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PubMed2006

Comparison of elicitation methods for moral and affective beliefs in the theory of planned behaviour.

Although the theory of planned behaviour (TPB) has been applied successfully in the area of food choice, it has been criticized for its pure utilitarian approach to the factors determining behaviour. Despite the increase in predictive power of the model with added components such as affective attitude and moral and ethical concerns, in most studies the elicitation process still only addresses people's utilitarian beliefs about the behaviour with little attention paid to other aspects. This study compares the traditional method of elicitation of advantages and disadvantages with two other methods (word association and open-ended) in the elicitations of beliefs, attitudes and moral concerns in relation to the consumption of organic foods. Results show the traditional method to be best for eliciting cognitive beliefs, open-ended emotion task for eliciting emotional beliefs and open-ended beliefs task best for moral concerns. The advantages and disadvantages of each method are discussed.

Agriculture↗
PubMed2005

Lay and expert perceptions of zoonotic risks: understanding conflicting perspectives in the light of moral theory.

As in many other areas, there is a divide between lay and expert perceptions of risk within the food sector, and this can lead to disagreement over priorities in food risk management. The risk perception literature tends to stress that the parties involved in this disagreement have different concepts of risk and hence are bound more or less to talk at cross-purposes. This paper suggests an alternative analysis: In the light of moral theory, the conflicting perspectives can be understood as a genuine moral conflict. When this conflict is conceptualised, a rational dialogue becomes possible. The paper reports a series of qualitative interviews with lay people and experts on zoonotic food risks. The interviews are used to reconstruct the values underlying some of the dominant perspectives. The conflict between these stylised perspectives is then analysed with the help of moral theory. Finally, some consequences for risk communication are made clear.

Creutzfeldt-Jakob Syndrome↗
PubMed2004

A median voter model of health insurance with ex post moral hazard.

One of the main features of health insurance is moral hazard, as defined by Pauly [Pauly, M.V., 1968. The economics of moral hazard: comment. American Economic Review 58, 531-537), people face incentives for excess utilization of medical care since they do not pay the full marginal cost for provision. To mitigate the moral hazard problem, a coinsurance can be included in the insurance contract. But health insurance is often publicly provided. Having a uniform coinsurance rate determined in a political process is quite different from having different rates varying in accordance with one's preferences, as is possible with private insurance. We construct a political economy model in order to characterize the political equilibrium and answer questions like: "Under what conditions is there a conflict in society on what coinsurance rate should be set?" and "Which groups of individuals will vote for a higher and lower than equilibrium coinsurance rate, respectively?". We also extend our basic model and allow people to supplement the coverage provided by the government with private insurance. Then, we answer two questions: "Who will buy the additional coverage?" and "How do the coinsurance rates people are now faced with compare with the rates chosen with pure private provision?".

Insurance, Health↗
PubMed2001

Paternalism, patient autonomy, and moral deliberation in the physician-patient relationship. Attitudes among Norwegian physicians.

Sixteen statements on physician attitudes in the physician-patient relationship were presented to a representative sample of Norwegian physicians (N=990). Three moderately correlated theoretical dimensions were identified in a principal component analysis: paternalism, patient autonomy, and moral deliberation. The paternalism scores increased significantly with age, and psychiatrists scored significantly lower than physicians in somatic specialties. Psychiatrists had the highest scores on the patient autonomy dimension, whereas surgeons scored the lowest. Moral deliberation scores increased slightly with age. To explore the pattern of scores across the three dimensions, the scores were dichotomized and combined in eight different ways. The resulting typology included five different physician profiles: (1) classical paternalists (high scores on paternalism, low scores on both patient autonomy and moral deliberation), (2) modern paternalists (high scores on both paternalism and deliberation, low scores on patient autonomy), (3) autonomists ( high scores on patient autonomy, low scores on both paternalism and deliberation), (4) deliberationists (high scores on deliberation and patient autonomy, low scores on paternalism), and (5) ambivalents (high or low scores on all dimensions, or high or low scores on both paternalism and patient autonomy). The four groups of physicians with 'consistent' attitudes contained between 12 and 19% of the total sample, whereas 37% belonged to the 'ambivalent' group. Laboratory doctors and surgeons belonged significantly more often in the group of classical paternalists than did general practitioners, whereas male physicians were more often modern paternalists than were female physicians. Among the autonomists, women were more numerous than men, doctors in their 40s clearly more numerous than those in their 60s, and psychiatrists clearly more numerous than residents.

