Journal A.

What are Your "Moral Instincts," Or

Your Natural Way of Making Moral Decisions?

Brian O'Toole, Ph.D.

There are no right or wrong answers to these questions. Rather, you are asked to answer each question with the response that seems most natural to you and to your own way of making moral decisions.

A violent storm devastates a nearby area in your state, leaving many injured and homeless. Your church wants to take up a special collection to address the needs of those victims. You generously donate $50.00 because:

You feel sorry for the tragic victims of the storm and are moved to help, and personally feel better being open to giving a generous donation.

You figure that if everyone donates a reasonable amount then such contributions won’t hurt as much as individuals, and overall there will be a great benefit to the storm victims.

You were spared from the storm, and you believe that all those who have been blessed by God have an obligation to share their resources with the less fortunate.

It would seem selfish and insensitive of you not to make some donation.

What, for you, is the most convincing argument why our country should not allow capital punishment?

Capital punishment has not been shown to be a deterrent to crime and may in fact contribute to violence in society.

Capital punishment is a barbaric and abhorrent practice.

Life is sacred and no one has the right to take another life.

Capital punishment dehumanizes us as a society and it is practiced out of a spirit of revenge which is a demeaning human quality

A close friend of yours confides that he/she is having an adulterous affair. You disapprove of this because:

Cheating on one's spouse seems to be sneaky, dishonest, and a betrayal of trust, these are not qualities you like to see now in your friend.

It is wrong to be unfaithful in marriage, adultery is a violation of marriage vows.

You want the marriage to work, and it saddens you to think that the marriage of your close friends, which you valued and took for granted, has now deteriorated to this.

You fear that in the end your friend, his/her spouse, and their children will all be severely hurt by this experience, and you see no good coming out of it.

You are a member of your hospital's ethics committee. A case is presented regarding an elderly patient with end stage cancer that has metastasized into the bones. He is now in your ICU in multiple organ system failure and is ventilator dependent. He lacks decision making capacity and has no advance directives. His prognosis is poor and he is expected to die. His elderly wife insists, however, that "everything be done" to keep him alive. The attending physician wishes to write a DNR order and fears approaching the wife for consent. You believe the ethics committee should support the physician's decision because:

The patient is dying; cardiopulmonary arrest is inevitable and efforts to resuscitate him in this condition will, in all likelihood, fail.

Families do not have a right to medically futile treatment.

Attempting CPR would only inflict suffering on this poor patient in our vain attempt to try to keep him alive (it’s because of cases like these that we used to have "slow codes")

Physicians and caregivers should not be forced to violate their professional obligation to provide medical treatments which, in their judgment, will cause significant harm to a patient with little likelihood of any corresponding benefit.

You make a New Year's resolution to be less critical, and more supportive of your spouse, children or friends because:

It's the right thing to do; all people should make a resolution at the start of a new year to improve themselves and to be better in their relationships.

You don't feel good about how you've been acting lately, and feel a need to rejuvenate your relationships.

You've been disappointed in yourself in how you've been acting lately and you want to become a better spouse/parent/person or friend.

There has been a lot of bickering and misunderstanding lately, and your New Year's resolution will hopefully help everyone to get along better leading to a more pleasant home environment or a better overall outlook on life.

You feel the management style of your administrative team has been too hierarchical. You would like to improve dialogue and team decision making. You argue for this with your CEO saying:

These are essential ways to show respect and promote our dignity and self-respect.

We feel frustrated by our inability to impact key decisions; low morale is indicative of a problem here.

Pooling of ideas can lead to better results and better decision-making.

Part of being a good leader is to be able to dialogue with one another and to make decisions by consensus.

You are promoting budgeting for a special multi-disciplinary approach to address the needs of the dying and their families in your institution. Even though not all the costs of providing this service will be reimbursed, you nonetheless argue for this approach saying:

This is a good way to make sure that our caregivers do not over treat or under treat the terminally ill, which is a chronic problem in our American healthcare system.

Not to address these needs contribute to interest in assisted suicide, which is morally wrong.

Part of our professional responsibility in our role as caregivers in the Catholic healthcare ministry is to address the special needs of the terminally ill.

We often feel helpless in dealing with the dying and their loved ones; this service will provide us with an excellent way to compassionately respond to those most deserving of our care.

Your elderly mother suffers a massive stroke and is now largely unresponsive with a poor prognosis for any improvement. Years ago she made you her Health Care Proxy with only one directive: "I trust you to do whatever is best for me." Her physician asks you about the insertion of a feeding tube into her stomach. You are reluctant to do so because:

You don't think living like this is any good; as her son/daughter, you'd be letting your mom down if you didn't live up to your promise to do what you thought was best for her.

It tears you up to see your mom like this; you can’t believe she'd want to have her life prolonged like this, and you can 't stand the thought of this going on.

You don't see any good reason to keep anyone, but especially your mom, a treatment that would only keep her body alive.

