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PubMed1994

Using moral and epistemological reasoning as predictors of prejudice.

Regression analyses indicated that a sample of American students who were humanitarian-egalitarian in their outlook, who possessed a high level of education, who were less supportive of the Protestant Ethic, and who employed a high percentage of relativism in their decision making were more likely to have positive attitudes toward minorities than those not possessing such attributes. Age proved to be a predictor of negative attitudes toward minorities. The findings help provide a rationale for further investigation of the relationship between moral and epistemological reasoning as well as for implementation of moral education programs as means to reduce negative racial attitudes.

Adolescent↗

PubMed2005

Moral obligations of patients: a clinical view.

After a unilateral focus on medical professional obligations to patients in most of the 20th century, there is a growing, if modest, interest in patient responsibility. This article critiques some public assertions, explores the ethics literature, and attempts to find some consensus and moral grounds for positions taken on the question, "Does a patient have moral obligations in the process of interactions with medical and other professional caregivers?" There is widespread agreement on a few responsibilities, such as "truth telling" and "avoiding harm to others," but no apparent consensus either on the list of duties or on the appropriate justification for such duties. The context and clinical realities of patient interactions are noted to suggest that feasibility is important in making judgments of patient obligations.

Attitude of Health Personnel↗

PubMed2003

Replying to Veatch's concerns: special moral problems with total artificial heart inactivation.

Moral problems arise when contemplating the inactivation of total artificial heart technology: however, an ethical obligation to explant the device as part of therapy withdrawal is not one of them. Further, arguments will be presented justifying that inactivation of the device is not morally equivalent to active killing of the patient. When device inactivation is clinically and ethically warranted, this decision should not be unilaterally made by the physician but through thorough discussion with the patient (if possible), the patient's surrogate, and the medical team. Consultation with legal counsel and the hospital ethics committee may also be appropriate

Advance Directives↗

PubMed2004

Doing without deliberation: automatism, automaticity, and moral accountability.

Actions performed in a state of automatism are not subject to moral evaluation, while automatic actions often are. Is the asymmetry between automatistic and automatic actions justified? In order to answer this question we need a model of moral accountability that does justice to our intuitions about a range of modes of agency, both pathological and non-pathological. Our aim in this paper is to lay the groundwork for the development of such a model.

Adult↗

PubMedDate not supplied

The moral status of a human fetus: a response to Lee.

It is an undeniable empirical fact that a human fetus is a member of the species homo sapiens from the moment of conception. There is thus an important sense in which it is a human being in itself, and not simply part of a pregnant woman's body, despite what defenders of abortion on demand might want us to think. It is also reasonable to suppose that all human beings, and thus human fetuses, are persons, with all that entails, but this is a metaphysical presupposition as opposed to an empirical fact, and is thus contentious. It is argued, however, that this should be of little comfort to the defenders of abortion, because the mere fact that human fetuses have an inherent tendency to become persons is sufficient reason to confer a moral status upon them, which renders abortion morally problematic at best.

Abortion, Induced↗

PubMedDate not supplied

Moral responsibility, consciousness and psychiatry.

This article discusses the connection between consciousness and responsibility. Moral responsibility plays a crucial, but often implicit role in psychiatry in that it is often a therapeutic aim as well as an important evaluative concept. This article explains one of the more influential 'psychological' theories of moral responsibility, developed by Harry Frankfurt. In the second part of this article, a modified version of this account is applied to a range of psychiatric phenomena.

Consciousness↗

PubMed1977

Morale of the urban aged: a regression analysis by race.

This research examined the degree to which previous factors shown to be related to morale were isomorphic for aged whites and aged blacks. The data consisted of a random sample of low income aged blacks and whites in Philadelphia and were collected by the late Donald P. Kent as part of the Aged Services Porject and consisted of 722 black elderly and 214 white elderly, all of whom were 65 years of age or older. The results of a regression analysis indicated that for blacks the only two significant predictors of morale were health and participation in solitary activities. For whites, in addition to health and solitary activities, interaction with family and sex were also found to be significant. It was concluded that for these data the predictors are not isomorphic between races.

Black or African American↗

PubMed2004

Examination of the Philadelphia Geriatric Morale Scale as a subjective quality-of-life measure in elderly Hong Kong Chinese.

