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PubMed2003

Moral diversity among physicians and conscientious refusal of care in the provision of abortion services.

Physicians are independent moral agents whose values, like those of nonphysicians, are shaped by personal experience, religious beliefs, family, and lifetime mentors. Most individuals are free to exercise their moral values in the ways that they see fit within the boundaries of legality. Physicians' moral values take on special significance, however, when considering services patients may request but that contradict that physician's moral beliefs, such as termination of pregnancy. In this article I analyze the competing obligations to self and to patient that a conscientiously objecting physician must consider when his or her personal morality affects his or her relationship with the patient. Despite each physician's freedom to choose his or her mode of practice and which services to provide, a physician with a moral viewpoint that would prevent even counseling on certain options should consider practicing in an area of medicine in which the patient's right to full disclosure of options and informed consent is not compromised by the physician's personal moral stance.

Abortion, Legal↗
PubMed1975

Moral judgment and parental identification among children.

The relationship of moral judgment and parental identification was studied in 50 boys and 50 girls, all of whom were white, lower-middle-class children, aged 9 1/2 to 11 1/2 years. Two hypotheses were proposed: (1) that within each sex group, children with a higher-level parental identification attain a higher stage of moral judgment than children with a lower level of parental identification; and (2) that there are no sex differences in the stage of moral judgment attained by Ss from similar socioeconomic backgrounds. Ss were screened for socioeconomic status and age. Moral judgment was defined in terms of Piaget's "two moralities" of the child and measured by a structured interview that consisted of five subtests taken from Piaget. Parental identification was measured by means of a semantic space and differential technique, and Ss were grouped on the basis of low, medium and high levels of paternal and maternal identification. Results indicate that there are no significant sex differences in moral judgment. Within each sex group there is a clear positive relationship between high-level identification and a higher stage of moral judgment.

Age Factors↗
PubMed1977

Enhancement of maturity of moral judgment by parent education.

Relationships between maturity of moral judgment of parents, role-taking opportunities in the home, roletaking ability in children and maturity of children's moral judgment were studied. A parent intervention program designed to increase role-taking opportunities in the home thought to lead to an increase in the maturity of moral judgment of children was utilized. Suggestive evidence for the claim that it is possible to accelerate rates of moral maturity of children through intervening indirectly to train their parents was found. Significant relationships were also found between maturity of moral judgment in children and role-taking AND OPPORTUNITIES FOR role-taking in the home. Maturity of moral judgment of parents was not found to be significantly related to maturity of moral judgment of their children.

Adult↗
PubMed2005

Morale and job perception of community mental health professionals in Berlin and London.

INTRODUCTION: Morale and job perception of staff in community mental health care may influence feasibility and quality of care, and some research has suggested particularly high burnout of staff in the community. The aims of this study were to: a) assess morale, i. e. team identity, job satisfaction and burnout, in psychiatrists, community psychiatric nurses and social workers in community mental health care in Berlin and London; b) compare findings between the groups and test whether personal characteristics, place of working and professional group predict morale; and c) explore what tasks, obstacles, skills, enjoyable and stressful aspects interviewees perceived as important in their jobs. METHODS: In all, 189 mental health professionals (a minimum of 30 in each of the six groups) responded to a postal survey and reported activities per week using pre-formed categories. Perception of professional role was assessed on the Team Identity Scale, job satisfaction on the Minnesota Job Satisfaction Scale, and burnout on the Maslach Burnout Inventory. Seven simple open questions were used to elicit the main tasks, skills that staff did and did not feel competent in, aspects that they did and did not enjoy in their job, and obstacles and factors that caused pressure. Answers were subjected to content analysis using a posteriori formed categories. RESULTS: Weekly activities and morale varied between sites and professional groups. Some mean scores for groups in London exceeded the threshold for a burnout syndrome, and are particularly less favourable for social workers. Working in London predicted higher burnout, lower job satisfaction and lower team identity. Being a psychiatrist predicted higher team identity, whilst being a social worker was associated with higher burnout and lower job satisfaction. Male gender predicted lower burnout and higher team identity. However, professional group and site interacted in predicting burnout and job satisfaction. Psychiatrists in London had much more favourable scores than the other two groups, whilst this did not hold true in Berlin. Answers to open questions revealed universal aspects, such as enjoying direct patient contact and disliking bureaucracy, but also various views that were specific to a site or professional group or both. CONCLUSIONS: Burnout remains a problem for some, but not all, professional groups in community mental health care, and social workers in London appear to be a group with particularly low morale. Differences between professional groups depend on the location, and it remains unclear to what extent job-related and general factors impact on the morale of mental health professionals. Answers to open questions reveal general as well as specific aspects of the job perception of the professional groups, some of which may be relevant for service development, training and supervision. More conceptual and methodological work and more extensive studies are required to develop a better understanding of how community mental health professionals perceive their job and how morale may be improved.

