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PubMed1990

Establishing the moral basis of medicine: Edmund D. Pellegrino's philosophy of medicine.

Edmund D. Pellegrino's philosophy of medicine is explored in categories such as the motivation in constructing a philosophy of medicine, the method, the starting point of the doctor-patient relationship, negotiation about values in this relationship, the goal of the relationship, the moral basis of medicine, and additional concerns in the relationship (concerns such as gatekeeping, philosophical anthropology, axiology, philosophy of the body, and the general disjunction between science and morals). A critique of this philosophy is presented in the following areas: methodology, relation to ontology and sociology, the dynamic of individual and social concerns, and the new social condition of medicine. Finally, some suggestions for the future revitalization of philosophy of medicine are made based on Pellegrino's ideas. The focus throughout is on the moral basis and moral consequences of the philosophy of medicine, and not on other important themes.

Beneficence↗
PubMed1982

'Role' as a moral concept in health care.

In this article, it is argued that an appropriate starting point for an analysis of ethical issues in health care is the consideration of the role obligation of health care professionals. These obligations have customary, legal, and moral elements. By appreciating the different kinds of health care roles and their purposes, one can begin to understand some of the role conflicts which arise in the health care community. Moreover, one can see that some criticisms of health care professionals are mistaken. Nonetheless, there are internal conflicts with the roles of persons engaged in health care and historically some role obligations have violated fundamental universal norms. Whereas the latter inadequacy of health care role obligations can be eliminated, the former will, to at least some extent, always be with us. In short, it may be argued that some of the so-called "moral dilemmas"in health care can be resolved by taking the perspective of role morality. As will be shown, this does not suggest that there are no limitations of role morality.

Conflict, Psychological↗
PubMed1992

Evaluation of teaching medical ethics by an assessment of moral reasoning.

This study assessed the hypothesis that the formal teaching of medical ethics promotes a significant increase in the growth and development of moral reasoning in medical students. Results indicated a statistically significant increase (P less than or equal to 0.0005) in the level of moral reasoning of students exposed to a medical ethics course compared to the control group that was not exposed to the medical ethics course. When the posttest scores were adjusted by subtracting the pretest scores, the differences were even more significant (P less than or equal to 0.0002). This study confirmed similar findings of another study using a different instrument of assessment. Brief discussion is given of the fundamental premise that the appropriate function of teaching medical ethics in our modern pluralistic society is to improve students' moral reasoning about value issues regardless of what their particular set of moral values happens to be.

Education, Medical, Undergraduate↗
PubMed1995

Moral expertise: a problem in the professional ethics of professional ethicists.

Philosophers, particularly moral philosophers, are increasingly being involved in public decision-making in areas which are seen to raise ethical issues. For example, Dame Mary Warnock chaired the 'Committee of Inquiry into Human Fertilization and Embryology' in the UK in 1982-4; the Philosophy Department at Auckland was commissioned by the Auckland Regional Authority to report on the ethical aspects of fluoridating the public water supply in 1990; and many of us are serving on ethics committees of various sorts. Not only are philosophers actually being called on or consulted, but many of us would argue that a philosophical contribution in such areas is essential. The involvement of moral philosophers in public policy decisions raises a question of professional ethics, viz, what role should a philosopher's own moral perspective or judgements play in the advice s/he gives, or contribution s/he makes, to public decision-making on ethical issues. Like most problems in professional ethics, this prompts reflection on the nature of the profession, and in particular on the expertise we take moral philosophy to offer. It also prompts reflection on how processes of public decision making in ethically problematic areas should be understood. I explore these issues in this paper.

Advisory Committees↗
PubMed1990

Measuring nurses' moral judgments.

Studies of the moral reasoning of nurses yield inconsistent findings. Using Cronbach and Meehl's interpretive framework, the author demonstrates the lack of construct validity for Kohlberg's theory of moral development and related measures of moral reasoning. Gilligan's relational theory of moral orientations is proposed as an alternative theory worth testing in nurse samples.

Humans↗
PubMed1987

Fertilisation and moral status: a scientific perspective.

The debate about the moral status of the embryo has gained new impetus because of the advances in reproductive technology that have made early human embryo experimentation a possibility, and because of the public concern that this arouses. Several philosophical arguments claiming that fertilisation is the event that accords moral status to the embryo were initially formulated in the context of the abortion debate. Were they formulated with sufficient precision to account for the scientific facts as we now understand them? Or do these arguments need modification? Aspects of three arguments for moral status being acquired at fertilisation are examined in relation to current scientific knowledge, highlighting the reasons why such arguments, at present, seem to provide an inadequate basis for the determination of moral status.

Beginning of Human Life↗
PubMed1999

Achieving moral health care: the challenge of patient partiality.

