Empathic concern drives costly altruism

Why do we self-sacrifice to help others in distress? Two competing theories have emerged, one suggesting that prosocial behavior is primarily motivated by feelings of empathic other-oriented concern, the other that we help mainly because we are egoistically focused on reducing our own discomfort. Here we explore the relationship between costly altruism and these two sub-processes of empathy, specifically drawing on the caregiving model to test the theory that trait empathic concern (e.g. general tendency to have sympathy for another) and trait personal distress (e.g. predisposition to experiencing aversive arousal states) may differentially drive altruistic behavior. We find that trait empathic concern – and not trait personal distress – motivates costly altruism, and this relationship is supported by activity in the ventral tegmental area, caudate and subgenual anterior cingulate, key regions for promoting social attachment and caregiving. Together, this data helps identify the behavioral and neural mechanisms motivating costly altruism, while demonstrating that individual differences in empathic concern-related brain responses can predict real prosocial choice.

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Trait empathic concern predicts altruistic action.

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State distress, but not trait distress, predicts altruistic action.

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A network comprised of VTA, caudate and sgACC support other-oriented prosocial decisions.

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Neural evidence supporting caregiving model: social reward and attachment guides altruism.

Neural processing of moral violations among incarcerated adolescents with psychopathic traits

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We examine brain responses during moral judgment in youth with psychopathic traits.

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Conduct disorder symptoms negatively predicted anterior temporal responses.

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Callous–unemotional traits negatively predicted amygdala-moral rating associations.

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Brain dysfunction patterns during moral judgment vary by psychopathic trait type.

Neuroimaging studies have found that adult male psychopaths show reduced engagement of limbic and paralimbic circuitry while making moral judgments. The goal of this study was to investigate whether these findings extend to adolescent males with psychopathic traits. Functional MRI was used to record hemodynamic activity in 111 incarcerated male adolescents while they viewed unpleasant pictures that did or did not depict moral transgressions and rated each on “moral violation severity”. Adolescents were assessed for psychopathic traits using the Psychopathy Checklist-Youth Version (PCL-YV), Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (KSADS-PL) Conduct Disorder supplement, and Inventory of Callous and Unemotional Traits-Youth Version (ICU-Y). While viewing pictures depicting moral transgressions, CD scores were negatively correlated with hemodynamic responses in the anterior temporal cortex. Adolescents scoring low on the ICU-Y showed a positive correlation between right amygdala responses and severity of violation ratings; those with high ICU-Y scores showed a negative correlation. While viewing unpleasant pictures with and without moral transgressions, PCL-YV scores were negatively correlated with hemodynamic responses in the left amygdala. Overall, the results are consistent with those previously found in adult male psychopaths, but vary depending on the type of psychopathy assessment.

Moral rigidity in obsessive-compulsive disorder: do abnormalities in inhibitory control, cognitive flexibility and disgust play a role?

BACKGROUND AND OBJECTIVES

Abnormalities in cognitive control and disgust responding are well-documented in obsessive-compulsive disorder (OCD), and also interfere with flexible, outcome-driven utilitarian moral reasoning. The current study examined whether individuals with OCD differ from healthy and anxious individuals in their use of utilitarian moral reasoning, and whether abnormalities in inhibitory control, cognitive flexibility and disgust contribute to moral rigidity.

METHODS

Individuals with OCD (n = 23), non-OCD anxiety (n = 21) and healthy participants (n = 24) gave forced-choice responses to three types of moral dilemmas: benign, impersonal, personal. Scores on measures of cognitive flexibility, inhibitory control and trait disgust were also examined.

RESULTS

Individuals with OCD gave fewer utilitarian responses to impersonal moral dilemmas compared to healthy, but not anxious, individuals. Poorer cognitive flexibility was associated with fewer utilitarian responses to impersonal dilemmas in the OCD group. Furthermore, greater trait disgust was associated with increased utilitarian responding to personal dilemmas in the OCD group, but decreased utilitarian responding to impersonal dilemmas in the anxious group.

LIMITATIONS

Although we did not find an association between inhibitory control and moral reasoning, smaller associations may be evident in a larger sample.

