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PubMed1984

Abused, neglected, and nonmaltreated children's conceptions of moral and social-conventional transgressions.

The effect of child maltreatment on children's social-cognitive development was examined by investigating abused, neglected, and nonmaltreated children's judgments regarding the permissibility of social-conventional and moral transgressions pertaining to physical harm, psychological distress, and the unfair distribution of resources. Abused and neglected children and a control group of nonmaltreated children matched on IQ, age, and social class judged the seriousness, deserved punishment, generalizability, and rule contingency of familiar transgressions for themselves and others. Abused subjects were more likely than neglected subjects to consider psychological distress to be universally wrong for others; neglected subjects were more likely than abused subjects to judge the unfair distribution of resources to be universally wrong for themselves. Abused and control children, but not neglected children, judged all transgressions to deserve more punishment when committed by others than when committed by the self. All children distinguished between morality and social convention and between different types of moral transgressions on all 4 criteria. Furthermore, all children were more egocentric in their judgments for the self than for others. These findings are discussed in relation to research on the effects of child maltreatment and on moral judgment.

Child↗
PubMed1995

The moral and the healthy: identical, overlapping or orthogonal?

The pathogenic paradigm which underlies almost all current Western medical research and practice focuses on concrete diseases and is devoted, at least in theory, to the relief of suffering from these diseases. Clearly, the relief of suffering is a humane, moral pursuit. I have posed the salutogenic paradigm as a major challenge, urging the importance of research directed to the understanding of the mystery of and clinical work directed to the facilitation of movement toward the health end of a health ease/dis-ease continuum. I have proposed the Sense of Coherence (SOC) concept as a key answer to the salutogenic question. As this model is increasingly welcomed, I have become increasingly sensitive to the ethical dangers raised by it, or by any orientation, such as the WHO definition of health, which has salutogenic elements. This paper is devoted to examining these ethical problems. The first follows from the need to define the concept of health. The temptation is to confuse health well-being with other aspects of well-being, reflecting the value judgments of the definer. Such confusion becomes dangerous when the definer holds power over others. The second problem, which has two coordinate parts, is even more serious. It arises out of the search for health-promoting factors. It pressures one to assume that a. what is functional, useful and positive for health is morally good; and b. what is morally good is functional for health. (And, of course, the converse assumptions about moral evils.)

Ethics, Medical↗
PubMed1995

An analysis of some dimensions of the concept of moral sensing exemplified in psychiatric care.

There are few studies that focus on the interpersonal aspect of everyday ethical conflicts. Conceptual frameworks for research into ethical decision making in the health care system are mainly based on an ethic in which objectivity and principle-based thinking is emphasized, leaving the experience of concrete moral conflicts relatively unexplored. The aim of this paper is to analyze the dimensions of "moral sensing," a concept identified in an earlier grounded theory study of psychiatric nursing. Four dimensions of the concept of moral sensing, i.e., feeling, intuition, benevolence and genuineness, were synthesized by reviewing the works of past and contemporary philosophers. The analysis of moral sensing and its dimensions is exemplified by actual nurse-patient encounters in psychiatric nursing practice.

Decision Making↗
PubMed1993

[Difference in impact of social support on morale and medical utilization between elderly with low activity of daily living and elderly with high activity of daily living].

The impact of social support on morale and medical utilization among elderly with low activity of daily living (ADL) were compared to those of elderly with high ADL. Social support was measured from three aspects--receiving emotional support, receiving instrumental support, and providing emotional support, all based on the individual perception of the elderly person. Subjects were 125 persons with low ADL obtained from a national random survey of 3,288 people aged 60 and over. They were matched with 125 high ADL people with the same age categories and sex. 1. Persons with low ADL had lower PGC-Morale Scale Score than persons with high ADL. In the low ADL group, the percentage who went to a physician less than 3 times during the past three months was 30.6%. 2. In the low ADL group, people who perceived receiving high emotional support to others also scored high in PCG-Morale Scale. People who perceived being able to provide emotional support to others also scored high in PCG-Morale Scale. In the high ADL group, only perception for receiving emotional support had an impact on the score. 3. Social support of any kind did not have an impact on medical utilization in either group.

Activities of Daily Living↗
PubMed1996

Moral reasoning and malpractice. A pilot study of orthopedic surgeons.

The relationship between moral reasoning and malpractice claims was studied in 53 orthopedic surgeons. Levels of moral reasoning were defined by the percentage of principled responses (P-score) on Rest's Defining Issues Test, while annualized rates of malpractice claims were computed on the basis of data from a regional, physician-owned, interindemnity/liability protection trust. Orthopedic surgeons with fewer than 0.20 claims per year demonstrated significantly (P = 0.04) higher levels of moral reasoning (mean P-score of 43.8) than did those with claims rates higher than 0.40 claims per year (mean P-score of 38.0). Only 1 of 13 orthopedists with P-scores over 50 was found in the higher claims group, suggesting that high levels of moral reasoning may provide a protective element against malpractice claims.