Adult↗
PubMed2005

Understanding moral responsibility in the design of trailers.

This paper starts from the presupposition that moral codes often do not suffice to make agents understand their moral responsibility. We will illustrate this statement with a concrete example of engineers who design a truck's trailer and who do not think traffic safety is part of their responsibility. This opinion clashes with a common supposition that designers in fact should do all that is in their power to ensure safety in traffic. In our opinion this shows the need for a moral philosophy that helps engineers to interpret their responsibility and think more critically about it. For this purpose we will explore the moral philosophy of Alasdair MacIntyre, which is particularly interesting because he locates the beginning of moral thinking in the daily practice of a profession. This is consistent with the history of moral codes, for codes are also the product of moral reflection by professionals. We will use MacIntyre's philosophy to (1) explain what is wrong with the designers' understanding of their responsibility and (2) show a possible way to bring their reflection to a more self-critical level. We will also inspect MacIntyre's proposal critically.

Accidents, Traffic↗
PubMed2004

Risks of meat: the relative impact of cognitive, affective and moral concerns.

The purpose of the present research was, first, to examine the impact of particular perspectives (Study 1: cognitive and affective; Study 2: moral) on the perception and acceptance of risks associated with meat consumption, and intention to reduce meat consumption in the future. The first study showed that an affective focus generally had a stronger impact on risk perception and acceptance, and intention to reduce meat consumption, than a more cognitive focus. Moreover, moral considerations had a clear impact in all conditions. Results of a second study confirmed that a moral focus has powerful effects on all the dependent variables. The second purpose of the research was to examine the perseverance of the impact of cognitive, affective and moral perspectives. In both studies, a follow-up after three weeks showed increased perception of moral risks and a strong intention to reduce future meat consumption. Moreover, attitude towards meat consumption became less positive in the conditions with an affective and moral focus. There were also significant relations between intention to reduce meat consumption, actual reduction, and intention to adhere to this level in the future. Overall, risk acceptance was mediated by perceived health and moral risks, whereas intention about meat consumption was mediated by risk acceptance.

Adult↗
PubMed2006

Culture and stigma: adding moral experience to stigma theory.

Definitions and theoretical models of the stigma construct have gradually progressed from an individualistic focus towards an emphasis on stigma's social aspects. Building on other theorists' notions of stigma as a social, interpretive, or cultural process, this paper introduces the notion of stigma as an essentially moral issue in which stigmatized conditions threaten what is at stake for sufferers. The concept of moral experience, or what is most at stake for actors in a local social world, provides a new interpretive lens by which to understand the behaviors of both the stigmatized and stigmatizers, for it allows an examination of both as living with regard to what really matters and what is threatened. We hypothesize that stigma exerts its core effects by threatening the loss or diminution of what is most at stake, or by actually diminishing or destroying that lived value. We utilize two case examples of stigma--mental illness in China and first-onset schizophrenia patients in the United States--to illustrate this concept. We further utilize the Chinese example of 'face' to illustrate stigma as having dimensions that are moral-somatic (where values are linked to physical experiences) and moral-emotional (values are linked to emotional states). After reviewing literature on how existing stigma theory has led to a predominance of research assessing the individual, we conclude by outlining how the concept of moral experience may inform future stigma measurement. We propose that by identifying how stigma is a moral experience, new targets can be created for anti-stigma intervention programs and their evaluation. Further, we recommend the use of transactional methodologies and multiple perspectives and methods to more fully capture the interpersonal core of stigma as framed by theories of moral experience.