CONCLUSION

These data indicate that individuals with OCD use more rigid moral reasoning in response to impersonal moral dilemmas compared to healthy individuals, and that this may be associated with reduced cognitive flexibility. Furthermore, these data suggest that trait disgust may exert opposing effects on moral reasoning in individuals with OCD compared to those with other forms of anxiety.

Bullying Perpetration, Moral Disengagement and Need for Popularity: Examining Reciprocal Associations in Adolescence

Precursors and consequences of bullying have been widely explored, but much remains unclear about the association of moral and motivational factors. This study examined longitudinal associations between need for popularity, moral disengagement, and bullying perpetration. A total of 3017 participants, aged 11 to 16 years in wave 1 (49% girls; M_age = 13.15, SD = 1.09), were surveyed across four waves with six-month intervals. At the between-person level, cross-lagged modeling revealed a positive bidirectional association between moral disengagement and need for popularity; bullying perpetration was predicted by both need for popularity and moral disengagement. From the within-person level, random intercept cross-lagged analyses revealed that need for popularity predicted both moral disengagement and bullying perpetration. The results highlight the interplay between motivational and moral mechanisms that underlies bullying behavior.

Relationship of Moral Sensitivity and Distress Among Physicians

BACKGROUND

Providing health services is described as an important moral measure, since its major aim is to ensure the welfare of the people who need treatment and care. Moral sensitivity is the ability to identify the existing moral problem and understand the moral consequences of the decisions made on the patient's part. Physicians are always exposed to moral distress due to various circumstances.

OBJECTIVES

In this survey, we evaluated moral sensitivity and moral distress among physicians and the relationship of these ethical factors on them. Hence, we assessed y relationship between moral sensitivity and moral distress in physicians will facilitate their sound management so as to provide high-quality and safe health services. Moreover it will confirm proposed theories regarding this subject.

MATERIALS AND METHODS

This cross-sectional descriptive-analytic study aimed at investigating the relationship between moral sensitivity and moral distress among 321 specialist physicians working in hospitals affiliated to Tehran Medical Universities in Tehran. The samples were selected through two-stage random cluster sampling method. A three-partite questionnaire comprising of demographic characteristics, moral distress, and moral sensitivity was used for collecting data which then were analyzed using SPSS-20.

RESULTS

There was a negative significant relationship between moral sensitivity and moral distress frequency; there was a positive significant relationship between moral sensitivity and moral distress intensity. Participating in medical ethics courses increased moral sensitivity and decreased the frequency of moral distress.

CONCLUSIONS

Participating in medical ethics courses increased moral sensitivity and decreased the frequency of moral distress.

Distinct neuronal patterns of positive and negative moral processing in psychopathy

Psychopathy is a disorder characterized by severe and frequent moral violations in multiple domains of life. Numerous studies have shown psychopathy-related limbic brain abnormalities during moral processing; however, these studies only examined negatively valenced moral stimuli. Here, we aimed to replicate prior psychopathy research on negative moral judgments and to extend this work by examining psychopathy-related abnormalities in the processing of controversial moral stimuli and positive moral processing. Incarcerated adult males (N = 245) completed a functional magnetic resonance imaging protocol on a mobile imaging system stationed at the prison. Psychopathy was assessed using the Hare Psychopathy Checklist-Revised (PCL-R). Participants were then shown words describing three types of moral stimuli: wrong (e.g., stealing), not wrong (e.g., charity), and controversial (e.g., euthanasia). Participants rated each stimulus as either wrong or not wrong. PCL-R total scores were correlated with not wrong behavioral responses to wrong moral stimuli, and were inversely related to hemodynamic activity in the anterior cingulate cortex in the contrast of wrong > not wrong. In the controversial > noncontroversial comparison, psychopathy was inversely associated with activity in the temporal parietal junction and dorsolateral prefrontal cortex. These results indicate that psychopathy-related abnormalities are observed during the processing of complex, negative, and positive moral stimuli.

The extent and nature of stress of conscience among healthcare workers: A scoping review

BACKGROUND

Healthcare workers experience morally stressful situations during delivery of care which may trouble their conscience. Literature emerging in the context of global pandemics suggest increased frequency of morally stressful situations in healthcare and a link with negative outcomes such as attrition and burnout. Little is known about the emerging concept of stress of conscience which could provide a meaningful way to highlight and address these morally stressful situations in healthcare.

