A study of the foundations of ethical decision-making of nurses

A study of nurses and nursing students was conducted to determine the various philosophical positions they hold with respect to ethical decision-making in nursing and their relationship to the subjective-objective controversy in value theory. The study revealed that most nurses and nursing students tend to be subjectivists in value theory, i.e., believe that value judgments are purely personal, private expressions of one's own opinion or inner-feelings and not believe that value judgments are knowledge claims capable of being true or false and therefore not expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most nurses and nursing students are inconsistent in the philosophical foundations of their ethical decision-making, i.e., in decision-making regarding values they tend to hold beliefs which are incompatible with other beliefs they hold about values.     

Ethics Beyond Moral Theory

I develop an anti‐theory view of ethics. Moral theory (Kantian, utilitarian, virtue ethical, etc.) is the dominant approach to ethics among academic philosophers. But moral theory's hunt for a single Master Factor (utility, universalisability, virtue . . .) is implausibly systematising and reductionist. Perhaps scientism drives the approach? But good science always insists on respect for the data, even messy data: I criticise Singer's remarks on infanticide as a clear instance of moral theory failing to respect the data of moral perceptions and moral intuitions. Moral theory also fails to provide a coherent basis for real‐world motivation, justification, explanation, and prediction of good and bad, right and wrong. Consider for instance the marginal place of love in moral theory, compared with its central place in people's actual ethical outlooks and decision making. Hence, moral theory typically fails to ground any adequate ethical outlook. I propose that it is the notion of an ethical outlook that philosophical ethicists should pursue, not the unfruitful and distorting notion of a moral theory.     

Institutional culture and individual behavior: Creating an ethical environment

Much of the work in professional ethics sees ethical problems as resulting from ethical ignorance, ethical failure or evil intent. While this approach gets at real and valid concerns, it does not capture the whole story because it does not take into account the underlying professional or institutional culture in which moral decision making is imbedded. My argument in this paper is that this culture plays a powerful and sometimes determinant role in establishing the nature of the ethical debate; i.e., it helps to define what are viable action options, what is the organization’s genuine mission, and what behaviors will be rewarded or criticized. Given these conclusions, I also argue that consulting ethicists need more than an understanding of ethics theory, concepts and principles; they also need a sufficiently rich understanding of organizational culture and a willingness and an ability to critique that culture. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

Medical ethics' appropriation of moral philosophy: the case of the sympathetic and the unsympathetic physician

Philosophy textbooks typically treat bioethics as a form of "applied ethics"-i.e., an attempt to apply a moral theory, like utilitarianism, to controversial ethical issues in biology and medicine. Historians, however, can find virtually no cases in which applied philosophical moral theory influenced ethical practice in biology or medicine. In light of the absence of historical evidence, the authors of this paper advance an alternative model of the historical relationship between philosophical ethics and medical ethics, the appropriation model. They offer two historical case studies to illustrate the ways in which physicians have "appropriated" concepts and theory fragments from philosophers, and demonstrate how appropriated moral philosophy profoundly influenced the way medical morality was conceived and practiced.     

Contributions of empirical research to medical ethics

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine.     

Critical Theory as an Approach to the Ethics of Information Security

Information security can be of high moral value. It can equally be used for immoral purposes and have undesirable consequences. In this paper we suggest that critical theory can facilitate a better understanding of possible ethical issues and can provide support when finding ways of addressing them. The paper argues that critical theory has intrinsic links to ethics and that it is possible to identify concepts frequently used in critical theory to pinpoint ethical concerns. Using the example of UK electronic medical records the paper demonstrates that a critical lens can highlight issues that traditional ethical theories tend to overlook. These are often linked to collective issues such as social and organisational structures, which philosophical ethics with its typical focus on the individual does not tend to emphasise. The paper suggests that this insight can help in developing ways of researching and innovating responsibly in the area of information security.     

Consumer recycling: An ethical decision‐making process

Although recycling is often experienced as a moral dilemma, studies that systematically approach this issue from an ethical perspective are scarce. Moreover, previous studies have explored recycling by mainly using single ethical constructs, such as moral norms, values or obligations, rarely approaching it as an ethical decision‐making process. Our study takes a more holistic approach and integrates the recycling literature with business ethics theory in order to develop a conceptual model of ethical decision making involved in recycling. The model is based on Jones' issue‐contingent model and its key concept, that is, moral intensity, which we extend by adding altruism as an important personality trait that influences pro‐social behaviour. The data were collected from a sample of 367 adult consumers, representative of the Slovenian population by gender and age. The hypotheses were tested using structural equation modelling. The results of our study confirmed the relationships between three key facets of ethical decision making: moral recognition, moral judgment and moral intention. Higher levels of moral recognition were found to lead to more positive moral judgments, which in turn positively influenced the formation of intentions to recycle. Moreover, moral intensity was found to be a significant predictor of moral recognition and moral judgment, while altruism was found to be a significant predictor of moral recognition. These findings hold important implications for public policy makers and social marketers who have to consider not only the consumer characteristics but also the issue characteristics in seeking to understand and influence consumer recycling. Copyright © 2013 John Wiley & Sons, Ltd.     

