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PubMed1998

Diagnosing moral disorder: the discovery and evolution of fetal alcohol syndrome.

The diagnosis of fetal alcohol syndrome (FAS) was invented in 1973. This paper investigates the process by which a cluster of birth defects associated with exposure to alcohol in utero came to be a distinct medical diagnosis, focusing on the first ten years of the medical literature on FAS. Fetal alcohol syndrome was "discovered" by a group of American dysmorphologists who published the first case reports and coined the term FAS. However, the nature of the diagnosis and its salient symptoms were determined collectively over time by the medical profession as a whole. The paper traces the natural history of the diagnosis in the U.S. through five stages: introduction, confirmation and corroboration, dissent, expansion, and diffusion. FAS serves as an example of the social construction of clinical diagnosis; moral entrepreneurship plays a key role and the medical literature on FAS is infused with moral rhetoric, including passages from classical mythology, philosophy, and the Bible. FAS is a moral as well as a medical diagnosis, reflecting the broader cultural concerns of the era in which it was discovered, including a greater awareness of environmental threats to health, the development of fetal medicine, an emphasis on "the perfect child," and a growing paradigm of maternal-fetal conflict.

Cross-Cultural Comparison↗
PubMed1999

Ethics education and physician morality.

Medical ethics education remains an important venue of moral education. In spite of the intensity of these efforts, the desired outcomes of medical ethics education remain obscure, undefined and largely untested. In the first part of this study, the goals of medical ethics are operationalized along cognitive, behavioral and attitudinal dimensions. This includes a written moral judgment test, a survey of ethical confidence, competence and interest, attitudinal surveys of physician assisted suicide, and aggressive treatment of newborns and, finally, self-reported behavior about the frequency of pro-bono work and treatment of self-abusive patients. Medical ethics education is operationalized by the type, scope and intensity of ethics education throughout a physician's education and subsequent career. Data were collected by a questionnaire distributed to the staff of a large urban hospital in 1996 (n = 200, response rate = 41%). Causal models measure the effects of medical education. The results suggest that ethics education plays an important but limited role in the attainment of these cognitive, attitudinal and behavioral outcomes. While some outcomes such as moral development, and ethical confidence are unaffected by ethics education, other attitudinal and behavioral objectives, such as ethics interest and pro-bono work are positively associated with formal ethics training as well as with demographic variables such as religious observance and age. Ethics education does not function as an isolated factor but as part of a web of interrelated factors that influence educational outcomes. In addition, it is clear that ethics education resists quantitative analysis to some extent. Rather, it is sometimes viewed as a discipline that is studied for its own sake with the hope that it may contribute to one's all around character in a way that cannot be directly assessed. These implications are explored in the conclusion of the paper.

Adult↗
PubMed2005

Abortion in the moral world of the Cameroon grassfields.

Despite high levels of unsafe abortion in Cameroon, remarkably limited attention has been paid to the moral dilemma for women who seek abortions. In-depth interviews were conducted with 65 Cameroonian Grasslands women within a hospital-based study, complemented by participant observation, use of hospital records and interviews with key informants. The paper demonstrates how a hidden moral code on abortion helps women to exercise individual agency despite prevailing moral values. At the same time, women's desire to keep abortion secret can impede adequate medical treatment, which in turn can increase the risk of complications and mortality. Abortion was more often condemned by the women because of the risk to their lives and of infertility rather than for religious reasons or because it is illegal. However, the economic and social realities of everyday life often overrode their fear of complications when they needed to end a pregnancy. The paper concludes that women have already broken through Cameroon's stringent restrictions on abortion through their practice. There is a large gap between what is permitted under the current law, which is colonial in origin, and women's need for legal abortion on broad socio-economic grounds. This calls for reflection on liberalisation of the present law.

Abortion Applicants↗
PubMed2005

Embryonic stem cell research and the moral status of human embryos.

