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PubMed2005

Identity and moral responsibility of healthcare organizations.

In this paper the moral responsibility of a Healthcare Organization (HCO) is conceived as an inextricable aspect of the identity of the HCO. We attempt to show that by exploring this relation a more profound insight in moral responsibility can be gained. Referring to Charles Taylor we explore the meaning of the concept of identity. It consists of three interdependent dimensions: a moral, a dialogical, and a narrative one. In section two we develop some additional arguments to apply his concept of personal identity to organizations. The final section works out the relationship of three dimensions of identity to some actual issues in contemporary HCOs: the tension between care and justice, the importance of dialogues about the diversity of goods, and the relevance of becoming familiar with the life-story of the HCO. Identity of an HCO is established and developed in commitments to and identification with certain goods that are central for a HCO. However, many of these goods are interwoven with everyday practices and policies. Therefore, moral responsibility asks for articulation of goods that often stay implicit and should not be reduced to a merely procedural approach. However difficult this articulation may be, if it is not tried at all HCOs run the risk of drifting away from their very identity as healthcare institutions: to offer care to patients and to do this in accordance with demands of social justice.

Delivery of Health Care↗
PubMed2006

Ethical concepts regarding the genetic engineering of laboratory animals: A confrontation with moral beliefs from the practice of biomedical research.

Intrinsic value and animal integrity are two key concepts in the debate on the ethics of the genetic engineering of laboratory animals. These concepts have, on the one hand, a theoretical origin and are, on the other hand, based on the moral beliefs of people not directly involved in the genetic modification of animals. This 'external' origin raises the question whether these concepts need to be adjusted or extended when confronted with the moral experiences and opinions of people directly involved in the creation or use of transgenic laboratory animals. To answer this question, 35 persons from the practice of biomedical research who are directly involved in genetic engineering (scientists, biotechnicians, animal caretakers and laboratory animal scientists) were interviewed. They were asked to give their moral opinion on different aspects of the genetic engineering of animals and to react to statements about the concepts of intrinsic value and animal integrity. Analysis of the interviews showed that, contrary to what is often assumed, the respondents embraced these concepts, even those senses that (more) specifically apply to genetic engineering. And although the respondents raised some objections that go beyond issues of animal welfare, these objections could quite well be expressed in terms of the concepts of intrinsic value and animal integrity. In short, the results of the present study strongly suggest that these concepts do not have to be adjusted or extended in the light of the moral experiences and opinions from practice.

Animals↗
PubMed2006

Caught in the act: the impact of audience on the neural response to morally and socially inappropriate behavior.

We examined the impact of witnesses on the neural response to moral and social transgressions using fMRI. In this study, participants (N=16) read short vignettes describing moral and social transgressions in the presence or absence of an audience. In line with our hypothesis, ventrolateral (BA 47) and dorsomedial (BA 8) frontal cortex showed increased BOLD responses to moral transgressions regardless of audience and to social transgressions in the presence of an audience relative to neutral situations. These findings are consistent with the suggestion that these regions of prefrontal cortex modify behavioral responses in response to social cues. Greater activity was observed in left temporal-parietal junction, medial prefrontal cortex and temporal poles to moral and to a lesser extent social transgressions relative to neutral stories, regardless of audience. These regions have been implicated in the representation of the mental states of others (Theory of Mind). The presence of an audience was associated with increased left amygdala activity across all conditions.

Behavior↗
PubMed2006

Moral reasoning as a model for health promotion.

The paper describes a model of moral reasoning used to guide the conduct of health researchers and recommends that this model be applied in health promotion. It argues that this model is a more appropriate and sound way of thinking about the means and ends of health education, with implications for both research and practice. When faced with ethical dilemmas about the most appropriate course of action in health research, investigators and bioethicists conduct normative analyses to identify good reasons for choosing one option over another. These reasons provide the grounds for determining what one should do, and for changing past practices in light of new moral considerations. Since the research community seems to think that this is a good way to guide and change their own behavior, this model of moral reasoning appears to have relevance and potential application to the field of health education, which engages in analogous processes of seeking to inform and change the behaviors of the lay public. The article sets this approach in the context of a humanistic understanding of human motivation and presents two case examples to illustrate the process of moral reasoning. The humanistic model outlined here helps to explain why health promotion has not made much progress in developing effective behavior change programs and it offers a more promising prospect for demonstrating success by identifying a broader range of relevant outcomes. The paper concludes by recommending that greater attention be paid to the ethical dimensions of human agency in order to develop a more coherent body of knowledge to advance both research and practice in health promotion.

