Does medical education inhibit the development of moral reasoning in medical students? A cross-sectional study.
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Cross-Sectional Studies↗
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A longitudinal study on the development of moral judgement in Korean nursing students.
This longitudinal study examined the development of moral judgement in 37 nursin students attending a university in Suwon, Korea. The participants completed the Korean version of the Defining Issues Test to allow analysis of their level of moral judgement. The development of moral judgement was quantified using 'the moral development score' at each stage (i.e. the six stages detailed by Kohlberg) and the 'P(%) score' (a measure of the overall moral judgement level). The results were as follows: (1) the moral development score for stage 5A was consistently the highest across the four years of the students' course, showing significant differences in some sociodemographic factors including home, birth order and monthly income; and (2) the P(%) score was higher in fourth-year (47.47 +/- 11.21) than in first-year (46.13 +/- 9.73) students. There was no significant difference in the P(%) score according to sociodemographic factors. Further studies will examine in detail the correlation between curriculum and moral judgement development. We suggest that courses in ethics education should be made more relevant.
Data Collection↗
Parent and peer contexts for children's moral reasoning development.
This study addressed the polarization among theoretical perspectives in moral psychology regarding the relative significance of parents and peers in children's developing moral maturity. The sample was composed of 60 target children from late childhood and midadolescence, 60 parents, and 60 friends who participated in parent/child and friend/child dyadic discussions of a series of moral conflicts. The quality of parents' and friends' verbal interactions, ego functioning, and level of moral reasoning in these discussions was used to predict the rate of children's moral reasoning development over a 4-year longitudinal interval. Results revealed that interactions with both parents and peers were predictive of children's development but that these two types of relationships influence development in rather different ways. Implications of the findings for the understanding of these socialization agents' roles in moral development are discussed.
Adolescent↗
[A longitudinal study on moral judgment development in nursing and medical students].
PURPOSE: In this longitudinal study, we examined the moral judgment level and its related factors, such as individual characteristics. The result of this study will provide baseline data to establish policy of ethics education for college students and healthcare professionals. METHOD: We enrolled 37 nursing students and 20 medical students as the subjects in a university in Suwon, Korea. We conducted a questionnaire on the subjects using Korean version of Defining Issues Test(DIT) to analyze the subjects' moral judgment level. Collected data was coded using ASCII document and scored using Fortran program for computer. Then the data was statistically analyzed by SPSS Version 10.0. RESULT: Nursing students' moral development score at each stage were consistently higher at stage 5A across 4-years rather than other stages. On the other hand, medical students' moral development score were consistently higher at stage 4 than other stages. There was no significant difference in the change P(%) score at each academic year in both groups. In the perspective of the subjects' general characteristics, P(%) score showed no significant in both groups. CONCLUSION: Based on the results of this study, further studies will examine the correlation between curriculum and moral judgment development in detail. Moreover, we suggest that the current ethics education should be developed and evaluated in more realistic manner.
English Abstract↗
Justice and care: the implications of the Kohlberg-Gilligan debate for medical ethics.
Carol Gilligan has identified two orientations to moral understanding; the dominant 'justice orientation' and the under-valued 'care orientation'. Based on her discernment of a 'voice of care', Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.
Adolescent↗
Development of moral judgment and its relationship to the education and training of dietitians.
The purpose of this study was to compare the development of moral judgment in 171 dietetics students before and after training from internships (n = 96), coordinated undergraduate programs (n = 61), and preprofessional practice programs (n = 14). The results of the study supported the research hypothesis that greater moral development growth would occur in supervised practices that allow students more experiences promoting moral growth, such as clinical rotations with patients, peer discussions on ethical issues, and access to instructors trained in ethics. Analysis of covariance indicated differences in the posttest scores of the three groups. Student scores for the internship and the coordinated undergraduate program were significantly different. Scores of preprofessional practice program students did not differ from those of the other groups. Internship programs offered more time in clinical rotations, used trained ethicists more, and used more methods to introduce ethics into the curriculum than did the other programs.
Adult↗
Relapse prevention for the adolescent substance abuser.
