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PubMed2002

Economism, efficiency, and the moral ecology of good nursing practice.

The free-market rhetoric dominating health-policy discussions today frames health-care goods and services as commodities that consumers will or will not buy at a given price. Health-care systems are being redesigned and hospitals restructured with a view to increased efficiency and productivity. Drawing on the experiences of clinical nurses in the United States, this paper shows how the application of economism to nursing may severely disrupt the ecology of good practice, leading to difficulties in meeting minimal standards of nursing care and severely constraining the acts of compassion called for by the human experiences of illness, loss, and death. Concerns about moral responsibility and conflicts between institutional and nursing goals are described. Increasing mistrust of health-care systems on the part of practitioners, patients, and families suggests that it is time to attend closely to the moral ecology of caring practices.

Economics, Nursing↗
PubMedDate not supplied

On knowing the 'why'. Particularism and moral theory.

If particularism is right, the broad moral claims we make are usually riddled with exceptions. But such generalizations can still be a useful, even necessary part of moral life. They help us show what we should do, and they are essential for understanding why we should do it.

Ethical Theory↗
PubMed2002

[Euthanasia as a moral problem in individual and social dimensions].

In the article, the author conducts a reasoning which results in a moral consent to perform an act of euthanasia on oneself. However, the problem of our times is the demand for the right to assisted euthanasia, particularly the doctor-assisted euthanasia. It is argued that the only situation in which an assistance in performing euthanasia finds a moral justification is a situation of a complete physical incapability to terminate a patient's own life. It is also argued that an assistant cannot be a doctor because in such a case we would be forced to acknowledge euthanasia as the final stage of the treatment process.

Attitude of Health Personnel↗
PubMed2003

Structural estimation of a principal-agent model: moral hazard in medical insurance.

Despite the importance of principal-agent models in the development of modern economic theory, there are few estimations of these models. I recover the estimates of a principal-agent model and obtain an approximation to the optimal contract. The results show that out-of-pocket payments follow a concave profile with respect to costs of treatment. I estimate the welfare loss due to moral hazard, taking into account income effects. I also propose a new measure of moral hazard based on the conditional correlation between contractible and noncontractible variables.

Contracts↗
PubMed1992

Victimizers and their victims: children's conceptions of the mixed emotional consequences of moral transgressions.

4-8-year-old children's conceptions of the emotional consequences of moral transgressions were assessed in 2 experiments. In Experiment 1, most children expected victimizers to feel positive emotions and victims to feel negative emotions, but 8-year-olds who assessed victims first subsequently attributed less positive emotions to victimizers. Despite efforts to manipulate the salience of victims' losses in Experiment 2, children had similar expectations about the emotional consequences of transgressions. However, a developmental shift emerged: 4-year-olds attributed extremely positive emotions to victimizers due to the material gains produced by victimization, whereas 8-year-olds attributed less positive emotions to victimizers, in part due to the unfairness and harm produced by victimization. Probe questions revealed that older children also attributed additional negative-valence emotions to victimizers, suggesting that victimizers are expected to feel conflicting rather than exclusively positive emotions. Discussion focused on potential cognitive constraints in children's conceptions of moral emotions.

Awareness↗
PubMed2001

[The phytoplankton community of Punta Morales, Nicoya Gulf, Costa Rica ].

Three daily samplings of the phytoplankton community were made at two consecutive days in March, April, May, September, October, November and December 1997, at Punta Morales, Golfo de Nicoya, Costa Rica. Samples were collected during each tide at depths of 50% and 10% of light penetration using a Niskin bottle. A total of 43 taxa were identified. Centric diatoms, pennates and flagellates represented 90% of total phytoplankton abundance. In the phytoplankton fraction (cells > 30 microm), diatoms were the most abundant group, and Skeletonema costatum (32%) dominated. In nannophytoplankton (cells < 30 microm), Chaetoceros (23.7%) was the most abundant taxon, followed by flagellates (23%) and Cylindrotheca closterium (13.1%). These results agree with previous surveys and suggest that a typical net phytoplankton community persist through time in the Punta Morales zone. The number of nannophytoplankton fraction cells varied seasonally and suggests quantitative changes in species abundance, with possible modifications of cellular size or chain length in filamentous species. The codominance between S. costatum and Chaetoceros spp. during the rainy season suggested the ocurrence of an early ecological sucession, and nutrients could be the factor generating such population changes.

Animals↗
PubMed2005

Euthanasia and assisted suicide: a liberal approach versus the traditional moral view.