Can applied ethics be effective in health care and should it strive to be?

Drawing upon his work in medical centers, Caplan explores the question of how well ethicists function in hospitals. He asks if their use of the "engineering model" of applied ethics, which emphasizes conceptual clarification, mastery of ethical theory, and impartiality, has made any difference in the way medicine is practiced. Noting that ethicists have been more effective in influencing heatlh policy at the national than at the institutional level, Caplan concludes that they have been less successful in teaching medical ethics, working with health personnel, and helping to formulate hospital policies. He attributes their difficulties primarily to the inadequacies of the engineering model of applied ethics for solving problems in a clinical setting. Caplan cautions ethicists to be aware both of the limitations of the engineering model and of the motives of health personnel in asking for help which may have little to do with resolving moral dilemmas.     

Ethik des methodologischen Humanismus: Kritische Bemerkungen zur Relativit?t von Normen und zum Pluralismus von Systemen der Moral

According to the author, moral systems deal with our unconditional ultimate values. An ethical theory fixes the rules which allow us to distinguish good grounds and valid arguments in moral matters. The general attitude is decidedly antinaturalistic. Since value statements do not describe (perceptible) states of affairs they cannot have a truth value. Being ultimate, moral values give rise to commands which have to be obeyed most urgently, i.e., before any requirements of pudence.The author proposes his own hierarchy of values which is supposed to correspond to the convictions of most normal people. The justification of a norm can only be given internally, i.e., relative to the accepted system of values. To the external question concerning the system as a whole there can be no absolute answer. Moral systems must influence the real human communicites; with respect to concrete situations within which an individual will have to take decisions a so-called system of defeasible deontic logic will be needed. The general conception is close to ``Pflichtethik' resting on the principle ``noblesse oblige'.     

The Moral Metacognition Scale: Development and Validation

Scholars have advocated for the inclusion of metacognition (i.e., the extent to which one thinks about one’s thinking) in our understanding of the ethical decision making process and in support of moral learning. An instrument to measure metacognition as a domain-specific capacity related to ethical decision making (i.e. moral metacognition) is not found in the current literature. This research describes the development and validation of the 20-item Moral Metacognition Scale (MMS). Psychometric properties of the scale were assessed by exploration (Study 1) and confirmation (Study 2) of the factor structure, and the demonstration of convergent (Studies 3 and 4), discriminant (Studies 3 and 4), and predictive (Study 4) validity. Moral metacognition, as measured by the MMS, was significantly correlated with ethical awareness and ethical judgment. Limitations of our research, suggestions for future exploration, and practical implications are discussed.     

Should We Be Talking About Ethics or About Morals?

This article seeks to revisit the distinction between the words ethics and morals. First, we understand the word ethics to be focused on the way we seek to live our own life, and hence to connote a relativistic and essentially subjective perspective, whereas we understand the word morals to be focused on the way we should live our lives together, especially through sensitivity to viewpoints other than our own. Second, we perceive a usefulness in such a differentiation when the ethical values of those in a dilemmatic situation are conflicted in order to prioritize moral decision making in contemporary society. We argue that in our current era, characterized by a multiplicity of faiths and by pronounced value pluralism, a philosophical basis for moral decision making needs to be clearly attuned with intersubjectivity and interconnectivity among people. It should be able to determine principles of conduct toward others, no matter how one’s own ethical values, conceptions of the good, or life choices might differ from those of others. To do this, we relocate ethical decision making away from an essentially monological reflection on our own values and purposes into a social space wherein we have an inclusive, noncoercive, and reflective dialogue.     

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.     