AIM

The aim of this scoping review was to provide an overview of the literature on, (i) the extent, (ii) the factors associated, and (iii) the interventions to prevent or mitigate stress of conscience among healthcare workers.

DESIGN

The study was guided by the framework provided by Arksey and O'Malley in 2005 and the PRISMA Guidelines. Relevant healthcare databases were searched in November 2020 to identify relevant studies.

RESULTS

The search identified 24 studies for inclusion in the analysis, 19 of these were from Nordic countries, particularly Sweden. Across those studies, stress of conscience was prevalent among healthcare workers and the levels varied with demographic factors, individual personalities, perceptions of belonging and the workplace culture and environment. Stress of conscience was associated with negative outcomes such as burnout, moral burden, workplace stress, and low quality of care. Although there were few quality interventions studies, facilitating healthcare workers to provide person-centred care appears to be a promising intervention.

CONCLUSIONS

The concept of stress of conscience provides a contemporary framework to assess, highlight and discuss the degree of the negative impact of perceived violations of professional and personal values in healthcare. However, the limited studies suggest that exploring stress of conscience, including trials of potential interventions, particularly beyond Nordic countries is essential to fill the gaps in the literature.

Dealing with the other between the ethical and the moral: albinism on the African continent

Albinism is a global public health issue but it assumes a peculiar nature in the African continent due, in part, to the social stigma faced by persons with albinism (PWAs) in Africa. I argue that there are two essential reasons for this precarious situation. First, in the African consciousness, albinism is an alterity or otherness. The PWA in Africa is not merely a physical other but also an ontological other in the African community of beings, which provides a hermeneutic for the stigmatising separateness or difference of the PWA. The second reason hinges on a distinction drawn by Jürgen Habermas between the ethical point of view and the moral point of view. While the former consists of the ethos, customs, or idea of the good shared by a group of persons with a shared tradition or way of life, the latter consists of what is good for all and transcends particular traditions or ways of life. Consequently, the African ethical point of view, the ethics of solidarity, justifies within the African worldview the established alterity and, by implication, stigmatization of PWAs. On this view, actions that promote harmony and prevent discord and disequilibrium among accepted beings in the African community are permissible. I further show that unless there is a change in the physical and ontological conception of PWAs and a leap from the ethical point of view to the moral point of view, the negative attitudes toward PWAs will not change. The leap to the moral point of view does not suggest an abandonment of the ethical point of view but only recommends that the two meet halfway in respect for universally accepted norms of human actions. To achieve this, I will show that much needs to be done in the areas of policy formulation, law, health care services, and education.

Exploring moral distress in Australian midwifery practice

PROBLEM

Australian midwives are considering leaving the profession. Moral distress may be a contributing factor, yet there is limited research regarding the influence of moral distress on midwifery practice.

BACKGROUND

Moral distress was first used to describe the psychological harm incurred following actions or inactions that oppose an individuals' moral values. Current research concerning moral distress in midwifery is varied and often focuses only on one aspect of practice.

AIM

To explore Australian midwives experience and consequences of moral distress.

METHODS

Semi-structured interviews were used to understand the experiences of moral distress of 14 Australian midwives. Interviews were recorded and transcribed verbatim. Data were analysed using thematic analysis and NVIVO12©.

FINDINGS

Three key themes were identified: experiencing moral compromise; experiencing moral constraints, dilemmas and uncertainties; and professional and personal consequences. Describing hierarchical and oppressive health services, midwives indicated they were unable to adequately advocate for themselves, their profession, and the women in their care.

DISCUSSION

It is evident that some midwives experience significant and often ongoing moral compromise as a catalyst to moral distress. A difference in outcomes between early career midwives and those with more than five years experiences suggests the cumulative nature of moral distress is a significant concern. A possible trajectory across moral frustration, moral distress, and moral injury with repeated exposure to morally compromising situations could explain this finding.

CONCLUSION

This study affirms the presence of moral distress in Australian midwives and identified the cumulative effect of moral compromise on the degree of moral distress experienced.