Clinical Trials as Topic↗
PubMed1986

Changes in ego and moral development in adolescents: a longitudinal study.

A longitudinal study was designed to examine the relation between Loevinger's measure of ego development and moral development as indexed by Rest's Defining Issues Test in a sample of 123 adolescents at 12 to 14 years of age and four years later. Study I assessed differential rates of change and theoretically predicted directions of change in the two developmental functions and gender differences in ego development. Substantial ego stage movement occurred (60 per cent advancement, 40 per cent stability); moral growth was moderate. Girls scored a half ego stage ahead of boys; patterns of directional change were similar. Ego level and moral development related at either fixed point in time, but ego functioning in early adolescence did not predict subsequent moral development. Study II addressed adolescents' perceptions of parenting styles in relation to these social cognitive functions. Parental behaviours that involve loving or support related to higher ego levels; parental demanding associated with lower ego development in early adolescence. Traditional gender-related parent socialization was found among girls and boys with greater ego development. The mediating role of perceived childrearing styles was considered in relation to gender differences in ego development.

Adolescent↗
PubMed2004

Abortion: the legal right has been won, but not the moral right.

In 1978 the abortion law was liberalised in Norway. It permits abortion on request up to 12 weeks of pregnancy, and after that with the agreement of a medical commission, taking the woman's own views into consideration. In 2003, 96% of abortions took place before 12 weeks of pregnancy. There is considerable support among the population for the current law, and the right to abortion does not seem to be under threat, yet opponents of abortion attack the law frequently. Debates on recent biotechnology laws and difficulties introducing the abortion pill, on the spurious grounds that it would make abortion too easy, imply continuing moral qualms about abortion. While abortion among young, unmarried women is more accepted, many married women feel they have to justify their decision. Women are expected to feel sorrow, shame and guilt because of their sexual conduct for many reasons, but especially if the result is an unwanted pregnancy. It is easier to protect the law when there is recognition of the moral right to choose abortion. The legal battle has been won, but winning the moral battle is important in Norway now. I believe that until having an abortion is considered as acceptable morally as using contraception, women will not have gained their full reproductive rights.

Abortion, Induced↗
PubMed1998

The inadequacy of a duty-based approach to the moral problems of health care.

Moral beliefs commonly are thought to be eternal and not subject to change, a perspective frequently reinforced by religious authority and secular traditions. Yet an examination of morality shows that moral beliefs and actions have changed over time in response to various factors. Indeed, the point could be argued that one of the challenges to morality is responding to change--no less so in the domain of bioethics and health care than in society at large.

Community Health Nursing↗
PubMed1989

Countering moral hazard in public and private health care systems: a review of recent evidence.

Within both publicly and privately financed health care systems different funding mechanisms have evolved, or have been proposed, to deal with the problem of 'moral hazard'. Moral hazard arises when financial incentives within the health care system lead to either inefficient demands for care by consumers or inefficient supply of care by providers. In this paper the problem of moral hazard is outlined in more detail, and different ways of countering moral hazard are reviewed in terms of three criteria: effect on patient utilisation of health services in general: effect on utilisation by different groups of patients; and effect on health status. It is concluded that evidence on different methods of funding health services can only be judged in the context of objectives. If the objectives of health care delivery are 'maintenance or improvement of health' and 'equal access for equal need' then charges of finance of care through health maintenance organisations both appear to be less favourable than 'free' care at the point of delivery whilst the latter is not necessarily more costly as a result. Research on other suggested alternatives is required, otherwise radical changes to health care financing in the UK will simply result in movement from one unproven system to another.

Capitation Fee↗
PubMedDate not supplied

Morale of mental health professionals in Community Mental Health Services of a Northern Italian Province.

AIMS: To explore morale of psychiatrists and psychiatric nurses working in Community Mental Health Centres (CMHC) in an Italian Province, and identify influential factors. METHODS: Thirty psychiatrists and 30 nurses working in CMHCs in Modena completed questionnaires on burnout, team identity and job satisfaction. They also answered open questions about different aspects of their work. Answers were subjected to content analysis. Regression analyses were used to identify factors that predicted morale across groups. RESULTS: Psychiatrists had higher scores on emotional exhaustion and depersonalisation. There were no significant differences between the two groups in job satisfaction and job or role perception. Professionals reported positive relationships with patients as the most enjoyable aspects of their job, whilst team conflicts and high workloads were seen as most difficult to cope with. Multivariate analyses showed that being a psychiatrist and perceiving team conflicts as a main cause of pressure in the job predicted higher burnout. CONCLUSIONS: Simple open questions coupled with quantitative measures appear a promising tool to investigate morale of mental health professionals and identify factors determining morale. Research, training and service development should focus on relationship aspects both with patients and within teams to reduce burnout in CMHCs.

