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PubMed2002

How (and where) does moral judgment work?

Moral psychology has long focused on reasoning, but recent evidence suggests that moral judgment is more a matter of emotion and affective intuition than deliberate reasoning. Here we discuss recent findings in psychology and cognitive neuroscience, including several studies that specifically investigate moral judgment. These findings indicate the importance of affect, although they allow that reasoning can play a restricted but significant role in moral judgment. They also point towards a preliminary account of the functional neuroanatomy of moral judgment, according to which many brain areas make important contributions to moral judgment although none is devoted specifically to it.

Journal Article↗
PubMed2001

The moral foundation of medical leadership: the professional virtues of the physician as fiduciary of the patient.

Leadership in medicine, as in other settings, should be based on values that provide appropriate direction for the use of institutional power and authority. Leadership also requires managerial competence. Managerial knowledge and skills can be used for worthy and unworthy goals and therefore require a moral foundation. Using the methods of ethics, we argue that the concept of the physician as the moral fiduciary of the patient should be the moral foundation of management decisions by physician-leaders. We take this concept from the history of eighteenth century medical ethics and develop it in terms of four professional virtues--self-effacement, self-sacrifice, compassion, and integrity. We apply these four virtues to show how physician-leaders should create a moral culture of professionalism in health care organizations. We then identify four vices--unwarranted bias, primacy of self-interest, hard-heartedness, and corruption--that undermine this moral culture of professionalism. Because health care organizations now play a central role in patient care, their moral culture and therefore physician-leaders have become vital elements in physicians being able to maintain their professionalism. Physician-leaders bear major responsibility to shape organizational cultures that support the fiduciary professionalism of physicians.

Ethics, Medical↗
PubMed1999

Moral development and psychopathological interference in conscience functioning among adolescents after trauma.

OBJECTIVES: To compare moral development and psychopathological interference with conscience functioning (PI) among adolescents exposed to different degrees of earthquake-related trauma and to investigate the relationship of moral development and PI to exposure to trauma, severity of posttraumatic stress disorder (PTSD) symptoms, postearthquake adversities, and extent of loss of nuclear family members. METHOD: Adolescents (N = 193) from 2 cities at different distances from the epicenter were evaluated. The Stilwell Structured Conscience Interview was used to assess moral development and PI. Structured self-report instruments were used to obtain ratings of severity of earthquake-related trauma, posttraumatic stress symptoms, and postearthquake adversities. RESULTS: Adolescents in the city near the epicenter manifested advanced moral development as compared with their counterparts in the less affected city. Concomitantly, they endorsed responses indicating PI. Levels of PI were significantly correlated with severity of PTSD symptoms. CONCLUSION: In the aftermath of a catastrophic natural disaster, children assume greater responsibilities and confront a multitude of morally challenging interpersonal situations which may result in an advancement of their moral development. Yet, at the same time, PTSD symptoms and negative schematizations of self and others may give rise to disturbances in conscience functioning. The findings suggest that therapeutic consideration should be given to assisting children in integrating the horror of their traumatic experiences and the harshness of posttrauma adversities into an adaptive schema of good and evil in themselves and the world.

Adolescent↗
PubMed2001

Drawing a line: situating moral boundaries in genetic medicine.

Bioethics traditionally focuses on establishing moral limits between different types of acts. However, boundaries are established by communities and individuals who differ in the constraints shaping their moral world. Phase boundaries, the sites of transition between two physical phases such as a liquid and a gas, provide a metaphor for 'drawing a line' in bioethics discourse. Phase boundaries occur where the physical constraints allow both phases to coexist in stable equilibrium. This relationship can also be considered in reverse, using the known position of the phase boundary to disclose the physical constraints. By analogy, instead of trying to locate the 'correct' moral boundary, the alternative perspective of 'reverse ethics' works from a commonly accepted boundary to examine the constraints of the moral world that are being used to establish it. Genetic interventions into the human body provide interesting examples of boundary establishment. In gene therapy, focusing on boundaries has resulted in a model of moral permissibility that ignores some alternative standpoints and increases the potential for conflict between them. Reverse ethics examines such conflicts in terms of the nature of moral worlds that have come into contact with each other, taking seriously the diversity of factors governing the location of a boundary, in ways that might help shift some entrenched lines of conflict.