Culture↗
PubMed2005

Toward a procedure for integrating moral issues in health technology assessment.

OBJECTIVES: Although ethics has been on the agenda in health technology assessment (HTA) since its inception, the integration of moral issues is still not standard and is performed in a vast variety of ways. Therefore, there is a need for a procedure for integrating moral issues in HTA. METHODS: Literature review of existing approaches together with application of various theories in moral philosophy and axiology. RESULTS: The article develops a set of questions that addresses a wide range of moral issues related to the assessment and implementation of health technology. The issues include general moral issues and moral issues related to stakeholders, methodology, characteristics of technology, and to the HTA process itself. The questions form a kind of checklist for use in HTAs. CONCLUSIONS: The presented approach for integrating moral issues in HTA has a broad theoretical foundation and has shown to be useful in practice. Integrating ethical issues in HTAs can be of great importance with respect to the dissemination of HTA results and in efficient health policy making.

Bioethics↗
PubMed1990

The use of stories in moral development. New psychological reasons for an old education method.

Contemporary approaches to moral development and moral education emphasize propositional thinking and verbal discussion of abstract moral dilemmas. In contrast, this article proposes that narratives (stories) are a central factor in a person's moral development. Support for this position comes from recent theoretical contributions of Bruner, Sarbin, Spence, Tulving, and others, who have emphasized narrative thought as a major form of cognition that is qualitatively different from abstract propositional or scientific thinking. In addition, over the last 10 to 20 years psychologists investigating and conceptualizing moral development have come to emphasize such processes as empathy (Hoffman), caring and commitment (Gilligan), interpersonal interaction (Haan), personal character and personality (Coles; Hogan; Staub; Rushton). It is proposed that narratives and narrative thinking are especially involved in how these processes lead to moral development and therefore that narrative should be rehabilitated as a valuable part of moral education.

Adolescent↗
PubMed1991

Structural flexibility of moral judgment.

One of the central assumptions of Kohlberg's theory of moral development--that moral judgment is organized in structures of the whole--was examined. Thirty men and 30 women were given 2 dilemmas from Kohlberg's Moral Judgment Interview, a 3rd involving prosocial behavior, and a 4th involving impaired driving. Half the Ss responded to the prosocial and impaired-driving dilemmas from the perspective of a hypothetical character, and half responded from the perspective of the self. No sex or perspective differences in moral maturity were observed. Ss scored highest in moral maturity on Kohlberg's dilemmas, intermediate on the prosocial dilemma, and lowest on the impaired-driving dilemma. In partial support of Kohlberg's contention that his test assesses moral competence, there was a negative linear relationship between scores on his test and the proportion of Stage 2 judgments on the 2 other dilemmas. An interactional model of moral judgment is advanced.

Adolescent↗
PubMed2002

The self-importance of moral identity.

Recent theorizing in moral psychology extends rationalist models by calling attention to social and cultural influences (J. Haidt, 2001). Six studies using adolescents, university students, and adults measured the associations among the self-importance of moral identity, moral cognitions, and behavior. The psychometric properties of the measure were assessed through an examination of the underlying factor structure (Study 1) and convergent, nomological, and discriminant validity analyses (Studies 2 and 3). The predictive validity of the instrument was assessed by examinations of the relationships among the self-importance of moral identity, various psychological outcomes, and behavior (Studies 4, 5, and 6). The results are discussed in terms of models of moral behavior, social identity measurement, and the need to consider moral self-conceptions in explaining moral conduct.