Adult↗
PubMed2004

Physicians' practices related to the use of terminal sedation: moral and ethical concerns.

OBJECTIVE: Although terminal sedation (TS) has generally been seen as legal and ethically acceptable, ethical and moral issues remain. Little is known about the use of TS in general clinical practice and about how TS is viewed by physicians, given moral and ethical concerns. The objectives of this study are (1) to describe attitudes of physicians regarding terminal sedation; (2) to explore demographic characteristics, such as age, gender, subspecialty, and number of years in practice, that might be related to the use of TS; and (3) to compare physicians who have and have not used TS on the degree to which they view TS as moral and consistent with their professional and personal ethics. METHODS: An anonymous survey of New Jersey physicians was conducted at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine. A 39-item questionnaire assessing general opinions about, experiences with, and religious, moral, ethical attitudes toward TS and other end-of-life treatments was utilized. RESULTS: A majority of physicians (73%) had used TS for a patient. Most (93%) said there were circumstances under which they would use TS. With regard to questions about whether TS would be "immoral," "would violate my religious beliefs," "would violate my professional ethics" and "is inconsistent with the physician's role of preserving life," approximately 55% of those who have used TS disagreed; for those who have not used TS, approximately 35% disagreed. SIGNIFICANCE OF RESULTS: Professional education and opportunities for discussion appear necessary to help reconcile the conflicts raised in the use of this end-of-life treatment strategy.

Adult↗
PubMed2000

Corporate moral responsibility in health care.

The question of corporate moral responsibility--of whether it makes sense to hold an organisation corporately morally responsible for its actions, rather than holding responsible the individuals who contributed to that action--has been debated over a number of years in the business ethics literature. However, it has had little attention in the world of health care ethics. Health care in the United Kingdom (UK) is becoming an increasingly corporate responsibility, so the issue is increasingly relevant in the health care context, and it is worth considering whether the specific nature of health care raises special questions around corporate moral responsibility. For instance, corporate responsibility has usually been considered in the context of private corporations, and the organisations of health care in the UK are mainly state bodies. However, there is enough similarity in relevant respects between state organisations and private corporations, for the question of corporate responsibility to be equally applicable. Also, health care is characterised by professions with their own systems of ethical regulation. However, this feature does not seriously diminish the importance of the corporate responsibility issue, and the importance of the latter is enhanced by recent developments. But there is one major area of difference. Health care, as an activity with an intrinsically moral goal, differs importantly from commercial activities that are essentially amoral, in that it narrows the range of opportunities for corporate wrongdoing, and also makes such organisations more difficult to punish.

Ethics, Institutional↗
PubMed2003

Persecutors or victims? The moral logic at the heart of eating disorders.

Eating Disorders, particularly anorexia and bulimia, are of immense contemporary importance and interest. News stories depicting the tragic effects of eating disorders command wide attention. Almost everybody in society has been touched by eating disorders in one way or another, and contemporary obsession with body image and diet fuels fascination with this problem. It is unclear why people develop eating disorders. Clinical and sociological studies have provided important information relating to the relational systems in which eating disorders are mainly found. This paper shows that their explanations are not conclusive and points out that the reasons why people develop eating disorders should not be found in the dysfunctional interactions occurring in both familial and social systems, but in the moral beliefs that underlie these interactions. Eating disorders are impossible to understand or explain, unless they are viewed in the light of these beliefs. A moral logic, that is a way of thinking of interpersonal relations in moral terms, gives shape to and justifies the clinical condition, and finds consistent expression in abnormal eating behaviour. The analysis offered here is not mainstream either in philosophy (eating disorders are in fact seldom the subject of philosophical investigation) or in clinical psychology (the methods of philosophical analysis are in fact seldom utilised in clinical psychology). However, this paper offers a important contribution to the understanding of such a dramatic and widespread condition, bringing to light the deepest reasons, which are moral in nature, that contribute to the explanation of this complex phenomenon.

Culture↗
PubMed2003

[Improving job morale of nurses despite insurance cost control. 1: Organization assessment].

