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PubMed1981

Dimensions of health and their importance for morale in old age: a multivariate examination.

Numerous researchers have pointed to the centrality of health in personal adaptation in the later years. This investigation examines morale in regard to 16 health indicators. Probability techniques were used to draw a sample of 104 noninstitutionalized people, 65 years of age and older. Product-moment correlations indicated a substantial relatedness among the the health indicators. A principal components factor analysis generated five health dimensions: Assessing and Promoting Own Health, Health Behavior and Facilities, Disease and Its Control, Sensory Abilities, and Source of Care. Morale was bivariately related most to the individual measures of fatigue, comparative health level, visual acuity, and general self-rated health. A multiple regression analysis indicated that morale was reported to be higher among those who felt more rested upon wakening in the morning, who had better visual abilities, and who saw their health level as being at least as good as in the past.

Aged↗
PubMed2005

Gambling, exchange systems, and moralities.

History and ethnography show us that, across societies of the past and present, gambling varies considerably with respect to its organization, social meanings, and how it is regarded in moral terms. This paper presents a basic scheme for analyzing the relationship between gambling and society. A theoretical starting point is that reciprocity is fundamental to social and economic systems. An anthropological theory of exchange systems makes a broad distinction between a structural dimension (generalized versus balanced reciprocity) and a normative dimension (from voluntary to involuntary). A model of four basic forms of reciprocity, each having a characteristic exchange mode and morality, can thus be constructed. Gambling is here understood as an exchange system embedded in the reciprocal orders of society and having a necessary relationship to these; it can take on the characteristics of such an order or it can be regarded as conflicting with it. Much of the variation in the form and morality of gambling therefore emerges as systematic and explainable by a theory of forms of reciprocal exchange.

Behavior, Addictive↗
PubMed2006

Human and animal subjects of research: the moral significance of respect versus welfare.

Human beings with diminished decision-making capacities are usually thought to require greater protections from the potential harms of research than fully autonomous persons. Animal subjects of research receive lesser protections than any human beings regardless of decision-making capacity. Paradoxically, however, it is precisely animals' lack of some characteristic human capacities that is commonly invoked to justify using them for human purposes. In other words, for humans lesser capacities correspond to greater protections but for animals the opposite is true. Without explicit justification, it is not clear why or whether this should be the case. Ethics regulations guiding human subject research include principles such as respect for persons-and related duties-that are required as a matter of justice while regulations guiding animal subject research attend only to highly circumscribed considerations of welfare. Further, the regulations guiding research on animals discount any consideration of animal welfare relative to comparable human welfare. This paper explores two of the most promising justifications for these differences between the two sets of regulations. The first potential justification points to lesser moral status for animals on the basis of their lesser capacities. The second potential justification relies on a claim about the permissibility of moral partiality as found in common morality. While neither potential justification is sufficient to justify the regulatory difference as it stands, there is possible common ground between supporters of some regulatory difference and those rejecting the current difference.

Animal Experimentation↗
PubMed2005

The contribution of Kantian moral theory to contemporary medical ethics: a critical analysis.

Kantian deontology is one of three classic moral theories, among virtue ethics and consequentialism. Issues in medical ethics are frequently addressed within a Kantian paradigm, at least --although not exclusively--in European medical ethics. At the same time, critical voices have pointed to deficits of Kantian moral philosophy which must be examined and discussed. It is argued that taking concrete situations and complex relationships into account is of paramount importance in medical ethics. Encounters between medical or nursing staff and patients are rarely symmetrical relationships between autonomous and rational agents. Kantian ethics, the criticism reads, builds on the lofty ideal of such a relationship. In addition to the charge of an individualist and rationalist focus on autonomy, Kantian ethics has been accused of excluding those not actually in possession of these properties or of its rigorism. It is said to be focussed on laws and imperatives to an extent that it cannot appreciate the complex nuances of real conflicts. As a more detailed analysis will show, these charges are inadequate in at least some regards. This will be demonstrated by drawing on the Kantian notion of autonomy, the role of maxims and judgment and the conception of duties, as well as the role of emotions. Nevertheless the objections brought forward against Kantian moral theory can help determine, with greater precision, its strengths and shortcomings as an approach to current problems in medical ethics.

Emotions↗
PubMed2006

Catharsis and moral therapy I: a Platonic account.

This paper aims at analysing the ancient Greek notions of catharsis (clearing up, cleaning), to holon (the whole) and therapeia (therapy, treatment, healing) to assess whether they may be of help in addressing a set of questions concerning the didactics of medical ethics: What do medical students actually experience and learn when they attend classes of medical ethics? How should teachers of medical ethics proceed didactically to make students benefit morally from their teaching? And finally, to what extent and in what forms and formats can the kind of cathartic treatment envisaged by Plato still be considered a necessary preliminary to moral learning? The three questions will be addressed by means of a reconstructive analysis and assessment of the Platonic notions of catharsis and holistic therapy present in the Charmides and the Sophist. Besides, the didactic potential of Plato's dialogue form and moral regimen will be tried out. The ultimate aim is to investigate the possibilities of developing a therapeutic conception of medical ethics.