Bioethics↗
PubMed2005

Pathways to conscience: early mother-child mutually responsive orientation and children's moral emotion, conduct, and cognition.

BACKGROUND: Associations between early mother-child mutually responsive orientation (MRO) and children's conscience have been previously established, but the mechanisms accounting for those links are not understood. We examined three such mediational mechanisms: (a) the child's enhanced enjoyment of interactions with the mother, (b) increased committed, self-regulated compliance with the mother, and/or (c) a decreased need for maternal use of power assertion. Children's conscience was seen as a complex system encompassing moral emotion (guilt), conduct, and cognition. METHODS: In a longitudinal design, MRO was observed in mothers' and children's multiple naturalistic interactions at 9, 14, and 22 months. The mediators were observed at 33 months. Children's conscience was observed at 45 months (moral emotion) and at 56 months (moral conduct and cognition). RESULTS: The mediating paths were different for the three components of conscience. MRO had a direct, unmediated effect on moral emotion. MRO influenced moral conduct through two mediational paths: by promoting the child's enjoyment of interactions with the mother and by enhancing committed compliance. MRO influenced moral cognition by promoting the child's enjoyment of mother-child interactions. Maternal power assertion did not mediate the relation between MRO and conscience once the influence of the other mediators was considered. CONCLUSIONS: The impact of the early mother-child relationship on future conscience appears to be a complex process that progresses along distinct paths.

Child↗
PubMed2003

On the relation between moral, legal and evaluative justifications of pre-implantation genetic diagnosis (PGD).

In Germany the question whether to uphold or repeal the judicial prohibition on Pre-implantation Genetic Diagnosis (PGD) is being debated from quite different standpoints. This paper differentiates the major arguments according to their reasons as a) moral, b) evaluative (i.e. cultural/religious), and c) legal. The arguments for and against PGD can be divided by content into three groups: arguments relating to the status of the embryo, focusing on individual actions in the implementation of PGD, and relating to the foreseeable or probable consequences of PGD. In Germany, from a legal perspective, the status of the embryo does not permit the intervention of PGD; from a purely moral perspective, a prohibition on PGD does not appear defensible. It remains an open question, however, whether the moral argument permitting PGD should be restricted for evaluative (cultural) reasons. The paper discusses the species-ethical reasons, for which Jurgen Habermas sees worrisome consequences in the wake of PGD to the extent that we comprehend it as the forerunner of a 'positive eugenics'. It would so disrupt the natural preconditions of our universal morality. The question of whether to prohibit or allow PGD is not merely a question of simple moral and/or legal arguments, but demands a choice between evaluative, moral and (still to be specified) species-ethical arguments, and the question remains open.

Embryo, Mammalian↗
PubMed1995

Moral growth in medical students.

Although students bring to medical school a fairly well established value system, the potential for moral growth through the medical school environment and experience is substantial. The educational environment poses a succession of developmental and adaptive tasks to be accomplished. Several of these tasks are discussed her, tasks that are value-laden and involve, directly or indirectly, the interplay of ethical theory and practice. During the past quarter century, the two influences that have had the greatest impact on the moral growth and moral reasoning capacity of medical students have been the incorporation into the medical school curriculum of courses in medical humanities and the admission to medical school of an increasing number of female students. The female students have brought to medical school a level or dimension of moral reasoning (morality as care or responsibility for others) to augment the male students' focus on rights and justice considerations.

Attitude to Death↗
PubMed1997

The moral status of intellectually disabled individuals.

The moral status accorded to an individual (or class of individuals) helps to account for the weight of the moral obligations considered due to an individual (or class of individuals). Strong arguments can be given to indicate that the moral status accorded, justly or unjustly, to individuals with intellectual disabilities is less than that accorded to those considered intellectually able. This paper suggests that such a view of the moral status of intellectually disabled individuals derives from individualism. Ontological and normative components of individualism are identified. It is shown that individualistic, ontological criteria for personhood compromise the integrity of "dependent" individuals. And it is shown that the normative component of individualism further compromises the integrity of intellectually disabled individuals. An alternative view of the self is outlined in which dependence features centrally. It is tentatively suggested that such a view of the self may prove more congenial to enhancing the moral status of individuals with intellectual disabilities.

