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PubMed1985

An ethical analysis of double bind conflicts as experienced by care workers feeding severely demented patients.

When patients with incurable dementia diseases no longer take food or fluid voluntarily, the care workers experience distress and anxiety. Thirty-nine care workers were interviewed about their thoughts, feelings and attitudes towards feeding severely demented patients. A phenomenological approach was used and the interviews were developed, attention paid to Bateson's double bind theory, Kohlberg's theory of moral development and ethical theories. Ethical theories, principles and rules, containing messages at different logical levels and the lack of empirical knowledge of the demented patients' inner world, led to the care worker's difficult double bind situations. To solve the conflicts the care workers need insight in all aspects of the problem. In order to understand all the components in a double bind situation it is important to redefine it from outside.

Beneficence↗

PubMed2000

The moral justification scale: reliability and validity of a new measure of care and justice orientations.

Research increasingly suggests that there are limitations to Kohlberg's theory of moral development. Gilligan in particular has observed that Kohlberg's theory considers abstract principled reasoning as the highest level of moral judgment, and penalizes those who focus on the interpersonal ramifications of a moral decision. Gilligan calls these justice and care orientations. The present paper describes the development of the Moral Justification Scale, an objective measure of the two orientations. The scale consists of six vignettes, of which two are justice oriented, two are care oriented, and two are mixed, incorporating both orientations. Construct validity was evaluated by expert judges and, overall, was high. Cronbach's alpha was .75 for the Care subscale and .64 for the Justice subscale, indicating adequate internal consistency. Split-half reliabilities were as follows: Care, r = .72, p < .01, and Justice, r = .60, p < .05. Regarding test-retest reliability (approximately two weeks), r = .61, p < .05, for Care; r = .69, p < .05, for Justice. Neither subscale correlated significantly with the Marlowe-Crowne Social Desirability Scale. Thus, the Moral Justification Scale shows promise as an easily administered, objectively scored measure of Gilligan's constructs of care and justice.

Acculturation↗

PubMed2006

The neural processing of moral sensitivity to issues of justice and care.

The empirical and theoretical consideration of ethical decision making has focused on the process of moral judgment; however, a precondition to judgment is moral sensitivity, the ability to detect and evaluate moral issues [Rest, J. R. (1984). The major components of morality. In W. Kurtines & J. Gewirtz (Eds.), Morality, moral behaviour, and moral development (pp. 24-38). New York, NY: Wiley]. Using functional magnetic resonance imaging (fMRI) and contextually standardized, real life moral issues, we demonstrate that sensitivity to moral issues is associated with activation of the polar medial prefrontal cortex, dorsal posterior cingulate cortex, and posterior superior temporal sulcus (STS). These activations suggest that moral sensitivity is related to access to knowledge unique to one's self, supported by autobiographical memory retrieval and social perspective taking. We also assessed whether sensitivity to rule-based or "justice" moral issues versus social situational or "care" moral issues is associated with dissociable neural processing events. Sensitivity to justice issues was associated with greater activation of the left intraparietal sulcus, whereas sensitivity to care issues was associated with greater activation of the ventral posterior cingulate cortex, ventromedial and dorsolateral prefrontal cortex, and thalamus. These results suggest a role for access to self histories and identities and social perspectives in sensitivity to moral issues, provide neural representations of the subcomponent process of moral sensitivity originally proposed by Rest, and support differing neural information processing for the interpretive recognition of justice and care moral issues.

Adult↗

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↗

PubMed1980

Abortion in adolescence: the ethical dimension.

The purpose of this essay is to present a bioethical approach to the abortion dilemma in adolescence. It is addressed to health workers involved in the medical care of adolescents and to those involved in adolescent counseling. The introduction presents an overview of the subject in the U.S.A., its medical significance (obstetric, gynecologic, psychologic) as well as some anthropological historico-legal data relating to adolescent abortion. This is followed by a practical description of ethical theory. The main body of the presentation consists of a review of the most important contributions of bioethical thought as they relate to abortion. Adolescent abortion in particular is addressed in the context of issues such as autonomy, rights and responsibility. This includes a description of moral development in adolescence and an analysis of moral aspects of treatment of adolescents. Some personal comments and propositions are made, with the aim of generating further contributions.

