Helping children grow in moral health. Responsibilities of children, caliber of home, parental example.
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Ethics of caring and the institutional ethics committee.
Institutional ethics committees (IECs) in health care facilities now create moral policy, provide moral education, and consult with physicians and other health care workers. After sketching reasons for the development of IECs, this paper first examines the predominant moral standards it is often assumed IECs are now using, these standards being neo-Kantian principles of justice and utilitarian principles of the greatest good. Then, it is argued that a feminine ethics of care, as posited by Carol Gilligan and Nel Noddings, is an unacknowledged basis for IEC discussions and decisions. Further, it is suggested that feminine ethics of care can and should provide underlying theoretical tools and standards for IECs.
Decision Making↗
Prosocial development in late adolescence: a longitudinal study.
Change in prosocial moral reasoning over 15 years, gender differences in prosocial reasoning, and the interrelations of moral reasoning, prosocial behavior, and empathy-related emotional responses were examined with longitudinal data from 17-18- and 19-20-year-olds and data from adolescents interviewed for the first time. Hedonistic reasoning declined in use until adolescence, and then increased somewhat in early adulthood. Needs-oriented and stereotypic reasoning increased until mid-childhood or early adolescence and then declined in use. Direct reciprocity and approval reasoning, which appeared to be on the decline in mid-adolescence in previous follow-ups, showed no decline into early adulthood. Several modes of higher-level reasoning increased in use across adolescence and early adulthood. Females' overall reasoning was higher than males'. Scores on interview and objective measures of prosocial moral reasoning were positively correlated. Consistent with expectations, there was some evidence of relations among prosocial reasoning, prosocial behavior, sympathy, and perspective taking.
Adolescent↗
Religion and adolescent sexuality.
The health professional can be helpful to the adolescent, the adolescent's family, and the community through participating in and initiating local sex education programs. Religious settings provide a great potential for sexuality education within a value framework. A helpful curriculum will include the meaning of sexuality; developing a positive concept of sexuality, and a healthy sexual identity; present the issues of adolescent sexuality, including the various health issues; and an understanding of quality relationships within the family and among peers. If health professions and the community religious institutions can joint together, they can reach the goals of most programs in human sexuality, namely, "learning to appreciate our sexuality as a positive potential for self-expression, fulfillment and intimacy; respect for the personhood and well-being of others; and responsible decision-making."
Abortion, Induced↗
Cross-sectional age differences in the self-conceptions of adults.
105 young, 104 middle-aged, and 96 elderly adults were asked to supply 20 answers to the question "Who am I." This followed previous research which has shown the responses of children and adolescents display an age-related increase in the number of abstract ideas used to answer this question. Participants of all age groups also used a high number of abstract ideas to characterize themselves, but the nature of these abstractions showed maturation-related variations in openness, competence, and moral integrity. This pattern of results supports Erik Erikson's theory of identity development in adulthood.
Adult↗
Biology, ethics, and public policy: deliberations at an unstable intersection.
Biology, ethics, and politics intersect in many public policy issues. The unique features of the meeting point in each case are affected by changes in scientific and technological knowledge, moral analysis in a pluralistic society, and political relations. No one of the three can be ignored without repercussions. This essay, however, concentrates on ethics. The ethical dimension must allow for genuine differences in fundamental moral stance, which always persist alongside scientific developments. Two scientific/medical issues with considerable ethical and political implications are discussed: (1) application of human embryonic stem cell research in regenerative medicine and (2) neuroscientific reductionism in the context of behavioral research and moral responsibility. Public advisory committees and other governmental structures for pursuing public policy should not rely merely on cost-benefit analysis to form policy, as if it were uniquely objective, but should also recognize the necessity of considering science and ethics together as two separate yet complementary foundations of policy. Minimizing the distinctness of the biological and ethical dimensions will make any conclusions unstable and their later implementation more difficult.
Animals↗
Development of an instrument to measure the cognitive structure used to understand personhood in patients.
Based on a theory of moral regard for personhood, a criterion-related instrument was developed to measure variations in the cognitive structure used to give meaning to personhood in patients. The cognitive structure, called empathetic maturity, has three hierarchical levels. It is measured indirectly through analysis of thought structure. Psychometrics were established in a sample of 41 nurses. Cronbach's alpha was .68. Construct validity was established by correlation with the Defining Issues Test at r = .51. p < .01; with age and education controlled, r = .44, p < .01.
Adult↗
Community mental health: avoided by some, neglected by others.
Why is there no mention of community mental health in reports and studies where it might reasonably be expected to form a major consideration. Examples of its omission are provided and reasons for its apparent avoidance and neglect advanced. The importance of mental health as a community health and development issue is argued in terms of moral responsibility and economic necessity. It is suggested that governments, health workers and the community in general need to be better informed about community mental health: they need to understand it, value it, facilitate its development and seek to maintain it. A multi-level, multi-sectorial approach is advocated to achieve these goals.
