BACKGROUND. Induced abortion is often discussed in terms of ethics. The aim of the present report is to describe the abortion ethics as it was expressed by women undergoing a legal abortion. OBJECTIVE. Moral considerations expressed during semistructured interviews by 128 women two weeks after a first trimester abortion in Stockholm 1987-90 are reported. RESULT. The women had faced a choice between abortion and parenthood. At the time of the abortion many of them were living under conditions that meant they were unable to offer a child the security they regarded as a child's right. The conflict the women spontaneously described as their main moral dilemma was not a conflict between the woman and the fetus, but a conflict between several close relationships, also concerning the prospective father. The ethics that the women applied to the problems of abortion was founded on a long-term responsibility to care for persons in their relationships. CONCLUSION. The women interviewed had three levels of moral reasoning simultaneously present. 1. A theoretical level--most of all concerning other women--a liberal view of rights: abortion should be a freely obtainable option. 2. A theoretical level--above all, concerning themselves--a restrictive deontological view: the extinction of life is morally wrong and should be avoided. 3. A practical level--when the problem was a reality: a consequentialist ethics of care. According to this ethics of care it was important that the abortion could be performed as early as possible during pregnancy.
In previous issues of this journal, Carol Gilligan's original concept of mature care has been conceptualized by several (especially Norwegian) contributors. This has resulted in a dichotomous view of self and other, and of self-care and altruism, in which any form of self-sacrifice is rejected. Although this interpretation of Gilligan seems to be quite persistent in care-ethical theory, it does not seem to do justice to either Gilligan's original work or the tensions experienced in contemporary nursing practice.
A close reading of Gilligan's concept of mature care leads to a view that differs radically from any dichotomy of self-care and altruism. Instead of a dichotomous view, a dialectical view on self and other is proposed that builds upon connectedness and might support a care-ethical view of nursing that is more consistent with Gilligan's own critical insights such as relationality and a practice-based ethics. A concrete case taken from nursing practice shows the interconnectedness of professional and personal responsibility. This underpins a multilayered, complex view of self-realization that encompasses sacrifices as well.
When mature care is characterized as a practice of a multilayered connectedness, caregivers can be acknowledged for their relational identity and nursing practices can be recognized as multilayered and interconnected. This view is better able to capture the tensions that are related to today's nursing as a practice, which inevitably includes sacrifices of self. In conclusion, a further discussion on normative conceptualizations of care is proposed that starts with a non-normative scrutiny of caring practices.
Fourteen experienced nurses participated in an explorative study aimed at describing the experiential aspects of moral decision making in psychiatric nursing practice. In-depth interviews were conducted according to the grounded theory method. These were transcribed, coded and categorized in order to generate conceptual categories. The concept of benevolence was identified as a central motivating factor in the nurses' own accounts of situations in which decisions were made on behalf of the patient. This seems to conceptualize the nurses' expressed aim to do that which is 'good' for the patient in responding to his or her vulnerability. This study indicates the need for further research into the subjective, experiential aspect of ethical decision making from a contextual perspective.
This paper is a report of a study conducted to describe nursing and social services students' ethical reasoning at the start of their studies.
Gilligan argued that there are two modes of moral reasoning - the ethic of justice, focusing on individuals' rights, and the ethic of care, focusing on responsibilities in relationships. Recent research has established the ethic of care as a developmental phenomenon. It has been widely argued that the ethic of care is crucial for nursing, but there has been little international research in this area.
Participants were first-year nursing and social services students in Finland (N =112). Their care-based moral reasoning was measured using the Ethic of Care Interview, and their ethical reasoning on an abortion-related dilemma was analysed by content analysis. Expressed ethical codes and principles were calculated according to levels. The data were collected over a 5-month period in 2007-2008.
Students' level of care reasoning was varied. Their current level of care reasoning was reflected in their responses to the ethical dilemma. Ethical reasoning at each level and its specific premises constituted a distinct entity. Use of the principle of self-determination was positively related to levels of care development. Care-based moral reasoning constitutes the bedrock for ethical reasoning among these novice students.
Educators should be sensitive to the variation in students' current developmental levels in care reasoning. Reflective discussion on real-life ethical conflicts should be an explicit part of education and clinical practice in caring professions.
