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PubMed1993

The structural consistency of moral judgments about AIDS.

This study compared the structure (i.e., stage) of moral judgments to dilemmas involving AIDS to the structure of moral judgment on Kohlberg's test to determine whether attitudes and opinions about AIDS affect level of moral judgment. Subjects included 40 men, who responded to (a) two standard dilemmas from Colby and Kohlberg's (1987) test of moral judgment, (b) two of Kohlberg's dilemmas ammended to involve AIDS, (c) a set of AIDS dilemmas derived from incidents reported in the media, (d) a set of questions tapping attitudes toward people with AIDS, and (e) Rubin and Peplau's (1975) just-world scale. Moral judgment was structurally consistent across the three sets of dilemmas, and only weakly related to attitudes towards AIDS and belief in a just world. Moral choices did not covary with moral stage. These results are consistent with Kohlberg's contention that moral judgment is organized in "structures of the whole."

AIDS Serodiagnosis↗
PubMed2005

Morale in the oldest old: the Umeå 85+ study.

OBJECTIVE: to describe morale among the oldest old, and to investigate which social, functional and medical factors are associated with morale in this population. DESIGN: a cross-sectional study. SETTING: a population-based study in the municipality of Umeå, a city in Northern Sweden. SUBJECTS: half of the 85-year-old population, and the total population of 90-year-olds and > or = 95-year-olds (95-103) were asked to participate (n = 319) and 238 were interviewed. METHODS: structured interviews and assessments during home visits, interviews with relatives and caregivers and review of medical charts. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to measure morale. Participants were assessed with the Barthel Activities of Daily Living (ADL) Index, Geriatric Depression Scale (GDS-15), Mini-Mental State Examination (MMSE), Mini Nutritional Assessment (MNA), and a symptom questionnaire. Multiple regression analyses were conducted to find independent factors to explain the variation in the PGCMS score. RESULTS: eighty-four per cent (n = 199) of those interviewed answered the PGCMS. Three-quarters had middle range or high morale. GDS score, type of housing, previous stroke, loneliness and number of symptoms, adjusted for age group and sex, explained 49.3% of the variance of total PGCMS score. CONCLUSIONS: a large proportion of the oldest old had high morale. The most important factors for high morale were the absence of depressive symptoms, living in ordinary housing, having previously had a stroke and yet still living in ordinary housing, not feeling lonely and low number of symptoms. The PGCMS seems applicable in the evaluation of morale among the oldest old.

Activities of Daily Living↗
PubMed1998

Moral volition: the fifth and final domain leading to an integrated theory of conscience understanding.

OBJECTIVES: To define discrete developmental levels of understanding of the ways in which normal children and adolescents link autonomy and will to moral obligation and to study the correlation between this progression and previously identified stages of conscience conceptualization. METHOD: One hundred thirty-two normal volunteers between the ages of 5 and 17 years were individually interviewed using the moral volition section of the semistructured Stilwell Conscience Interview. Analysis of the interviews resulted in five levels of understanding of moral self-evaluation and volitionally chosen behavior. RESULTS: Analyses of variance and covariance showed that the five levels of moral volition had significant correlation with five conceptualization stages, with stage criteria showing a stronger correlation than age. Self-identified tasks of oughtness were hierarchically defined beginning with those defining a morality of restraint followed by moralities of mastery/sufficiency, virtuous striving, idealization, and individual responsibility. Perception of increased independence of self in interaction with conscience was noteworthy at stages 4 and 5. CONCLUSIONS: Moral volition is the domain of conscience functioning that defines understanding of moral self-evaluation and volitionally chosen actions; five levels of understanding can be demonstrated in normal children between the ages of 5 and 17 years.

Adolescent↗
PubMed2000

Moral distress in perinatal nursing.

