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PubMed1990

Moral intuition, good deaths and ordinary medical practitioners.

Debate continues over the acts/omissions doctrine, and over the concepts of duty and charity. Such issues inform the debate over the moral permissibility of euthanasia. Recent papers have emphasised moral sensitivity, medical intuitions, and sub-standard palliative care as some of the factors which should persuade us to regard euthanasia as morally unacceptable. I argue that these lines of argument are conceptually misdirected and have no bearing on the bare permissibility of voluntary euthanasia. Further, some of the familiar slippery slope arguments against voluntary euthanasia compromise the principle of autonomy to which both supporters and opponents of euthanasia adhere. I discuss a model for doctor/patient relationships which can be applied to cases which would be seen by all disputants as strong prima facie cases for euthanasia. I argue that in certain cases it will be ordinary medical practitioners who are duty-bound to assist death.

Aged↗

PubMed1992

Learning to see: moral growth during medical training.

During medical training students and residents reconstruct their view of the world. Patients become bodies; both the faults and the virtues of the medical profession become exaggerated. This reconstruction has moral relevance: it is in part a moral blindness. The pain of medical training, together with its narrowness, contributes substantially to these faulty reconstructions. Possible improvements include teaching more social science, selecting chief residents and faculty for their attitudes, helping students acquire communication skills, and helping them deal with their own pain. Most importantly, clearer moral vision requires time and scope for reflection.

Attitude of Health Personnel↗

PubMed1992

Teaching moral reasoning to student nurses.

Teaching moral reasoning to students is a challenge for all nursing educators. The National League for Nursing and American Nurses' Association emphasize the importance of ethical content within the curriculum. Review of the literature indicates that ethics has been part of the nursing curriculum since the early 1900s. However, the focus of nursing ethics has changed to more critical reflective thinking versus duties and etiquette. Educators have used a variety of methods for teaching ethics and integrating it into the curriculum. Yet nursing graduates still lack adequate skills to be morally accountable practitioners. This creates a dilemma for the educator to find ways to integrate more ethics content into an already crowded curriculum. The code of ethics of holistic nurses may serve as a basis to guide nurse educators in resolving some of the problems encountered in promoting moral education.

Codes of Ethics↗

PubMed1997

The virtues in the moral education of nurses: Florence Nightingale revisited.

The virtues have been a neglected aspect of morality; only recently has reference been made to their place in professional ethics. Unfashionable as Florence Nightingale is, it is nonetheless worth noting that she was instrumental in continuing the Aristotelian tradition of being concerned with the moral character of persons. Nurses who came under Nightingale's sphere of influence were expected to develop certain exemplary habits of behaviour. A corollary can be drawn with the current UK professional body: nurses are expected to behave in certain ways and to display particular kinds of disposition. The difference lies in the fact that, while Nightingale was clear about the need for moral education, current emphasis is placed on ethical theory and ethical decision-making.

Education, Nursing↗

PubMed1997

Teaching ethics: effect on moral development.

The purpose of this study was to determine the development of moral judgement in first-year and senior baccalaureate nursing students. These students were enrolled in three separate nursing programmes, each of which differed significantly in ethical content. The sample totalled 180 students enrolled in three New England programmes. Programme A included an ethics course taught by a professor of ethics. Programme B integrated ethical issues into all nursing theory courses. Programme C did not include ethical content in theory courses. The design was of a developmental cross-sectional study. The dependent variable was the development of moral judgement, as measured by Rest's Defining Issues Test. The independent variable was the amount of ethics taught in the nursing programmes and the level of academic education. The senior nursing students from programme A scored significantly higher than the other senior groups on the Defining Issues Test. The conclusion is that an ethics course with group participation and a decision-making element significantly facilitated nursing students' development of moral judgement.

Clinical Competence↗

PubMed1997

Developing moral imagination and the influence of belief.

