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PubMed2002

What conception of moral truth works in bioethics?

For the most part, philosophers have regarded moral truth as propositional and as what follows from the application of moral theory to particular problematic cases. Here I maintain that this is not a useful way of conceiving moral truth in bioethics. Rather, we are better off conceiving of moral truth as what emerges from a process of inquiry conducted in a certain manner. There are four elements to this process: (1) careful exploration of the embedded norms of medical practice, research, and delivery; (2) recognition of the irreducible plurality of ultimate moral values within and between these practices; (3) the cultivation and exercise of moral imagination; and (4) the attainment, however temporarily, of wide reflective equilibrium. This process, I argue, is reflected in the way bioethics is most fruitfully practiced, and it is further to be recommended by being true to the character of moral conscientiousness generally. This analysis suggests that moral truth is "unstable," but that this is not a bad thing. Further, the implication is drawn that moral theory would be better informed if formulated on the basis of paying more attention to lived moral practices.

Bioethical Issues↗
PubMed2005

Evolutionary, biological origins of morality: implications for research with human embryonic stem cells.

Medical research with human embryonic stem cells, despite its enormous potential to reduce human suffering, is banned in many countries and heavily restricted in others. "Moral reasons" are invoked to justify bans and restrictions on this promising research. Rather surprisingly, while those moral reasons have been extensively discussed and hotly debated in several papers, not a single article on the moral aspects of that research has attempted to answer this fundamental question: What is morality? Considering that a scientifically objective definition of morality is essential to determine whether those moral reasons are justified or groundless, this article focuses on the evolutionary origins of morality and its biological basis. Morality arose as a selectively advantageous product of evolution and preceded all religions and philosophies by millions of years. For the 99% of humankind's evolution, morality was axiomatically aimed at reducing the sufferings of the social members, because pains and afflictions, as expressions of diseases and impairments, tended to hasten the extinction of the small ancestral groups, which characteristically consisted of a few tens of members. Had the therapeutic use of human embryos been available in remote times, our ancestors would have deemed it unquestionably immoral to save amorphous and microscopic agglomerates of insensitive cells representing neither parental nor social investment, at the expense of the lives of the suffering members of their little communities. Unless we venture the untenable thesis that the unlikelihood of extinction of our immense societies entitles us to overturn the meaning of morality, we cannot but conclude that bans and restrictions on research with human embryonic stem cells are patently immoral.

Altruism↗
PubMed1998

Politics, moral reasoning and the Defining Issues Test: a reply to Barnett et al. (1995).

Previous research has consistently shown that those on the political Right tend to prefer or use conventional or Stage 4 moral reasoning, while those on the political Left prefer principled or Stage 5 reasoning (cf. Kohlberg, 1976). One interpretation of this finding is that developmental level of moral reasoning influences a person's political views, another that the moral 'stages' associated with contrasting political positions are in fact contrasting politico-moral ideologies and that people choose the form of moral reasoning which best expresses their own political identity. We report four studies to test aspects of these alternatives. Participants (N = 50) in Study 1 rated moral arguments representing different stages as differentially relevant to people of varying political persuasions. In Study 2, participants (N = 106), assigned to play the role of constituency political parties (either Labour or Conservative) selecting candidates to represent their party, evaluated imaginary candidates differentially as a function of the kinds of moral arguments the candidates expressed. In Study 3 (N = 61), principled and particularly conventional moral arguments were again found to express contrasting political identities. In Study 4 (N = 51) a manipulation of the salience of participants' political identity produced as predicted high correlations between moral reasoning scores and measures of political attitudes when political identity was salient but not when personal identity was salient. The findings overall, however, only partially support the view that political identity influences moral reasoning. We conclude that, although degree of preference for conventional or Stage 4 reasoning is a function of political identity, principled reasoning may be unrelated to political orientation. We also propose that these two forms of reasoning do not reflect successive development stages and that preference for one may be independent of preference for the other.

Adult↗
PubMed2006

Consequences, action, and intention as factors in moral judgments: an FMRI investigation.