This work focuses on an emerging concept in nursing ethics--moral distress. Unlike an ethical dilemma where one does not know the right thing to do, in contrast, moral distress occurs when one knows the right thing to do but is constrained by the institution or one's coworkers in doing it. Moral distress is a process that involves recognition that a decision is difficult to act upon; the experience of emotional distress inherent in that situation; choosing strategies; and then acting. Whistle blowing and collaborative practice models both provide strategies for moral action in moral distress situations. Less dramatic and quieter forms of moral action will also be examined. Finally, developing the strength to move from moral distress to moral action will be discussed, as well as research implications for this emerging ethical issue.

Conflict, Psychological↗
PubMed2005

The moral affiliations of disgust: a functional MRI study.

Recent investigations in cognitive neuroscience have shown that ordinary human behavior is guided by emotions that are uniquely human in their experiential and interpersonal aspects. These "moral emotions" contribute importantly to human social behavior and derive from the neurobehavioral reorganization of the basic plan of emotions that pervade mammalian life. Disgust is one prototypic emotion with multiple domains that include viscerosomatic reaction patterns and subjective experiences linked to (a) the sensory properties of a class of natural stimuli, (b) a set of aversive experiences and (c) a unique mode of experiencing morality. In the current investigation, we tested the hypotheses that (a) the experience of disgust devoid of moral connotations ("pure disgust") can be subjectively and behaviorally differentiated from the experience of disgust disguised in the moral emotion of "indignation" and that (b) pure disgust and indignation may have partially overlapping neural substrates. Thirteen normal adult volunteers were investigated with functional magnetic resonance imaging as they read a series of statements depicting scenarios of pure disgust, indignation, and neutral emotion. After the scanning procedure, they assigned one basic and one moral emotion to each stimulus from an array of six basic and seven moral emotions. Results indicated that (a) emotional stimuli may evoke pure disgust with or without indignation, (b) these different aspects of the experience of disgust could be elicited by a set of written statements, and (c) pure disgust and indignation recruited both overlapping and distinct brain regions, mainly in the frontal and temporal lobes. This work underscores the importance of the prefrontal and orbitofrontal cortices in moral judgment and in the automatic attribution of morality to social events. Human disgust encompasses a variety of emotional experiences that are ingrained in frontal, temporal, and limbic networks.

Adult↗
PubMed2005

An investigation of moral judgement in frontotemporal dementia.

OBJECTIVE: To investigate the basis of disturbed moral judgment in patients with frontotemporal dementia (FTD). BACKGROUND: FTD is characterized by difficulty in modulating social behavior. Patients lack social propriety and may perform sociopathic acts. In addition, FTD patients often lack empathy for others. These findings suggest alterations in the nature of morality in patients with FTD. METHOD: We administered an inventory of moral knowledge and two moral dilemmas to 26 patients with the frontal variant of FTD, 26 patients with Alzheimer disease (AD), and 26 normal control subjects. The FTD patients met Consensus Criteria for FTD and had corroborative frontal abnormalities on functional neuroimaging. The FTD and AD patients were comparably impaired on dementia measures. RESULTS: All these groups showed the retention of knowledge for moral behavior and the ability to make "impersonal" moral judgments. In contrast, the FTD patients were impaired in their ability to make immediate, emotionally based moral judgments compared with the patients with AD and the normal control subjects. CONCLUSIONS: These findings are consistent with an attenuation of the automatic emotional identification with others that is part of the innate moral sense. Such a disturbance may result from neurodegenerative disease affecting the ventromedial frontal cortex.

Aged↗
PubMed2004

Quality of life: a longitudinal analysis of correlates of morale in old age.

This paper examines recurrent continuous morale in old age within a statistical modelling paradigm. The Anglicised Philadelphia Geriatric Centre Morale Scale was used as a small component of a major longitudinal study of old age in rural North Wales, U.K. The literature review and cross-sectional analysis of morale in old age is published elsewhere. This paper deals with the aspect of the longitudinal analysis of morale in old age. The proposed statistical modelling relates recurrent morale to a set of explanatory variables that includes subjective as well as objective measures. In order to assess the degree to which explanatory variables influence morale, an adequate statistical model must handle the possibility that substantial variation between respondents will be due to unmeasured and potentially unmeasurable variables (residual heterogeneity), multicollinearity, and past behaviour effect. These applications are illustrated using morale in old age from the North Wales Longitudinal Study Old Age. The results suggested a strong presence of heterogeneity effect, i.e., current levels of morale appear to be individual specific and independent of its previous levels.