The paper analyses whether the old problem concerning the moral status or value of human embryos is implicated in the moral evaluation of embryonic stem cell research. It briefly outlines the moral status debate and then proceeds to show that all current attempts to bypass the problem fail.

Embryo Research↗
PubMed1999

The British National Health Service: a tarnished moral vision?

Last year (1998) saw the celebration of the 50th Anniversary of the British National Health Service (NHS). One of the few completely nationalized systems of health care in the world, the NHS is seen by many as a moral beacon of what it means to provide equitable medical treatment to all citizens on the basis of need and need alone. However, others argue that it has failed to achieve the overall goals for which it was created. Because of scarce resources, some urgently needed care is not available at all, while that which is received is sometimes second class. For these reasons, it is claimed that the NHS should be scrapped and replaced by other systems of health care delivery. This paper outlines the history of the NHS, indicating some of the problems and innovations which have led to its current organization and structure. The philosophical foundations of the NHS are then articulated and defended on the grounds that it still represents a morally coherent and economically efficient approach to the delivery of health care. Scarce resources are the key problem facing the NHS, making rationing inevitable and it is shown that this is not incompatible with the moral foundations of the service. However, there can be little doubt that the NHS is now becoming dangerously under-funded. The paper concludes with arguments about why this is so and what might be done about it.

Ethics, Medical↗
PubMed2002

On being poor and feeling poor: low socioeconomic status and the moral self.

Persons of low socioeconomic status generally experience worse health and shorter lives than their better off counterparts. They also suffer a greater incidence of adverse psychosocial characteristics, such as low self-esteem, self-efficacy, and self-mastery and increased cynicism and hostility. These population data suggest another category of harm to persons: diminished moral agency. Chronic socioeconomic deprivation can create environments that undermine the development of self and capacities constitutive to moral agency--i.e., the capacity for self-determination and crafting a life of one's own. The harm affects not only the choices a person makes, but the chooser herself. This moral harm is particularly salient in modern Western societies, especially in the United States, where success and failure is attributed to the individual, with little notice of the larger social and political realities that inform an individual's circumstances and choices.

Aged↗
PubMed2003

Optimal commodity taxation with moral hazard and unobservable outcomes.

The optimal public insurance-taxation scheme is derived for a model with unobservable outcomes. If the government can only observe aggregate commodity expenditures, reimbursement insurance is constrained-efficient. However, two distortions accompany the reimbursement scheme. First, consumers are induced to take (forego) actions which increase (decrease) the likelihood of adverse outcomes (i.e., ex ante moral hazard). Second, reimbursement insurance creates a subsidy distortion (i.e., ex post moral hazard). Ex ante moral hazard calls for taxation (subsidization) of commodities which increase (decrease) the probability of adverse outcomes. The second distortion calls for taxation (subsidization) of commodities which are sufficiently strong complements to (substitutes for) the insured commodity. An example centered on cigarettes and medical insurance is presented.

Fees and Charges↗
PubMed2003

Moral problems in palliative care practice: a qualitative study.

Clarifying and analysing moral problems arising in the practice of palliative care was the objective of participatory observations in five palliative care settings. The results of these observations will be described in this contribution. The moral problems palliative caregivers have to deal with in their daily routines will be explained by comparison with the findings of a previously performed literature study. The specific differences in the manifestation of moral problems in the different palliative care settings will be highlighted as well.

Attitude to Death↗
PubMed2004

Parental discipline and externalizing behavior problems in early childhood: the roles of moral regulation and child gender.