The traditional philosophical doctrines of Consequentialism, Doing and Allowing, and Double Effect prescribe that moral judgments and decisions should be based on consequences, action (as opposed to inaction), and intention. This study uses functional magnetic resonance imaging to investigate how these three factors affect brain processes associated with moral judgments. We find the following: (1) Moral scenarios involving only a choice between consequences with different amounts of harm elicit activity in similar areas of the brain as analogous non-moral scenarios; (2) Compared to analogous non-moral scenarios, moral scenarios in which action and inaction result in the same amount of harm elicit more activity in areas associated with cognition (such as the dorsolateral prefrontal cortex) and less activity in areas associated with emotion (such as the orbitofrontal cortex and temporal pole); (3) Compared to analogous non-moral scenarios, conflicts between goals of minimizing harm and of refraining from harmful action elicit more activity in areas associated with emotion (orbitofrontal cortex and temporal pole) and less activity in areas associated with cognition (including the angular gyrus and superior frontal gyrus); (4) Compared to moral scenarios involving only unintentional harm, moral scenarios involving intentional harm elicit more activity in areas associated with emotion (orbitofrontal cortex and temporal pole) and less activity in areas associated with cognition (including the angular gyrus and superior frontal gyrus). These findings suggest that different kinds of moral judgment are preferentially supported by distinguishable brain systems.

Adolescent↗
PubMed2002

[Gender and relation of life-style to morale in older people living in regional cities].

The purpose of this study was to examine the morale of older people living in 7 cities (and towns), using the PGC morale scale, from the relationship between morale score and life-style. Data were collected from 1,269 people aged 60 or more in the community (619 males and 650 females) in cities (and towns). A questionnaire included the PGC morale scale and 14 life-style factors. There was no remarkable gender difference in the morale score. The relationship between morale and life-style were different in both sexes and higher in males. Female morale when living with a husband is generally high. It is important for females to have a husband. In the relationship between economics and morale, economic satisfaction was considered to be more important than the level of income. Eating regularly, participating as a volunteer and having a best friend are related to morale, but factors of job, smoking, drinking and sports enforcement-frequency are not. It is considered that there is no significant gender difference, but the relationship between morale and life-style in older people living in cities (towns) are different in both sexes.

Aged↗
PubMed1992

Children's obligatory and discretionary moral judgments.

This study examined children's obligatory moral judgments (which reflect a moral requirement) and discretionary moral judgments (which reflect moral worthiness, but not a requirement). 72 children participated across grades 2, 5, and 8 (mean ages, 8-3, 11-0, and 13-11). Children were interviewed in response to stimulus stories that controlled for the degree of agent's cost (low and high) for performing positive moral acts (giving money for food to an impoverished, hungry person) and negative moral acts (not stealing money for food). Results showed that negative moral acts were more often conceived as obligatory than positive moral acts. In addition, the results support the proposition that children's concepts of obligation underlie judgments to codify law, that justice reasoning builds on concepts of welfare, and that with increasing age discretionary moral reasoning incorporates such character traits as benevolence, sacrifice, and supererogation. Discussion includes consideration of how the study's conceptualization and analysis can provide guidance to a moral-developmental research program.

Adolescent↗
PubMed2005

Human morality and temperament.

This chapter has tried to make two points. First, the concept of morality refers to a developmental cascade of phenomena whose essential features are (a) inhibition of punished acts; (b) a representation of prohibited actions; (c) the emotions of uncertainty, empathy, shame, and guilt; (d) the semantic concepts of good and bad; (e) accepting the moral obligations of social categories; and (f) the concepts of fairness and the ideal. The inhibition of prohibited actions and the cognitive representation of prohibited behaviors, as well as the affect states that follow violations, appear by the end of the second year of life. The concepts of good and bad appear early in the third year, the experience of guilt and awareness of social categories by 4-6 years, and the notions of fairness, the ideal, and relational social categories during the school years. Second, some of the variation in the intensity and frequency of the moral emotions is attributable to the child's temperament. Eleven-year-old children who had been high-reactive infants and admitted to feelings of guilt when they violated a family standard were cortically and autonomically more aroused than the low reactives who reported equally frequent experiences of guilt. Further, high reactives who were perceived by their mothers as highly sensitive to punishment were biologically more aroused than high reactives perceived as less sensitive. Both universal developmental phenomena tied to brain maturation and temperamental variation associated with neurochemistry contribute to the complex phenomena that constitute the moral domain. The role of affect in promoting the adherence to standards remains controversial. Kant believed that people acted morally because acceptance of the categorical imperative required proper behavior-reason was the guardian of social harmony. Peirce and Dewey, by contrast, argued that anticipation of the emotions of anxiety, shame, and guilt motivated loyalty to the community's ethical standards. The fact that adults pay to watch a film that they know will generate a deep feeling of sadness--an emotion most do not seek or welcome in their daily lives--and will remark that they enjoyed the movie warrants an explanation. One possibility is that the experienced emotion affirms their moral values. The Australian film The Rabbit Proof Fence describes three aboriginal sisters who have been taken from their mother to a camp a thousand miles away to be socialized in Australian values. The three girls run away, and most of the film illustrates the hardships that they endure and their close escapes from the authorities who are pursuing them as they walk the thousand miles to reach their home. The audience's empathic sadness for the children affirms their moral belief that children should love their parents and miss their home. I suspect that those in the audience who felt the most intense sadness would praise the film with greater enthusiasm than those who had muted feelings. Because sadness is an emotion that few enjoy or try to attain, there must be another reason for deciding that the film was gratifying. The affirmation of one's moral beliefs could be that source of gratification. The tension between the importance of a rational and the importance of an affective basis for morality is seen in modern industrialized societies where the balance between the feeling of virtue that follows enhancing another and the pleasure that follows the enhancing of self has shifted toward favoring the latter state. Increasing numbers of Americans do not regard their gender, ethnicity, vocation, place of residence, or friendships or the religion of their parents as distinctive sources of virtue. As a result, they are freed from the moral obligations that were attached to these categories in the past and rely primarily on the anticipation of sensory delight and self-enhancement as guides for action and sources of reassurance that they are managing their lives correctly. Although it is likely that future scientists will synthesize a drug that blocks feelings of guilt without affecting the knowledge that an act is wrong, it is less certain that broad use of this drug would eliminate loyalty to the mutual obligations that make a society habitable. Nonetheless, a posture of vigilance is appropriate, for humans, unlike gorillas, can hold representations of envy, hostility, and anger, even toward those whom they have never met, for a very long time. Therefore, empathy and the anticipation of guilt or shame may restrain rudeness, dishonesty, and aggression when reason fails.