Aged↗
PubMed2004

"There but for the grace of God": moral responsibility and mental illness.

Setting the terms of praise- and blameworthiness has long dominated philosophers' discussions of responsibility. Analytic philosophy has most often looked to reason and the abstract relations between individual rational judgements and actions to advance the discourse on moral responsibility. Those whose capacity for reasoned judgement is impaired are deeply problematic. Is it proper to morally appraise "the mentally ill"? The philosopher T.M. Scanlon discusses moral responsibility as a precondition of moral appraisal and contends that it is not appropriate to appraise a person as (morally) praise- or blameworthy if that person cannot be held responsible for the action(s) for which he is being praised or blamed. What are the conditions, then, under which one can properly be said to be responsible for one's actions? Can one hold "the mentally ill" responsible for their actions? If not, can it in any way be reasonable to expect them to "take responsibility" for their actions and/or characters? The expectation that "the mentally ill" will attempt to control, i.e. take responsibility for their behaviour despite the fact of their mental illness is a pervasive feature of psychiatric approaches to the care and treatment of "the mentally ill". It would seem that such treatment approaches are coherent only to the degree "the mentally ill" can be considered responsible moral agents. This paper explores these issues with regard to that form of mental illness categorized as the personality disorders. It describes the morally and clinically relevant features of personality disorder, explains how they do not fit traditional analytic paradigms of "mental illness" and elaborates the argument that persons with this category of mental illness are fully moral persons who are rightly subject to praise and blame.

Humans↗
PubMed2004

The development of a brief and objective method for evaluating moral sensitivity and reasoning in medical students.

BACKGROUND: Most medical schools in Japan have incorporated mandatory courses on medical ethics. To this date, however, there is no established means of evaluating medical ethics education in Japan. This study looks 1) To develop a brief, objective method of evaluation for moral sensitivity and reasoning; 2) To conduct a test battery for the PIT and the DIT on medical students who are either currently in school or who have recently graduated (residents); 3) To investigate changes in moral sensitivity and reasoning between school years among medical students and residents. METHODS: Questionnaire survey: Two questionnaires were employed, the Problem Identification Test (PIT) for evaluation of moral sensitivity and a portion of the Defining Issues Test (DIT) for moral reasoning. Subjects consisted of 559 medical school students and 272 residents who recently graduated from the same medical school located in an urban area of Japan. RESULTS: PIT results showed an increase in moral sensitivity in 4th and 5th year students followed by a decrease in 6th year students and in residents. No change in moral development stage was observed. However, DIT results described a gradual rising shift in moral decision-making concerning euthanasia between school years. No valid correlation was observed between PIT and DIT questionnaires. CONCLUSION: This study's questionnaire survey, which incorporates both PIT and DIT, could be used as a brief and objective means of evaluating medical students' moral sensitivity and reasoning in Japan.

Attitude of Health Personnel↗
PubMed2006

Developing the concept of moral sensitivity in health care practice.

The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the research team's understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills.

Adult↗
PubMed2000

Psychoanalysis and the moral high ground.

The author reflects on the power and ubiquity of moral issues in the human psyche and thus inevitably in psychoanalysis, and suggests that our moral sense may be an adaptive biological strategy. Goodness is sought in others and aspired to in the self, as part of an innate need to build the ego upon experiences of good objects. Kleinian theory suggests a 'natural morality' that can be discerned in the move towards the 'depressive position', involving increasing care and concern for others. The hunger for goodness within is experienced as a moral quest, with strivings both to approve of, and to be approved of by, one's objects. Goodness, felt as moral rightness, is highly prized, and may be claimed falsely for the self or for objects in the form of the 'moral high ground'. Derailments of the analytic standpoint easily occur, away from the search for objective truth towards assumption of the moral high ground, on the part of the patient, the analyst or both. The author shows this occurring clinically and reflects also on how psychoanalytic theory can be misused in the pursuit of moral superiority.