Ego↗
PubMed1993

Teaching medical ethics to first-year students by using film discussion to develop their moral reasoning.

PURPOSE: To evaluate a project on teaching medical ethics to first-year students by using film discussion to develop the students' moral reasoning. METHOD: The participants were 114 first-year students at Texas A&M University Health Science Center College of Medicine in 1989-90, 1990-91, and 1991-92: (1) 48 (20 women and 28 men) who participated during the fall quarter in an elective course on social issues in medicine, which consisted of weekly one-hour discussions of short films; (2) 37 (18 women and 19 men) who participated in the course during both the fall and winter quarters; and (3) a control group of 29 (8 women and 21 men) who did not take the course and so had no exposure to the film discussions. The influence of the discussions on the students' moral reasoning was measured by using Rest's Defining Issues Test for pretests and posttests. The scores of the three groups were compared by using multivariate analysis of variance. RESULTS: There were statistically significant increases in the moral reasoning scores of both the course registrants with one-quarter exposure to the film discussions (p < .002) and those with two-quarter exposure (p < .008) compared with the scores of the students who did not take the course and had no exposure (p < .109). CONCLUSION: No doubt there was a self-selecting bias on the part of the course registrants; however, since both groups of registrants showed significant increases on their posttest scores, clearly the course did have a positive influence on these students' moral reasoning. Thus, it is possible to develop young people's moral reasoning in medical school as well as in earlier educational environments.

Control Groups↗
PubMed1998

The amount of small-group case-study discussion needed to improve moral reasoning skills of medical students.

PURPOSE: To examine how much exposure to small-group case-study discussion is necessary to significantly increase moral reasoning skills. METHOD: For the classes of 1991-1998 at Texas A&M, using Rest's Defining Issues Test, the authors tested groups of students for moral reasoning skills both before and after the students participated in small-group case-study discussions of medical ethics. RESULTS: From 960 students asked to participate, the authors collected complete data for 729 students (75.9% response rate). Small-group case-study exposures ranged from 0 to 44 hours. Groups of students exposed to 20 hours or more demonstrated a significant increase in their moral reasoning scores. Groups with less than 20 hours of exposure demonstrated no significant increase in their scores. CONCLUSION: This study indicates that moral reasoning skills are teachable and measurable, and that small-group discussion significantly increases moral reasoning skills. Further studies are needed to increase the generalizability of these findings.

Education, Medical, Undergraduate↗
PubMed1988

In search of the moral foundation of nursing.

This article is offered as an extension of the work of Yarling and McElmurry, who ostensibly discussed the moral foundations of nursing. They did not actually broach their intended topic, but they did offer important clues for further analysis. This presentation attempts to show how the moral foundation of nursing might be discerned by indicating both its linkage to the great moral ideas and certain confusions in current nursing ideology. It is claimed that the moral foundation of nursing--indeed, the moral inspiration at the heart of nursing practice--must come from a clearly developed understanding of the idea of nursing.

Ethics, Nursing↗
PubMed1993

Structuring moral meaning in psychiatric nursing practice.

Comparatively little is known about the experiential aspect of moral decision making in psychiatric nursing. Earlier research in this area has mainly focused on the cognitive aspects of moral reasoning, using hypothetical cases. The purpose of this study was to examine the experience of moral decision making in psychiatric nursing practice. In-depth interviews with fourteen nurses, purposively selected for their reputed competency and long experience in psychiatric care, were conducted. By using the strategy of 'constant comparative analysis', the grounded theory, 'structuring moral meaning' was derived, which consists of three interrelated processes, perceiving, knowing and judging. This process identifies the nurse's manner of making sense of a perceived moral conflict and justifying 'good' actions within the nurse-patient framework.

Beneficence↗
PubMed1997

Moral sensitivity in psychiatric practice.

This study reports the results of a study of Swedish psychiatrists' responses to moral statements related to decision making in the psychiatric context. Use was made of the Moral Sensitivity Questionnaire, a modified instrument previously constructed from a theory of moral sensitivity. This Likert-type scale contains 30 items constructed from the following categories: interpersonal orientation, structuring moral meaning, benevolence, modifying autonomy, experiencing moral conflict, and trust in medical knowledge and principles of care. The purpose was to identify possible differences in responses rather than to evaluate right or wrong responses. The analysis is based on 754 completed questionnaires. The results of the study showed some significant differences in the item and category levels; for example, male psychiatrists experienced more conflicts than female psychiatrists and agreed to a greater extent that medical knowledge was most important in deciding what was best for the patient. The results also showed that more female than male psychiatrists thought that the relationship with the patient was most important in psychiatric practice.