Ethics, Medical↗
PubMed1995

Embryo experimentation and the murder prohibition: a casuistic examination of the utilitarian and pro-life positions on the moral status of the embryo.

Argument concerning the permissibility of embryo experimentation has tended to proceed from the opposed ethical principles of utilitarianism and the sanctity of human life, neither of which entirely reflects Western society's present position on murder and moral obligations. Singer's utilitarian arguments propose a test of subject attributes for admission to the protection of morality, and it is argued that this approach is entirely at odds with our current axiomatic application of the murder prohibition of post-birth humans. Similarly, those arguing from a pro-life position do not take account of the ambivalence of our application of this principle to the pre-birth human, as seen in abortion. In the attempt to deal with the quandary of the moral position of the embryo, we should, following the philosophical precedent of casuistry, start from the position of our current moral certainties, rather than expose ourselves to the social dangers of an untried rationality divorced from practice.

Australia↗
PubMed1998

Moral evaluation and concepts of health and health promotion.

This article considers the moral implications of some of the ways in which society, including nursing, thinks about health and health promotion. How we think about health shapes what we describe as healthy or unhealthy, as well as those factors that promote or hinder the attainment and maintenance of health. In turn, these concepts lead to actions that have moral significance. These issues are of particular import to nursing because health is central to what we understand our aims to be. To this end, the article addresses definitions of health, the relationship between morality and health, health promotion and the moral harms following from some of those practices, and the challenges to nursing.

Attitude to Health↗
PubMed2001

Response Mode Effects and Moral Values.

In five studies, we measured the extent to which subjects weight moral product attributes in different response modes. We found that nonprice judgments such as likelihood of purchase ratings were more reflective of expressed moral attitudes than were pricing responses, and that holistic price evaluations were especially unlikely to reflect moral considerations. Post-task ratings confirmed the preference results, as did an experiment controlling for the influence of task goals. Our results have implications for compatibility theories of preference elicitation, the predictability of respondent ratings of attribute unacceptability, and the measurement of utilities for morally charged attributes. Copyright 2001 Academic Press.

Journal Article↗
PubMed2004

Drug price regulation under consumer moral hazard. Two-part tariffs, uniform price or third-degree price discrimination?

Drug price differences across national markets as they exist in the EU are often justified by the concept of Ramsey prices: with fixed costs for R&D, the optimal mark-ups on marginal costs are inversely related to the price elasticity in the individual markets. This well-known result prevails if consumer moral hazard is taken into account. Contrary to the situation without moral hazard, the uniform price does not necessarily dominate discriminatory pricing in welfare terms. The two-part tariff is a better alternative as it allows governments to address moral hazard. A uniform price combined with lump-payments reflecting differences in the willingness to pay and the moral hazard in member states appears to be an attractive option for a common EU drug market.

Cost Control↗
PubMed2006

Severity of illness and the welfare effects of moral hazard.

The extent to which the moral hazard caused by health insurance represents economic inefficiency has been the subject of much debate. This paper incorporates health status in a model of moral hazard, and finds that seriously ill patients are likely to exhibit greater moral hazard than healthier patients but the proportion of moral hazard that is inefficient declines with the severity of illness. Because of these competing tendencies, the cost of resource misallocation is parabolic in the severity of illness. The effect of the consumer's initial wealth endowment is also considered.

Efficiency↗
PubMed2004

Genetic engineering and the moral status of non-human species.

Genetic modification leads to several important moral issues. Up until now they have been discussed from the viewpoint that only individual living beings, above all animals, are morally considerable. The standpoint that also collective entities such as species belong to the moral sphere have seldom been taken into account in a more thorough way, although it is advocated by several important environmental ethicists. The main purpose of this article is to analyze in more detail than often has been done what the practical consequences of this ethical position would be for the use of genetic engineering on animals and plants. The practical consequences of the holistic standpoint (focused on collective entities) of Holmes Rolson, III, is compared with the practical consequences of the individualistic standpoints (focused on individual living beings) of Bernard E. Rollin and Philipp Balzer, Klaus Peter Rippe, and Peter Schaber, respectively. The article also discusses whether the claim that species are morally considerable is tenable as a foundation for policy decisions on genetic engineering.

Animals↗
PubMed1985

Analyzing mental health evaluation: moral and ethical dimensions.