Adult↗
PubMed2001

The application of ethics to engineering and the engineer's moral responsibility: perspectives for a research agenda.

There are different possibilities for defining the areas for the application of ethics to engineering. They range from descriptive analysis of engineers' relationship to moral criteria and extend to normative issues on how engineers should design more "sustainable" technology. In this paper, a frame of reference is proposed, which makes it possible to elaborate in a transparent manner goals for analysis of the scope of ethics in engineering Its point of departure is marked by two questions. 1) which types of situation in the practice of engineering require ethical reflection? and 2) to what extent are engineers expected to assume moral responsibility in the practice of their profession? The answers to both of these questions presuppose reflection on the societal processes of setting definitions and of making ascriptions. Understanding these processes of societal "construction" of demands for ethical reflection in engineering and of engineers' moral responsibilities should be an important objective of the analysis of ethics in engineering.

Decision Making↗
PubMed2003

Technological paternalism: on how medicine has reformed ethics and how technology can refine moral theory.

The objective of this article is to investigate ethical aspects of technology through the moral term "paternalism". The field of investigation is medicine. The reason for this is twofold. Firstly, "paternalism" has gained moral relevance through modern medicine, where physicians have been accused of behaving paternalistic and threatening patients' autonomy. Secondly, medicine is a brilliant area to scrutinise the evaluative aspects of technology. It is argued that paternalism is a morally relevant term for the ethics of technology, but that its traditional conception is not adequate to address the challenges of modern technology. A modification towards a "technological paternalism" is necessary. That is, "technological paternalism" is a fruitful term in the ethics of technology. Moreover, it is suited to point out the deficiencies of the traditional concept of paternalism and to reform and vitalise the conception of paternalism in ethics in order to handle the challenges of technology.

Biomedical Technology↗
PubMed1986

Principles and the search for moral certainty.

In medical ethics, principles have an important but frequently overextended role. The need for exact answers and moral formulae sometimes leads to the misuse of principles, such that they usurp the central place of persons and become ends in themselves. The Baby Jane Doe case is discussed as a prominent instance of both the proper uses and abuses of principles. A more fitting role for principles is described and illustrated, stressing the use of principles as tools of moral discernment and the time-laden character of moral judgments.

Abnormalities, Multiple↗
PubMed1986

An examination of the relationships among interpersonal stress, morale and academic performance in male and female medical students.

Conflicts between medical students and persons involved in their clinical training are a common, yet little studied, source of stress for students. The study reported in this paper examined the relationships between interpersonal stress, specific to training, and measures of students' morale and academic performance during the clinical phase of medical education. The results show that although interpersonal stress was inversely related to morale in both male and female students, the relationship was stronger for females. Morale and interpersonal stress variables strongly predicted the academic performance of female students, as measured by the grades they received in clinical clerkships and their scores on the Part II examination of the National Board of Medical Examiners. The results for males were less clear-cut, as the predictor variables were significantly related to only one of the two performance measures. These findings are consistent with the view that non-cognitive factors have particular relevance for the performance of female medical students.

Achievement↗
PubMed1992

Syphilis, sex and crack cocaine: images of risk and morality.

A new epidemic of syphilis in the Portland, Oregon metropolitan region mirrors a national trend in the United States. The epidemic is centered in urban areas, is associated with heterosexual transmission, and disproportionately affects people of color, especially African-Americans. The epidemic has been linked to sexual activity among users of crack cocaine, and particularly to the practice of trading sex and crack. Here, we report an analysis of in-depth interviews of 40 respondents, of whom 31 have used crack cocaine, 12 have experience as professional sex workers (prostitutes), and 12 are confirmed recent syphilis cases or their sexual contacts. These respondents confirm that sexual activity involving multiple anonymous partners often takes place within the context of crack cocaine use. They also describe sexual activity among more casual users of the drug. But respondents present themselves as having maintained an adherence to common American values regarding cleanliness, mortality, and sexual behavior. They speak of choosing sex partners according to whether a prospective partner 'looks clean.' This image of cleanliness goes beyond simple bodily hygiene, and into the realm of judgement about moral character. A person is more likely to be judged clean if he or she is known to come from a nice family, has a pleasant demeanor, or appears concerned about self-control. Such people are seen as fundamentally decent, and therefore less likely to have syphilis, a disease associated with deterioration, tearing down, dirtiness and disordering. Thus, respondents use conceptions of cleanliness and morality in constructing definitions of high- and low-risk sexual behavior, as they negotiate a life that endangers their sense of moral control. In doing this, they invoke beliefs and values central to the dominant culture surrounding them. This points to the limits of defining crack cocaine users, and other communities of drug users, as being culturally different from the rest of us.