Adult↗
PubMed2001

The passions of maturity: morality and creativity in later life.

Studies of moral development have concentrated on children and adolescents rather than older adults. Yet people continue to face and reflect on moral dilemmas throughout the life-course. This article examines how a group of older women and men from a rural New York community deal with issues of meaning and purpose in their mature years, and compares their experiences with those of elders from India. Through a series of ethnographic vignettes, three American approaches to the moral nature of late life are explored: viz., deep involvement in art, in public service, and in self-exploration. Rural people discovered many forms of passion, ranging from the personal, professional and political to the ethical and expressive. In their attempts to negotiate both passion and purpose, these individuals also found themselves contending with major contradictions in their own culture, especially the tensions between self fulfillment and social responsibility, duty and creativity, and personal meaning and reciprocity. Their sense of purpose is compared with that of sannyasins, older spiritual seekers from India, whose goals stressed a very distinct set of cultural ideals.

Journal Article↗
PubMed2003

Autonomy, sanity and moral theory.

The concept of autonomy plays at least two roles on moral theory. First, it provides a source of constraints upon action: because I am autonomous you may not interfere with me, even for my own good. Second, it provides a foundation for moral theory: human autonomy has been thought by some to produce moral principles of a more general kind. This paper seeks to understand what autonomy is, and whether the autonomy of which we are capable is able to serve these roles. We would naturally hope for a concept of autonomy that is value-neutral rather than value-laden. That is to say, we would want the judgement that I am autonomous to depend wholly on, say, structural features of my psychology, and in no way to require us to make ethical judgements, or other value judgements. Being value-neutral is perhaps desirable in a concept of autonomy serving the first role, and plausibly indispensible in one playing the second. I shall argue, however, that value-neutral conceptions of autonomy are impoverished and out of line with our intentions; set out and defend an explicitly value-laden conception of autonomy; and explore the implications of such a view for the ability of autonomy to play the roles mentioned above.

Adult↗
PubMed1986

Age differences in the structure of the Philadelphia Geriatric Center Morale Scale.

In this research we examined age differences in the factorial structure of the Philadelphia Geriatric Center (PGC) Morale Scale. In particular, we viewed the covariance structure of the PGC Morale Scale items as a function of several parameter matrices. We analyzed the factorial invariance by testing hypotheses involving the equivalence constraints of one or more parameter matrices in the young-old (65-74) and the old-old (75 and over) populations. Data for this research came from the 1968 National Senior Citizens Survey. Analysis of covariance structures, or LISREL, was used to assess the factorial invariance of the PGC Morale Scale. Although there are some statistically significant age differences in the factorial structure, substantively they are less important.

Aged↗
PubMed1997

Positive thinking and moral oppression in cancer care.

Anecdotal evidence suggests that many cancer patients experience moral and psychological pressure to 'think positively' about their disease in order to 'fight' cancer. Such pressure seems to be both internally and externally generated. This paper examines some of the psychological literature which supports the connection between positive thinking and recovery but it also looks at the moral implications of these kinds of ideas, particularly when patients have to face deterioration in their health and the prospect of death. In emphasizing the positive, there may be two important consequences. Firstly, negative feelings may be marginalized or simply denied, a phenomenon which carries its own psychological implications and secondly, when faced with a failure to recover, people may interpret this as a moral failure i.e. they did not try hard enough. It is the writer's contention that such ideas can result in a sense of guilt and blame which could be diminished if not eradicated, if health care professionals were more careful to understand what is at stake when inculcating or endorsing an attitude of 'positive thinking'.

Attitude to Health↗
PubMed2001

Religious affiliation and social commitment as determinants of moral attitudes in the prevention of AIDS or the fight against poverty.

