Stuck in the middle: the many moral challenges with bariatric surgery

Bariatric surgery is effective on short- and medium-term weight loss, reduction of comorbidities, and overall mortality. A large and increasing portion of the population is eligible for bariatric surgery, which increases instant health care costs. A review of the literature identifies a series of ethical challenges: unjust distribution of bariatric surgery, autonomy and informed consent, classification of obesity and selecting assessment endpoints, prejudice among health professionals, intervention in people's life-world, and medicalization of appearance. Bariatric surgery is particularly interesting because it uses surgical methods to modify healthy organs, is not curative, but offers symptoms relief for a condition that it is considered to result from lack of self-control and is subject to significant prejudice. Taking the reviewed ethical issues into account is important when meeting persons eligible for bariatric surgery, as well as in the assessment of and decision making on surgery for obesity.     

Medical school oath-taking: the moral controversy

Professions typically formulate codes of ethics. Medical students are exposed to various codes and often are expected to recite some code or oath at their graduation. This article reports the findings of a study of one large medical class, asked upon entry to medical school and again at the beginning of their fourth term, which of 13 specified professional, religious, and secular codes of ethics they would turn to for moral guidance in their practice of medicine. The study finds great diversity in the students' choices and no clear pattern of change by their fourth term. Very few students chose the oath they would be asked to recite at their graduation. The article probes the problems this creates for school administrators and professors as well as students. It asks the implications for professional oath-taking at graduation and in the practice of the profession.     

Self-determination and motivation for bariatric surgery: a qualitative study

This study examined how obese individuals acquire their motivation to undergo weight loss surgery and characterized the motivations within the framework of the self-determination theory (SDT). Participants expecting to have bariatric surgery were recruited and participated in semi-structured interviews. Interview accounts characterized different types of motivation for individuals seeking surgical weight loss treatments on the SDT continuum of relative autonomy. This study demonstrated that the more one’s motivation was internally regulated, related to one’s personal life and supported for competency, the more personal and hopeful were the anecdotes participants mentioned in accounts, thus the more positive the surgical outcomes were anticipated. Study limitations and future research were discussed as was the need for a systematic scheme to categorize types of motivation within the SDT, a longitudinal approach to measure actual weight loss outcomes based on the patient’s pre-surgical motivation, and a further investigation with a larger sample size and balanced gender ratio. Practical implications of the study findings were also discussed as a novel strategy to internalize bariatric patients’ motivation, further helping to improve their long-term quality of life post-surgery.     

Hypnotic disgust makes moral judgments more severe

Highly hypnotizable participants were given a posthypnotic suggestion to feel a flash of disgust whenever they read an arbitrary word. They were then asked to rate moral transgressions described in vignettes that either did or did not include the disgust-inducing word. Two studies show that moral judgments can be made more severe by the presence of a flash of disgust. These findings suggest that moral judgments may be grounded in affectively laden moral intuitions.     

Moral migration: Desires to become more empathic predict changes in moral foundations

Many people want to change their personality traits—and research on volitional change has documented their success in doing so. In the present study, we examine whether people also wish to change their levels of empathy, and whether these desires precede shifts in dispositional empathy and morality over a 15-week period. We recorded participants’ change goals, followed by weekly measurements of empathic concern and perspective-taking, as well as moral foundations. Results indicated that most participants wished to cultivate empathic concern and, especially, perspective-taking. Those who sought to develop these qualities tended to actually do so at a faster rate than their peers who did not—and, as a consequence, also drifted toward a characteristically liberal, individualizing morality.     

Men dissociate sexual attraction from moral judgement more than women

Would you find an opposite‐sex individual physically less attractive if you knew that he/she was a bad person? Would you feel the same if you were a man or a woman? This study examined whether gender differences exist in the influence of moral judgements on heterosexual physical attraction. In a first Experiment, participants (N = 214) rated on attractiveness photographs of opposite‐sex persons. Each photograph was paired with a “good” and a “bad” (from a moral point of view) sentence to depict a quality or activity of the displayed person (i.e., she/he is a defender of human rights in an NGO vs. she/he belongs to a terrorist group). Compared with women, men were significantly less influenced by sentence valence in their attractiveness ratings. A second Experiment (N = 105) using photographs of very attractive people showed the same pattern of results. The data suggest that sexual attraction is relatively less permeable to moral factors in men, and that this sex difference is consistent with an evolutionary approach to human sexuality.     

Market mindset impacts moral decisions: The exposure to market relationships makes moral choices more utilitarian by means of proportional thinking

We show that exposure to market relationships increases people’s tendency to make utilitarian moral choices by means of proportional thinking—the definitional feature of the market mindset. In Experiment 1, participants primed with market relationships made more utilitarian choices in both the trolley and the footbridge dilemmas. In Experiment 2, priming market mindset led to more utilitarian moral choices and to greater focus on the proportion of survivors to victims. Experiment 3 showed that the effect of market mindset on utilitarian choices held only when the numbers of potential deaths and saved lives were clearly specified. A preregistered Experiment 4 demonstrated that the motivation to use proportional thinking mediates the relationship between market mindset and making utilitarian choices. Experiment 5, also preregistered, showed that the main effect we demonstrated is not due to suppressed emotions and that proportional thinking increases utilitarian choices as part of a broader orientation on rationality.     