Attitude to Health↗
Moral issues arising from genetics.
Gene therapy, pre-natal diagnosis, genetically altered bacteria, patenting new life forms: these are all outgrowths from the development of genetics. Our focus will be on the moral issues engendered by some of the genetic techniques which are now so well integrated into clinical medicine. The section on genetic counseling is meant to show the most frequent moral problems encountered as they might really occur. Genetic screening is presented as a mix of preventive medicine and aid for genetic counseling. Genetic engineering is discussed in the context of evolution and human needs and desires.
DNA, Recombinant↗
Catholic moral teaching, medically assisted nutrition and hydration and the vegetative state.
A wide range of medical, legal and ethical opinion regarding withholding or withdrawing medically assisted nutrition and hydration (ANH) from vegetative state (VS) and persistent vegetative state patients (PVS) has been presented in professional journals over the past twenty years. This article concerns the moral aspects of this debate as it has developed within the Catholic Church, especially in the United States. It presents traditional Catholic teaching about the extent and limits of the moral obligation to employ medical means in the preservation of human life, and examines how this teaching applies to the specific question of supplying ANH to PVS patients. It provides a critique of two contradictory views on the morality of discontinuing ANH for PVS patients presented by Catholic theologians. It examines the teaching of Pope John Paul II, who identifies ANH as a natural means of preserving life that must be maintained as long as it preserves the patient's life or alleviates his suffering. Finally, it discusses the practical implications this papal teaching has for the treatment of PVS patients in all Catholic health care facilities.
Catholicism↗
Analogy in moral deliberation: the role of imagination and theory in ethics.
This paper develops themes addressed in an article by Eric Wiland in the Journal of Medical Ethics 2000;26:466-8, where he aims to contribute to the debate concerning the moral status of abortion, and to emphasise the importance of analogies in moral argument. In the present paper I try to secure more firmly a novel understanding of why analogy is an essential component in the attempt to justify moral beliefs. I seek to show how analogical argument both encapsulates and exercises the notions of rationality and imagination and that the construction, development, and comparison of analogies fundamentally underpins ethical argument. In so doing, it enables us to adopt imaginative and ethically illuminating perspectives but in a manner that does not relinquish any claims to intellectual rigour. I present a critique of a brand of "moral particularism" by showing how it cannot, if construed in a certain way, adequately conceive of how we use analogies and imaginary cases in ethics. Although such a particularism is thus impotent with regard to ethical debate, I show that the wider motivation behind particularism that can be extracted is of clear relevance and importance to medical practitioners.
Abortion, Induced↗
On corruption.
This paper begins with the premise that in most individuals and in most cultures there is an inevitable force that presses toward the production of corruption as time passes, a force that requires vigilant resistance. Corruption is here defined as a falling away from the ego ideal of the individual or the ideals of the culture, which results in certain unfortunate and maladaptive changes in attitude and behavior of both the group and the individual. Support is given to the premise by a brief review of the work of Robert Hutchins and of Oswald Spengler, both of whom were eloquent and learned advocates of the premise, although, perhaps for personal reasons, they were too pessimistic. There follows a discussion of the metapsychology of corruption both in individuals and in cultures, both from an ego psychology point of view and from a self psychology point of view. Freud's paper on narcissism and Kohut's "psychology of the self in the narrow sense" are taken as starting points. Using the terms of the former, a divestment of the ego ideal of narcissistic libido is described, along the lines of, and somewhat parallel to, Freud's concept of secondary narcissism. Using Kohut's early concept of a separate line of development for narcissism, it is suggested that a similar separate line of development can exist for "corruption" in both individuals and cultures. At the root of this development are the repeated narcissistic wounds inevitable in the course of individual life and in the life of a culture as it tries to live up to its ideals. Resistance to the demoralizing effects of the vicissitudes of life is an important function of the ego, and depends on the strength of the ego, of the cohesiveness of the sense of self, and of a conscious awareness of the dangerous pressures toward corruption that pervade our civilization and resolve not to be swept up by these pressures. This leads to the main point of the paper, focus on the status of the ego ideal of the psychoanalyst or, conversely, his or her level of "corruption," whether conscious or unconscious. It is maintained that this level and the particular value system of the analyst, as well as the level of energy invested in living up to his or her value system, is communicated subtly to both one's students and patients, and has a vital role in the treatment process.(ABSTRACT TRUNCATED AT 250 WORDS)
Cultural Characteristics↗
Trust in health care: theoretical perspectives and research needs.