Choosing which COVID-19 patient to save? The ethical triage and rationing dilemma

Killing someone directly is never morally right, but sometimes, choosing someone to save and leaving another to die is. The moral philosophy, law, and medical ethics have all wrestled with the problem of distinguishing between saving someone and leaving another to die. While this distinction might seem intuitively straightforward, it becomes far more complex when applied in treating patients of novel Coronavirus Disease pandemic (COVID-19). The World Health Organization reports more than eight million and half cases of infection and more than 450,000 deaths, 26% in USA. However, with the exponential rise in number of COVID-19 victims and the shortage of life-saving ventilators, the pandemic has imposed to health professionals an ethical medical triage decision-making based on the utilitarian theory to maximize total benefits and life expectancy. Moreover, the decision to put restrictions on treatment beneficence is not discretionary, but an indispensable response to the overwhelming impacts of COVID-19 pandemic. The main concern is not whether to underline priorities, but how to do so systematically and ethically, instead of building decisions on individualized institutional aspirations or health professionals' intuition. The serious glaring disequilibrium, in healthcare market, between supply and demand for scarce medical resources in several developed nations (including the USA, UK, France, Italy, Spain, etc.) imposes a fundamental question: which COVID-19 patient to save when facing scarce resources?

Institutional Guidance of Affective Bonding: Moral Values Development in Brazilian Military Education

In this article, our aim is to analyze institutional practices guided to promote the development of moral values within the context of military education of Brazilian Army combatant commissioned officers. From a cultural psychological approach, we discuss how social guidance within military culture operates at different levels of the affective-semiotic regulation of individuals, structuring complex experiences that give rise to hypergeneralized meaning fields regarding morality and military values. For this goal, we first introduce some theoretical topics related to values development, emphasizing their affective roots and role in the emergence, maintenance, amplification and attenuation of all relations between the person and the environment. Following a brief discussion on how social institutions try to promote changes in personal values, we provide an overview of values present in the military culture and socialization. Finally, the text focuses on the education of Brazilian Army combatant commissioned officers, describing how practices related to different levels of affective-semiotic experience combine in order to promote the internalization and externalization of specific moral values. We conclude suggesting issues for future investigation.

Intuitive Moral Reasoning in High-Functioning Autism Spectrum Disorder: A Matter of Social Schemas?

Using a schema-theoretical perspective in the field of moral cognition, we assessed response behavior of adolescent (n = 15) and adult (n = 22) individuals with Autism Spectrum Disorder (ASD) in comparison with adolescent (n = 22) and adult (n = 22) neurotypically developed controls. We conceptualized the Intuitive Moral Reasoning Test-in five moral dilemmas, participants had to choose between two alternative actions and assess their decision with respect to emotional valence, arousal, moral acceptability and permissibility from both the perspective of the acting person and then of the victim. Patients with ASD displayed a different decision and response behavior, particularly when the dilemmas were based on extreme life situations in combination with a social schema involving close social relationships.

A feminist phenomenology on the emotional labor and morality of live-in migrant care workers caring for older people in the community

Background

Global societal changes, such as increasing longevity and a shortage of family caregivers, have given rise to a popular worldwide trend of employing live-in migrant care workers (MCWs) to provide homecare for older people. However, the emotional labor and morality inherent in their interactions with older people are largely unknown. The aim of the present study is to understand the corporeal experiences of live-in migrant care workers in the delivery of emotional labor as seen in their interactions with older people by: (1) describing the ways by which they manage emotional displays with older people; and (2) exploring their morality as enacted through emotional labor.

Methods

We performed a secondary analysis drawing on feminist phenomenology to thematically analyze data from interviews with 11 female MCWs. Follow-up interviews were conducted with 10 participants. The participants had two to 15 years of experience in caring for older people in their homes in Hong Kong.

Results

Performing emotional labor by suppressing and inducing emotions is morally demanding for live-in MCWs, who experience socio-culturally oppressive relationships. However, developing genuine emotions in their relationships with older people prompted the MCWs to protect the interests of older people. Through demonstrating both fake and genuine emotions, emotional labor was a tactic that live-in MCWs demonstrated to interact morally with older people.

Conclusions

Emotional labor allowed live-in MCWs to avoid conflict with older people, and to further protect their own welfare and that of others. This study highlights the significance of empowering live-in MCWs by training them in ways that will help them to adapt to working conditions where they will encounter diverse customs and older people who will develop an increasing dependence on them. Thus, there is a need to develop culturally appropriate interventions to empower live-in MCWs to deliver emotional labor in a moral manner.