Department of Surgery, Faculty of Medicine, University of Sherbrooke and the Centre for Clinical Research, Centre hospitalier universitaire de Sherbrooke, QC. johane.patenaude@usherbrooke.ca
The requirements of professionalism and the expected qualities of medical staff, including high moral character, motivate institutions to care about the ethical development of students during their medical education. We assessed progress in moral reasoning in a cohort of medical students over the first 3 years of their education.
We invited all 92 medical students enrolled at the University of Sherbrooke, Que., to complete a questionnaire on moral reasoning at the start of their first year of medical school and at the end of their third year. We used the French version of Kohlberg's Moral Judgment Interview. Responses to the questionnaire were coded by stage of moral development, and weighted average scores were assigned according to frequency of use of each stage.
Of the 92 medical students, 54 completed the questionnaire in the fall of the first year and again at the end of their third year. The average age of the students at the end of the third year was 21 years, and 79% of the students included in the study were women. Over the 3-year period, the stage of moral development did not change substantially (i.e., by more than half a stage) for 39 (72%) of the students, shifted to a lower stage for 7 (13%) and shifted to a higher stage for 8 (15%). The overall mean change in stage was not significant (from mean 3.46 in year 1 to 3.48 in year 3, p = 0.86); however, the overall mean change in weighted average scores showed a significant decline in moral development (p = 0.028).
Temporal variations in students' scores show a levelling process of their moral reasoning. This finding prompts us to ask whether a hidden curriculum exists in the structure of medical education that inhibits rather than facilitates the development of moral reasoning.
Faculty of Medicine, University of Sherbrooke, and Centre for Clinical Research, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada. Johnae.Patenaude@USherbrooke.ca
Many authors are concerned by students' moral reasoning not developing normally during medical education.
This study is concerned with how the components of student' moral reasoning are affected by their medical studies.
Ninety-two medical students were tested on entry into first year and on finishing third year, to determine evolutionary changes in their moral reasoning. Changes in their use of arguments specific to each stage of moral development were measured.
Significant changes were observed in the weighted global score (-18.14 +/- 59.17, P = 2.8%). Changes in global score correlated with changes in stages of moral reasoning. The multivariate structure of moral reasoning was reorganised into two principal components, which, respectively, explained almost 82% (first year) and 72% (third year) of the total variability in scores. Moral reasoning stages characterized by law-and-order and social-contract/legalistic orientations proved important for explaining the variability in students' moral reasoning at the start of medical training, while instrumental-relativist and interpersonal-concordance orientations explained variability post third year.
Students restructure their handling of ethical questions by using arguments with more instrumental-relativist and interpersonal-concordance orientations, rather than those of the more desirable law-and-order or social-contract/legalistic type. To assess better the skills required for moral reasoning, a more sophisticated approach is needed than that of a simple measure of improvement/stagnation/deterioration.
The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the research team's understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills.
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.
In this short-term longitudinal study, we systematically examined the distinctiveness of guilt- and shame-proneness in early adolescents (N = 395, mean age = 11.8 years) in terms of differential relations with peer reported prosocial behavior, withdrawal, and aggression. Results from structural equation modeling indicated that guilt-proneness concurrently predicted more aggressive and less prosocial behavior as well as subsequent increases in prosocial behavior. Shame-proneness predicted subsequent decreases in prosocial behavior. Although girls reported a greater proneness to experience guilt and shame than boys, the associations between the two dispositional emotions and social behaviors were found to be similar across time and gender.
This study investigates values and affective empathy as predictors for care-based moral development. Fifty-three students from a university of applied sciences were interviewed with Skoe's Ethic of Care Interview at the beginning of their studies and two years later. Value priorities were measured by Schwartz et al.'s Portrait Value Questionnaire, empathy variables by Davis' Interpersonal Reactivity Index, and feelings of sympathy were rated using a real-life moral conflict. The results showed that students in care-oriented fields progressed in care reasoning. Real-life sympathy and the value of self-direction positively predicted development in care reasoning, whereas personal distress was a negative predictor. The results indicate that care-based moral development is more closely connected with affective empathy than personal values. Individuals who feel empathy for others, and who prefer independent thinking and action, achieve the greatest gains in care development. In conclusion, educators should encourage students' empathy and moral reasoning in authentic moral conflicts.