Within the context of the debate over the recent suspended sentence given to John Stuart Godfrey by Underwood J in the Supreme Court of Tasmania for assisting his elderly mother with her suicide, this article examines some of the more popular arguments for and against the moral acceptability of euthanasia and assisted suicide. This article considers the arguments put forward on the "difference principle" by Rachels and Nesbitt before critically examining the liberal approach to the euthanasia issue as proposed by Kuhse. It is argued that whilst Kuhse is correct to reject the difference principle, she does so for the wrong reasons. The penultimate section of the article provides an overview of the traditional moral view against killing. The final part assesses whether the arguments put forward by proponents of the liberal approach are capable of overcoming this view.

Aged↗
PubMed2006

Moral agency in pain medicine: philosophy, practice and virtue.

Although established as a field of specialization, pain medicine remains somewhat fractionated. Such lack of cohesion creates dissonance on multiple levels, and thus, impedes the provision of effective pain care. This paper asserts that there is a core philosophy of medicine that reflects the intellectual and moral quality of the healing relationship. I argue that pain medicine, in all its constituent disciplines, is bound to this philosophy. The intricate relationship between pain, the pain patient, and the pain physician creates pragmatic and moral dilemmas that may not be well served by the use of prima facie principles. It is argued that an agent-based, virtue ethics best enable the clinician to both apprehend the complexity of this relationship and appreciate other ethical approaches in the discourse arising from issues of care.

Ethics, Medical↗
PubMed2006

Moral education in medical schools.

The present report summarizes challenges in teaching medical ethics, defines its goals, describes theoretical frameworks for moral education, and reviews strategies for teaching medical ethics to serve as guidelines in developing medical ethics instruction. Medical teachers should clarify the instructional goals in cognitive, attitudinal, and behavioral domains. The cognitive developmental and behavior-analytic theories called for ethical instruction using a series of discussions based on real-life ethical dilemmas while pointing out all the basic rules related to medical practice. Ethical courses for medical students should be student-centered, problem-based, and integrative. Ethical instruction should be systematically taught to every student, but additional elective courses could also be used. Moral education for residents should be more focused to issues specific to their specialties. Medical researchers need both formal ethical training and informal teaching, and role modeling. Finally, experienced staff could use small group discussions of shared ethical problems to maintain their ethical knowledge and skills.

Education, Medical↗
PubMed1991

Morality and pretextuality, psychiatry and law: of "ordinary common sense," heuristic reasoning, and cognitive dissonance.

The thesis of this paper is that we will not make significant progress in understanding the tensions between the legal and mental health systems until we look carefully at a series of dissonances that affect both systems. We must consider the way that the law frequently condones pretextuality as a way of dealing with troubling or cognitively dissonant information, and the way that mental health professionals encourage a self-referential concept of morality as a way of subverting legal doctrines with which they disagree. These dissonances must be considered contextually in connection with the ways that courts generally read social science data and the ways that jurors and legislators employ such cognitive devices as "ordinary common sense" and heuristic reasoning in their judgments of cases involving mental disability questions. To ameliorate the current dilemma, we must redefine institutional and professional roles, reconsider the way we privilege expertise, recalibrate our allocation of "moral jurisdiction" over these matters, and consciously confront the way our simplifying thinking mechanisms distort the underlying social and political issues.

Forensic Psychiatry↗
PubMed1991

[Significance of parent-child relations for development of moral reasoning in adolescence: a study of psychiatrically disordered adolescents].

In accordance with structural-developmental theory in the tradition of Piaget and Kohlberg, moderate amounts of conflict between adolescents and their parents should influence the sociomoral development of the adolescents in an optimal way. The same hypothesis is compatible with a social-constructivistic approach (Youniss, Keller, Haan, Miller), which emphasizes the role of communicative processes in the development and validation of moral rules. The results of our empirical study with 43 severely mentally disturbed adolescents aged 14 to 19 years indirectly confirm this hypothesis. Adolescents with moderate amounts of family conflict reached a higher stage in moral reasoning than those with either very severe problems or only minor problems with their parents. In an additional analysis we investigated the relation between the severity of the conflicts and the emotional attachment of the adolescent to his or her parents. Our data indicate that moderate problems in the interaction between child and parents are associated with a family atmosphere that seems to facilitate the development of an integrated personality and identity. A balanced coexistence of separateness and connectedness offers the young person the best chance to develop and clearly communicate his or her own point of view and to solve interpersonal problems by reaching a consensus that takes into account the needs and interests of the other family members.

Adolescent↗
PubMed1991

Professional culture and organizational morality: an ethnographic account of a therapeutic organization.

