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PubMed1991

Medical students' professional ethics: defining the problems and developing resources.

An AAMC working group concluded that medical educators have paid insufficient attention to students' development of professional standards and to the immediate ethical dilemmas that students face as students. Its discussion of the primary determinants of medical students' ethical development focused on improving: (1) the evaluation of candidates for admission; (2) the medical school learning climate, including recognition of the challenges inherent in the increasing cultural diversity among students and patients; and (3) communication to students of expectations of professional behaviors and standards. An AAMC initiative is outlined that includes preparation of a resource book featuring cases illustrating common ethical dilemmas that medical students face, descriptions of effective honor systems, suggestions for faculty development, and an annotated bibliography.

Adolescent↗
PubMed1999

Individual moral judgment and cultural ideologies.

Moral judgment cannot be reduced to cultural ideology, or vice versa. But when each construct is measured separately, then combined, the product predicts powerfully to moral thinking. In Study 1, 2 churches (N = 96) were selected for their differences on religious ideology, political identity, and moral judgment. By combining these 3 variables, a multiple correlation of .79 predicted to members' moral thinking (opinions on human rights issues). Study 2 replicated this finding in a secular sample, with the formula established in Study 1 (R = .77). Individual conceptual development in moral judgment and socialization into cultural ideology co-occur, simultaneously and reciprocally, in parallel, and not serially. Individual development in moral judgment provides the epistemological categories for cultural ideology, which in turn influences the course of moral judgment, to produce moral thinking (e.g., opinions about abortion, free speech).

Adult↗
PubMed1981

Eleanor Clarke Slagle Lectureship--1981. Occupational therapy revisited: a paraphrastic journey.

Occupational Therapy's roots are in the subsoil of the moral movement developed in Europe during the Age of Enlightenment. Philippe Pinel, a French philosopher-physician, and William Tuke, an English merchant-philanthropist, developed the principles and applied them to the insane in institutions. Moral treatment came to the United States as part of the Quaker's religious and intellectual luggage. It expanded rapidly in private, as well as in public, institutions for the insane. During the last quarter of the 19th century moral treatment disappeared. It re-emerged in the early decades of the 20th century as Occupational Therapy. A diverse group of women and men developed principles and definitions and founded an organization to support the practice of the re-titled moral treatment and management. Susan Tracy, a nurse; George Barton, an architect; William Rush Dunton, Jr., a physician; Eleanor Clarke Slagle, a partially trained social worker also trained in invalid occupations; and Adolf Meyer, another physician, figure prominently in the development of this century's Occupational Therapy. A second generation of occupational therapists elaborated upon, codified, and applied the founders' principles. Their efforts through one individual: Beatrice D. Wade, OTR, FAOTA. Lessons from 200 years of development of moral treatment and occupational therapy are cited.

Adult↗
PubMed1991

Conceptual issues in nursing ethics research.

Empirical studies that have attempted to describe nurses' ethical practice have used conceptual frameworks derived primarily from the disciplines of bioethics and psychology. These frameworks have not incorporated important concepts developed by nursing theorists over the past two decades. This article points out flaws in the past research frameworks and proposes a synthesis of ethical theory, nursing practice contexts, and empirical research methods to enrich theoretical development in nursing ethics.

Ethical Analysis↗
PubMed1991

The role of experience, narrative, and community in skilled ethical comportment.

Two major types of narrative--constitutive or sustaining narratives and narratives of learning--are presented to illustrate the functions of narrative in everyday ethical expertise and socially embedded caring practices. Four narrative themes illustrate constitutive and sustaining narratives: healing and transcendence, the heroic saving of a life, fostering care and correction, and stories of being present. Five themes illustrate narratives of learning: the skill of involvement, being open to experience, disillusionment, facing death and suffering, and liberation. Quandary- and rights-based procedural ethics address ethical problems and breakdown and overlook everyday ethical comportment. Public storytelling is recommended as a way to explore notions of the good and ethical concerns.

Assertiveness↗
PubMed2005

Shaping ethics: youth workers matter.

The authors propose that youth workers and educators committed to informing and shaping the ethical understandings of young people first need to explore and become aware of their own ethics. This requires front-line staff and caregivers to critically reflect on the impact their day-to-day choices and decisions have on youth. Once they become clearer about their own ethics and the consequences of their decisions, youth workers are then in a position to promote opportunities for youth to make ethical choices. The authors use observations and ideas from their experiences with the Minnesota Youth Work Institute. Their overarching aim is to promote ethical congruence between what is taught, how it is taught, and how it is practiced in daily work with youth.

Adolescent↗
PubMed1992

The consent process and children.