Meta-analysis of the moral brain: patterns of neural engagement assessed using multilevel kernel density analysis

The neuroimaging literature in moral cognition has rapidly developed in the last decade with more than 200 publications on the topic. Neuroimaging based models generally agree that limbic regions work with medial prefrontal and temporal regions during moral processing to integrate emotional, social, and cognitive elements into decision-making. However, no quantitative work has been done examining neural response across types of moral cognition tasks. This paper uses Multilevel Kernel Density Analysis (MKDA) to conduct neuroimaging meta-analyses of the moral cognitive literature. MKDA replicated previous findings of the neural correlates of moral cognition: the left amygdala, medial prefrontal cortex, bilateral temporoparietal junction, and posterior cingulate. Random forest algorithms classified neural features as belonging to simple/utilitarian moral dilemmas, explicit/implicit moral tasks, and word/picture moral stimuli tasks; in combination with univariate contrast analyses, these results indicated a distinct pattern of processing for each of the members of these paradigm pairs. Overall, the results emphasize that the task selected for use in a moral cognition neuroimaging study is vital for the elicitation and interpretation of results. It also replicates and re-establishes the neural basis for moral processing, especially important in light of implementation errors in previous meta-analysis.

To feel or not to feel: a scoping review and mixed-methods meta-synthesis of moral distress among surgeons

BACKGROUND

There is increasing concern about the prevalence and impact of moral distress among healthcare workers. While this body of literature is growing, research specifically examining sources of moral distress among surgeons remains sparse. The unique attributes of the surgeon-patient relationship and the context of surgery may expose surgeons to sources of distress that are distinct from other healthcare providers. To date, a summative assessment of moral distress among surgeons does not exist.

METHODS

We conducted a scoping review of studies focused on moral distress among surgeons. Using guidelines established by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), relevant articles were identified in EBSCOhost PsycINFO, Elsevier EMBASE, Ovid MEDLINE, and Wiley Cochrane Central Register of Controlled Trials Library from January 1, 2009 to September 29, 2022. Detailed data abstraction was performed on a predetermined instrument and compared across studies. A mixed-methods meta-synthesis was employed for data analysis, and both deductive and inductive methodology was used in our thematic analysis.

RESULTS

A total of 1,003 abstracts were screened, and 26 articles (19 quantitative and 7 qualitative) were included for full-text review. Of these, 10 focused only on surgeons. Our analysis revealed numerous definitions of moral distress and 25 instruments used to understand the sources of distress. Moral distress among surgeons is complex and influenced by factors at multiple levels, The most frequent sources originate at the individual and interpersonal levels. However, the environmental, community and policy levels also noted sources of distress.

CONCLUSIONS

The reviewed articles identified several common themes and sources of moral distress among surgeons. We also found that research investigating sources of moral distress among surgeons is relatively sparse and confounded by various definitions of moral distress, multiple measurement tools, and frequently conflated terms of moral distress, moral injury, and burnout. This summative assessment presents a model of moral distress delineating these distinct terms, which may be applied to other professions at risk for moral distress.

Situating Moral Agency: How Postphenomenology Can Benefit Engineering Ethics

This article identifies limitations in traditional approaches to engineering ethics pedagogy, reflected in an overreliance on disaster case studies. Researchers in the field have pointed out that these approaches tend to occlude ethically significant aspects of day-to-day engineering practice and thus reductively individualize and decontextualize ethical decision-making. Some have proposed, as a remedy for these defects, the use of research and theory from Science and Technology Studies (STS) to enrich our understanding of the ways in which technology and engineering practice are intricated in social and institutional contexts. While endorsing this approach, this article also argues that STS scholarship may not sufficiently address the kinds of questions about normativity and agency that are essential to engineering ethics. It proposes making use of the growing body of research in a field called "postphenomenology," an approach that combines STS research with the traditional phenomenological concern with the standpoint of lived-experience. Postphenomenology offers a method of inquiry that combines STS's investigation into social and institutional dimensions of technology with phenomenological reflection on our lived experience of embodied engagement with technical objects and sociotechnical systems, particularly the ways in which these involvements affect our moral perception and agency. The aim in using this approach in engineering ethics is thus to illuminate moral dimensions of everyday professional life of which practitioners may not typically be aware. The article concludes with some concrete curricular interventions for engineering ethics classrooms.