The present study is an analysis of the effect of religious affiliation and social commitment on moral attitudes in the fight against acquired immunodeficiency syndrome (AIDS) or the fight against poverty. French citizens (N = 284) who either belonged to the Roman Catholic church or were without religious affiliation, who were committed to the prevention of AIDS or to the fight against poverty, completed a 9-item scale drawn from R. C. Katz, J. Santman, and P. Lonero's (1994) Morally Debatable Behaviors Scale-Revised. Results indicated that the responses were significantly affected by the religious affiliation and beliefs of respondents: Roman Catholics expressed less moral tolerance than nonreligious respondents. An interaction between commitment and religious belief showed that Roman Catholics committed to the fight against AIDS were less tolerant of illegal conduct than those committed to the fight against poverty, whereas no difference appeared between nonreligious respondents. No gender effect appeared.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Human fetal gene therapy: moral and ethical questions.

This two-part paper discusses moral and ethical questions raised by future trials of human fetal gene therapy. The first part examines broad moral issues to explore whether fetal gene therapy is a morally praiseworthy goal. Ought it be done at all? These issues include (i) how the concept of fetal gene therapy originally arose as a goal envisioned at the beginning of prenatal diagnosis, (ii) preimplantation genetic diagnosis as a better preconceptual alternative for parents at higher genetic risk, (iii) alternatives to genetic abortions, (iv) the social and economic priority of fetal gene therapy, and (v) whether fetal gene therapy is a "slippery slope" that will end in germ-line gene therapy. This part concludes that far more reasons exist to commend fetal gene therapy than to reject it, given its limits and modest social and economic priority. The second part responds to specific ethical questions that must be raised about any protocol for human gene therapy. These questions and issues are adapted to the prenatal situation: (i) how the previable fetus becomes a "patient," (ii) concern for clinical benefit and minimizing risks to the fetus and pregnant woman, (iii) concern for the voluntary and informed participation of the pregnant woman, the father, and for protection of their privacy, (iv) concern for fair selection of subjects, (v) considerations of harm to germ line cells, and (vi) the role of public oversight of fetal gene therapy. The article concludes by recommending a continuation of the consolidated Recombinant Advisory Committee (RAC) for the near future.

Abortion, Spontaneous↗
PubMed1992

Techno-thanatology: moral consequences of introducing brain criteria for death.

This paper is based on the hypothesis that the effort to establish new criteria for diagnosing human death, which has been taking place over the past twenty years or more, can be viewed as a paradigm case for the impact of scientific and technological progress on morality. This impact takes the form of three tendencies within the change in morality, which may be characterized as 'denaturalization', 'functionalization' and 'homogenization'. The paper concludes with the view that these tendencies do not indicate a decline of morality, as feared by some authors, but rather a structural change.

Beginning of Human Life↗
PubMed1995

Where the brain appreciates the moral of a story.

To identify the distributed brain regions used for appreciating the grammatical, semantic and thematic aspects of a story, regional cerebral blood flow was measured with positron emission tomography in nine normal volunteers during the reading of Aesop's fables. In four conditions, subjects had to monitor the fables for font changes, grammatical errors, a semantic feature associated with a fable character, and the moral of the fable. Both right and left prefrontal cortices were consistently, but selectively, activated across the grammatical, semantic, and moral conditions. In particular, appreciating the moral of a story required activating a distributed set of brain regions in the right hemisphere which included the temporal and prefrontal cortices. These findings emphasize that story processing engages a widely distributed network of brain regions, a subset of which become preferentially active during the processing of a specific aspect of the text.

Attention↗
PubMedDate not supplied

Vulnerable populations and morally tainted experiments.

This article addresses the dilemma facing an editor when he or she has to decide whether or not to publish a manuscript that describes unethical research. I will explore three options the editor may follow: a) publish the unethical research; b) publish it with an explicit condemnation of the methods used; c) reject the article on moral grounds. I will consider the importance of deterring unethical research, why the deterrence argument has been overlooked and the relevance it has in developing countries which seem to be more exposed to morally tainted experiments. I will suggest a combined policy. For cases in which the ethical problems are serious -- where basic human rights are not respected, where consent has been given without complete or proper information or voluntary participation by subjects, or where deceit has been practised -- I would support the strong policy of rejecting the article on moral grounds. For dubious cases, where the risk assessment can be doubted or where there are suspicions of ethical problems, I argue for a policy under which the article is published along with a serious discussion of the ethical problems suspected, allowing a rebuttal by the authors. In this way, while maintaining a strong deterrent policy, we recognize that sometimes it is not so clear if a research project was unethical, and only in such cases (where the ethical problems are dubious), the article may be published with an editorial.