Adult↗
PubMed1999

The moral status of beings who are not persons: a casuistic argument.

This paper addresses the question: Who or what can have a moral status in the sense that we have direct moral duties to them? It argues for a biocentric answer which ascribes inherent moral status value to all individual living organisms. This position must be defended against an anthropocentric position. The argument from marginal cases propounded by Tom Regan and Peter Singer for this purpose is criticised as defective, and a different argument is proposed. The biocentric position developed here is related to that of Albert Schweitzer and Paul F. Taylor, but rejects their assumption of equal inherent value for all living organisms. It argues instead for equal moral status value for moral persons and agents, and gradual moral status value for nonpersons, depending on their degree of similarity with moral persons. Mary Ann Warren's recent book on Moral Status is also discussed. The argument is constructed as a casuistic argument, proceeding by analogical extension from persons to nonpersons. The meta-ethical question of its pragmatic validity is discussed.

Animal Rights↗
PubMed2006

Stages of moral development among Brazilian dental students.

This research study aimed to evaluate the level of moral and ethical development of first-year students in a dental school. The students were presented with a dilemma that touched on personal and conflicting values. In responding to the questions posed, they had to present their criteria for judgments and norms that directly influence their behavior. Answers were then analyzed, leading to the categorization of interviewees into five stages of moral development according to Kohlberg's moral development system. The first, lowest stage in Kohlberg's system was reached by 11 percent of students. Most interviewees (47 percent) were in stage two, where individuals are conscious of their own conflicting interests, but an individualistic and instrumental set of morals tends to regulate those interests. Thirty percent of interviewees were identified with stage three, and 8.3 percent were found in stage four, whose main characteristic is the perception of self as a member of society, thus integrating interpersonal perspectives. Only one student reached stage five, in which the person recognizes universal rights and establishes a hierarchy of priorities. No individuals were found in stage six of moral development. The level of moral development found was low for students at this level, which may compromise the optimal moral development of the future dentist. The low level of moral development found may jeopardize the work of the future professionals, their treatment of patients, and society as a whole.

Adolescent↗
PubMed2006

Impact of the Konstanz method of dilemma discussion on moral judgment in allied health students: a randomized controlled study.

The objective of the study was to determine the effect of the Konstanz method of moral dilemma discussion (KMDD) on moral judgment in allied health students. The study employed the Moral Judgment Test, translated from English into Thai and validated in 247 students, as an moral judgment instrument. The scale satisfied four validity criteria: preference hierarchy, quasi-simplex structure of stage preference, affective-cognitive parallelism, and positive correlation between education and moral competence score (C-index). Test-retest reliability at a 1-month interval was 0.90. To investigate the impact of the KMDD, 83 pharmacy technician and dental nursing students were asked to participate in the study. The subjects were randomly assigned into control (n = 41) or experimental (n = 42) groups. The experimental group participated in a 90-min KMDD once a week for 6 consecutive weeks. Students in the control group also met once a week for 6 weeks to discuss the topics not related to ethics. All subjects completed the Moral Judgment Test before and after the intervention and again 6 months later. Split-plot ANOVA of the C-indexes at the beginning revealed that the experimental and control groups were not different (20.57 +/- 13.45 and 24.98 +/- 16.12). However, the experimental group scored significantly higher than the control group did after the intervention (35.18 +/- 10.96 and 24.20 +/- 14.70) and 6 months later (33.00 +/- 11.02 and 23.67 +/- 14.35). The KMDD appears to be a practical and effective intervention for developing moral judgment in allied health students. The effect on moral judgment remains at least 6 months after the intervention.