We tested whether individual differences in a component of early conscience mediated relations between parental discipline and externalizing behavior problems in 238 3.5-year-olds. Parents contributed assessments of discipline practices and child moral regulation. Observations of children's behavioral restraint supplemented parental reports. Parents and teachers reported on child externalizing symptoms. Parental induction, warm responsiveness, and less frequent use of physical punishment generally were associated with higher levels of moral regulation and fewer externalizing problems. Moreover, moral regulation partially mediated relationships between discipline and externalizing symptoms, with the clearest case of mediation involving induction. However, relationships were found for boys only. Results support a mediation model wherein inductive and physical discipline may influence the expression of boys' externalizing behavior through effects on conscience. Finally, results suggest that different developmental processes may be associated with early externalizing problems in boys and girls, and confirm that fathers' reports contribute to our understanding of the origins of child externalizing problems.

Child↗
PubMed2004

Empirical data and moral theory. A plea for integrated empirical ethics.

Ethicists differ considerably in their reasons for using empirical data. This paper presents a brief overview of four traditional approaches to the use of empirical data: "the prescriptive applied ethicists," "the theorists," "the critical applied ethicists," and "the particularists." The main aim of this paper is to introduce a fifth approach of more recent date (i.e. "integrated empirical ethics") and to offer some methodological directives for research in integrated empirical ethics. All five approaches are presented in a table for heuristic purposes. The table consists of eight columns: "view on distinction descriptive-prescriptive sciences," "location of moral authority," "central goal(s)," "types of normativity," "use of empirical data," "method," "interaction empirical data and moral theory," and "cooperation with descriptive sciences." Ethicists can use the table in order to identify their own approach. Reflection on these issues prior to starting research in empirical ethics should lead to harmonization of the different scientific disciplines and effective planning of the final research design. Integrated empirical ethics (IEE) refers to studies in which ethicists and descriptive scientists cooperate together continuously and intensively. Both disciplines try to integrate moral theory and empirical data in order to reach a normative conclusion with respect to a specific social practice. IEE is not wholly prescriptive or wholly descriptive since IEE assumes an interdepence between facts and values and between the empirical and the normative. The paper ends with three suggestions for consideration on some of the future challenges of integrated empirical ethics.

Empirical Research↗
PubMed1990

Perceptions of social responsibilities in India and in the United States: moral imperatives or personal decisions?

Indian and American adults' and children's (N = 400) moral reasoning about hypothetical situations in which an agent failed to help someone experiencing either life-threatening, moderately serious, or minor need was compared. For 1/3 of Ss, the agent's relationship to the needy other was portrayed as that of parent; for another 1/3, as that of best friend; for the rest, as that of stranger. Indians tended to regard the failure to aid another in moral terms in all conditions. In contrast, Americans tended to view it in moral terms only in life-threatening cases or in cases of parents responding to the moderately serious needs of their children. The results imply that Indian culture forwards a broader and more stringent view of social responsibilities than does American culture. Discussion centers on theoretical implications of the various cultural, need, role, and developmental effects observed.

Adult↗
PubMed1990

From the scene to the crime: the effect of alcohol and social context on moral judgment.

Forty men and women were given Kohlberg's Moral Judgment Interview (MJI) while drinking in a natural setting and were asked a series of questions about whether they should and would drive impaired. In a second testing in an academic context, these subjects were given an alternate form of the MJI and were asked whether they drove on the previous occasion. Forty additional men and women completed the MJI in an academic context and responded to the impaired driving questions hypothetically. Results revealed that Ss scored lower on moral maturity in the the social drinking contexts than in the academic contexts, especially when highly intoxicated. Ss responding hypothetically attributed more moral integrity to themselves than to others, indicating they would not drive impaired. The self-righteousness of these attributions was apparent in the behavior of Ss who drove to the social drinking settings--all but 1 drove home, however impaired.

Adult↗
PubMed2002

Inferences about the morality of an aggressor: the role of perceived motive.

The research investigated perceivers' inferences about the morality of target persons who engaged in aggressive behavior. Across several experiments, inferences about the morality of an aggressor were based more on the perceived motives of the target than on the presence of facilitating situational forces. For example, when a target's aggression was facilitated by personal rewards for aggression (instrumental aggression), perceivers inferred more negative motives and attributed lower morality to the target than when the target's aggression was facilitated by situational provocation (reactive aggression). The results suggest that perceived motives play an important role in dispositional inference and pose a problem for models that focus primarily on perceived causality, assumptions about base rates (consensus), or diagnosticity.