Abortion, Induced↗

PubMed1997

Collective will: a reformulation of Otto Rank's theory of personality individuation.

A reevaluation of Otto Rank's theory of personality individuation has been proposed which equates collective and individual will as essential and mutually facilitative aspects of self-development. Rank's viewpoint regarding social and moral development as necessarily normative and, hence, inimical to individuation is therefore challenged and disputed. It is further argued that the nature of will is not a priori moral and that it should be conceptualized empirically as a derivative of the self. The negative will has been defined as the counterposition of two wills against each other. It has been proposed that when the individual and collective will are in fixed opposition to each other their results can be destructive to personality development and to interpersonal and societal relations in general. The relative value given to either individual or collective aspects of will may be partly a function of the historical and sociopolitical environment of both the individuals whose personality development is thereby influenced and the theorist whose interest is devoted to understanding and remedying their problems.

History, 20th Century↗

PubMed2004

Ethics education and value prioritization among members of U.S. hospital ethics committees.

Calls for ethics education for members of hospital ethics committees presume that the effects and benefits of such education are well-established. This is not the case. A review of the literature reveals that studies consistently have failed to uncover any significant effect of ethics education on the moral reasoning, moral competency, and/or moral development of medical professionals. The present paper discuss this negative result and describes the author's national study of the value priorities of members of hospital ethics committees. This study discovered correlations between moral decision making and factors like age and type of institution where the committee operates. The results of this study also resemble those of previous studies in finding no correlation between ethics education and moral decision making. The author concludes that there is a need for more research on the effects of nonmoral personal, societal, and institutional factors on the moral reasoning of members of hospital ethics committees. Further, in the absence of any firm empirical basis, calls for ethics education for medical professionals and ethics committee members should be rethought.

Bioethical Issues↗

PubMedDate not supplied

Ethical responsibilities in nursing: research findings and issues.

Discussions in the literature assert that nurses are becoming increasingly cognizant of their ethical responsibilities, but that they are often ill prepared to participate in ethical decision making. A review of selected research literature from 1970 to 1987 was undertaken to validate these assertions. A total of 12 studies related to ethical responsibilities was identified in the review; all studies were published between 1980 and 1987. The majority of studies were at the descriptive and exploratory levels and employed Kohlberg's cognitive theory of moral development as their conceptual framework. Significant findings related to educational level and ethical responsibilities were consistent across studies. Findings related to age and clinical experience were mixed; the effects of economic level, religion-religiosity, ethnicity, and other variables on ethical responsibilities were not significant. Issues raised in the light of the existing research include the use of Kohlberg's theory as a conceptual orientation in nursing groups and limited data on the reliability and validity of instruments used in measuring ethical constructs. Recommendations for future research on ethical responsibilities include the validation of Kohlberg's theory for nursing investigations, exploration of other frameworks for developing a multidimensional view of ethical responsibilities, and the use of qualitative research designs.

Behavioral Research↗

PubMed1980

Moral and cognitive development in delinquent and nondelinquent children and adolescents.

Moral and cognitive development of delinquents and nondelinquents were investigated--96 boys and girls at three ages: 10-11, 12-13, and 14-15-16 years. Moral judgment was assessed via the Defining Issues Test, and moral conduct by a resistance to temptation task. General cognitive development was explored with Piagetian-like tasks: two concrete operational tasks, two formal tasks, and a role-taking task. With the exception of role-taking, the delinquents were found generally to lag behind nondelinquents in terms of moral and cognitive development. With increasing age, disparate performances between the two groups were consistently shown, with delinquents always lower than nondelinquents. The delinquents were also less likely to resist temptation than the nondelinquents, though no age differences were noted.

Adolescent↗

PubMed1995

Sex role orientation and its relationship to the development of identity and moral thought.