PURPOSE: This paper presents some key theoretical issues about trust, and seeks to demonstrate their relevance to understanding of, and research on, health systems. Although drawing particularly on empirical evidence from low- and middle-income countries (LMICs), the paper aims to stimulate thinking across country settings. DESIGN/METHODOLOGY/APPROACH: Drawing both on conceptual literature and relevant empirical research from LMICs, the paper presents an argument about the role of trust within key health system relationships and identifies future research needs. FINDINGS: Theoretical perspectives on four questions are first discussed: what is trust and can it be constructed? Why does it matter to health systems? On what is it based? What are the dangers of trust? The relevance of these theoretical perspectives is then considered in relation to: understanding the nature of health systems; issues of equity and justice in health care; and policy and managerial priorities. The identified research needs are investigation of: the role of trusting workplace relationships as a source of non-financial incentives; the influence of trust over the operation of different forms of citizen-health system engagement; approaches to training trustworthy public managers; and the institutional developments required to sustain trustworthy behaviour within health systems. PRACTICAL IMPLICATIONS: The policy and management actions needed to strengthen health systems within LMICs, and elsewhere, include: recruitment of health workers that have the attitudes and capacity for moral understanding and motivation; training curriculae that develop such motivation; and developing the institutions (e.g., communication and decision-making practices, payment mechanisms) that can sustain trusting relationships across a health system. It is also important to recognise that distrust in some relationships may act to guard against the abuse of power. ORIGINALITY/VALUE: Although the notion of trust has become of increasing importance in health policy debates in high-income countries, it has received less attention in the context of LMICs. The papers adds to the very limited literature on trust in LMIC health systems and also opens new lines of thinking for those working in high income countries--particularly around the role of health systems in generating wider social value.
Developing Countries↗
Relationships between maturity of moral judgment and measures of cognitive abilities.
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Aptitude Tests↗
Crossing the ethical chasm: embryo status and moral complicity.
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Beginning of Human Life↗
Contact sports, moral functioning and planned behaviour theory.
The goal was to test the psychometric properties of the Moral Functioning Scale in a Greek athletic context, and to investigate any possible relation between moral functioning and planned behaviour. The sample comprised 384 athletes, 103 from the sport of football (soccer), 97 from basketball, and 184 from water polo. To measure moral functioning the researchers used a scale developed by Gibbons, Ebbeck, and Weiss. Planned Behaviour was assessed with a questionnaire based on Planned Behaviour Theory. Hierarchical regression analysis indicated strong association for Attitudes, Intention, Role Identity, and Perceived Behavioural Control with the four dilemmas of the moral functioning scale. The moral reasoning measure is a promising tool for measuring athletes' moral dilemmas in Greece.
Adolescent↗
John Gregory (1724-1773) and his lectures on the duties and qualifications of a physician establishing modern medical ethics on the base of the moral philosophy and the theory of science of the empiric British Enlightenment.
In 1769/70 the Scottish physician and philosopher John Gregory (1724-1773) published Lectures On the Duties and Qualifications of a Physician. Gregory developed a truely ethical - in the sense of (moral) philosophically based - system of conduct in a physician. His concept of practising and teaching ethics in medicine and science is established on a very broad footing: combining Bacon's (1561-1626) general philosophy of nature and science with both, the general, likewise empirically based moral philosophy of his personal friend David Hume (1711-1776), and with the principles upheld by the so-called Common-Sense Philosophy. His Lectures had - particularly via the famous Code of Medical Ethics of Thomas Percival (1740-1804) - a decisive influence on our contemporary concepts of ethics in medicine and science. John Gregory is, without doubt, one of the most important and certainly the most comprehensive among the founders of what is known today as modern Bioethics.
Bioethics↗
Abused, neglected, and nonmaltreated children's conceptions of moral and social-conventional transgressions.
The effect of child maltreatment on children's social-cognitive development was examined by investigating abused, neglected, and nonmaltreated children's judgments regarding the permissibility of social-conventional and moral transgressions pertaining to physical harm, psychological distress, and the unfair distribution of resources. Abused and neglected children and a control group of nonmaltreated children matched on IQ, age, and social class judged the seriousness, deserved punishment, generalizability, and rule contingency of familiar transgressions for themselves and others. Abused subjects were more likely than neglected subjects to consider psychological distress to be universally wrong for others; neglected subjects were more likely than abused subjects to judge the unfair distribution of resources to be universally wrong for themselves. Abused and control children, but not neglected children, judged all transgressions to deserve more punishment when committed by others than when committed by the self. All children distinguished between morality and social convention and between different types of moral transgressions on all 4 criteria. Furthermore, all children were more egocentric in their judgments for the self than for others. These findings are discussed in relation to research on the effects of child maltreatment and on moral judgment.
Child↗