Child↗
PubMed1993

The moral development of medical students: a pilot study of the possible influence of medical education.

Medicine endorses a code of ethics and encourages a high moral character among doctors. This study examines the influence of medical education on the moral reasoning and development of medical students. Kohlberg's Moral Judgment Interview was given to a sample of 20 medical students (41.7% of students in that class). The students were tested at the beginning and at the end of their medical course to determine whether their moral reasoning scores had increased to the same extent as other people who extend their formal education. It was found that normally expected increases in moral reasoning scores did not occur over the 4 years of medical education for these students, suggesting that their educational experience somehow inhibited their moral reasoning ability rather than facilitating it. With a range of moral reasoning scores between 315 and 482, the finding of a mean increase from first year to fourth year of 18.5 points was not statistically significant at the P < or = 0.05 level. Statistical analysis revealed no significant correlations at the P < or = 0.05 level between the moral reasoning scores and age, gender, Medical College Admission Test scores, or grade point average scores. Along with a brief description of Kohlberg's cognitive moral development theory, some interpretations and explanations are given for the findings of the study.

Adult↗
PubMed2005

Moral problems and distress among nurse practitioners in primary care.

PURPOSE: To identify the ethical issues nurse practitioners (NPs) encounter in primary care, examine the types of moral problems that arise related to those issues, and determine the level of distress NPs experience. DATA SOURCE: Self-reported responses to an investigator-designed, anonymous, mailed survey on a convenience sample of 71 NPs practicing in primary care in one midwestern metropolitan area. CONCLUSIONS: This preliminary descriptive study identified a number and variety of ethical issues NPs encounter in primary care. The issue encountered with the greatest frequency was patient refusal of appropriate treatment. Distress was reported most often over problems of moral dilemma, followed by moral distress, and least often, moral uncertainty and moral outrage. Another type of moral problem, possibly related to conflict between patient autonomy and NP beneficence, occurred almost as often as moral dilemma. Not as many NPs reported encountering ethical issues or being distressed as the literature suggests. The reason for this is unclear but may be related to NPs' sense of moral responsibility or their ability to discern subtle ethical issues in the complex primary care environment. Regardless of moral problem, NPs felt frustrated and powerless. As a result, some changed jobs and contemplated leaving advanced practice. IMPLICATIONS FOR PRACTICE: More research is needed to clearly understand ethical issues and moral problems for NPs in primary care, how NPs identify and manage problems, and the effects on NPs and patients.

Humans↗
PubMed2005

Virtue ethics: an approach to moral dilemmas in nursing.