This paper examined the links among sex role orientation, ego identity development and moral reasoning. 76 female and 58 male students were assessed on Bem's sex role inventory, ego identity, care-based and justice-based moral thought. For women, identity was negatively related to femininity and positively related to androgyny. Also, high levels of care-based moral reasoning, i.e., a balanced concern for the welfare of self and others, was related to androgyny for women. There were no significant findings for men. No significant relationships were found between sex role orientation and justice-based moral reasoning. Thus, the results suggested that for women in particular, relinquishing the stereotyped sex role definition and becoming more androgynous is important for their ego identity as well as care-based moral development.

Adolescent↗

PubMed2001

Medical ethics education: to what ends?

The goals of medical ethics education comprise several dimensions: legal duties to secure informed consent, tell the truth and protect confidentiality; objective competencies that include an understanding of DNR regulations and surrogate decision-making procedures; discursive moral skills such as moral sensitivity, reciprocity and moral development that combine into the capacity for moral dialogue and debate; and finally, behavioural goals that challenge moral education to nurture a more humane, sensitive and communicative physician. Part one of this paper describes each of these goals, together with some of the inherent difficulties affecting implementation. Part two presents survey data from medical ethics instructors (n = 126) who were asked about the importance of each goal and their ability to successfully achieve each aim. While each goal is highly rated, only those goals associated with legal duties and objective competencies are thought to be achieved with any degree of relative success. Goals associated with character transformation, unique to medical ethics education, are among the most difficult to achieve. Additional empirical data corroborate these impressions. Moreover, it is not clear that medical ethics education has much to do with good care. Empirical data are scarce and the conceptual relationship between ethics and care remains highly problematic. Part three offers a number of divergent interpretations of care and concludes that they have little to do with medical ethics. There is no reason to expect that medical competence should be affected by moral competence. Medical ethics therefore might then be viewed as an educational enhancement: unnecessary for healthy doctoring but desirable among a small percentage of the profession who maintain an interest in ethical problems.

Character↗

PubMed1985

Becoming a nurse: the ethical perspective.

This paper examines selected features of neophyte nursing students' approach to the moral dimension of their future practice. It argues that rapid changes in medical technology and in social perceptions of morality necessitate a critical examination of the content, sequence and methods of introductory ethics education in nursing. It suggests that greater emphasis should be placed upon individual moral development; and that Codes of Ethics and Bills of Rights should be presented as ideal statements, to serve as guides in assessing the ethical situation of the client. Some reactions of students are reported.

Curriculum↗

PubMed2004

UME-21 and teaching ethics: a step in the right direction.

BACKGROUND AND OBJECTIVES: Ethics education for medical students has included a number of relatively vague descriptions of appropriate curricular objectives, but medical schools struggle with the general teaching of ethics, as well as with presenting the ethical dilemmas posed by managed care. This paper proposes some standards and uses them to analyze the general and managed care ethics content of the Undergraduate Medical Education for the 21st Century (UME-21) curricula. METHODS: We analyzed progress and final reports from each school to define their learning objectives, content, teaching methods, and evaluation strategies in ethics. Each was evaluated using principles of adult learning and Rest's Four Component Model of Moral Development. Good examples of curricular elements from participating schools are described. RESULTS: Ethics curricula varied widely among the schools. Goals and objectives were often stated in generalities. Teaching methods were diverse and innovative, and several new combinations of learning activities were created to highlight ethics topics. Content represented managed care and non-managed care topics in varying proportions. Student surveys of attitudes toward managed care and opinions of the ethics programs were the most commonly used as evaluation tools. Some schools were able to develop more direct means of evaluating student learning. The Four Component Model was not fully addressed in the programs developed by the participating schools. CONCLUSIONS: We make recommendations about the objectives, teaching methods, content, and evaluation methods of an ideal medical school curriculum in ethics.

Adult↗

PubMed2006

Nursing students' ethical decision-making: a review of the literature.