Moral imagination has been described by Murdoch as 'a way of seeing'. The focus of concern here is the influence of belief upon moral imagination and those attitudes that are needed if moral imagination is to be developed. The perspective adopted endorses a Humean recognition of the potent influence of personal experience upon those beliefs that are held, and therefore upon how we see the world. Kantian commitment to the power of the will, and to the ability of individuals to choose who they wish to be, allows room for optimism, a view which is supported by the findings of Liaschenko.

Attitude of Health Personnel↗

PubMed2004

Construction of a scale for measuring development of moral judgement.

The present research is a part of a study done to develop an objective measure of the development of moral judgement according to Kohlberg's theoretical construct. The Padua Scale of Moral Judgement and the relationship between empirical data and theory are presented. The scale was constructed from responses to the Sociomoral Reflection Measure-Short Form derived from Kohlberg's Moral Judgement Interview. Reliability and validity of the new scale as well as group age and sex differences were examined.

Adolescent↗

PubMed1986

Confidentiality: moral obligation or outmoded concept?

The frequency with which casual breaches of confidentiality occur in hospitals suggests that relatively few health care professionals regard confidentiality as a matter of serious moral concern. A number of factors contribute to this laxness. First, breaches are almost never motivated by malice. Second, the person who breached confidentiality will probably be unaware of any harm that may result or of his or her role in having caused it. Third, such harm likely will consist of feelings of shame and embarrassment--consequences that lack moral seriousness for many persons. Finally, the sheer quantity of patient information that is supposed to be confidential, combined with the number of personnel who have a legitimate "need to know," militates against any serious attitude toward confidentiality. But confidentiality is a serious moral issue. An essential element of self-identity is the right to choose who has access to the intimate details of our lives. To undermine that right is to undermine individual autonomy. A number of steps can be taken to strengthen a hospital's commitment to confidentiality: Upon admission, nonemergency patients should be informed of who will have access to their medical record and why. patients should be asked who should be kept informed of the details of their medical condition and who should be denied such details. Health care professionals should not be intimidated by persons who demand patient information but have no clear right to it. Such individuals should be referred to someone who can determine whether they are entitled to the information.

Confidentiality↗

PubMed1988

Families as caregivers: the limits of morality.

There is a developing trend to look to families to provide care and support of those in need of rehabilitation. A widespread assumption is that family care is superior care and, with modest degrees of support, families can provide that care. Yet we may question the ethical limits of the obligation of a family or family member to provide care when the demands are severe. Psychologic and moral problems that confront caregivers are examined. In some cases caregivers must sacrifice their present and future welfare. That the moral claim made upon them may seem a justifiable one in many respects does not mean that it will be endurable; that it is endurable does not mean that it is justifiable. The problem is exacerbated by lack of a supportive culture, one that rewards and honors those who take on heroic duties. Caregivers may be socially isolated. If heroic demands are to be made on family members, a richer moral culture is required, not just the provision of improved social services.

Persons with Disabilities↗

PubMed1981

Dental student response to moral dilemmas.

This study was performed to test whether there is any difference in the manner in which freshmen, sophomore, junior, and senior dental students respond to dental moral dilemmas. An instrument composed of three dental moral dilemmas was completed by 483 dental students during the first day of class of the fall 1979 semester. An analysis of the results showed that freshmen rated principled reasons more highly than sophomores, juniors, and seniors. It appears that the differences in response to moral dilemmas exist early in the dental educational process, even before students have substantial clinical experience.

Decision Making↗

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↗

PubMed1985

Viability and the moral status of the fetus.

The viability of the fetus has played a significant part in the framing of abortion legislation, but the use of viability as a criterion represents a compromise which is conceptually unclear and which fails to satisfy either side in the abortion debate. Both conservative and liberal views on abortion regard fetal development as morally irrelevant. For the moderate (or gradualist) view some point in the development must be found which indicates a change in the moral status of the fetus. Since viability changes according to available techniques for neonatal care it cannot be the criterion. Alternative criteria are surveyed and it is concluded that the onset of sensation is a significant transition point beyond which abortion and infanticide cannot be morally distinguished. It is suggested that either legislation should be amended to prohibit abortion after 18 to 20 weeks, or abortion to full term should be permitted and the possibility of legislation for infanticide be envisaged.

