seek to establish a common foundation for moral deliberation, they fail to appreciate significant similarities between their respective approaches. Instead of offering two completely unique and independent methods of moral deliberation, I suggest that principlism and pragmatism embrace common themes that point us in a positive direction, providing an effective framework useful for considering cross-cultural conflicts in healthcare.

Attitude to Health↗
PubMed1999

Individual moral judgment and cultural ideologies.

Moral judgment cannot be reduced to cultural ideology, or vice versa. But when each construct is measured separately, then combined, the product predicts powerfully to moral thinking. In Study 1, 2 churches (N = 96) were selected for their differences on religious ideology, political identity, and moral judgment. By combining these 3 variables, a multiple correlation of .79 predicted to members' moral thinking (opinions on human rights issues). Study 2 replicated this finding in a secular sample, with the formula established in Study 1 (R = .77). Individual conceptual development in moral judgment and socialization into cultural ideology co-occur, simultaneously and reciprocally, in parallel, and not serially. Individual development in moral judgment provides the epistemological categories for cultural ideology, which in turn influences the course of moral judgment, to produce moral thinking (e.g., opinions about abortion, free speech).

Adult↗
PubMed2006

Exploring the psychological underpinnings of the moral mandate effect: motivated reasoning, group differentiation, or anger?

When people have strong moral convictions about outcomes, their judgments of both outcome and procedural fairness become driven more by whether outcomes support or oppose their moral mandates than by whether procedures are proper or improper (the moral mandate effect). Two studies tested 3 explanations for the moral mandate effect. In particular, people with moral mandates may (a) have a greater motivation to seek out procedural flaws when outcomes fail to support their moral point of view (the motivated reasoning hypothesis), (b) be influenced by in-group distributive biases as a result of identifying with parties that share rather than oppose their moral point of view (the group differentiation hypothesis), or (c) react with anger when outcomes are inconsistent with their moral point of view, which, in turn, colors perceptions of both outcomes and procedures (the anger hypothesis). Results support the anger hypothesis.

Abortion, Induced↗