Now that evaluators have been sensitized to the importance of moral and ethical issues in their work, it is time to move beyond generalities and examine the moral and ethical implications of specific evaluation models in specific settings. This paper proposes a framework that can be used to examine moral and ethical dimensions of evaluation and illustrates it by analyzing a selected model of mental health evaluation. Such a systematic identification of moral issues can improve evaluation practice both proactively, by shaping the training of evaluators, and retrospectively, by contributing to meta-evaluation.

Data Collection↗
PubMed2003

Human health and stoic moral norms.

For the philosophy of medicine, there are two things of interest about the stoic account of moral norms, quite apart from whether the rest of stoic ethical theory is compelling. One is the stoic version of naturalism: its account of practical reasoning, its solution to the is/ought problem, and its contention that norms for creating, sustaining, or restoring human health are tantamount to moral norms. The other is the stoic account of human agency: its description of the intimate connections between human health, rational agency, and moral norms. There is practical guidance to be gained from exploring those connections, whether or not one is ready to follow stoic moral theory all the way to its austere end.

Health Status↗
PubMedDate not supplied

Conceptions of moral, social-conventional, and personal events among Chinese preschoolers in Hong Kong.

Sixty-one Chinese preschoolers from Hong Kong at 2 ages (Ms = 4.36 and 6.00 years) were interviewed about familiar moral, social-conventional, and personal events. Children treated personal events as distinct from moral obligations and conventional regulations. Children judged the child as deciding personal issues, based on personal choice justifications, whereas children judged parents as deciding moral and conventional issues. With age, children granted increased decision-making power to the child. In contrast, children viewed moral transgressions as more serious, generalizably wrong, and wrong independent of authority than other events, based on welfare and fairness. Punishment-avoidance justifications for conventional events decreased with age, whereas conventional justifications increased. Young Chinese preschool children make increasingly differentiated judgments about their social world.

Child, Preschool↗
PubMed1991

Ethics consultation as moral engagement.

I will begin by presenting some doubts about what might be called the "received view" of the role of the moral expert as a health care consultant. Then I will review the literature on moral experts and moral expertise and proceed to apply the results of that review to the notion that there are some who are expert in ethical decision making in health care. I will try to show that certain conclusions that can be drawn from this rather circumscribed topic have implications for the very conception of the relationship between moral theory and clinical ethics.

Bioethical Issues↗
PubMed2004

Research ethics committees: differences and moral judgement.

Many people argue that disagreements and inconsistencies between Research Ethics Committees are morally problematic and there has been much effort to 'harmonise' their judgements. Some inconsistencies are bad because they are due to irrationality, or carelessness, or the operation of conflicting interests, an so should be reduced or removed. Other inconsistencies, we argue, are not bad and should be left or even encouraged. In this paper we examine three arguments to reject the view that we should strive for complete consistency between committees. The first argument is that differences in judgement are not necessarily incompatible with ideas of justice for patients who are potential participants of research reviewed by different committees. We call this 'the justice argument.' The second argument is that such committees do not have access to a single moral truth, to which their judgement is supposed to correspond. We call this the 'moral pluralism argument.' The third argument is that the process of ethics committee review is also morally relevant and not solely the outcome. We call this the 'due process argument.' While we fall short of establishing exactly how much variation and on what substantive issues would ethical permissible, we show that it is largely inevitable and that a certain amount of variation could be seen as a desirable part of the institution of medical research.

Consensus↗
PubMed2006

Organ sales and moral distress.

The possibility that organ sales by living adults might be made legal is morally distressing to many of us. However, powerful arguments have been provided recently supporting legalisation (I consider two of those arguments: the Consequentialist Argument and the Autonomy Argument). Is our instinctive reaction against a market of organs irrational then? The aim of this paper is not to prove that legalization would be immoral, all things considered, but rather to show, first, that there are some kinds of arguments, offered in favour of legalisation, that are, in an important sense, illegitimate, and second, that even if legalisation might not be wrong all things considered, there are good reasons for our negative moral intuitions. Moreover, identifying these reasons will help highlight some features of moral decisions in non-ideal situations, which in turn might be relevant to some other moral or policy choices.

Commerce↗
PubMed2005

Principalism and moral dilemmas: a new principle.

Moral conflicts occur in theories that involve more than one principle. I examine basic ways of dealing with moral dilemmas in medical ethics and in ethics generally, and propose a different approach based on a principle I call the "mutuality principle". It is offered as an addition to Tom Beauchamp and James Childress' principalism. The principle calls for the mutual enhancement of basic moral values. After explaining the principle and its strengths, I test it by way of an examination of three responses--in the recent Festschrift for Dr Raanon Gillon--to a case involving parental refusal of a blood transfusion. The strongest response is the one that comes closest to the requirements of the mutuality principle but yet falls short. I argue that the mutuality principle provides an explicit future orientation in principalism and gives it greater moral coherence.

Blood Transfusion↗