Should Manual Driving be (Eventually) Outlawed?

In recent years, tech evangelists have made headlines predicting that in the future manual driving will be outlawed. This essay will investigate the question whether a ban of human driven cars can be defended on moral grounds in a future scenario in which autonomous cars are going to be significantly safer than manually driven cars. This article will argue that in such a future scenario manually driven cars, for moral reasons, indeed should be banned from participating in regular traffic. Since the moral argument for outlawing manually driven cars will likely be met by resistance by car-aficionados, in the final part of the paper, we are devising a proposal for reconciling the strong moral case for a ban of manually driven cars with the widespread fondness of manual driving.

Ethical Considerations in Crossing the Xenobarrier

Chimeras have been an important part of animal research for decades. Yet crossing the species barrier has always been seen as potentially morally problematic. In recent years, advances in chimeric research and the attendant possibilities-organ xenotransplantation, cognitive enhancement, and others-have given rise to further ethical concern. This contribution surveys the main ethical questions that have been discussed in the literature. We examine two arguments-from the order of nature and from human dignity-which aim to show that chimerization is inherently wrong. Finding the first untenable and the second largely inapplicable, we then turn to two unconvincing arguments designed to show that chimerization must necessarily lead to negative outcomes. Having thus found that no blanket statements can be made on the ethics of chimerization, we examine two important parameters relevant to the ethical evaluation of proposed chimeric research: the argument from moral status and from risk.

Moral distress in psychiatric nurses in Covid-19 crisis

BACKGROUND

The COVID-19 pandemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient's lack of cooperation in observing health protocols. This study has been conducted to explore and describe factors that caused moral distress in Iranian psychiatric nurses during the COVID-19 pandemic.

METHOD

This qualitative study with a conventional content analysis approach involved 12 nurses at the Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by semi-structured interviews, data analysis was performed based on the five steps of Graneheim and Lundman.

RESULTS

By continuous comparison and integration of data, 17 subcategories, 8 subcategories, and 3 categories were extracted from 252 initial codes. The causes of moral distress in psychiatric nurses during the COVID-19 pandemic were identified as emotional responses (Fear and Doubt), relational factors (Nurses' Relationship with Each Other, Nurse-physician Relationship, and Relationship whit Patients), and Institutional factors (Lack of Attention to Health Instructions, Failure to complete the treatment process for patients and Institutional Policies).

CONCLUSION

New dimensions of the causes of moral distress associated with the COVID- 19 pandemic are discovered in this study. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.

Expert opinion: Time to ban formal CI selection criteria?

This contribution addresses cochlear implantation (CI) selection criteria as a discussion topic. It expresses a personal viewpoint that challenges the usefulness and necessity of formal selection criteria. Scientifically, it is argued that CI selection must be highly individual, whereas the current criteria are general, not valid, not based on a wide consensus, and not up-to-date. Morally, it is argued that it is not legitimate to presume equality between patients and CI centers, that the current selection criteria create an ethical dilemma, and that an unresolvable contradiction exists between quality of life and measurability. Finally, liberalizing the criteria would probably have only a minimal impact on current practice and budget.

Moral challenges with surgical treatment of type 2 diabetes

AIM

To review the most important moral challenges following from the widespread use of bariatric surgery for type 2 diabetes for patients with BMI <35kg/m(2), although high quality evidence for its short and long term effectiveness and safety is limited.

METHODS

Extensive literature search to identify and analyze morally relevant issues. A question based method in ethics was applied to facilitate assessment and decision making.

RESULTS

Several important moral issues were identified: assessing and informing about safety, patient outcomes, and stakeholder interests; acquiring valid informed consent; defining and selecting outcome measures; stigmatization and discrimination of the patient group, as well as providing just distribution of health care. The main sources of these challenges are lack of high quality evidence, disagreement on clinical indications and endpoints, and the disciplining of human behavior by surgical interventions.

CONCLUSION

A lack of high quality evidence on the effect of bariatric surgery for the treatment of T2DM in patients with BMI<35/kg/m(2) poses a wide variety of moral challenges, which are important for decisions on the individual patient level, on the management level, and on the health policy making level. Strong preferences among surgeons and patients may hamper high quality research.

