Contextualizing clinical research: the epistemological role of clinical equipoise

Since its introduction in 1987, Benjamin Freedman’s principle of clinical equipoise has enjoyed widespread uptake in bioethics discourse. Recent years, however, have witnessed a growing consensus that the principle is fundamentally flawed. One of the most vocal critics has undoubtedly been Franklin Miller. In a 2008 paper, Steven Joffe and Miller build on this critical work, offering a new conception of clinical research ethics based on science, taking what they call a “scientific orientation” toward the ethics of clinical research. Though there is much to recommend Joffe and Miller’s scientifically oriented conception of clinical research ethics, I believe that both the critical and constructive projects suffer from the same basic mistake: inattention to context. The internal norms of science cannot be fully specified, let alone satisfied, independently of contextual (external) factors that only come into view when we are attentive to the particular context of that form of inquiry.     

The religious and moral foundations of pastoral counseling

This paper explores the significant issues related to the articulation of distinctions between pastoral counseling and the secular psychotherapies. The argument is made that pastoral counseling can be distinguished from the secular psychotherapies because the former is grounded in the moral vision of the religious traditions as well as the growing body of clinical knowledge the secular psychotherapies have made available to the culture. A dialectical model of moral inquiry is then presented as the most adequate for the pastoral counseling enterprise to carry out its inescapable moral task.He is a Candidate-in-Training at the C.G. Jung Institute in New York City.     

The role of moral commitments in moral judgment

Traditional approaches to moral psychology assumed that moral judgments resulted from the application of explicit commitments, such as those embodied in consequentialist or deontological philosophies. In contrast, recent work suggests that moral judgments often result from unconscious or emotional processes, with explicit commitments generated post hoc. This paper explores the intermediate position that moral commitments mediate moral judgments, but not through their explicit and consistent application in the course of judgment. An experiment with 336 participants finds that individuals vary in the extent to which their moral commitments are consequentialist or deontological, and that this variation is systematically but imperfectly related to the moral judgments elicited by trolley car problems. Consequentialist participants find action in trolley car scenarios more permissible than do deontologists, and only consequentialists moderate their judgments when scenarios that typically elicit different intuitions are presented side by side. The findings emphasize the need for a theory of moral reasoning that can accommodate both the associations and dissociations between moral commitments and moral judgments.     

The role of examples in moral philosophy

Contemporary moral philosophy for the most part relegates examples to a negative role, as counter-examples. In this essay a view is articulated according to which the example has a much more positive and more fundamental role to play in the argumentation of moral philosophy: according to this view, examples may provide grounding for general moral principles. Some of the philosophical implications or presuppositions of such a view of examples are examined.     

The lover of the beautiful and the good: Platonic foundations of aesthetic and moral value

Though acknowledged by scholars, Plato’s identification of the Beautiful and the Good has generated little interest, even in aesthetics where the moral concepts are a current topic. The view is suspect because, e.g., it is easy to find examples of ugly saints and beautiful sinners. In this paper the thesis is defended using ideas from Plato’s ancient commentators, the Neoplatonists. Most interesting is Proclus, who applied to value theory a battery of linguistic tools with fixed semantic properties—comparative adjectives, associated gradable adjectives, mass nouns, and predicate negations—all with a semantics that demand a privative scale of value. It is shown how it is perfectly possible to interpret value terms Platonically over privative Boolean algebras so that beautifuland good diverge while at higher levels other value terms are coextensional. Considerations are offered that this structure conforms to actual usage.     

The role of moral identity in the aftermath of dishonesty

People lie on a regular basis. However, lying can pose a threat to the self-view of being an honest and moral person. How do people respond to their previous dishonest acts? A way to deal with psychological discomfort arisen for previous lying is reconfirming oneself to be an honest and moral person, for example, by showing subsequent moral behavior. We hypothesize that people engage in this reconfirmation depending on whether their moral identity is central to their self-concept. This was supported in three studies in which, compared to low moral identifiers, high moral identifiers engaged in more efforts to uphold a moral self-image and were more likely to show a compensatory reaction rather than a consistency reaction to their previous dishonesty. Implications for the topics of moral self-regulation and compensatory ethics and for the concept of moral identity are discussed.     