Adolescent↗
PubMed2001

The emotional dog and its rational tail: a social intuitionist approach to moral judgment.

Research on moral judgment has been dominated by rationalist models, in which moral judgment is thought to be caused by moral reasoning. The author gives 4 reasons for considering the hypothesis that moral reasoning does not cause moral judgment; rather, moral reasoning is usually a post hoc construction, generated after a judgment has been reached. The social intuitionist model is presented as an alternative to rationalist models. The model is a social model in that it deemphasizes the private reasoning done by individuals and emphasizes instead the importance of social and cultural influences. The model is an intuitionist model in that it states that moral judgment is generally the result of quick, automatic evaluations (intuitions). The model is more consistent that rationalist models with recent findings in social, cultural, evolutionary, and biological psychology, as well as in anthropology and primatology.

Emotions↗
PubMed2003

Nursing morale: what is it like and why?

BACKGROUND: There has been increased concern in the United Kingdom about the problems of recruitment and retention in the nursing profession, and how this is influenced by low morale. Despite this, however, there are relatively few studies, particularly of a qualitative nature, where nurses are asked about their morale and what factors affect it. AIMS: The present study aimed to explore nursing morale and determine the factors which nurses believed to influence it. By doing so, it was hoped that factors which affect nurse recruitment and retention could be identified. METHODS: Fifty-eight nurses (28 males, 30 females) working in the National Health Service in Scotland were interviewed in depth about their morale and their concerns about their career. Thematic analysis was carried out and a number of main issues emerged. FINDINGS: Morale in this group was very low. A large number of nurses were considering leaving the profession and the majority would discourage others from becoming a nurse. The themes that emerged, which related to their disillusionment, included low pay, lack of support for education, limited opportunity for promotion, lack of resources and job insecurity. CONCLUSIONS: The findings suggest that while recent salary increases may have helped to improve morale, other factors must also be addressed if further decline in morale and a subsequent nursing shortage is to be avoided.

Adult↗
PubMed2000

Relationship of family socialization processes to adolescent moral thought.

The author investigated the relationship between salient family processes and adolescent moral thought among a sample of 271 adolescents and their parents. Family-process variables measured were adaptability, cohesion, and parent-adolescent communication; adolescent moral thought was measured by the influence the adolescent participants attributed to sources of moral authority. Perceptions of high family cohesion were associated with the greatest influence attributed to the family as a source of moral authority. Perceptions of high family adaptability were associated with greater influence attributed to all sources of moral authority. Parent-adolescent dyads who perceived high positive communication showed strong parent-adolescent agreement on the levels of influence attributed to all sources of moral authority. The findings (a) support the view that a strong relationship exists between family-socialization processes and the content of adolescent moral thought and (b) redress an empirical imbalance in research literature.

Adolescent↗
PubMed2003

Explaining the self-conception of perceived conduct using indicators of moral functioning in physical education.

The purpose of this study was to determine whether four indicators of moral functioning in physical education (moral judgment, moral reason, moral intention, and prosocial behavior) predicted the self-conception of perceived conduct. Participants were 204 male (n = 87) and female (n = 117) physical education students in fourth, fifth, and sixth grades. For the male students, the four indicators of moral functioning were found to be highly related, and, so, no subsequent analyses were conducted. For the female students, a standard multiple regression analysis revealed that the indicators of moral functioning accounted for 21% of the variance in perceived conduct. Discussion of the results highlights the value of considering in combination the moral functioning and self-concept literatures.

Analysis of Variance↗
PubMed2003

The dual biological identity of human beings and the naturalization of morality.