Illness and hospitalization are sources of vulnerability; they arguably endow nurses and midwives with the moral obligation to develop caring relationships with patients. Fairness and the equal treatment of patients are central to moral practice; current government publications are giving this political emphasis. This article argues that patient partiality is one factor that may result in insidiously unequal caregiving. Data generated during a qualitative study into professional caring suggest that patient partiality is an accepted part of everyday practice. Factors such as the patient's personality, nurse-patient familiarity and the perceived level of patients' understanding and interest in their illness emerged as possible sources of partiality and influence on practitioners' interactions with patients. The article argues that patient partiality can be managed morally if practitioners develop self-awareness and constantly reflect on the moral integrity of everyday practice. Throughout the article, unless it is stated that specific reference is being made to either nurses or midwives, reference to a nurse or practitioner denotes both. It is also emphasized that no implication is intended that any study participants provided unequal care. Rather, data are utilized solely to generate focused discussion around the concept of patient partiality.

Attitude of Health Personnel↗
PubMed1987

Value analysis: a method for teaching nursing ethics and promoting the moral development of students.

In an investigation of junior-level baccalaureate nursing students, the value analysis teaching strategy was used to teach content related to nursing ethics. It was hypothesized that such a strategy, which emphasized the need for careful evaluation and weighing of facts preparatory to drawing conclusions, would impact on the student's level of cognitive moral development. Cognitive moral development was defined in accord with Kohlberg's theory of moral development. Control and experimental populations were derived from two groups of students sequentially enrolled in the same course. Pre- and post-testing using scores on Rest's Defining Issues Test (DIT) showed significant differences in gain between control and experimental subjects. There was a strong association between DIT score gains and self-report of peer discussion of ethical issues. The major implication of this study is that instructional intervention produces measurable change in some students' level of moral judgment.

Curriculum↗
PubMed1994

The relevance of Noddings' ethics of care to the moral education of nurses.

Noddings' ethics of care is proposed as a model for moral education in nursing. A discussion of Noddings' moral theory is followed by a review of significant criticisms of her theory and her response to these criticisms. Finally, the usefulness of her moral theory as a guide to moral education in nursing is explored.

Curriculum↗
PubMed1990

Impacting moral reasoning in allied health students.

This study was designed to assess the relative impact of a course in biomedical ethics on the moral reasoning skills of junior-level students in a school of allied health. A pretest-posttest nonequivalent control group design was used. The course was found to significantly impact principled moral reasoning scores as measured by Rest's Defining Issues Test (DIT). Male-female differences in DIT score changes were also suggested. The nature of the instruction appears paramount to possible changes in moral thinking, indicating that moral education programs need to emphasize dilemma discussion in their formats.

Allied Health Occupations↗
PubMed1994

A comparison of combat's effects on PTSD scores in veterans with high and low moral development.

This study was designed to explore the effects of moral development on the relationship between combat intensity and severity of posttraumatic stress disorder. The effect of combat intensity on PTSD Interview total scores and several individual stress disorder symptom ratings was substantial in a Low Moral Development sample, but negligible in a High Moral Development group. These data suggest that moral development may blunt the effect of combat severity on PTSD. These effects were strongest on items that describe reexperiencing of the trauma and exaggerated arousal. Possible interpretations of the results and several caveats were discussed.

Adult↗
PubMed2002

From moral theory to penal attitudes and back: a theoretically integrated modeling approach.

From a moral standpoint, we would expect the practice of punishment to reflect a solid and commonly shared legitimizing framework. Several moral legal theories explicitly aim to provide such frameworks. Based on the theories of Retributivism, Utilitarianism, and Restorative Justice, this article first sets out to develop a theoretically integrated model of penal attitudes and then explores the extent to which Dutch judges' attitudes to punishment fit the model. Results indicate that penal attitudes can be measured in a meaningful way that is consistent with an integrated approach to moral theory. The general structure of penal attitudes among Dutch judges suggests a streamlined and pragmatic approach to legal punishment that is identifiably founded on the separate concepts central to moral theories of punishment. While Restorative Justice is frequently presented as an alternative paradigm, results show it to be smoothly incorporated within the streamlined approach.

Attitude↗
PubMed2002

The impact of political conflict on moral maturity: a cross-national perspective.

This cross-national study of moral reasoning among adolescents in Northern Ireland, Scotland and the Republic of Ireland, addresses the problem of possible moral truncation in Northern Ireland due to the political conflict. The Sociomoral Reflection Measure-Short Form (SRM-SF; Gibbs et al. (1992) Moral Maturity: Measuring the Development of Sociomoral Reflection. Englewood Cliffs, NJ: Erlbaum. was presented to a proportionate stratified sample of 14-15 year olds (n = 613) from three locations including a small town, large town and city in each country to control for urbanization. This adolescent sample consisted of participants from both of Northern Ireland's religious communities and was matched for age and sex. Analysis of the results suggested that despite the violent atmosphere over the last 30 years, the Northern Irish adolescents were not developmentally delayed in moral terms as previously feared (Fraser (1972) Special Education,61, 6-8; Fields (1973). A Society on the Run: A Psychology of Northern Ireland. Harmondsworth, Middlesex: Penguin; (1976) Northern Ireland: Society Under Siege. New Brunswick and London: Transaction Books; Lyons (1973) The Northern Teacher, 19-30)

Adolescent↗
PubMed2002

Functional networks in emotional moral and nonmoral social judgments.