Abortion, Induced↗

PubMed2005

Internet lives: social context and moral domain in adolescent development.

The author examines the thinking and behavior of adolescents within the digital world. What does all this instant messaging and blogging outside school hours mean? Why do adolescents do it? How much time do they spend doing it? How does it shape their social, emotional, and moral development? Bradley describes the phenomenon and explores some moral development ramifications of a new context of social experience for adolescents. It proposes that the digital world creates its own social context, with a different set of social conventions from the adult-mediated "real" world that adolescents also inhabit. It is a social context that most adults are aware of but do not understand. Adolescents' experiences in the online world influence their experiences in the face-to-face world and play an important role in the development of their social and moral knowledge. This chapter places the discussion within the context of literature on youth ethics that has been developed based on more traditional settings.

Adolescent↗

PubMed1991

Toward a methodology for moral decision making in medicine.

The failure of medical codes to provide adequate guidance for physicians' moral dilemmas points to the fact that some rules of analysis, informed by moral theory, are needed to assist in resolving perplexing ethical problems occurring with increasing frequency as medical technology advances. Initially, deontological and teleological theories appear more helpful, but criticisms can be lodged against both, and neither proves to be sufficient in itself. This paper suggests that to elude the limitations of previous approaches, a method of moral decision making must be developed incorporating both coherence methodology and some independently supported theoretical foundations. Wide Reflective Equilibrium is offered, and its process described along with a theory of the person which is used to animate the process. Steps are outlined to be used in the process, leading to the application of the method to an actual case.

Bioethical Issues↗

PubMed1990

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

To test the hypothesized immaturity of juvenile delinquents' moral reasoning, the results of 15 studies of the moral reasoning of juvenile delinquents were integrated quantitatively using meta-analysis. Hedges and Olkin (1985) methods were used to (a) compute effect sizes, (b) test the homogeneity of the obtained effect sizes, and (c) test the statistical significance of the pooled mean effect size. The results supported the hypothesis that the moral reasoning of juvenile delinquents is immature. It was concluded that several other issues are in need of investigation.

Adolescent↗

PubMed1981

Influence of a "friendly visitor" program on the cognitive functioning and morale of elderly persons.

Forty-nine nursing home residents were randomly assigned to a visitation condition focusing on conversational interaction, a visitation condition in which the playing of cognitively challenging games supplemented conversation, or a no-treatment control condition. Each subject in a visitation condition was visited by an undergraduate student twice per week for 8 weeks. Before and after the visitation period, all subjects were given four tests of cognitive functioning (vocabulary, matrices, memory, problem-solving), three tests of morale (Life Satisfaction Index A; Philadelphia Geriatric Center Morale Scale, self-perceived health), and were rated by nursing home activity directors on morale, program participation, alertness, sociability, and physical condition. A multivariate analysis of covariance, in which age, education, and length of nursing home residency were covariates, revealed a reliable overall effect for the treatment (p = .001). Subjects in both visitation conditions generally demonstrated improved performance relative to control subjects, and subjects in the conversation-plus-games condition demonstrated the greatest improvement. The univariate effects for memory, self-perceived health, and ratings of sociability were reliable.

Aged↗

PubMed1984

The influence of qualitative assessments of the social and physical environment on the morale of the rural elderly.

This study examined the impact of qualitative assessments of the social and physical environment on the morale of a community sample of 231 rural elderly. It was hypothesized that qualitative assessments would make a significant contribution to morale after the application of controls for background influences and activity participation. Providing support for the hypothesis, the set of six qualitative assessment variables explained 14% of the total variance in life satisfaction, the criterion of morale, when entered at the final stage of the analysis. Additionally, multiple regression analysis revealed that significant individual contributions to life satisfaction were made by availability of a confidant, transportation need, shopping enjoyment, neighbor satisfaction, and community satisfaction, from the qualitative assessment set.

Activities of Daily Living↗

PubMedDate not supplied

Toward a reconstruction of medical morality.

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive--together with the physician--at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship.....

Decision Making↗