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2016
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EMARAS ONE
Emanuel Lema
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[Morals and Values]
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• Private,
personal standards of what is right and wrong in conduct, character and
attitude
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Principles of ethics and integrity
4
Dr. Sikyewunda William
M.B;Ch.B (Makerere)
MPH Wales
Morals
and Values
Definition of Morality
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Private, personal standards of what is right and
wrong in conduct, character and attitude
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Principles concerning right and wrong or good
and bad behavior
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Yardsticks which work as prescription to human
behavior
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Norms of conduct whose legitimacy is justified
on the grounds that they are good or right or necessary for social welfare or
social life
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Morals may be created by and defined by society,
religion or individual conscience
Socially
Acceptable Moral Standard
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Unfair for group to impose its moral ideas on
rest of population
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No hard and fast rule as to socially acceptable
moral standard
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General behavioral expectation of person living
in given society
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In medical profession seniority recognized and
junior practitioners expected to greet seniors with respect
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Morals start from family
Similarities
between Law and Morality
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Both prescribe and proscribe conducts in given
society
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Supplement and reinforce each other
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Law operates within framework of morality which
prescribes obedience to rules established by custom or laid down by authority
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Both have some form of sanction - law takes
coercion and morality takes reprobation, repulsion and ostracism
Differences between law and morality
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Law does not punish every omission while
morality punishes every omission
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Law continuously evolving while morality is
constant
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Law legislated, coercive by nature, while
morality is neither of the two
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Morality easily enforced, but law more difficult
to enforce
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Locus of legal control is external; whereas that
of morality is internal
Terms
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Morality refers to the requirements for people
to live together in society
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Moral behaviour - way person perceives these
requirements and responds to them
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Moral development is pattern of change in moral
behaviour with age
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Process of learning to tell difference between
right and wrong
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Complex process begins in childhood and
continues throughout life
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Theories of moral development attempt to answer
questions
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How person becomes moral
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What factors influence way person behaves in
moral situation
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Specifically addressed moral development in
children and adults
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Focused on reasons why individual makes decision
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Moral development progresses through 3 levels
and 6 stages
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Levels and stages not linked to specific
developmental stage
Levels of Kohlberg’s Moral
Development Process
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1. Pre-moral or pre-conventional level –
children responsive to cultural values and labels interpreted in terms of
consequence of action - punishment or reward
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2. Conventional level – individual concerned
about maintaining expectations of family, group or nation for conformity and
loyalty to own expectations and society’s
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3. Post conventional, autonomous or principle
level – individual makes effort to define valid values and principles
Stages in the
levels
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Level and Stages
Level 1: Pre-conventional
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Stage 1 – Punishment and obedience orientation
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Stage 2 – Instrumental relativist orientation
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Explanation and Examples
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Action wrong if punished and right otherwise
e.g. Health worker attending to duty
only for fear of being sacked
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Action only for self satisfaction e.g. child
accepting treatment due to being given sweets
Stages in the
levels
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Level and Stages
Level 2: Conventional
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Stage 3 – Interpersonal concordance
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Stage 4 – Law and order orientation
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Explanation and Examples
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Action taken to earn approval from other person
e.g. In-charge allowing colleague off-duty for personal reasons
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Right behavior is following the rules e.g. Nurse
refusing relative to visit patient after visiting time
Stages in the
levels
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Level and Stages
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Level 3: Post-conventional
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Stage 5 – Social contract, legalistic
orientation
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Stage 6 – Universal ethical principles
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Explanation and Examples
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Adherence to laws that protect rights of others,
considering values and opinions of others and avoiding violation e.g. ensuring
worship for patients
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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
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Stage 1 – caring for oneself – focus is
survival. Ends when individual views this as selfish hence seeing need for
relationships with others
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Stage 2 – Caring for others – recognition and
responsibility Ends with realization of
need for balance with self care
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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
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Freely chosen, enduring belief or attitude about
worth of something
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Worth ascribed to person or object determines
behavior towards person or handling of
object
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Value set – small group of values held
internally along continuum from most important to least important forming value
system
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Value systems basic to way of life, giving
direction to behavior based on decisions and choices
BELIEF,
ATTITUDE
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Interpretation or conclusion that one accepts to
be true based more on faith than fact without necessarily involving value
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Attitudes – mental positions of feelings towards
something continuing over time, whereas belief may last only briefly
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Attitudes often judged as bad or good, positive
or negative, whereas beliefs judged as correct or incorrect
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Attitudes have thinking and behavioral aspects,
but feelings important component, vary greatly among individuals
TYPES
OF VALUES
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Values influence decisions and actions
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6 basic types of values underlying interests and
motives
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Each person’s value orientation is unique blend
of types with one predominant
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Identifying own orientation and that of others
helps understanding people’s perception
of situations and choices of action
TYPES OF
VALUES
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Theoretical: person values truth and empiricism,
critical, rational, keeps records and works with facts on ground
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Economic: interested in what is practical and
useful, not in irrelevance and wasting resources
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Aesthetic: values beauty, form and harmony,
dislikes untidiness and believes in orderliness
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Social: values humans, loving, kind, sympathetic
and unselfish. Enjoys teamwork
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Political: values power, interested in leading,
directing and recognition. . Religious:
values unity
Development
of Values
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Values formed over lifetime through information
from environment, family, and society
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People internalize values and perceive them as
personal values
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People need to inculcate societal values to feel
accepted, and need personal values to have sense of individuality
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Health professional values acquired during
socialization into Health sector
ESSENTIAL HEALTH PROVIDER VALUES
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Specific professional health provider values
stated in code of ethics, in standards of practice and in legal system
Four important values of health provider
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Strong commitment to service
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Belief in dignity and worth of each person
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Commitment to education
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Professional autonomy
VALUE
CLARIFICATION
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Process
of identifying, examining and developing individual values
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No one set of values is right for everyone
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When people identify their values, they can
retain or change them freely by choice, rather than unconsciously
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Promotes personal growth by fostering awareness,
empathy, and insight
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Process has 7 steps centered on 3 main
activities; choosing (Cognitive), prizing (Affective), and acting (Behavioural)
CLARIFYING HEALTH
WORKER’S VALUES
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Health workers and students need to examine
values they hold about life, health, illness and death
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Professionals need to be “value neutral” and
non-judgmental
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Health worker has commitment to clients
regardless of values held
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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
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Client ignores health professional’s advice
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Client exhibits inconsistent communication or
behavior e.g. pregnant woman continues to drink alcohol and smoke
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Client has history of numerous admissions to
health agency for same problem
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Client confused and uncertain about course of
action
In such situations health care provider should help client
clarify values
CLARIFYING CLIENT’S VALUES
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List alternatives
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Examine possible consequences of choice
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Choose freely
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Feel good about choice
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Affirm choice
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Act choice
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Act with pattern