PURPOSE: We examine the psychometric properties of the Philadelphia Geriatric Morale Scale (PGMS) in an elderly Chinese population in Hong Kong. DESIGN AND METHODS: The study consisted of two cohorts: (a) 759 participants aged 70 years and older living in the community who were recruited as part of a territory-wide health survey and interviewed in 1993-1994; and (b) 388 participants living in long-term-care institutions in 1995-1996. Participants who were cognitively impaired (Abbreviated Mental Test score less than 7) or who could not answer questions for other reasons were excluded. The 15-item PGMS was administered. The Rasch dichotomous model was used to assess the validity of the PGMS, and the 15-item Geriatric Depression Scale, previously validated in Chinese, was also administered to examine the concurrent validity. RESULTS: A confirmatory factor analysis identified three underlying factors similar to findings among Caucasians; however, not all the goodness-of-fit indices were acceptable. An exploratory factor analysis using principal axis factoring and promax rotation revealed two underlying factors that explained 35% of the total variance: reconciled aging and unstrained affect. Some items were redundant when applied to the institutional sample. Concurrent validity was demonstrated by the good correlation between the reconciled aging and unstrained affect domains and the Geriatric Depression Scale (r = -0.72 and r = -0.56 respectively). Female gender, older age, and residence in institutions were associated with lower morale. IMPLICATIONS: The PGMS is a valid quality-of-life measure in elderly Hong Kong Chinese persons, but its psychometric properties are slightly different from those for Caucasians.

Aged↗

PubMed1990

Ethics and the universality of morality.

Ethics is one of the forces shaping the life of human societies and the ethical system contributes to the group's survival and to keep peace and order to satisfy social needs. The definitions of ethics, of what is good and what makes an action right or wrong, varies widely at different times and at different places. However, some basic moral elements are acceptable to most advanced societies. Furthermore, many modern scholastic writers defend the absolute universality of at least some ethical laws. The limitations of universality survives in war, in race discrimination, etc. In modern times, it might be appropriate to search for principles for the universality of morality in ecological considerations. Progress in ethics is lagging far behind and we must understand now, when the complete annihilation of human species is a real possibility, that ethics and philosophy are at least as important as science.

Ethics↗

PubMed1986

Consent and randomized clinical trials: are there moral or design problems?

The purpose of this paper is to examine whether randomized clinical trial (RCT) methods are necessarily morally problematic. If they are intrinsically problematic, then there may be a dilemma such that tragic choices might have to be made between this socially very useful method for making medical progress on the one hand, and patients' rights and welfare, or physicians' duties on the other. It is argued that the dilemma may be avoided if RCTs can sometimes be viewed as an honorable and cooperative venture between investigators and subjects. Another dilemma may take shape, however, if too few people are willing to cooperate to maintain the structural integrity of many important RCTs. Given their importance, does this method justify easing some of the consent requirements? It is argued that RCT methods are not so ideal that special consideration should be given to them regarding consent requirements. To examine the compatibility of current consent requirements and frequently used RCT schemas, seven RCT designs are discussed. It is found that some, but not all, RCTs, are intrinsically problematic but that sufficient reason has not been found to hold all RCT schemas as intrinsically morally troubling.

Clinical Trials as Topic↗

PubMed1987

Moral dilemmas in perinatal medicine and the quest for large scale embryo research: a discussion of recent guidelines in the Federal Republic of Germany.

This paper reports on recent regulations and guidelines in the Federal Republic of Germany bearing on perinatal medical ethics, embryo research and trophoblast biopsy. Some of the regulations are defensive responses to new moral opportunities. In contrast, this paper calls for a more aggressive moral cost-benefit assessment of high technology medicine, which would include large-scale research on embryos prior to the fiftieth day post-menstruation.

Abortion, Induced↗

PubMed1988

Love and death: existential dimensions of physicians' difficulties with moral problems.

Physicians often appear more troubled by moral dilemmas than would seem justified given the present social and professional consensus on many of the questions involved. Their discomfort arises not only at ethical, technical, and behavioral levels (the most commonly identified sources of difficulty), but also at an existential level, that is, as the manifestation of conflicts rooted in the processes and conditions of our coming-to-be as persons. Analysis of this level of physicians' moral difficulties requires renewed attention to the physician as a person, and suggests new perspectives on the interpersonal environment of medical practice.

Bioethical Issues↗

PubMed1988

Ethics by committee: the moral authority of consensus.

Consensus is commonly identified as the goal of ethics committee deliberation, but it is not clear what is morally authoritative about consensus. Various problems with the concept of an ethics committee in a health care institution are identified. The problem of consensus is placed in the context of the debate about realism in moral epistemology, and this is shown to be of interest for ethics committees. But further difficulties, such as the fact that consensus at one level of discourse need not imply consensus at another, oblige us to look more closely at the deliberative process itself. That yields two complementary methods of deliberation that have proven their worth. Finally, placing ethics committees in the context of Dewey's philosophy of social intelligence suggests that consensus should be regarded primarily as a condition rather than as the goal of inquiry.

Bioethical Issues↗

PubMed1990

Moral discourse about medicine: a variety of forms.