Aggression↗
PubMed1996

Moral and social reasoning and perspective taking in later life: a longitudinal study.

In this study 27 older adults (ages 64-80) and 23 middle-aged adults (ages 35-54) were tested for moral stage, integrative complexity of social reasoning, and perspective-taking levels twice over a 4-year period. Moral reasoning stage levels did not change over time for either age group. Older adults, but not the middle-aged, showed a significant decline over time in level of moral perspective taking. Complexity of reasoning about several interpersonal social issues declined modestly in both age groups. More social-cognitive support, a higher education level, and better self-reported health were all found to be protective factors in forestalling declines in mature adults' sociocognitive reasoning, consistent with other research on cognitive measures in later life.

Adult↗
PubMed2000

Gender differences in moral orientation: a meta-analysis.

C. Gilligan's (1982) critique of L. Kohlberg's theory of moral reasoning and her assertion that two modes of moral reasoning (justice and care) exist have been the subject of debate within the field of psychology for more than 15 years. This meta-analysis was conducted to review quantitatively the work on gender differences in moral orientation. The meta-analysis revealed small differences in the care orientation favoring females (d = -.28) and small differences in the justice orientation favoring males (d = .19). Together, the moderator variables accounted for 16% of the variance in the effect sizes for care reasoning and 17% of the variance in the effect sizes for justice reasoning. These findings do not offer strong support for the claim that the care orientation is used predominantly by women and that the justice orientation is used predominantly by men.

Empathy↗
PubMed2003

The intelligence of the moral intuitions: comment on Haidt (2001).

The social intuitionist model (J. Haidt, 2001) posits that fast and automatic intuitions are the primary source of moral judgments. Conscious deliberations play little causal role; they are used mostly to construct post hoc justifications for judgments that have already occurred. In this article, the authors present evidence that fast and automatic moral intuitions are actually shaped and informed by prior reasoning. More generally, there is considerable evidence from outside the laboratory that people actively engage in reasoning when faced with real-world moral dilemmas. Together, these facts limit the strong claims of the social intuitionist model concerning the irrelevance of conscious deliberation.

Cognition↗
PubMed2005

Perceptions of moral character modulate the neural systems of reward during the trust game.

Studies of reward learning have implicated the striatum as part of a neural circuit that guides and adjusts future behavior on the basis of reward feedback. Here we investigate whether prior social and moral information about potential trading partners affects this neural circuitry. Participants made risky choices about whether to trust hypothetical trading partners after having read vivid descriptions of life events indicating praiseworthy, neutral or suspect moral character. Despite equivalent reinforcement rates for all partners, participants were persistently more likely to make risky choices with the 'good' partner. As expected from previous studies, activation of the caudate nucleus differentiated between positive and negative feedback, but only for the 'neutral' partner. Notably, it did not do so for the 'good' partner and did so only weakly for the 'bad' partner, suggesting that prior social and moral perceptions can diminish reliance on feedback mechanisms in the neural circuitry of trial-and-error reward learning.

Adult↗
PubMed2005

Opinion: the neural basis of human moral cognition.

Moral cognitive neuroscience is an emerging field of research that focuses on the neural basis of uniquely human forms of social cognition and behaviour. Recent functional imaging and clinical evidence indicates that a remarkably consistent network of brain regions is involved in moral cognition. These findings are fostering new interpretations of social behavioural impairments in patients with brain dysfunction, and require new approaches to enable us to understand the complex links between individuals and society. Here, we propose a cognitive neuroscience view of how cultural and context-dependent knowledge, semantic social knowledge and motivational states can be integrated to explain complex aspects of human moral cognition.

Brain↗