Adolescent substance abusers are particularly vulnerable to relapse. Three variables are of major importance in relapse prevention: the adolescent's cognitive development, his moral development and his emotional development. These must be constantly kept in mind during the treatment of the adolescent substance abuser.
Adolescent↗
Structural flexibility of moral judgment.
One of the central assumptions of Kohlberg's theory of moral development--that moral judgment is organized in structures of the whole--was examined. Thirty men and 30 women were given 2 dilemmas from Kohlberg's Moral Judgment Interview, a 3rd involving prosocial behavior, and a 4th involving impaired driving. Half the Ss responded to the prosocial and impaired-driving dilemmas from the perspective of a hypothetical character, and half responded from the perspective of the self. No sex or perspective differences in moral maturity were observed. Ss scored highest in moral maturity on Kohlberg's dilemmas, intermediate on the prosocial dilemma, and lowest on the impaired-driving dilemma. In partial support of Kohlberg's contention that his test assesses moral competence, there was a negative linear relationship between scores on his test and the proportion of Stage 2 judgments on the 2 other dilemmas. An interactional model of moral judgment is advanced.
Adolescent↗
Construction of a scale for measuring development of moral judgement.
The present research is a part of a study done to develop an objective measure of the development of moral judgement according to Kohlberg's theoretical construct. The Padua Scale of Moral Judgement and the relationship between empirical data and theory are presented. The scale was constructed from responses to the Sociomoral Reflection Measure-Short Form derived from Kohlberg's Moral Judgement Interview. Reliability and validity of the new scale as well as group age and sex differences were examined.
Adolescent↗
Teaching medical ethics to first-year students by using film discussion to develop their moral reasoning.
PURPOSE: To evaluate a project on teaching medical ethics to first-year students by using film discussion to develop the students' moral reasoning. METHOD: The participants were 114 first-year students at Texas A&M University Health Science Center College of Medicine in 1989-90, 1990-91, and 1991-92: (1) 48 (20 women and 28 men) who participated during the fall quarter in an elective course on social issues in medicine, which consisted of weekly one-hour discussions of short films; (2) 37 (18 women and 19 men) who participated in the course during both the fall and winter quarters; and (3) a control group of 29 (8 women and 21 men) who did not take the course and so had no exposure to the film discussions. The influence of the discussions on the students' moral reasoning was measured by using Rest's Defining Issues Test for pretests and posttests. The scores of the three groups were compared by using multivariate analysis of variance. RESULTS: There were statistically significant increases in the moral reasoning scores of both the course registrants with one-quarter exposure to the film discussions (p < .002) and those with two-quarter exposure (p < .008) compared with the scores of the students who did not take the course and had no exposure (p < .109). CONCLUSION: No doubt there was a self-selecting bias on the part of the course registrants; however, since both groups of registrants showed significant increases on their posttest scores, clearly the course did have a positive influence on these students' moral reasoning. Thus, it is possible to develop young people's moral reasoning in medical school as well as in earlier educational environments.
Control Groups↗
The development of moral judgment during nursing education in Finland.
This study describes moral judgment among first- and last-year nursing students in Finland and examines the effects of ethics teaching on the development of moral judgment. The data for this quantitative cross-sectional study were collected using the Defining Issues Test (DIT), which is based on Kohlberg's theory of moral reasoning stages. The questionnaires were sent to four polytechnics, which offer nursing education in southern Finland. A total of 52 first-year students and 54 last-year students participated. The results showed that students who had had to deal with ethical dilemmas in their practical training had higher moral judgment than students who did not. Last-year students had higher moral judgment than first-year students. Last-year students resorted to principle-based thinking more often than first-year students in resolving DIT dilemmas. The differences between the two groups were statistically significant. The results indicate that nursing education may has an effect upon students' moral judgment.
Adult↗
The ethic of care: a comparison of nursing and medical students.
The purpose of this research was to examine whether "caring" uniquely reflects the moral orientation of nursing students. Gilligan's theory of moral development and Kolhberg's theory of moral development structured this study of 119 nursing and medical students who described a real-life moral dilemma and responded to a hypothetical clinical moral dilemma. The findings suggest that nursing students use care more than justice considerations, but their moral orientation could best be described as mixed. Differences were found between nursing and medical students, but these differences appeared to be related to gender, not professional role. Therefore, it was concluded that a caring moral orientation is not unique to nursing.