Black or African American↗
PubMed2005

Contracts, covenants and advance care planning: an empirical study of the moral obligations of patient and proxy.

Previously we had speculated that the patient-proxy relationship existed on a contractual to covenantal continuum. In order to assess this hypothesis, and to better understand the moral obligations of the patient-proxy relationship, we surveyed 50 patient-proxy pairs as well as 52 individuals who had acted as proxies for someone who had died. Using structured vignettes representative of three distinct disease trajectories (cancer, acute stroke, and congestive heart failure), we assessed whether respondents believed that proxies should follow explicit instructions regarding life-sustaining therapy and act contractually or whether more discretionary or covenantal judgments were ethically permissible. Additional variables included the valence of initial patient instructions--for example, "to do nothing" or "to do everything"--as well as the quality of information available to the proxy. Responses were graded on a contractual to covenantal continuum using a modified Likert scale employing a prospectively scored survey instrument. Our data indicate that the patient-proxy relationship exists on a contractual to covenantal continuum and that variables such as disease trajectory, the clarity of prognosis, instructional valence, and the quality of patient instructions result in statistically significant differences in response. The use of interpretative or covenantal judgment was desired by patients and proxies when the prognosis was grim, even if initial instructions were to pursue more aggressive care. Nonetheless, there was a valence effect: patients and proxies intended that negative instructions to be left alone be heeded. These data suggest that the delegation of patient self-determination is morally complex. Advance care planning should take into account both the exercise of autonomy and the interpretative burdens assumed by the proxy. Patients and proxies think inductively and contextually. Neither group viewed deviation from patient instructions as a violation of the principal's autonomy. Instead of adhering to narrow notions of patient self-determination, respondents made nuanced and contextually informed moral judgments. These findings have implications for patient education as well as the legal norms that guide advance care planning.

Advance Care Planning↗
PubMed2006

Moral content and assignment marking: an exploratory study.

This small scale exploratory survey investigates the relation between the moral content of student assignments and potential marking behaviour by lecturers. A questionnaire containing a number of deliberately discriminatory statements was sent to a sample of nurse academics, and participants were asked to indicate whether the inclusion of these statements might affect the mark awarded. The sample was too small to undertake tests of statistical significance. However, the results tentatively suggest that a majority of participants would penalise assignments that contain morally questionable statements, and many would cite the code of professional conduct in justification. There appeared to be little difference in the response to statements that offered opinions (normative) or described actions (descriptive). However, differences between responses to statements discriminating against different groups were apparent, with racist statements being penalised more often and with greater severity than other categories. Qualitative data support the quantitative data. Several areas for discussion are identified, including the academic status of nursing, the use of the code of professional conduct, the moral claims made for nurses, a potential 'hierarchy of wrongness', student self censorship, and inconsistency in marking. Further research is justified.

Attitude of Health Personnel↗
PubMed2005

Decision-making in palliative care practice and the need for moral deliberation: a qualitative study.

The development of palliative care is increasing the interest in the moral problems that arise in the practice of palliative care. It is not clear how caregivers deal with these moral problems. In this article, we focus on the decision whether to continue treatment or to withhold it, and discuss the way caregivers deal with this question amongst themselves and in communication or consultation with the patient. We look at moral deliberation, the process of identifying the crucial arguments for this decision in palliative care.

Adaptation, Psychological↗
PubMed2005

The 'physical prophet' and the powers of the imagination. Part II: a case-study on dowsing and the naturalisation of the moral, 1685-1710.

In the first paper of this pair, I argued the importance of theories of the imagination in debates on divination [Vermeir, K. (2004). The 'physical prophet' and the powers of the imagination. Part I: A case-study on prophecy, vapours and the imagination (1685-1710). Studies in History and Philosophy of Science C, 35, 561-591]. In the present article, I will rely on these results in order to unearth the role of the imagination in a discussion on dowsing. References to the imagination were often implicit because of its negative associations, but I show in detail how the imagination was used to negotiate between the material and the spiritual, and between the natural, the supernatural and the moral. Natural philosophers, theologians and moralists all struggled for authority over divinatory phenomena. The debate evolved around the questions whether moral states could be naturalised and whether subtle material vapours could have moral qualities.

France↗
PubMed2005

Moral hazard and prescription medicine use in Australia--the patient perspective.