Research into education in ethical decision-making in nursing is scarce. This review is an overview of empirical literature published between 1980 and September 2006. The literature was retrieved from the Medline and CINAHL databases. The focus is on the methodology and findings of these studies for identifying knowledge gaps for further research. The methodological approaches and foci of the studies varied rendering the comparison and generalization of the findings difficult. The findings indicate that education has a positive impact on students' moral development. Future research should focus on educators and clinical instructors, and on the cooperation between theoretical and clinical instruction. A review of the theoretical scientific literature would provide valuable knowledge as well. Research in this area might also benefit from more context appreciating qualitative research as well as from the use of longitudinal research designs. Research projects at national and international level should be considered.

Attitude of Health Personnel↗

PubMed2000

Ethical cognition and selection-socialization in retail pharmacy.

There is a great deal of support for the contention that the ethical cognition of health care professionals are of consequence to the level of patient care provided. The present study examines the ethical cognition of what has traditionally been deemed a profession of incomplete or marginal status: the retail, or community, pharmacy setting. An empirical examination of ethical cognition compares a systematic random sample of retail pharmacists with pharmacy students. Additional comparisons are made with a baseline of ethical cognition abilities of other health care professionals, such as physicians and nurses. Based on cognitive-developmental theory and using a well-known measure of ethical reasoning, two hypotheses are explored regarding the ethical reasoning skills of retail pharmacy practitioners and pharmacy students. Results indicate that, contrary to cognitive moral development theory, students possess greater ethical reasoning skills than do their practitioner counterparts. In addition, baseline comparisons with other health professional groups reflect unfavorably on the retail pharmacists. It is suggested that the selection-socialization processes inherent in the retail pharmacy setting may result in on or more of the following outcomes: 1) the selection of lower ethical reasoners to the community pharmacy setting, 2) the exodus to other pharmacy settings of higher reasoners, and 3) a possible retrogression in the ethical cognition of community practitioners. Implications for retail practice and limitations are discussed.

Cognition↗

PubMed2004

Empirical ethics in action: lessons from two empirical studies in nursing ethics.

Despite the burgeoning of publications in nursing ethics, only more recently has empirical evidence on nursing ethics been published. How nursing ethics can be empirically studied as well as enriched by empirical data will be the focus of this paper. Two empirical studies will be briefly presented and their contribution to ethics discussed. The first one is a quantitative research project about nurses' ethical behavior in daily practice. Using an adapted version of Kohlberg's theory of moral development, this study tried to describe and explore nurses' responses to ethical dilemmas in daily nursing practice. The second study attempted to describe the specificity of residential palliative care. A qualitative approach was used to explore and describe the processes that take place on an inpatient palliative care unit, and the experiences of patients, relatives and palliative care team members. The analysis of the value of both research projects for ethics underlines the power of empirical understanding in the relationship between research and ethics. The need for integration of both qualitative and quantitative research methodologies is argued.

Cultural Diversity↗

PubMed1985

Ethical dilemmas in nursing: the role of the nurse and perceptions of autonomy.

This study investigated decision making in ethical dilemmas and attitudes toward professional autonomy. It was based on Murphy's identification of three nurse-patient relationship models. The model identification was the result of Murphy's investigation of the levels of moral reasoning of nurse practitioners, from Kohlberg's theory of moral development. Autonomy is necessary for patient advocacy in Murphy's highest order model of nurse-patient relationship. 109 freshmen, 103 seniors, and 82 graduates (baccalaureate nursing) were examined for model selection, risk-taking, restrictions, and anxiety in the decision-making process in specific situations. Autonomy was measured independently. The most significant results indicated that freshmen were less likely to select the autonomous model of relationship, had lower attitudes toward professional nursing autonomy, and were less willing to take risks. Graduates were lower than either student group in their perceptions of restrictions and anxiety. The responses to each dilemma itself varied by situation in relation to the model preferred.

Adolescent↗

PubMed1994

Universal prescriptivism: traditional moral decision-making theory revisited.

Universal prescriptivism is a recently developed moral decision-making theory that combines utilitarian and Kantian theories with two levels of moral thinking. A combined approach offers a creative solution to the weaknesses inherent in traditional moral theories. The paper describes the theory and discusses important implications for nursing education, practical ethical decision-making, and research. The relationship of an ethical theory of caring to traditional moral theory is discussed.

Decision Making↗