Moral structuring of children during the process of obtaining informed consent in clinical and research settings

Background

Informed consent is an important factor in a child’s moral structure from which different types of doctor–patient relationships arise. Children’s autonomy is currently under discussion in terms of their decent treatment, beyond what doctors and researchers perceive. To describe the influential practices that exist among clinicians and researchers toward children with chronic diseases during the process of obtaining informed consent.

Methods

This was a cross-sectional, qualitative study via a subjective and interpretivist approach. The study was performed by conducting semi-structured interviews of 21 clinicians and researchers. Data analysis was performed using the SPSS version 21® and Atlas Ti version 7.0® programs.

Results

The deliberative and paternalistic models were influential practices in the physician–patient relationship. In the deliberative model, the child is expected to have a moral awareness of their care. The paternalistic model determined that submission was a way of structuring the child because he or she is considered to be a subject of extreme care.

Conclusions

The differentiated objectification [educational] process recognizes the internal and external elements of the child. Informed consent proved to be an appropriate means for strengthening moral and structuring the child.

Differences in moral reasoning among medical graduates, graduates with other degrees, and nonprofessional adults

BACKGROUND

Reasoning and moral action are necessary to resolve day-to-day moral conflicts, and there are certain professions where a greater moral character is expected, e.g., medicine. Thus, it is desirable that medical students develop skills in this field. Some studies have evaluated the level of moral reasoning among medical students; however, there are no comparative studies involving other types of populations. Therefore, the objective of this study was to compare the moral reasoning among medical graduates with that of a group of young graduates with other degrees and of a group of nonprofessional adults.

METHODS

An exploratory cross-sectional study was conducted. Pediatric residents and pediatric subspecialty residents at a pediatric hospital were invited to participate, forming the group of "medical graduates". A group of young people from a social program and students with a master's degree in a science from the same pediatric hospital were also invited to participate, comprising the group of "graduates with other degrees". Finally, a group of beneficiaries of a family clinic was invited to participate, which we categorized as "nonprofessionals". To evaluate the differences in moral reasoning between these 3 groups, we applied the Defining Issues Test (DIT), a moral reasoning questionnaire designed by James Rest using Kohlberg's theory of moral development.

RESULTS

The moral reasoning of 237 subjects-88 from the "medical graduates" group, 82 from the "graduates with other degrees" group and 67 from the "nonprofessionals" group- was evaluated. We found differences in the profiles of moral development of the groups. The profile of the "nonprofessionals" showed a very high predominance of subjects at the preconventional level, 70%, but only 4.5% at the postconventional level. Among the "medical graduates", we observed 37.5% at the preconventional level and 34% at the postconventional level (X² p < 0.001); this group had the highest percentage in this category. This large difference could be because the differences in the ages and socioeducational levels of nonprofessionals are much wider than those among medical graduates. However, significant differences were also found when the profiles of medical graduates were compared with those of graduates with other degrees, since the latter demonstrated 56% at the preconventional level and 18% at the postconventional level (X² test, p = 0.02).

CONCLUSIONS

Significant differences were found in moral reasoning among the groups that we evaluated. Among the group of medical graduates, there was a higher percentage of subjects at the postconventional level than among the group of graduates with other degrees and a much higher percentage than among the group of nonprofessionals. Our conclusions give the first evidence that studying medicine seems to influence the development of moral reasoning in its students. Therefore, we consider it relevant to develop educational strategies where the student is involved in simulated but realistic decision-making situations, where there are moral dilemmas to resolve from their early years of training.

Bilingual children judge moral, social, and language violations as less transgressive than monolingual children

Learning the rules and expectations that govern our social interactions is one of the major challenges of development. The current study examined whether bilingualism is associated with differences in children's developing social knowledge. We presented 54 4- to 6-year-old monolingual and bilingual children with vignettes of moral transgressions (e.g., hitting), social transgressions (e.g., wearing pants on one's head), and language transgressions (e.g., calling a common object by a nonsense word) and asked about their permissibility. In line with previous research findings, results demonstrate that all children evaluated moral violations more harshly than conventional violations. Notably, however, bilingual children were more permissive of violations across moral, social, and language domains than monolingual children. These findings yield new insights into the role of early experience in the development of social knowledge. We propose that bilinguals' unique linguistic and social experiences influence their understanding of moral and conventional rules.