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PubMed1993

A comparison of the moral reasoning of physicians and clinical medical ethicists.

BACKGROUND: Because of the increasing controversy over who should provide ethics consultations, this study investigated differences in the moral reasoning and moral orientations of physicians and clinical ethicists. METHOD: From 1987 through 1990, extensive interviews were conducted with 39 physicians and 50 clinical medical ethicists (26 philosophers and 24 theologians) who were at 32 medical centers in 14 states from all sections of the United States. The interviews were used to gather selected demographic characteristics (age, gender, and profession--physician or ethicist) for the 89 individuals as well as to determine their scores for moral reasoning and moral orientation. Polyserial correlations and multivariant analyses were then performed between the demographic characteristics and the data on moral reasoning and moral orientation. RESULTS: The physicians consistently scored lower than the clinical ethicists in their moral reasoning skills in terms of both moral stage score (p < .01) and weighted average score (p < .01). However, the physicians were found not to be significantly different (p < .05) from the clinical ethicists in their moral orientations toward justice or care in terms of recognition, predominance, or alignment. No significant relationship was found between age and moral orientation. A significant relationship was found between age and stage of moral reasoning, with the older individuals scoring higher. No significant relationship was found between gender and stage of moral reasoning. A significant relationship was found between gender and moral orientation: the women were more likely to recognize elements of care in moral dilemmas and the men more likely to recognize elements of justice. CONCLUSION: This study provides initial evidence that clinical medical ethicists, whether philosophers or theologians, may be better skilled than physicians to do ethicists consultations. To the extent that higher levels of moral reasoning correlate with superior skills in performing clinical ethics consultations, this study shows the value of bringing philosophers and theologians into the clinical setting.

Adult↗
PubMed1998

How useful is Leuven personalism in the world of bioethics? The test case of artificial insemination.

Personalism in ethics denotes any system based upon the value of the person. Several versions of personalist morals have been developed over the past 50 years. Some have had particular interest in the field of medical ethics. Here the question is being studied about one such system, the so-called Leuven personalist morals and its usefulness in today's world of bioethics. In order to test the usefulness of this system the case of artificial insemination is examined both in the early 1970s in the context of the Leuven clinics and, subsequently, in the 1990s in a US policy document. The investigation reveals strengths and weaknesses of this personalism. Regarding AID it reveals unresolved oppositions. The conclusion seems to be that this personalism had, no doubt, a profound impact upon medical ethics within its own circle but, as regards the universal usefulness of the system, serious doubts remain.

Bioethics↗
PubMed1992

Developmental profiles of adolescents and young adults choosing abortion: stage sequence, décalage, and implications for policy.

Three groups of unmarried females (ages 12-14, 17-19, and 23-25) electing to have an abortion in the first trimester of their first pregnancy were administered the Washington University Sentence Completion Test, the Rest Defining Issues Test, and a moral judgment interview of their reasons for choosing an abortion. Results indicated that there were clear developmental differences between the youngest group and the two older groups on the general measures of ego development and principled moral reasoning, as theory would have predicted. There were, however, no major differences across the three groups on the level of reasoning which directly assessed the specific decision concerning abortion. Further, all three groups were assessed at the self-protective level characterized by Stage 2 reasons of financial consequences and the need to rely exclusively on one's own self in such a difficult dilemma. These findings and developmental profiles are compared to national base rates, and the possible implications of apparent décalage, or discrepancy between the general stage assessments and the specific assessment on abortion, are discussed. In addition, the similarity between the older group of adolescents and the young adults was examined, particularly in light of the current controversy over mandatory parental consent.

Abortion Applicants↗
PubMed2005

Understanding mass school shootings: links between personhood and power in the competitive school environment.