Faced with declining resources for health care and greater pressures to improve productivity of nursing staff, nursing administrators must act now to develop organizational responses to morale problems among nursing staff. As part of a two-part series for JONA, the authors describe low-cost organizational approaches that address nursing morale. Presented in Part 1 is a low-cost diagnostic process for assessing needs of staff and appraising organizational dimensions contributing to morale. Assessment findings provide clear direction for developing organizational approaches for improving morale.

Cost Control↗
PubMed1997

Children's moral and ecological reasoning about the Prince William Sound oil spill.

Sixty 2nd, 5th, and 8th graders were interviewed on their moral and ecological reasoning about the 1990 Exxon Valdez oil spill that occurred in Prince William Sound, Alaska. Results showed that children understood that the oil spill negatively affected the local Alaskan shoreline, marine life, fishermen, recreationists, and the oil company. Children cared that harm occurred to the shoreline and marine life and conceived of both types of harm as violating a moral obligation. Fifth and 8th graders, compared with 2nd graders, used a greater proportion of anthropocentric reasoning (e.g., that nature ought to be protected to protect human welfare) and biocentric reasoning (e.g., that nature has intrinsic value, rights, or a teleology). Discussion focuses on how studying children's reasoning about nature not only extends the bounds of what counts as moral--to include a relationship with the natural world--but also provides a unique means by which to conduct basic research on children's moral development.

Adolescent↗
PubMed1998

Can prototypes inform moral developmental theory?

L. J. Walker and R. C. Pitts (1998) suggest that research on prototypes of moral excellence can lead to important new insights for accounts of moral development that are unlikely to emerge from the efforts of theorists working within psychological or philosophical paradigms. In this commentary, I argue that (a) experts in philosophical and psychological paradigms can and do contribute to revisions of theories of moral excellence, and (b) the study of prototypes has limited value for resolving some important theoretical issues. Three research topics that can be informed by the investigation of prototypes of moral excellence are described.

Adolescent↗
PubMed1998

Korean children's concepts of adult and peer authority and moral reasoning.

This study examined Korean children's judgments about authority commands regarding moral events bearing on property rights (dealing with lost property), distributive justice (sharing candy), and public welfare (disposing of trash). Sixty children from the 1st, 3rd, and 5th grades were presented with story variations in which an individual intervened, giving a command to children, or in which 2 different persons gave opposing commands. At all ages, children judged that a principal, a teacher, a class president, and a child who held no position of authority have legitimacy and should be obeyed when giving directives considered morally right. Children also accorded greater legitimacy to persons giving commands consistent with moral demands (a teacher, a class president, or a child with no position of authority) over a principal's command contrary to the moral evaluation. Justifications for their choices were based on rights, sharing, and welfare. The findings showed that Korean children do not take a unilateral orientation to adult authorities or unquestioningly accept authority directives.

Adult↗
PubMed1975

Sex differences in moral internalization and values.

The subjects were fifth- and seventh-grade white middle-class children and their parents. The major moral internalization indices pertain to internal moral judgment, guilt intensity, and fear of punishment. The findings support the prevalent view that consideration for others is more salient in females. They also suggest, with considerable consistency (especially in adults) that moral transgressions are more likely to be associated with guilt in females and fear in males. No sex differences in internal moral judgment were obtained. Evidence was presented suggesting that the differences in children may be due partly to different discipline and affection patterns. It was also suggested that the results for adults as well as children might be explained by differential sex-role socialization as well as by increasing pressures on males over the life cycle to achieve and succeed, which may often conflict with concerns about the welfare of others.

Achievement↗
PubMed1992

Culture and moral judgment: how are conflicts between justice and interpersonal responsibilities resolved?

A 2-session study examined Indian and American adults' and children's (N = 140) reasoning about moral dilemmas involving conflicts between interpersonal and justice expectations. Most Indians gave priority to the interpersonal expectations, whereas most Americans gave priority to the justice expectations. Indians tended to categorize their conflict resolutions in moral terms. In contrast, when Americans gave priority to the interpersonal alternatives, they tended to categorize their resolutions in personal terms. Results imply that Indians possess a postconventional moral code in which interpersonal responsibilities are seen in as fully principled terms as justice obligations and may be accorded precedence over justice obligations. Findings also suggest that a personal morality of interpersonal responsiveness and caring is linked to highly rights-oriented cultural views, such as those emphasized in the United States.

Adolescent↗