Reading daily newspaper articles often evokes opinions and social judgments about the characters and stories. Social and moral judgments rely on the proper functioning of neural circuits concerned with complex cognitive and emotional processes. To examine whether dissociable neural systems mediate emotionally charged moral and nonmoral social judgments, we used a visual sentence verification task in conjunction with functional magnetic resonance imaging (fMRI). We found that a network comprising the medial orbitofrontal cortex, the temporal pole and the superior temporal sulcus of the left hemisphere was specifically activated by moral judgments. In contrast, judgment of emotionally evocative, but non-moral statements activated the left amygdala, lingual gyri, and the lateral orbital gyrus. These findings provide new evidence that the orbitofrontal cortex has dedicated subregions specialized in processing specific forms of social behavior.

Adult↗
PubMed1988

Interrelations of empathy, cognition, and moral reasoning with dimensions of juvenile delinquency.

The interrelations of a variety of indices of sociocognitive development (empathy, role-taking, logical cognition, and moral reasoning) were studied in delinquent and nondelinquent adolescents. Delinquent males (grouped into psychopathic, neurotic, and subcultural subgroups) and a matched nondelinquent comparison group were administered individually two empathy scales (the Davis Interpersonal Reactivity Index and the Mehrabian and Epstein Questionnaire Measure of Emotional Empathy), an adaptation of Byrne's and Flavell's role-taking tasks, two Piagetian cognitive tasks, and two of Kohlberg's structured moral dilemmas. Delinquents as a group displayed significantly more immature modes of role-taking, logical cognition, and moral reasoning than did nondelinquents. The delinquent subgroups, however, did not significantly differ from one another on these dimensions. Role-taking, logical cognition, and moral reasoning were significantly related to one another. Anticipated differences in level of empathy between the delinquent and nondelinquent adolescents failed to occur. A number of interpretations for this unexpected finding are offered.

Adolescent↗
PubMed1983

Moral judgment in relation to behavioral and cognitive disorders in adolescents.

The capacity for formulating moral judgments shown by 20 emotionally disturbed, cognitively delayed adolescents was related to their social behaviors as observed in a classroom situation. Adolescents reported by their teachers to be shy and submissive were less capable of reasoning about moral issues than were adolescents who were seen as more assertive and socially engaged. The level of moral judgment was not a function of intelligence or ability to understand concrete operations. The implication that social engagement is a critical determinant of moral judgment for these adolescents is discussed.

Adolescent↗
PubMed2006

The moral judgment of juvenile delinquents: a meta-analysis.

A meta-analysis of 50 studies was conducted to investigate whether juvenile delinquents use lower levels of moral judgment than their nondelinquent age-mates and, if so, what factors may influence or moderate the developmental delay. The results show a lower stage of moral judgment for juvenile delinquents (d=.76). Effect sizes were large for comparisons involving male offenders, late adolescents, delinquents with low intelligence, and incarcerated delinquents. The largest effect sizes were found for period of incarceration and comparisons involving juvenile delinquents with psychopathic disorder. Production instead of recognition measures, dilemma-free assessment methods, and non-blind scoring procedures yielded relatively large effect sizes, whereas effect sizes were medium for comparisons involving delinquents with average intelligence, non-incarcerated delinquents, female offenders, as well as early and middle adolescents. Psychopathic disorder and institutionalization were identified as unique moderators of the link between moral judgment and juvenile delinquency. It is concluded that developmentally delayed moral judgment is strongly associated with juvenile delinquency, even after controlling for socioeconomic status, gender, age and intelligence.

Adolescent↗
PubMed2005

The role of moral disengagement in the execution process.

The present study tested the proposition that disengagement of moral self-sanctions enables prison personnel to carry out the death penalty. Three subgroups of personnel in penitentiaries located in three Southern states were assessed in terms of eight mechanisms of moral disengagement. The personnel included the execution teams that carry out the executions; the support teams that provide solace and emotional support to the families of the victims and the condemned inmate; and prison guards who have no involvement in the execution process. The executioners exhibited the highest level of moral, social, and economic justifications, disavowal of personal responsibility, and dehumanization. The support teams that provide the more humane services disavowed moral disengagement, as did the noninvolved guards but to a lesser degree than the support teams.

Adaptation, Psychological↗