Biomedical Research↗
PubMed1999

Killing, letting die and moral perception: a reply to Grant Gillett.

A number of philosophers in recent times have employed arguments to show that there is no morally relevant difference between killing a patient and allowing that patient to die in those circumstances where the outcome is virtually identical and where death is preventable, at least for a significant time. From his perspective as both a philosopher and a clinician, Grant Gillett has rejected such general and abstract arguments in the light of the intuitions and moral perceptions available to clinicians and those who care for the terminally ill. I argue that his strategy fails, is massively question-begging, and that his appeal to the notion of 'moral particularism', far from being an alternative to cogent philosophical argument, actually supports the very position he has attempted to discredit.

Decision Making↗
PubMed2002

Benefiting from 'evil': an incipient moral problem in human stem cell research.

When does benefiting from others' wrongdoing effectively make one a moral accomplice in their evil deeds? If stem cell research lives up to its therapeutic promise, this question (which has previously cropped up in debates over fetal tissue research or the use of Nazi research data) is likely to become a central one for opponents of embryo destruction. I argue that benefiting from wrongdoing is prima facie morally wrong under any of three conditions: (1) when the wrongdoing is one's agent; (2) when acceptance of benefit directly encourages the repetition of the wrongful deed (even though no agency relationship is involved); and (3) when acceptance of a benefit legitimates a wrongful practice. I conclude by showing that, because of the ways in which most embryonic stem cell lines come into being, people who oppose embryo destruction may use human embryonic stem cells without incurring moral blame.

Biomedical Research↗
PubMed2005

Nurses' moral agency in negotiating parental participation in care.

The purpose of this study was to investigate the issues for nurses in facilitating parental participation in the care of the hospitalized child. A qualitative study informed by grounded theory was undertaken. Nine nurses were recruited from an acute, high-dependency, 23-bed paediatric cardiac/renal unit in Melbourne, Australia. Data collection involved individual semistructured interviews, hospital policies related to family-centred care and a focus group interview. Constant comparative analysis was undertaken to develop an understanding of the data collected in the context of the nurses' experiences and the environment in which they work. Moral agency was identified as the central phenomenon of the study. Causal conditions related to this included the child's best interests, disputes about care and nurses' expectations. These causal conditions were seen to potentially lead to moral distress for the nurses. The coping mechanisms and strategies that affected moral agency have been identified.

Child↗
PubMed2006

The power of ethics: a case study from Sweden on the social life of moral concerns in policy processes.

In this paper I report on an ethnographic study of an ethics policy developed by a start-up genomics company at the time it gained all commercial rights to a population-based biobank in the town of Umeå in northern Sweden. Tracing the interdependencies between power and morality, my research compares moral reflections and stances among 1) policymakers, 2) health professionals and 3) donors, in relation to the issues identified in the policy. These people seem to agree that trust and fairness are important issues and that 'something' needs protection in the face of commercial genetic research. However, their perceptions of trust, fairness and what it is that needs protection differ significantly. I conclude by considering the implications of variances in moral perspectives for the social study of ethics.

Anthropology, Cultural↗
PubMed1995

Persons of lesser values--moral argument and the "final solution".

For many persons, 'Holocaust-abomination' is a fixed point on their moral compass: if anything can be evil, it was. Yet at least one of the justifications deployed by its perpetrators (the eugenics argument) involves widely-held values concerning human health and procreation. Hence persons endorsing many current activities based on those values (e.g. genetic counselling) have been charged with being on a morally deplorable slippery slope. This paper sketches the necessary structure of a moral position capable of consistently embracing those values without placing its occupants on that slippery slope.

Ethical Analysis↗