Adult↗
Spontaneous development of moral concepts.
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Child↗
The influence of gender on conflicts of interest in the allocation of limited critical care resources: justice versus care.
After noting that the principle of autonomy has been inadequate for the resolution of many of the complex and difficult moral dilemmas involving conflicts of interest in the allocation of limited critical care resources, this paper analyzes the concepts of justice and care as alternative solutions to moral problems and applies them to the issue of repeat organ transplants to a single recipient. These concepts are found to be the basis of the notions of moral reasoning and moral orientation, respectively, which serve in moral development theory as two fundamentally different ways to approach moral problem solving. Following an elaboration of moral reasoning as found in Kohlberg's cognitive moral development theory, the influence of gender on moral reasoning is investigated. The empirical data show that women (mean Defining Issues Test score, 47.18) score significantly higher (P < or = .0001) than men (mean Defining Issues Test score, 41.77) in the use of moral reasoning based on the concept of justice for resolving moral dilemmas. Following an elaboration of moral orientation as found in Gilligan's moral theory of the ethics of care, the influence of gender on moral orientation is investigated. The empirical data show that women use the concept of care significantly more often (P < or = .0139) than their male colleagues in resolving moral dilemmas. From these data it is concluded that men are more likely than women to use justice in the resolution of moral dilemmas, such as the conflicts of interest in the allocation of limited critical care resources, but that if women do use, or are required by the social system to use, justice in the resolution of moral dilemmas, they do a better job of it than men.
Critical Care↗
A longitudinal study of adolescents' attitudes about assistance in the development of moral values.
A questionnaire-based study of 2,863 adolescents (ages 12 to 22 years), with data collected over 15 years, measured the extent to which informants believed that elementary, secondary, and college-age young people should receive guidance on moral issues from the family, school, clergy, peers, and/or the individual himself or herself. Averaging the ratings of all respondents over the first three categories yielded an overall authority score of 1.85, where a score of 2.00 represented a belief in moderate influence. Results showed a minimal difference in the ratings between genders, among different age groups, and across the different calendar years of questionnaire administration. Much more substantial differences existed among the actual influences investigated and across the ages of those to whom the influence was to be directed.
Adolescent↗
A Latino perspective on the role of ethnicity in the development of moral values: implications for psychoanalytic theory and practice.
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Adult↗
Lying and killing: language and the moral reasoning of twelve- and fifteen-year-olds by social group.
Twenty groups of children of different social class, ethnic, national and regional backgrounds were matched by non-verbal reasoning ability and school experience. Their moral stances on "lying" and "killing" and their reasons for those stances were recorded orally on a one-to-one basis, using a school setting conducive to concentration and uninhibited communication. Individual literacy levels had no influence on results. There was an impressive consistency in moral attitudes and in reasons offered for those attitudes across children of quite different social backgrounds. There was also a very common access to higher level, autonomous reasoning among the adolescents surveyed. A strong link between moral development and language development can be inferred from the findings, but the parallel is not clear cut.
Adolescent↗
In search of an everyday morality: the development of a measure.
Current interest in moral theorizing has been dominated by Kohlberg's cognitive-developmental view. Haan (1982) has challenged psychology's reliance on this rationalistic focus and has argued for a rethinking of morality's meaning in accord with everyday human experience. In light of this challenge, the present study gives both theoretical and empirical support to the advancement of a morality for everyday life. Specifically, a new measure called the Visions of Morality Scale (VMS) is reported. The VMS is sensitive to three dimensions which are necessary for an everyday morality: (1) a human constitutive component which is universally experienced by all human beings (empathy); (2) the inclusion of a behavioral component which reflects actual behavior (pro-social inclinations); and (3) a view of morality that is multilevel (private, interpersonal, and social). A brief sketch of the VMS is provided. Results are presented from a study of 181 high school students which relate the VMS to empathy and political orientation. Highly significant relationships were found among morality, political orientation, and empathy. In addition, results revealed numerous sex differences. Finally, the implications of an everyday morality are discussed.
Adolescent↗