Intuition and The Junctures of Judgment in Decision Procedures for Clinical Ethics

Moral decision procedures such as principlism or casuistry require intuition at certain junctures, as when a principle seems indeterminate, or principles conflict, or we wonder which paradigm case is most relevantly similar to the instant case. However, intuitions are widely thought to lack epistemic justification, and many ethicists urge that such decision procedures dispense with intuition in favor of forms of reasoning that provide discursive justification. I argue that discursive justification does not eliminate or minimize the need for intuition, or constrain our intuitions. However, this is not a problem, for intuitions can be justified in easy or obvious cases, and decision procedures should be understood as heuristic devices for reaching judgments about harder cases that approximate the justified intuitions we would have about cases under ideal conditions, where hard cases become easy. Similarly, the forms of reasoning which provide discursive justification help decision procedures perform this heuristic function not by avoiding intuition, but by making such heuristics more accurate. Nonetheless, it is possible to demand too much justification; many clinical ethicists lack the time and philosophical training to reach the more elaborate levels of discursive justification. We should keep moral decision procedures simple and user-friendly so that they will provide what justification can be achieved under clinical conditions, rather than trying to maximize our epistemic justification out of an overstated concern about intuition.     

Rethinking Moral Agency in Markets: A Book Discussion on Behavioral Economics

Recent work in behavioral economics and psychology provides valuable resources for religious ethicists. This book discussion examines contributions by Cass Sunstein, Daniel Kahneman, George Akerlof and Rachel Kranton, Uri Gneezy and John A. List, and Douglas Hough. This literature raises important questions about ethical decision‐making, moral agency and responsibility, and the ethics of life in global capitalism. It also opens up promising areas for interdisciplinary dialogue between economics and religious studies. This book discussion concludes that religious ethicists have much to contribute to the conversations about moral anthropology that are now being held in behavioral economic research, and to the broader political economic debates in which this research participates.     

道德推脱对员工道德决策的影响：德行领导的调节作用

运用问卷调查的方法,以819名员工为研究被试,探讨了德行领导在道德推脱影响道德决策过程中的调节作用。采用层次回归分析的方法研究发现：德行领导对道德推脱与道德识别、道德判断之间的关系具有调节作用;但德行领导不会对道德推脱与道德意图之间的关系产生调节作用,而会对道德意图产生显著的直接影响。     

Moral property eliminativism

This paper argues that there is significant motivation for contemporary ethicists to affirm a view I call “moral property eliminativism.” On this eliminativist view, there are no moral properties, but there are moral truths that are made true by only nonmoral entities. Moral property eliminativism parallels eliminativist views defended in other domains of philosophical inquiry, but has gone nearly entirely overlooked by contemporary ethicists. I argue that moral property eliminativism is motivated by the claim that there cannot be differences in moral truths without differences in nonmoral ontology—a claim widely endorsed by contemporary ethicists. Engaging with a variety of ways whereby one might resist the motivation I cite for moral property eliminativism, I argue that alternative contemporary metaethical views tend to purchase moral properties at the price of unnecessary theoretical complexity.     

Individual differences in causal learning and decision making

In judgment and decision making tasks, people tend to neglect the overall frequency of base-rates when they estimate the probability of an event; this is known as the base-rate fallacy. In causal learning, despite people's accuracy at judging causal strength according to one or other normative model (i.e., Power PC, DeltaP), they tend to misperceive base-rate information (e.g., the cause density effect). The present study investigates the relationship between causal learning and decision making by asking whether people weight base-rate information in the same way when estimating causal strength and when making judgments or inferences about the likelihood of an event. The results suggest that people differ according to the weight they place on base-rate information, but the way individuals do this is consistent across causal and decision making tasks. We interpret the results as reflecting a tendency to differentially weight base-rate information which generalizes to a variety of tasks. Additionally, this study provides evidence that causal learning and decision making share some component processes.     

Ethical Problems in Planning for and Responses to Pandemic Influenza in Ghana and Malawi

Ethical problems are addressed in various ways within countries in planning for and response to pandemic influenza. Here we report on a qualitative study, in which 46 policymakers in Malawi and Ghana were interviewed on how they identified and resolved ethical problems. The study results revealed that ethical problems involving conflicts of values and choices were raised in reference to the extent and role of resources (inequities) and nature of public health interventions (intrusive measures), including the extent and processes of decision making, reasoning, and justification. There is a need for an ethical framework within pandemic preparedness plans to resolve and avert these problems.     

Self-Evaluation Bias of Social Comparisons in Ethical Decision Making: The Impact of Accountability

The purpose of this paper is to examine how accountability and judgment biases that occur in social comparisons may be related to ethical decision making. Using Jones' (1991 ) model as the theoretical framework to investigate this phenomenon, we found that self-enhancing individuals (i.e., those who thought they were more ethical in comparison to their peers) demonstrated higher responsiveness to increases in accountability than did self-effacing individuals (i.e., those who thought they were less ethical in comparison to their peers). We discuss these findings and outline the implications for future ethics research. Further, we provide practical guidance to those who administer ethics compliance programs on effective ways of facilitating ethical behavior in organizations.