The dual moral self: moral centrality and internal moral motivation

In this study, the relationship between two aspects of the moral self, moral centrality and internal moral motivation, was analyzed. It is argued that these 2 aspects are conceptually distinct but nonetheless empirically related. Based on a cross-sectional study of 205 adolescents (M age = 14.83 years, SD = 2.21 years) it was found that moral centrality and internal moral motivation, even though substantially correlated, interacted in predicting moral emotion expectancies. Even though moral centrality was unrelated to adolescents' age it predicted a longitudinal increase in internal moral motivation over a 1-year interval. Overall, the findings call for a differentiation of moral centrality and internal moral motivation as 2 distinct but interrelated aspects of moral self-development that follow different developmental trajectories and are differentially related to age. At the same time, the study points out that adolescence may be less important for the development of the moral self than commonly assumed.     

Age differences in moral judgment: Older adults are more deontological than younger adults

In 2 studies, an older and a younger age group morally evaluated dilemmas contrasting a deontological judgment (do not harm others) against a utilitarian judgment (do what is best for the majority). Previous research suggests that deontological moral judgments are often underpinned by affective reactions and utilitarian moral judgments by deliberative thinking. Separately, research on the psychology of aging has shown that affect plays a more prominent role in the judgments and decision making of older (vs. younger) adults. Yet age remains a largely overlooked factor in moral judgment research. Here, we therefore investigated whether older adults would make more deontological judgments on the basis of experiencing different affective reactions to moral dilemmas as compared with younger adults. Results from 2 experiments indicated that older adults made significantly more deontological moral judgments. Mediation analyses revealed that the relationship between age and making more deontological moral judgments is partly explained by older adults exhibiting significantly more negative affective reactions and having more morally idealistic beliefs as compared with younger adults.     

Subsidized abortion: moral rights and moral compromise

The right of indigent women to have government-subsidized abortions is considered in light of the opposing societal opinions on the morality of abortion. Arguments for funding abortions as another facet of health care, and the welfare rights and freedom of indigents, are discussed. A compromise between pro- and anti-abortion factions in society is suggested--the elimination of government funding for elective abortions while continuing to allow them for those who can pay.     

Medical tourism in india: perceptions of physicians in tertiary care hospitals

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy.     

Stress reactions following acute situations involving moral challenges among health care professionals

Many health care professionals have to make morally difficult decisions during acute, stressful situations. The aim was to explore the applicability of an existing qualitatively developed model of individual reactions among professional first responders following such situations using a quantitative approach. According to the model, the interaction of antecedent individual and contextual characteristics affect the immediate emotional reactions to acute, stressful events involving a moral dilemma. Continuous coping efforts and the quality of social support will also affect the long‐term positive and negative reactions to the event. The participants (n = 204, about 50% response rate) represented three Swedish health care professions stationed at a university hospital and a regional hospital: Physicians (n = 50), nurses (n = 94) and “others” (n =60, mainly social welfare officers and assistant nurses). Except for the personality dimension emotional stability which was measured using an established instrument, all measurement scales were operationalizations of codes and categories from the qualitative study (ten scales altogether). Four multiple regression analyses were performed with long‐term positive and negative reactions in everyday acute and morally extremely taxing situations respectively as dependent variables. The outcome showed that long‐term positive reactions covaried with much use of the coping strategies Emotional distancing and Constructive emotional confrontation and a perception of a well‐functioning Formal social support. Regarding long‐term negative reactions, higher age and little use of Emotional distancing accounted for much of the variance. Immediate emotional reactions also contributed significantly. Conclusion: the results largely supported the model concepts and their assumed relationships.     

The effects of moral judgment and moral identity on moral behavior: an empirical examination of the moral individual

Recognizing limitations in classic cognitive moral development theory, several scholars have drawn from theories of identity to suggest that moral behavior results from both moral judgments and moral identity. The authors conducted 2 survey-based studies with more than 500 students and managers to test this argument. Results demonstrated that moral identity and moral judgments both independently influenced moral behavior. In addition, in situations in which social consensus regarding the moral behavior was not high, moral judgments and moral identity interacted to shape moral behavior. This interaction effect indicated that those who viewed themselves as moral individuals pursued the most extreme alternatives (e.g., never cheating, regularly cheating)--a finding that affirms the motivational power of a moral identity. The authors conclude by considering the implications of this research for both theory and practice.     

Rationality and moral autonomy: An essay in moral psychology

Although there are many variations on the theme, so much is made of the good of moral autonomy that it is difficult not to suppose that there is everything to be said for being morally autonomous and nothing at all to be said for being morally nonautonomous. However, this view of moral autonomy cannot be made to square with the well-received fact that most people are morally nonautonomous — not, at any rate, unless one is prepared to maintain that most people are irrational in this respect. I am not. Thus, I reject what I take to be the prevailing view of moral autonomy. I argue that it is false that (1) moral autonomy is such that it is rational for every person to prefer being morally autonomous to being morally nonautonomous, but true that (2) moral autonomy is such that if anyone is morally autonomous, then it is rational for him to prefer being morally autonomous to being morally nonautonomous.