The role of public exposure in moral and nonmoral shame and guilt

Although scholarly traditions assume that shame results more from the public exposure of a transgression or incompetence than guilt does, this distinction has little empirical support. Four studies, using either undergraduate participants' responses to hypothetical scenarios, their remembered experiences, or the coding of literary passages, reexamined this issue. Supporting traditional claims, public exposure of both moral (transgressions) and nonmoral (incompetence) experiences was associated more with shame than with guilt. Shame was also more strongly linked with nonmoral experiences of inferiority, suggesting 2 core features of shame: its links with public exposure and with negative self-evaluation. The distinctive features of guilt included remorse, self-blame, and the private feelings associated with a troubled conscience.     

Behavioral equipoise: a way to resolve ethical stalemates in clinical research

Randomized trials depend on clinicians feeling that they are morally justified in allowing their patients to be randomized across treatment arms. Typically such justification rides on what has been called "clinical equipoise"--when there is disagreement of opinion among the community of experts about whether one treatment is better than another, then physicians can ethically enter their patients into a clinical trial, even if individual physicians are not at equipoise. Recent debates over prominent studies, however, illustrate that controversy can be easily created rather than dispelled by trials, with many clinicians choosing not to use the proven therapy until they receive more convincing evidence of its superiority. In such situations, we propose that a new standard of equipoise be used to guide decisions about the ethical justifications for research trials--a standard of behavioral equipoise. Under behavioral equipoise, a trial is potentially justifiable if it addresses behavioral resistance to prior scientific evidence.     

The role of emotions for moral judgments depends on the type of emotion and moral scenario

Emotions seem to play a critical role in moral judgment. However, the way in which emotions exert their influence on moral judgments is still poorly understood. This study proposes a novel theoretical approach suggesting that emotions influence moral judgments based on their motivational dimension. We tested the effects of two types of induced emotions with equal valence but with different motivational implications (anger and disgust), and four types of moral scenarios (disgust-related, impersonal, personal, and beliefs) on moral judgments. We hypothesized and found that approach motivation associated with anger would make moral judgments more permissible, while disgust, associated with withdrawal motivation, would make them less permissible. Moreover, these effects varied as a function of the type of scenario: the induced emotions only affected moral judgments concerning impersonal and personal scenarios, while we observed no effects for the other scenarios. These findings suggest that emotions can play an important role in moral judgment, but that their specific effects depend upon the type of emotion induced. Furthermore, induced emotion effects were more prevalent for moral decisions in personal and impersonal scenarios, possibly because these require the performance of an action rather than making an abstract judgment. We conclude that the effects of induced emotions on moral judgments can be predicted by taking their motivational dimension into account. This finding has important implications for moral psychology, as it points toward a previously overlooked mechanism linking emotions to moral judgments.     

The role of emotion expectancies in adolescents' moral decision making

This study investigated the impact of emotion expectancies on adolescents’ moral decision making in hypothetical situations. The sample consisted of 160 participants from three different grade levels (mean age = 15.79 years, SD = 2.96). Participants were confronted with a set of scenarios that described various emotional outcomes of (im)moral actions and needed to decide what they would do if they were in the protagonist’s shoes. Findings demonstrate that emotion expectancies differentially influenced adolescents’ hypothetical decision making in antisocial versus prosocial behavioral contexts. Whereas negatively charged self-evaluative emotions over failing to act morally (e.g., guilt) were the strongest predictor for moral choice in antisocial behavioral contexts, positively charged self-evaluative emotions over acting morally (e.g., pride) most strongly predicted moral choice in prosocial contexts. Older adolescents paid greater attention to outcome-oriented emotions that make the decision to act morally less attractive (e.g., regret). Overall, the study suggests that emotion expectancies influence moral decision making in unique and meaningful ways.     

Sex role orientation and its relationship to the development of identity and moral thought

This paper examined the links among sex role orientation, ego identity development and moral reasoning. 76 female and 58 male students were assessed on Bern's sex role inventory, ego identity, care-based and justice-based moral thought. For women, identity was negatively related to femininity and positively related to androgyny. Also, high levels of care-based moral reasoning, i.e., a balanced concern for the welfare of self and others, was related to androgyny for women. There were no significant findings for men. No significant relationships were found between sex role orientation and justice-based moral reasoning. Thus, the results suggested that for women in particular, relinquishing the stereotyped sex role definition and becoming more androgynous is important for their ego identity as well as care-based moral development.