An ethnographic exploration of the social reality of a counselling and training institute points to the profound impact of the therapeutic paradigm on the 'patterned regularities', the general principles, rules and daily practices, in other words, the organizational morality. The limited house-rules or practices emerged mainly as 'enabling conditions' to let professional autonomy prevail and to maintain the game rather than to prescribe behaviour. Organizational rules, structures, mechanics served as a platform for negotiations among different groups of 'provinces of meaning'. These negotiations do not necessarily show any sense of organizational logic or administrative rationality. Perhaps the opposite is true. Loosely coupled interactions and consensual validation rather than goal-oriented thinking appeared to be the predominant organizational occupation. The irrational, at times even ironic dynamics operative in organizational morality are nevertheless meaningful. They function as 'mapping' and sense-making devices and can be seen as vehicles for reflecting and ordering underlying meanings.

Counseling↗
PubMed1991

Academic boycott--political strategy or moral imperative? Selective support as a justifiable alternative.

Academic boycott has been justified as an appropriate political strategy in the struggle against the oppression of apartheid. Moral outrage against racist policies has led to the claim that academic boycott is a morally imperative component of a broader sanctions policy. This claim has neither been substantiated by a reasoned ethical argument nor weighted against an ethically justifiable approach that is consistent with universal humanitarian aspirations and which allows rejection of apartheid to be coupled to constructive endeavours.

Ethics, Medical↗
PubMed1990

Moral and ethical development research in nursing education.

Research in moral development is breaking into exciting new territory with the long overdue inclusion of the female perspective. Nursing education needs to be on the forefront of this cutting edge, seeking new ways to help students confront the difficult moral dilemmas they will face daily as members of the nursing profession.

Curriculum↗
PubMed1989

[Participation and separation: reference criteria for the study of the genesis of the moral personality and its pathology].

In order to illustrate the hypothesis according to which there might exist a corresponding link between, on the one hand, a vectorial participant or separating, dynamics generating the ego's moral personality, and on the other hand, the dynamics of a relation to the proper law of a society in its cultural and religious tradition, we have firstly analysed the nature and the function of symbol as a common denominator to each of these two dynamics. This has led us to establish similar points within the "Verleugnung", i.e. the expression of the psychic phenomenon of denying reality, and within the expression of the social phenomenon of belief. These similar points then bear witness to a mode of inscription of the law in the individual psychology as well as in the collective unconsciousness and its legal expression. By applying this pattern to the analytic theory of the different identification process levels and of the gradual constitution of the superego, we finally find out how a lack or an absence of concord between these two dynamics (individual and social) reflect the optimal circumstances of occurrence of a pathology of the moral personality, according to a psychiatric nosography.

Anthropology, Cultural↗
PubMed1989

Moral beliefs of physicians, medical students, clergy, and lay public concerning AIDS.

A questionnaire was developed to assess religiously based moral beliefs about acquired immunodeficiency syndrome. The questionnaire was administered to a group of primarily black physicians, a selection of freshman medical students, two groups of clergy representing contrasting philosophical orientations, a group of young urban black and white attendees of a black cultural event, and two groups of older whites from rural Tennessee who were attending health fairs. Other attitudes about acquired immunodeficiency syndrome and related issues were also assessed. Results showed that 40% to 70% of rural whites strongly endorsed the idea that acquired immunodeficiency syndrome is a product of "divine intervention" or "divine retribution." More than half attributed the epidemic to a fulfillment of biblical prophecy. Two of five conservative clergy strongly agreed with the idea of divine intervention, whereas only one in 20 liberal clergy concurred. Approximately one in 10 physicians endorsed these propositions. The responses of freshman medical students were strikingly similar to those of physicians, except that less than half as many believed acquired immunodeficiency syndrome represents the fulfillment of a biblical prophecy. Physicians were remarkably similar to rural whites and conservative clergy in their distrust of the experts concerning the potential contagion of human immunodeficiency virus. When responses to several key items on the questionnaire were combined to create a measure of "conservatism," mean total scores differentiated all groups in the manner predicted. We conclude that religiously based moral beliefs about acquired immunodeficiency syndrome can have dangerous implications for the treatment of its victims by society and its caregivers.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1987

Adolescent sexuality: values, morality and decision making.

The first section of this paper presents a theoretical basis of morality and value formation which provides the background for an examination of adolescent sexual and cognitive development. Data from a study of influences on the sexual decisions of five hundred 13- to 19-year-olds are analyzed in the remainder of the article. Relationships between individual characteristics and the importance of various influences are interpreted in light of the structure of values and moral development.

Adolescent↗
PubMed1986

[The moral crisis of dehumanization and psychiatry].

The excessive determination is in relation with the recent theory of the brain. The brain is only from the discovery of Babinski an executive organ, but there is the personality with the moral problems. The excessive importance of the prognostic from Kraepelin and Bleuler is a danger that have seen by Baillarger, one of the founder of Medico-psychologique society. It is important to emphasize the action of moral factors from the revelation of hebraïc Bible until Pinel, Esquirol and the other foundators of french psychiatry until Clerambault, Marchand and Guiraud.

Attitude of Health Personnel↗