Nurses are increasingly confronted with situations of moral difficulty, such as not to feed terminally ill patients, whistle blowing, or participation in termination of pregnancy. Most of these moral dilemmas are often analyzed using the principle-based approach which applies the four moral principles of justice, autonomy, beneficence, and non-malificence. In some instances, consequentialism is considered, but these frameworks have their limitations. Their limitations has to do with a consideration for the interpersonal nature of clinical nursing practice on the one hand, and is not always clear on how to judge which consequences are best on the other hand. When principles are in conflict it is not always easy to decide which principle should dominate. Furthermore, these frameworks do not take into account the importance of the interpersonal and emotional element of human experience. On the contrary, decision-making about moral issues in healthcare demands that nurses exercise rational control over emotions. This clearly focuses the attention on the nurse as moral agent and in particular their character. In this article I argue that virtue ethics as an approach, which focus of the character of a person, might provide a more holistic analysis of moral dilemmas in nursing and might facilitate more flexible and creative solutions when combined with other theories of moral decision-making. Advancing this argument, firstly, I provide the central features of virtue ethics. Secondly I describe a story in which a moral dilemma is evident. Lastly I apply virtue ethics as an approach to this moral dilemma and in particular focusing on the virtues inherent in the nurse as moral agent in the story.

Attitude of Health Personnel↗
PubMed2006

Moral agency in other animals.

Some philosophers have argued that moral agency is characteristic of humans alone and that its absence from other animals justifies granting higher moral status to humans. However, human beings do not have a monopoly on moral agency, which admits of varying degrees and does not require mastery of moral principles. The view that all and only humans possess moral agency indicates our underestimation of the mental lives of other animals. Since many other animals are moral agents (to varying degrees), they are also subject to (limited) moral obligations, examples of which are provided in this paper. But, while moral agency is sufficient for significant moral status, it is by no means necessary.

Altruism↗
PubMed1999

Moral perception and the pursuit of medical philosophy.

This paper begins by examining the claim that the practice of medicine is essentially a moral endeavor. According to this view, all clinical practice has moral content, and each clinical situation has a moral dimension. I suggest that in order to recognize this moral dimension, clinicians must engage in an interpretive process, and that they must be able to interpret clinical data in ethical terms. However, clinicians often lack the 'moral perception' required to appreciate this moral dimension. I will argue that physicians lack moral perception when the clinical data they are given do not offer sufficient opportunity for interpretation. This paper draws on the work of Merleau-Ponty to suggest that this loss of interpretation is, paradoxically, the result of the way that patients experience illness. This thesis may be productive, first, because it suggests opportunities to explore the process of moral perception. This thesis also suggests ways for ethicists and educators to enhance clinicians' perception of the ethical dimensions of clinical practice. Finally, the concept of moral perception, when grounded in the patient's experience of illness, creates a fruitful area of inquiry that warrants inclusion in what may someday be the philosophy of medicine's canon.

Decision Making↗
PubMed1982

Moral reasoning and decisions in dilemmas of neonatal care.

The relationship between levels of moral reasoning and decisions in dilemmas of neonatal care was investigated in a sample of 452 pediatricians. Subjects included residents, faculty members, and practitioners recruited from a variety of university-affiliated and community hospitals. It was hypothesized that physicians whose moral reasoning was more fully developed would less actively treat particular cases. Such cases might include those where a patient's family requested such a limit (designated "negative family attitude") or the quality of life likely to be led after therapy was so low as to preclude even a minimal degree of human activity or social interaction (designated "unsalvageable prognosis"). The hypothesis was tested through the use of two questionnaires. The first questionnaire, devised by Crane, assessed the physician's reported degree of activism in treating six cases of infants born with severe defects. The structure of moral reasoning was measured by a second questionnaire, Rest's Defining Issue Test. Subjects were scored by the degree to which they use universal, ethical principles in resolving a series of moral dilemmas. Results of the absolute level of activism (Table 1) showed that among both residents and postresidents, the degree to which cases are actively treated depends, for salvageable patients, on the type of damage and on the possibility for research. Results involving moral reasoning showed a different pattern among residents and postresidents. Among residents, a significant correlation exists between principled reasoning and the absence of active treatment (r = - 0.41, Form A; r = - 0.23, Form B). As predicted, such correlations were strongest for cases of negative family attitude or of unsalvageable prognosis. The pattern of correlations among postresidents showed either no relationship to moral reasoning or the reverse of the residency pattern (r = -0.08, Form A; r = 0.30, Form B). The influence of the type of institution a resident operates within was assessed by analysis of variance. Inasmuch as moral reasoning and institutional type both had significant main effects (Form A), their magnitude differed. Institutional type accounted for 43% of the variation in mean activism scores whereas moral reasoning accounted for only 4%; however, because one could, a priori, expect institutional norms and customs to be powerful determinants of behavior, any additional, identifiable influence deserves attention. The structure of individuals' moral reasoning seems to be such an influence.

Attitude of Health Personnel↗
PubMed2005

The moral contours of empathy.