Traditionally, recommendations and procedures for obtaining consent and assent from children to participate in research have varied somewhat from institution to institution. At least some of this inconsistency can be attributed to a lack of consensus on what consent means when applied to individuals less than 18 years of age. Developmental theories provide some rationale for reconsidering the arbitrary age limit of 18 years for informed consent. In this article, the concepts of consent and assent are discussed relative to developmental characteristics of children and adolescents and implications for consent and assent procedures are discussed.

Adolescent↗
PubMed2004

The development of a brief and objective method for evaluating moral sensitivity and reasoning in medical students.

BACKGROUND: Most medical schools in Japan have incorporated mandatory courses on medical ethics. To this date, however, there is no established means of evaluating medical ethics education in Japan. This study looks 1) To develop a brief, objective method of evaluation for moral sensitivity and reasoning; 2) To conduct a test battery for the PIT and the DIT on medical students who are either currently in school or who have recently graduated (residents); 3) To investigate changes in moral sensitivity and reasoning between school years among medical students and residents. METHODS: Questionnaire survey: Two questionnaires were employed, the Problem Identification Test (PIT) for evaluation of moral sensitivity and a portion of the Defining Issues Test (DIT) for moral reasoning. Subjects consisted of 559 medical school students and 272 residents who recently graduated from the same medical school located in an urban area of Japan. RESULTS: PIT results showed an increase in moral sensitivity in 4th and 5th year students followed by a decrease in 6th year students and in residents. No change in moral development stage was observed. However, DIT results described a gradual rising shift in moral decision-making concerning euthanasia between school years. No valid correlation was observed between PIT and DIT questionnaires. CONCLUSION: This study's questionnaire survey, which incorporates both PIT and DIT, could be used as a brief and objective means of evaluating medical students' moral sensitivity and reasoning in Japan.

Attitude of Health Personnel↗
PubMed1994

The impact of a dental ethics curriculum on moral reasoning.

This study explored the effects of problem-oriented dental ethics curriculum, consisting of 39 contact hours distributed over four years on moral reasoning development and on attitudes about the value of instruction. Students (n = 720) in the classes of 1985 through 1992 participated in the required curriculum and completed, as freshman and seniors, the Defining Issues Test (DIT), a well-validated test of moral reasoning. In addition, students responded to open-ended questions about the value of ethics instruction. Cross-sectional comparison of the eight classes of entering freshman with two classes of third quarter juniors (n = 265) who completed the DIT prior to implementing the ethic curriculum indicated that the dental curriculum offered prior to 1981 had little influence on moral reasoning. Pre- to posttest DIT comparisons for seven of the eight classes of instructed students indicated statistically significant improvement. Comparison of the effect sizes (Cohen's d) of our intervention with the average effect size reported in a meta analysis of effective interventions indicates that results cannot be attributed to student maturation alone. Analysis of individual change patterns suggest that the success occurred despite a higher than average (17 percent vs. 6 percent) number of students who showed regression from pre- to posttest. Substantive explanations (gender, motivation, regression to the mean) did not appear to account for the change patterns, but theoretical explanations, based on observations in other settings, offer insights for further research and curriculum development. In conclusion, the results indicate that students not only benefit from ethics instruction, but value it.

Adult↗
PubMed1995

Aristotle, nursing and health care ethics.

Even a brief consideration of the nature of nursing will indicate that an ethical dimension underlies much, if not all, of nursing practice. It is therefore important that students and practitioners are facilitated in developing an ethical awareness and sensitivity from early in their professional development. This paper argues that Aristotelian virtue theory provides a practice-based focus for health care ethics for a number of reasons. Also, because of his emphasis on the character of the moral agent, and on the importance of perception and emotion in moral decision-making, Aristotelian virtue theory provides a useful supplement to the traditional duty-based approaches to health care ethics analysis, which are increasingly being identified in the literature as having limits to their application within the health care context.

Ethical Theory↗
PubMed1991

Ethical manipulations: an ethical evaluation of the debate surrounding genetic engineering.

"Manipulation" per se is not bad. The crucial question in the moral debate about genetic engineering is: When and how are we allowed to manipulate? Unfortunately, the moral discussion surrounding this question is itself being manipulated. There are moral manipulations (by those who wish to either reassure or to alarm) and there are ethical manipulations (the failed utilitarian calculus and the centering of the discussion only around rules, rights, and duties). A different ethical approach is needed: one based on virtues. The duty of ethics is to help us understand the moral possibilities in each situation, i.e., to develop our moral sensibility. In the area of genetic engineering research we are motivated by a will to know, but at the same time we fear total self knowledge. We want to control, to improve our world and ourselves, but we recoil at obtaining ultimate perfection. Therefore, we must value the unknowable, the uncontrollable. Our everincreasing capacity to mould the world and ourselves is making it more difficult to develop a sensitivity for what is given and cannot be made. It is dangerous for our ethics to assume the activistic traits of our technology. We risk losing a fundamental element of what we are, or ought to be. We should train ourselves in moral passivity.

Attitude↗