Morals and Values ...




2016

EMARAS ONE

Emanuel Lema



[Morals and Values]
           Private, personal standards of what is right and wrong in conduct, character and attitude







Principles of ethics and integrity 4
Dr. Sikyewunda William
M.B;Ch.B (Makerere)
MPH Wales
Morals and Values
Definition of Morality
        Private, personal standards of what is right and wrong in conduct, character and attitude
        Principles concerning right and wrong or good and bad behavior
        Yardsticks which work as prescription to human behavior
        Norms of conduct whose legitimacy is justified on the grounds that they are good or right or necessary for social welfare or social life
        Morals may be created by and defined by society, religion or individual conscience

Socially Acceptable Moral Standard
        Unfair for group to impose its moral ideas on rest of population
        No hard and fast rule as to socially acceptable moral standard
        General behavioral expectation of person living in given society
        In medical profession seniority recognized and junior practitioners expected to greet seniors with respect
        Morals start from family

                               Similarities between Law and Morality
        Both prescribe and proscribe conducts in given society
        Supplement and reinforce each other
        Law operates within framework of morality which prescribes obedience to rules established by custom or laid down by authority
        Both have some form of sanction - law takes coercion and morality takes reprobation, repulsion and ostracism

                                Differences between law and morality
        Law does not punish every omission while morality punishes every omission
        Law continuously evolving while morality is constant
        Law legislated, coercive by nature, while morality is neither of the two
        Morality easily enforced, but law more difficult to enforce
        Locus of legal control is external; whereas that of morality is internal
                                   
                              Terms
        Morality refers to the requirements for people to live together in society
        Moral behaviour - way person perceives these requirements and responds to them
        Moral development is pattern of change in moral behaviour with age

        Moral Development
        Process of learning to tell difference between right and wrong
        Complex process begins in childhood and continues throughout life
        Theories of moral development attempt to answer questions
        How person becomes moral
        What factors influence way person behaves in moral situation
                     Lawrence Kohlberg’s Theory of Moral Development
        Specifically addressed moral development in children and adults
        Focused on reasons why individual makes decision
        Moral development progresses through 3 levels and 6 stages
        Levels and stages not linked to specific developmental stage
              
               Levels of Kohlberg’s Moral Development Process
        1. Pre-moral or pre-conventional level – children responsive to cultural values and labels interpreted in terms of consequence of action - punishment or reward
        2. Conventional level – individual concerned about maintaining expectations of family, group or nation for conformity and loyalty to own expectations and society’s
        3. Post conventional, autonomous or principle level – individual makes effort to define valid values and principles

                                 Stages in the levels
        Level and Stages
Level 1: Pre-conventional
        Stage 1 – Punishment and obedience orientation
        Stage 2 – Instrumental relativist orientation
        Explanation and Examples 
        Action wrong if punished and right otherwise e.g. Health worker attending to duty  only for fear of being sacked
        Action only for self satisfaction e.g. child accepting treatment due to being given sweets

                               Stages in the levels
        Level and Stages
Level 2: Conventional
        Stage 3 – Interpersonal concordance
        Stage 4 – Law and order orientation
        Explanation and Examples
        Action taken to earn approval from other person e.g. In-charge allowing colleague off-duty for personal reasons
        Right behavior is following the rules e.g. Nurse refusing relative to visit patient after visiting time
                                Stages in the levels
        Level and Stages
        Level 3: Post-conventional
        Stage 5 – Social contract, legalistic orientation
        Stage 6 – Universal ethical principles
        Explanation and Examples
        Adherence to laws that protect rights of others, considering values and opinions of others and avoiding violation e.g. ensuring worship for patients
        Universal moral principles internalized and respect for rights upheld e.g. whistle-blowing against errant boss
       

                     Carol Gilligan’s Stages of Moral Development
3 stages with each ending with transition of discomfort with behavior
        Stage 1 – caring for oneself – focus is survival. Ends when individual views this as selfish hence seeing need for relationships with others
        Stage 2 – Caring for others – recognition and responsibility  Ends with realization of need for balance with self care
        Stage 3 – Caring for self and others – balance between caring for others and for self. Responsibility now for self and others
             
                                            VALUES
Definition of Value
        Freely chosen, enduring belief or attitude about worth of something
        Worth ascribed to person or object determines behavior towards  person or handling of object
        Value set – small group of values held internally along continuum from most important to least important forming value system
        Value systems basic to way of life, giving direction to behavior based on decisions and choices
                                        
                                      BELIEF, ATTITUDE
        Interpretation or conclusion that one accepts to be true based more on faith than fact without necessarily involving value
        Attitudes – mental positions of feelings towards something continuing over time, whereas belief may last only briefly
        Attitudes often judged as bad or good, positive or negative, whereas beliefs judged as correct or incorrect
        Attitudes have thinking and behavioral aspects, but feelings important component, vary greatly among individuals
                                         TYPES OF VALUES
        Values influence decisions and actions
        6 basic types of values underlying interests and motives
        Each person’s value orientation is unique blend of types with one  predominant
        Identifying own orientation and that of others helps understanding  people’s perception of situations and choices of action

                                    TYPES OF VALUES
        Theoretical: person values truth and empiricism, critical, rational, keeps records and works with facts on ground
        Economic: interested in what is practical and useful, not in irrelevance and wasting resources
        Aesthetic: values beauty, form and harmony, dislikes untidiness and believes in orderliness
        Social: values humans, loving, kind, sympathetic and unselfish. Enjoys  teamwork
        Political: values power, interested in leading, directing and recognition.         . Religious: values unity

                                      Development of Values
        Values formed over lifetime through information from environment, family, and society
        People internalize values and perceive them as personal values
        People need to inculcate societal values to feel accepted, and need personal values to have sense of individuality
        Health professional values acquired during socialization into Health sector
                             
                     ESSENTIAL HEALTH PROVIDER VALUES
        Specific professional health provider values stated in code of ethics, in standards of practice and in legal system
Four important values of health provider
        Strong commitment to service
        Belief in dignity and worth of each person
        Commitment to education
        Professional autonomy

                                     VALUE CLARIFICATION
        Process  of identifying, examining and developing individual values
        No one set of values is right for everyone
        When people identify their values, they can retain or change them freely by choice, rather than unconsciously 
        Promotes personal growth by fostering awareness, empathy, and insight 
        Process has 7 steps centered on 3 main activities; choosing (Cognitive), prizing (Affective), and acting (Behavioural)
       
                         CLARIFYING HEALTH WORKER’S VALUES
        Health workers and students need to examine values they hold about life, health, illness and death
        Professionals need to be “value neutral” and non-judgmental
        Health worker has commitment to clients regardless of values held
        Health care professional may have moral obligation to respond to  client’s value that may cause harm to client and/or others e.g. CSW’s values

                                  CLARIFYING CLIENT’S VALUES
        Client ignores health professional’s advice
        Client exhibits inconsistent communication or behavior e.g. pregnant woman continues to drink alcohol and smoke
        Client has history of numerous admissions to health agency for same problem
        Client confused and uncertain about course of action
In such situations health care provider should help client clarify values
                      
              CLARIFYING CLIENT’S VALUES
        List alternatives
        Examine possible consequences of choice
        Choose freely
        Feel good about choice
        Affirm choice
        Act choice
        Act with pattern