Moral evaluations of medical research and care focus on different issues, e.g., clinical choices, public policy and cultural values. Technical ethical concepts and arguments do not suffice for all issues. Analysis of the literature suggests that, in addition to ethical discourse, prophetic, narrative, and policy discourse function morally. The article characterizes each of these forms, and suggests the insufficiency of each if it is taken to be the only mode of analysis.

Bioethical Issues↗

PubMed1993

The method of public morality versus the method of principlism.

Two years ago in two articles in a thematic issue of this journal the three of us engaged in a critique of principlism. In a subsequent issue, B. Andrew Lustig defended aspects of principlism we had criticized and argued against our own account of morality. Our reply to Lustig's critique is also in two parts, corresponding with his own. Our first part shows how Lustig's criticisms are seriously misdirected. Our second and philosophically more important part picks up on Lustig's challenge to us to show that our account of mortality is more adequate than principlism. In particular we show that recognition of mortality as public and systematic enables us to provide a far better description of morality than does principlism. This explains why we adopt the label "Dartmouth Descriptivism."

Beneficence↗

PubMed1994

Health care reform: a study in moral malfeasance.

Instead of benefitting from open meetings and public discussions, the Clintons drafted their health care plan in private and asked that it be accepted in haste. They advance an ideology that claims we can receive the best care for all without any increase in cost or rationing, and then they use "ethicists" to justify this ideology through a supposedly common morality. However, there is no such common morality. In the context of American pluralism, one must look to the actual consent of the governed and recognize the limits on state authority. The result will be a two tiered system of health care, with a basic tier focusing on cost-effective care for the poor that eliminates suffering rather than equalizing inputs, and a space for collateral private insurance.

Advisory Committees↗

PubMed1998

The moral education of medical students.

The author begins his essay by discussing George Eliot's novel Middlemarch, in which a doctor, early in his career, wanders from his idealistic commitment to serving the poor. Although he establishes a prominent practice, he considers himself a failure because "he had not done what he once meant to do." The essay explores how many of us (physicians included) forsake certain ideals or principles--not in one grand gesture, but in moment-to-moment decisions, in day-to-day rationalizations and self-deceptions, until we find ourselves caught in lives whose implications we have long ago stopped examining, never mind judging. Medical education barrages students with information, fosters sometimes ruthless competition, and perpetuates rote memorization and an obsession with test scores--all of which stifle moral reflection. Apart from radically rethinking medical education (doing away with the MCAT, for example, as Lewis Thomas proposed), how can we teach students to consider what it means to be a good doctor? Calling upon the work of Eliot, Walker Percy, and others, the author discusses how the study of literature can broaden and deepen the inner lives of medical students and encourage moral reflectiveness.

Education, Medical, Undergraduate↗

PubMed1997

The efficacy and effectiveness of process consultation in improving staff morale and absenteeism.

OBJECTIVES: The purpose of this randomized controlled trial was to test the efficacy and effectiveness of process consultation consisting of a series of nurse manager-consultant problem-solving meetings for leadership development that would lead to their staff's improved morale, quality of care, and reduced absenteeism. METHODS: Thirteen consenting clinical inpatient units were stratified for four variables known to affect outcome and were then randomly assigned to treatment and control conditions. The nurse managers from the seven experimental units were paired with outside nurse consultants from the McMaster University School of Nursing (Hamilton, Ontario, Canada) in a cooperative form of retraining in problem-solving through process consultation. Morale was determined through measures of perceptions of the work environment, an attitude scale concerning work (alienation), a personality measure (hardiness), and one of each scale for work satisfaction and for sources of satisfaction and dissatisfaction. Demographic data and information regarding family life responsibilities were collected as well. Assessment of quality of care was determined by the frequency and type of incident reports and by patients' perception of their satisfaction. A ratio of absence hours to total paid hours of work was used to compare experimental and control units' absenteeism rates. RESULTS: Experimental subjects reported a statistically significant improvement in the characteristics of their work setting and in the quality of working relationships. The consultation process facilitated a perceived change in the organizational context of the experimental hospital units with less centralization of authority and more clarity about expectation. These organizational changes were accompanied by improved working relationships and less alienation from work. There was no statistically significant difference in absenteeism. However, a subanalysis of the units by "dose" of the intervention identified those who benefited from the effects of the consultation. Subjects whose nurse managers participated more actively in the consultation process accounted for the changes in working relationships and perceived organizational changes. The "low-dose" experimental subjects were more like the control subjects, with the exception of absenteeism, for which they had higher rates. CONCLUSIONS: The findings of this study suggest that process consultation can alter the staff's perceptions of the characteristics of the work setting, can reverse negative attitudes (alienation), and can create a more positive and supportive working environment (improved working relationship). However, the results suggest the need to target this type of intervention to managers who have the personal resources to engage in self-evaluation and personal development and thus to participate in the consultative process.

Absenteeism↗