Adolescent↗
PubMed2007

What's fair? The unconscious calculus of our moral faculty.

This essay argues that much of the research in moral psychology has focused on moral performance, on what people do. The study of moral competence, in contrast, has largely been ignored. I use the analogy to linguistics as a model for exploring our moral competence, and suggest that we are endowed with a moral faculty that operates over the causes and consequences of actions. This moral faculty is endowed with principles and parameters that are universal. Acquiring a particular moral system entails setting the parameters. On this model, emotions such as empathy are consequences (as opposed to causes) of unconscious but principled moral evaluations.

Emotions↗
PubMed1991

Study of the influence of veterinary medical education on the moral development of veterinary students.

Although veterinary medicine endorses high moral character and adherence to a code of ethics, to our knowledge, virtually no studies have examined the influence of veterinary medical education on the moral development of its students. Using the Kohlberg standard moral judgment interview, this study examined that relationship in a sample of 20 veterinary medical students (16.0% of the veterinary college's student body). The students were tested at the beginning and at the end of their veterinary medical education to determine whether their moral reasoning scores had increased to the same extent as those of other postgraduate students. It was found that normally expected increases in moral reasoning did not occur over the four years of veterinary medical education for these students, suggesting that their veterinary medical educational experience somehow inhibited their moral reasoning ability rather than facilitated it. With a range of moral reasoning scores between 313 and 436, the mean increase from first year to fourth year of 12.5 points was not statistically significant. Statistical analysis revealed no significant correlations between the moral reasoning scores on age or gender, although there were significant correlations with Medical College Admissions Test scores and grade point average scores.

Education, Veterinary↗
PubMed1990

In search of an everyday morality: the development of a measure.

Current interest in moral theorizing has been dominated by Kohlberg's cognitive-developmental view. Haan (1982) has challenged psychology's reliance on this rationalistic focus and has argued for a rethinking of morality's meaning in accord with everyday human experience. In light of this challenge, the present study gives both theoretical and empirical support to the advancement of a morality for everyday life. Specifically, a new measure called the Visions of Morality Scale (VMS) is reported. The VMS is sensitive to three dimensions which are necessary for an everyday morality: (1) a human constitutive component which is universally experienced by all human beings (empathy); (2) the inclusion of a behavioral component which reflects actual behavior (pro-social inclinations); and (3) a view of morality that is multilevel (private, interpersonal, and social). A brief sketch of the VMS is provided. Results are presented from a study of 181 high school students which relate the VMS to empathy and political orientation. Highly significant relationships were found among morality, political orientation, and empathy. In addition, results revealed numerous sex differences. Finally, the implications of an everyday morality are discussed.

Adolescent↗
PubMed1995

The relationship of moral reasoning and AIDS knowledge to risky sexual behavior.

Two hypotheses were tested in this study: (a) moral reasoning and risky sexual behaviors are inversely correlated; (b) the relationship between AIDS knowledge and sexual behavior is mediated by moral reasoning such that AIDS knowledge and risky sexual behaviors are inversely correlated for higher-level moral reasoners but not for lower-level reasoners. Subjects were 103 undergraduate students who completed an instrument assessing moral reasoning, the Defining Issues Test, and two questionnaires assessing sexual behavior and knowledge about AIDS. Factor analysis identified five sexual risk-taking factors with alphas of .60 or higher. Results supported both hypotheses: (a) Risk taking during sexual intercourse (i.e., lower likelihood of using condoms) and risk taking during anal sex were significantly inversely correlated with moral reasoning; (b) For high moral reasoners, two measures of sexual risk taking were significantly negatively correlated with knowledge about AIDS: as knowledge increased, risk taking during sexual intercourse and engagement in a variety of sexual experiences decreased. The reverse relationship was true for low moral reasoners. Implications for moral development theory and research as well as for AIDS prevention campaigns are discussed.

Acquired Immunodeficiency Syndrome↗