This paper explores perspectives about certain individual and social characteristics that may contribute to school shootings by students. It begins with perspectives on individual/environment fit, arguing first that persons marginalized by their caregivers during their upbringing, and by their peers, are lacking in the social interactions that help develop ethical behavior. Our argument contends that lacking such interactions may result in the failure to develop a sound moral philosophy. Further, we argue that when such persons enter the highly competitive environment found in some suburban and rural schools, some will be continually and consistently marginalized, finding their means of self-expression and sense of significance subdued. Their need for self-expression and a sense of significance as persons will surface, but without the benefit of a moral philosophy to guide that expression, this may result in deviant means of expression, such as violence--even extraordinary violence. We do not attempt to identify a list of specific traits of school shooters, which might lead to the development of a profile of school shooters. Rather, we are concerned with the characteristics of the environment in which shootings might occur, and how students not fully prepared for that environment might react. Thus, this paper is an overview of how seeds of the neglect of the basic needs of personhood, when sown early in life, and nurtured by peers, might come to fruition in the fertile field of the competitive school environment.

Adolescent↗
PubMed1997

Ethical conflicts reported by Certified Nephrology Nurses (CNNs) practicing in dialysis settings.

OBJECTIVE: The purpose of the investigators was to describe and classify ethical conflicts experienced by Certified Nephrology Nurses (CNNs) practicing in dialysis settings in four eastern states and the District of Columbia, and to explore associated demographic, educational, and practice setting factors associated with these ethical conflicts. DESIGN: A descriptive survey design was used. SAMPLE/SETTING: All members of the American Nephrology Nurses Association (ANNA) who were CNNs working in Maryland, Virginia, and the District of Columbia, and a random sample of those in New York State and Pennsylvania were contacted. METHODS: Those CNNs working in dialysis settings were asked to complete the Demographic Data Form and the Moral Conflict Questionnaire developed by Fry (1990). Eighty-eight met inclusion criteria, agreed to participate, and described ethical conflicts. RESULTS: By far the most common practice context for the described ethical conflicts were decisions about discontinuation or initiation of dialysis (69%). Participants were clear about the moral problem and ethical principles involved. CONCLUSIONS: Participants reported being involved in serious ethical conflicts about patient care. Since two-thirds were not resolved, further research should investigate whether existing mechanisms in practice settings for resolution of ethical conflicts are not working or are not being used by nurses.

Adult↗
PubMed1994

Theological ethics, moral philosophy, and public moral discourse.

The advent and growth of bioethics in the United States in the late 1960s and early 1970s precipitated an era of public moral discourse, that is, the deliberate attempt to analyze and formulate moral argument for use in public policy. The language for rational discussion of moral matters evolved from the parent disciplines of moral philosophy and theological ethics, as well as from the idioms of a secular, pluralistic world that was searching for policy answers to difficult bioethical questions. This article explores the basis and content of the unique contributions of both theological and philosophical ethics to the development of public moral discourse.

Advisory Committees↗
PubMed2005

Teaching medical ethics: Phramongkutklao College of Medicine's model.

BACKGROUND: Third-year (first preclinical year) Royal Thai Army (RTA) medical cadets were exposed to a rural community in a community medicine field activity. The poor, kind rural people gave good conditions for student's professional development and empathy. OBJECTIVES: To report a community medicine field work activity for professional development of the RTA medical school. MATERIAL AND METHOD: Descriptive analysis on two occasions to evaluate the third-year RTA medical cadets' impressions immediately after the community medicine field activity in a rural area in central Thailand and one year later using baseline scores of cadets' impressions against our institute's objectives. RESULTS: At the end of the field work, 90.9% of the cadets reported they achieved several institute objectives. The four most frequent mentioned were ethical development (70.6%), professionalism (84.3%), human relationship & communication skills (92.2%), and capability to work in the cmmunity (64.7%). Furthermore, RTA medical cadets rated the staff as good role models (51%). CONCLUSION: The community field work course provided a good environment for the third year medical cadets in building morality and professional development to be good doctors.

Clinical Competence↗
PubMed1992

Personal characteristics of Chinese children and their discrepancies: a report on children's development in Anhui (I).

The authors report on a 1990 survey on the characteristics of children in China which included 1,000 primary school pupils in Anhui Province. The focus is on differences between only children and those with brothers or sisters. The results suggest that "the development of temperaments, moral character, behavior and basic ability of primary school pupils in Anhui is generally healthy despite certain discrepancies among different types of children."