The last two centuries have been the centuries of the discovery of the cell evolution: in the XIX century of the germinal cells and in the XX century of two groups of somatic cells, namely those of the brain-mind and of the immune systems. Since most cells do not behave in this way, the evolutionary character of the brain-mind and of the immune systems renders human beings formed by t wo different groups of somatic cells, one with a deterministic and another with an indeterministic (say Darwinian) behavior. An inherent consequence is that of the generation, during ontogenesis, of a dual biological identity. The concept of the dual biological identity may be used to explain the Kantian concept of the two metaphysical worlds, namely of the causal necessity and of the free will (Azzone, 2001). Two concepts, namely those of complex adaptive systems (CAS) and of emergence (Holland, 2002), are useful tools for understanding the mechanisms of adaptation and of evolution. The concept of complex adaptive systems indicates that living organisms contain series of stratified components, denoted as building blocks, forming stratified layers of increasing complexity. The concept of emergence implies the use of repeating patterns and of building blocks for the generation of structures of increasing levels of complexity, structures capable of exchanging communications both in the top-down and in the bottom-up direction. Against the concept of emergence it has been argued that nothing can produce something which is really new and endowed of causal efficacy. The defence of the concept of emergence is based on two arguments. The first is the interpretation of the variation-selection mechanism as a process of generation of information and of optimization of free energy dissipation in accord with the second principle of thermodynamics. The second is the objective evidence of the cosmological evolution from the Big Bang to the human mind and its products. Darwin has defended the concept of the continuity of evolution. However evolution should be considered as continuous when there is no increase of information and as discontinuous when there is generation of new information. Examples of such generation of information are the acquisition of the innate structures for language and the transition from absence to presence of morality. There are several discontinuity thresholds during both phylogenesis and ontogenesis. Morality is a relational property dependent on the interactions of human beings with the environment. Piaget and Kohlberg have shown that the generation of morality during childhood occurs through several stages and is accompanied by reorganization of the child mental organization. The children respect the conventions in the first stage and gradually generate their autonomous morality. The transition from absence to presence of morality, a major adaptive process, then, not only has occurred during phylogenesis but it occurs again in every human being during ontogenesis. The religious faith does not provide a logical justification of the moral rules (Ayala, 1987) but rather a psychological and anthropological justification of two fundamental needs of human beings: that of rendering Nature an understandable entity, and that of increasing the cooperation among members of the human societies. The positive effects of the altruistic genes in the animal societies are in accord with the positive effects of morality for the survival and development of the human societies.

Adaptation, Biological↗
PubMed1995

Classical Anglican moral theology: unavoidably non-ecumenical.

In its specific moral conclusions ecclesiastical Anglican theology shares much with traditional Protestantism, Roman Catholicism, and Eastern Orthodoxy. In its understanding of the method and purpose of moral theology classical Anglicanism sometimes diverges from earlier Roman Catholicism -- and anticipates the most positive developments in contemporary Roman Catholic moral theology -- while sharing a common theological heritage with Rome in its understanding of natural law, the moral agent, and the moral act. Anglicans situate moral reasoning within the Church of the patristic Tradition, which distinguishes them from Protestants, yet do not accept the Roman magisterium's self-understanding. Consequently, the Anglican mode of moral reasoning has strong affinities with the Orthodox churches.

Bioethics↗
PubMed1996

Moral consensus in public ethics: patient autonomy and family decision-making in the work of one state bioethics commission.

Focusing on the work of one bioethics commission, the New York State Task Force on Life and the Law, this article explores the role played by moral consensus in public ethics. Task Force members, who were appointed to represent diverse interests in New York State, identified a culturally strong value of individual autonomy as the ethical basis for their work on life-sustaining treatment. This moral consensus permitted the members to unite across their differences and develop public policy recommendations that substantially reformed a highly troubling New York law. However, the principle of autonomy insufficiently guides decisions by caring family members for incompetent adults in cases where little is known of patient preference. A different, more innovative moral vision is required--one that grants a more robust moral authority to the family. While government efforts that rely on moral consensus developed in a broad-based and well-reasoned manner can serve us well, in some cases the consensus will provide inadequate moral guidance. Government bioethical efforts must guard against the limits of moral vision in light of their disproportionate societal power.

Adult↗