All Australian citizens are provided affordable access to prescription medicines through the nation's system of universal pharmaceutical subsidies--the pharmaceutical benefits scheme. The rapid increase in pharmaceutical related expenditure has generated the concern that Australians are taking advantage of prescription subsidies and are using more medicines than are necessary, thereby creating a 'moral hazard'. This concern is predicated on a number of assumptions about patient behaviour rather than on empirical observation. These assumptions amount to a view that patients are consumers who treat prescription medicines as common goods subject to informed and rational calculation of the cost and benefits of their use. This paper reports the findings of an in-depth interview study undertaken to explore how prescription cost influences Australians' medicine use. Qualitative data were analysed to compare medicine users' descriptions of the role of prescription cost in medicine use against the assumptions that underlie the belief in moral hazard. Moral hazard did not appear to be significantly operating in the accounts of medicine use collected for this study. Interviewees' accounts of medicine use revealed an act characterised by ambivalence, a mix of desire and antipathy, faith and suspicion. Medicines appeared in interviewees' accounts as both pharmacologically and symbolically potent substances, which despite their familiarity as objects, are often mysterious to non-expert patients. Cost appeared as a secondary factor in patients' decision to access a prescription medicine. Using a prescription was predicated on the medicine being necessary, with necessity typically established by an expert doctor prescribing the medicine. Prescription medicines did not appear as 'common goods' where subsidised access motivates a 'consumer' to demand more or make the prospect of prescription use more attractive or necessary.

Australia↗
PubMed2005

Women as moral pioneers? Experiences of first trimester antenatal screening.

The implementation of innovative medical technologies can raise unprecedented ethical, legal and social dilemmas. This is particularly so in the area of antenatal screening, which is dominated by the language of risk and probabilities. Second trimester serum screening for Down's syndrome and neural tube defects has a well-established place in antenatal care. Increasingly, first trimester screening with biochemical and ultrasound markers is being proposed as advance on this, yielding higher detection rates of Down's syndrome at an earlier gestational age. This article explores the experiences of 14 women offered innovative first trimester screening, which takes place within the context of a detailed ultrasound scan. The study is set within the UK, where recent policy changes mean that the offer of screening for fetal anomalies, particularly Down's syndrome, will become a routine part of antenatal care and offered to all pregnant women. This paper focuses on the significance of the scan in first trimester screening, and some of the potential dilemmas for women that can result from this. It then discusses the ways in which women made their decisions about screening, in particular, their work as 'moral pioneers'. We found that the part played by the ultrasound scan in first trimester screening, particularly in relation to the higher-quality images now being obtained, has the potential to introduce new and novel ethical dilemmas for pregnant women. Although concerns have been raised about pregnant women viewing ultrasound scans as benign, many of the women reported having thought carefully through their own moral beliefs and values prior to screening. It seems that whatever other implications they may have, first trimester screening technologies will continue the tradition of pregnant women acting as 'moral pioneers' in increasingly complex settings.

Adult↗
PubMed2005

Theory of mind and moral cognition: exploring the connections.

It is widely recognized that people sometimes use theory-of-mind judgments in moral cognition. A series of recent studies shows that the connection can also work in the opposite direction: moral judgments can sometimes be used in theory-of-mind cognition. Thus, there appear to be cases in which people's moral judgments actually serve as input to the process underlying their application of theory-of-mind concepts.

Cognition↗
PubMed2002

'Could you please pass one of those health leaflets along?': exploring health, morality and resistance through focus groups.

This paper derives from research in which focus groups were used as a preliminary method of eliciting peoples' perceptions, attitudes and opinions towards health and health promotion in a Northern British city. However, applying criticisms associated with social constructionist theories (e.g. discourse analysis and rhetorical analysis), some recently emerging work on focus groups (see The challenge and promise of focus groups, in: Barbour, Kitzinger (Eds.), Developing Focus Group Research: Politics, Theory and Practice, Sage, London, 1999, p. 1; Focus Groups in Social Research, Sage, London, 2001) has suggested that their traditional use, as a kind of 'window' onto peoples' attitudes and opinions, misses important dimensions of the way in which these phenomena are actively negotiated and constructed during the course of the focus group. Working on the premise that these observations are particularly pertinent to health issues, this paper draws on data from one focus group in order to provide a detailed working example of the way in which attitudes and opinions towards health issues are actively constructed during the course of interaction. In addition, in accordance with social constructionist theories, attention will be paid to the way in which such construction is inextricably linked to social and moral actions such as the negotiation of blame and allocation of responsibility. Through an analysis of six extracts, the paper ultimately identifies three 'positions' or 'stances', which develop over the course of the focus group, often in opposition to one another. These are: (1) 'positive mental attitude'; (2) 'genes and luck'; and (3) 'resistance'. Each of these positions becomes associated, not only with certain moral values, but also 'attached' to certain people within the group. One of the main aims of this analysis is to illustrate how, through the everyday nature of such debates, health remains an intrinsically moral phenomenon.

Attitude to Health↗