Adult↗
PubMed1998

The mettle of moral fundamentalism: a reply to Robert Baker.

This article is a reply to Robert Baker's attempt to rebut moral fundamentalism, while grounding international bioethics in a form of contractarianism. Baker is mistaken in several of his interpretations of the alleged moral fundamentalism and findings of the Advisory Committee on Human Radiation Experiments. He also misunderstands moral fundamentalism generally and wrongly categorizes it as morally bankrupt. His negotiated contract model is, in the final analysis, itself a form of the moral fundamentalism he declares bankrupt.

Advisory Committees↗
PubMed1978

A comparison of moral reasoning in drug addicts and nonaddicts.

Assessed moral reasoning of 20 male addict patients and 17 nonprofessional male hospital employees by Kohlberg's methods. The mean level of moral reasoning of the drug addict group (2.97) was not found to differ significantly from that of the nonaddict comparison group (2.88). Furthermore, moral reasoning in addicts was not found to be related significantly to a number of background and personality characteristics. The findings, therefore, indicated that moral reasoning and moral behavior are not related significantly in drug addicts. It was concluded that the deviant behavior of this group is more likely the result of a deficiency in ego controls.

Adult↗
PubMed2002

Morality and the limits of societal values in health care allocation.

In this paper, we consider whether there is a clear moral justification for the proposal that societal value preferences (SVPs) should be included in Cost Effectiveness Analyses (CEA) of health care resource allocations. We argue, first, that proponents of the use of SVPs need to be clear about the relationship between these values and moral principles. In particular, once moral principles are accepted as ruling out some SVPs (such as those that are irrational or revealing prejudice), an account is required of why we need to appeal to SVPs rather than moral principles to determine a just division of health care resources. Secondly, we consider whether an independent moral justification might underwrite the use of SVPs. In various places in the literature the notions of representation, presumed consent and democratic decision making appear to be invoked as candidates for fulfilling this justificatory role. We discuss some problems with each of these justifications in the hope of eliciting a more comprehensive proposal from the proponents of SVPs. We conclude that, although a number of interesting proposals have been made, no compelling justification for including SVPs in CEA has yet been systematically articulated.

Community Participation↗
PubMed1980

Perceived choice, social interaction, and dimensions of moral of residents in a home for the aged.

In a study of 50 residents in a home for the aged, the relationships of health at relocation, choice in relocation, income, perceived choice within an institutional environment, and social interaction to four indices of morale were examined in hierarchical multiple regression designs. The theoretical concept of decisional control (i.e., perceived choice) guided the investigation. Significant multivariate effects were found for all dimensions of morale: agitation, attitude toward own aging, lonely dissatisfaction, and a combined morale index. Choice within the institution and social interaction were the major contributors to these significant multivariate relationships, but income was also influential in analysis of the attitudinal and combined morale indices for a subsample. Retrospective measures of health at relocation and choice in relocation were unstable in their contributions to overall multivariate relationships. Relationships of age, recency of loss of a significant other, and length of residency to morale were explored and found not to be significant. Results are discussed against the background of theoretical expectations, and avenues for future research are identified.

Aged↗
PubMed2000

Bridging the gap between moral reasoning and adolescent engagement in risky behavior.

Relations among moral reasoning, domain judgment and engagement in risky behaviors were assessed with 68 students attending a Just Community school and 122 comparison students from the larger high school with which the alternative school is affiliated. Risky behaviors were perceived as personal decisions, rather than as ones of morality or convention. Engagement and domain judgment of risky behavior interacted; with increasing substance involvement, students were more likely to view the decision to use drugs and alcohol as a personal decision than as either a moral or conventional decision. Domain judgments of risks appeared to moderate the relation between moral reasoning and engagement in risky behavior, suggesting that moral education interventions must encourage youth to explore their views that much of their behavior is only their own business.

Adolescent↗