Adolescent↗
PubMed1999

Health care education for dialogue and dialogic relationships.

This article will address the question: how can health care education best take seriously the task of educating for professional practice within a post-traditional, liberal democratic society? In the setting of modernity, the altered personal and professional self has to be explored and constructed as part of a reflective process of connecting personal and professional change: in essence, to develop self-knowledge. A moral life, or 'working morality', that evolves out of a process of ongoing dialogue and conversation is required. What is advocated here is a more social model of health care education that acknowledges a social or communal dimension to knowledge and the centrality of relationships for the full development of the individual personally and professionally, fosters our capacity to identify who we are both personally and professionally, connects reason and dialogue, and educates for dialogue and dialogic relationships.

Cultural Diversity↗
PubMed2002

Issues in adolescent health: a challenge for nursing.

The young people of today are the greatest investment we as adults have in our future. The care and nurturing we afford the adolescent is just as important as that which we afford to children or the elderly. Although most adolescents have a preoccupation with their bodies, they do not always engage in activities that will protect and develop them. Adolescents are often exposed to peer pressure, the effects of which may impact negatively on their behaviour and their health. Many adolescent health and behavioural issues evolve from developmental changes and can manifest in a confrontational attitude toward society, parents and others. They are hormonally 'fully charged', and their adolescent sexuality can have enormous effects on their future physical, psychosocial, moral and sexual development. Nurses have a pivotal role to play in ensuring children and adolescents learn the facts relating to the consequences of engaging in unhealthy behaviour and lifestyle. Nurses must also encourage parents to model and reinforce good health practices, such as serving balanced and nutritious meals at regular times and planning positive family activities. In this paper we review some of the salient issues in adolescent health today.

Adolescent↗
PubMed2005

Teaching ethics and technology with Agora, an electronic tool.

Courses on ethics and technology have become compulsory for many students at the three Dutch technical universities during the past few years. During this time, teachers have faced a number of didactic problems, which are partly due to a growing number of students. In order to deal with these challenges, teachers in ethics at the three technical universities in the Netherlands--in Delft, Eindhoven and Twente--have developed a web-based computer program called Agora (see www.ethicsandtechnology.com). This program enables students to exercise their ethical understanding and skills extensively. The program makes it possible for students to participate actively in moral reflection and reasoning, and to develop the moral competencies that are needed in their later professional practice. The developers of the program have tried to avoid two traps. Firstly, they rejected, from the outset, a cookbook style of dealing with ethical problems that applied ethics is often taken to be and, secondly, they wanted to design a flexible program that respects the student's as well as the teacher's creativity, and that tries to engage students in moral reflection. Agora meets these requirements. The program offers possibilities that extend beyond the requirements that are usually accepted for case-exercises in applied ethics, and that have been realised in several other computer models for teaching ethics. In this article, we describe the main considerations in the development of Agora and the features of the resulting program.

Engineering↗
PubMed1998

There is no moral authority in medicine: response to Cowdin and Tuohey.

Central to the Cowdin-Tuohey paper is the concept of a moral authority proper to medical practitioners. Much as I agree with the authors in refusing to degrade doctors to the status of mere technicians, I argue that one does not succeed in retrieving the moral dimension of medical practice by investing doctors with moral authority. I show that none of the cases brought forth by Cowdin-Tuohey really amounts to a case of moral authority. Then I try to explain why no such cases can be found. Developing an insight that is common to all the major moral thinkers in the philosophia perennis, I show that doctors are professionally competent with respect only to a part of the human good; morally wise persons are competent with respect to that which makes man good as man. I try to show why it follows that a) professional expertise has no natural tendency to pass over into moral understanding, and that b) doctor and non-doctor alike start from the same point in developing their understanding of medical morality. It follows that the authors fail in their attempt to de-center the moral magisterium of the Church by setting up centers of moral authority outside of the Church.

Abortion, Induced↗
PubMed2004

Recruiting and developing an effective workforce in the British NHS.

