BackgroundHealthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals’ moral conflicts through the lens of justice and care to obtain suggestions for conflict resolutions.MethodSemi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited using the snowball sampling method. Interviews (...) were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person’s thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally’s taxonomy.ResultsAmong 31 responses, 2 that did not mention moral conflict were excluded, leaving 29 responses that were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The “rules” category of justice and the “welfare of others” category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective.ConclusionsThe nurses in this study suggest that they make moral judgments based on moral values that are intertwined with justice and care perspectives complex manner.Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider’s responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care is recommended. (shrink)

Moral reasoning typically relates unexpectedly weakly with both Machiavellianism and authoritarianism. Although researchers often explain this by pointing to apparent shortcomings in both the construct and the measure of moral reasoning, such explanations are questionable given the many instances of support for hypotheses involving moral reasoning using the same construct and measure. As these latter cannot only sometimes be flawed, we explored the possible influence of moral reasoning index choice on observed results by using multiple indices available in the Defining (...) Issues Test. In a sample of 201 employed persons surveyed in 1998, with results reported for the first time, advanced moral reasoners tended to be neither Machiavellian nor authoritarian. However, the specific moral reasoning index employed was critical to detecting these hypothesized inverse relationships. Specifically, we proposed that currently unavailable D scores would be the relevant index for examining inverse relationships with Machiavellianism and that P scores would be most appropriate in the context of inverse relationships with authoritarianism, particularly among persons inclined to utilize their characteristic moral reasoning. We extrapolate the conceptual logic underpinning such relationships, and suggest that appropriate index choice flows from this logic and is essential to hypothesis testing across a broad array of constructs. Future research could adopt this logic to examine relationships involving constructs with implications similar to those found in Machiavellianism and authoritarianism. (shrink)

Evidence-based practice suggests the best approach to improving professionalism in practice is ethics curricula. However, recent research has demonstrated that millennium graduates do not advocate for patients or assert themselves during moral conflicts. The aim of this article is the exploration of evaluation techniques to evaluate one measurable outcome of ethics curricula: moral reasoning. A review of literature, published between 1995 and 2013, demonstrated that the moral orientations of care and justice as conceptualized by Gilligan and Kohlberg are utilized by (...) nursing students to solve ethical dilemmas. Data obtained by means of reflective journaling, Ethics of Care Interview (ECI) and Defining Issues Test (DIT), would objectively measure the interrelated pathways of care-based and justice-based moral reasoning. In conclusion, educators have an ethical responsibility to foster students' ability to exercise sound clinical judgment, and support their professional development. It is recommended that educators design authentic assessments to demonstrate student's improvement of moral reasoning. (shrink)