Morally contoured empathy is a form of "reasonable partiality" essential to the healthy care of dependents. It is critical as an epistemic aid in determining proper moral responsiveness; it is also, within certain richly normative roles and relationships, itself a crucial constitutive mode of moral connection. Yet the achievement of empathy is no easy feat. Patterns of incuriosity imperil connection, impeding empathic engagement; inappropriate "empathic" engagement, on the other hand, can result in self-effacement. Impartial moral principles and constraints offer at best meager protection against these perils, and hence serve poorly in securing morally contoured empathy. More nuanced and practical guidance should be sought in normatively substantive conceptions of our roles and relationships and their defining moral stakes. These, joined with more abstract moral tools, can facilitate rich, narratively textured interpretations of morality's demands. While the content of our normative conceptions must be continually debated, engaging in this debate is vital to the achievement of proper empathy, and thus to effective, respectful, morally healthy care of dependents.

Empathy↗
PubMed2006

What frontotemporal dementia reveals about the neurobiological basis of morality.

There is evidence that moral behavior is a product of evolution and an innate aspect of the human brain. Functional magnetic resonance studies in normals, investigations of psychopaths, and acquired sociopathy from brain lesions suggest a neurobiology of moral behavior. Reports of sociopathy among patients with frontotemporal dementia (FTD) have provided a further opportunity to clarify the neurobiology of morality. They confirm a morality network that includes the ventromedial frontal cortex, the orbitofrontal cortex, and the amygdalae. The right ventromedial region is critical for the emotional tagging of moral situations, the orbitofrontal cortex responds to social cues and mitigates impulsive reactions, and the amygdalae are necessary for threat detection and moral learning. Alterations in moral behavior in FTD may result from a loss of the emotional label of moral dilemmas, coupled with disinhibited responses. More investigations are needed to fully understand how the brain mediates moral or ethical behavior.

Amygdala↗
PubMed2003

Bioethics in a multicultural world: medicine and morality in pluralistic settings.

Current approaches in bioethics largely overlook the multicultural social environment within which most contemporary ethical issues unfold. For example, principlists argue that the "common morality" of "society" supports four basic ethical principles. These principles, and the common morality more generally, are supposed to be a matter of shared "common sense." Defenders of case-based approaches to moral reasoning similarly assume that moral reasoning proceeds on the basis of common moral intuitions. Both of these approaches fail to recognize the existence of multiple cultural and religious traditions in contemporary multicultural societies. In multicultural settings, patients and their families bring many different cultural models of morality, health, illness, healing, and kinship to clinical encounters. Religious convictions and cultural norms play significant roles in the framing of moral issues. At present, mainstream bioethics fails to attend to the particular moral worlds of patients and their family members. A more anthropologically informed understanding of the ethical issues that emerge within health care facilities will need to better recognize the role of culture and religion in shaping modes of moral deliberation.

Anthropology, Cultural↗
PubMed1998

Naturalistic conceptions of moral maturity.

By examining naturalistic conceptions of moral maturity, this project sought a more comprehensive understanding of moral excellence than is evident in dominant theories of moral development. Studies 1 and 2 involved different samples of 120 adults (17-25, 35-55, and 65+ years). Study 3 involved a sample of 180 undergraduates. In Study 1, a free-listing procedure was used to generate the attributes of a highly moral person as well as those for two related person-concepts. In Study 2, a rating procedure for these attributes was used to generate a prototype of the moral person-concept. In Study 3, a similarity-sorting task was used to uncover people's implicit typology of moral maturity. The findings indicate that naturalistic notions of moral excellence not only contain themes of principled reasoning but also reference aspects of moral character and virtue that enlarge our understanding of the psychological functioning of the mature moral agent.

Adolescent↗
PubMed2004

Differing conceptions of moral exemplarity: just, brave, and caring.

People's conceptions of different types of moral exemplarity were examined in an attempt to augment the current emphasis on moral rationality with a fuller understanding of moral personality. In Study 1 (with 805 adults), a free-listing procedure was used to generate the attributes of 3 types of moral exemplars (just, brave, and caring). In Study 2 (with 401 undergraduates), prototypicality- and personality-rating procedures were used to generate a personality profile for each type of moral exemplar and to examine the relations among them. In Study 3 (with 240 undergraduates), a similarity-sorting procedure was used to identify the typologies implicit in people's understanding of these different types of moral exemplarity. The findings indicate that moral excellence can be exemplified in rather divergent ways and that understanding of moral functioning would be enhanced by attention to this wider range of moral virtues.

Adolescent↗