The British NHS faces major challenges recruiting, motivating and retaining staff in a period of sustained growth and change. This paper examines the prevalence of skill shortages and organisations' coping strategies, as well the factors that motivate staff in the workplace and in the NHS in particular. It argues that the evidence base for informed policy-making needs radical improvement. It then considers a number of approaches to pay that are being used or suggested to attract, motivate and retain staff. These include performance pay, team pay and local pay determination, as well as considering broader factors such as morale and staff development. The paper then draws together some conclusions for policy-makers. These argue that better evidence is needed as to what is happening in the public sector labour market in order to frame appropriate responses and that thorough evaluation of policy initiatives is necessary to establish their utility before their widespread implementation.

Employment↗
PubMed2005

Specialist educational intervention for mental health nursing staff: delivery, content and personal impact.

AIM: This paper reports a study to ascertain the views of acute ward-based mental health nursing staff on the delivery, content and personal impact of an innovative 18-day, whole team educational intervention in acute mental health care. BACKGROUND: There are grave concerns internationally about the quality of inpatient mental health care for people with acute psychiatric problems. Educational courses are needed to improve these services. However, existing schemes are often selective, hard to access and limited to developing highly specialist skills for senior nurses. They have also been criticized for making no difference to clinical practice. There is little evidence to guide the development of these or alternative team-based courses. METHOD: Qualitative data were collected over a 6-week period using 12 focus group interviews and individual questionnaires. RESULTS: Four themes were identified. The joint education of nursing staff from different organizations was welcomed and reduced feelings of ward isolation. Mixing qualified and unqualified staff was not regarded positively. In terms of course content and learning themes, unqualified staff were more likely to report positive learning outcomes for knowledge, skills, attitude, morale and personal development; qualified nurses were more likely to indicate positive outcomes in anonymized data from questionnaires than from focus groups. Both groups reported little chance of knowledge implementation without changes in the organization of care. CONCLUSION: Whilst it may be desirable to educate whole nursing teams, more benefit might be gained from shared education between several organizations and separating the education of qualified and unqualified staff before combining these groups in team education. Participants remained pessimistic about their chances of implementing new knowledge and skills in current acute inpatient mental health environments.

Acute Disease↗
PubMed1975

Children's use of motives and intentionality in person perception and moral judgement.

Preschool, second-, and fifth-grade children watched films and heard stories which portrayed an actor who intentionally or accidentally injured another for either good or bad motives. After each film or story, children were interviewed to determine their understanding of the actor motives and the intentionality of his act and their moral judgements. The results suggest that children of all ages understood the concepts of motive and intentionality, but that the ability to make accurate inferences about motives and intentionality develops with age. Motives affected children's evaluations at all ages, but intentionality affected only grade school children's evaluations. The results for moral judgment were discussed in terms of a theory which included features of both cognitive-developmental and social learning explanations of moral development.

Age Factors↗
PubMedDate not supplied

The selfish karyotype. An analysis of the biological basis of morals.

An analysis is made of the kin-selection/group-selection debate on the issue of the biological basis of morals. The kin-selection view sees altruism, and morals in the case of humans, as resting solely on genetic factors; in fact, on this view, evolution itself is to take place only through genetic change -- a position which cannot be reconciled with our knowledge that species evolution involves karyotypic change. Morality is thought to stem from a particular gene which at one time was completely absent from the human population but which later entered and spread through it. On the generally accepted conception of kin selection, this 'altruistic' gene is to be responsible not only for apparently altruistic behaviour towards near relatives, but also for parental care. Thus this view, among other things, has the absurd consequence that there was a period directly after humans first came into existence during which we did not care for our young. In contrast, the group-selection view, as developed here, sees morality as stemming from the species' karyotype, and to be passed on karyotypically from species to species through evolution. As suggested by Darwin, morality is thus derived from our social instincts, and is fundamentally directed to members of one's tribe or community, not to members of one's family. In keeping with this perspective, it is suggested here that the biological basis of morals does not concern the continuation of each individual's gene line, but the continuing existence of the individual's community, and thus, indirectly, the survival of the human species, through supporting the continuing instantiation of its karyotype.

Altruism↗