You can see how a feeding tube would be necessary to keep your mom alive, but if she ends up in a nursing home, bed bound and "out of it" then it seems as if this is only going to prolong her suffering and your grief.

You have lost interest in attending church due to your new pastor’s boring and uninspiring homilies. You are tempted to quit going but decide against this because:

Attending church is part of "keeping the Lord's day holy."

You would feel guilty if you didn’t go to church.

You don't want yourself or your children to get out of the habit of attending church.

You are personally committed to your faith and to participation in your church; you wouldn't seriously think of not going to church.

You were "let go" from your former healthcare position and given a relatively meager severance package. You harbor some ill feelings about this. At your new healthcare position, you are occasionally given the opportunity, and are often tempted, to "bad mouth" the corporate leadership of your former healthcare position. Normally you refrain from this, however, because:

You know you wouldn’t feel right publicly expressing your negative feelings merely to keep "grinding the axe" against your former employer.

You may create a negative impression about yourself at your new position.

You've never been the kind to “bad mouth" others.

In today's healthcare environment, it is not wise to "burn your bridges."

A member if your management team uses profanity at meetings. In private, you ask him to stop this because:

You personally find this very offensive and very inappropriate.

You are concerned because the use of profanity detracts from the effectiveness of his contributing remarks.

The use of profanity casts his character in a bad light, especially in a meeting with fellow healthcare professionals.

It is wrong to use profanity, and its use is demeaning to everyone in the room.

A downsizing at your institution is planned. You argue that all those affected, even lower level employees should be offered benefits and training or out placement help. The cost of your proposal greatly concerns your CEO. You still argue for your position, however, saying:

We should consider the Golden Rule - we would all want to be treated this way if we were to be laid off.

This approach is consistent with our mission and values; it is in keeping with the mission and values of our healthcare institution.

This approach would minimize the negative effect not only on those laid off, but also on the survivors and the future of the organization.

A layoff is devastating, and we owe it to tour employees as human beings to minimize the suffering this layoff is causing them.

Your widowed mother passes away. Your siblings begin to disagree over how to claim mementoes from her house. You propose that everyone take turns selecting one item because:

We're a family; Mom wouldn't want her children fighting over her possessions.

It is fair; it is the most just and equitable way of dispensing mementoes.

This will minimize bickering and assure that everyone has some special remembrances.

This is hard enough to do as it is, why make it harder? When we are all dealing with our own grieving, we should at least be considerate of one another.

You hold a position of influence in your PHO, and are involved in contract negotiations. Your PHO is competing with a healthcare facility in another city for a managed care contract. You are contacted by a discontented, high level employee from the other healthcare facility and offered critical information - for a price - that would allow your PHO to be successful in efforts to obtain the contract. While you are sorely tempted to meet with this person to acquire this information, in the end you decide against doing this because:

This would be wrong - it would violate the business rules of fair play and forthright negotiations.

You would feel dishonest doing this, and would be greatly offended if your competitor engaged in this practice.

You are not the kind of person to make deals "under the table" and you refuse to compromise your own values and integrity.

There is always the possibility that your actions would be discovered this could not only potentially ruin the deal but would also cause you embarrassment and quite likely limit your effectiveness in any future business negotiations.

Your hospital completes a merger with another smaller hospital. Your board encourages the CEO to quickly supplant their top management with your own leadership team to absorb that hospital into your own mission and values and culture. You are uncomfortable with this approach, however, but instead argue that we should work with the smaller hospital's leadership and to preserve much of their own management style and culture while trying to ease them in the way your system works because:

You have already sensed the anxiety and uncertainty gripping the management and employees at this hospital resulting from the merger, and it wouldn’t seem right to further their insecurity and concern by quickly and drastically changing all that is familiar to them.

It would be wrong to eliminate competent leadership and disrespectful to the other hospital's in-grained culture.

Following your board's advice may cause "bad blood" between the two hospitals and delay your effectively working together.

You wouldn't like yourself very much or feel very proud of your hospital if you agree to "boxing" the top management and "ran roughshod" over a culture that had been in place for so long at the smaller hospital.

Moral Instincts Survey

Answer Guide and Explanations

Question	Principles	Consequences	Virtue/Character	Moral Sentiment
1	C	B	D	A
2	C	A	D	B
3	B	D	A	C
4	B	A	D	C
5	A	D	C	B
6	A	C	D	B
7	B	A	C	D
8	C	D	A	B
9	A	C	D	B
10	D	B	C	A
11	D	B	C	A
12	A	C	B	D
13	B	C	A	D
14	A	D	C	B
15	B	C	D	A

KEY POINTS:

1. All four of these ways of approaching ethical decision making are valid and each is supported by extensive literature in ethics.

2. Almost all of us use all four of these ways of ethical decision making. We utilize different approaches in different roles and at different times in our life. Yet we do so unreflectively and almost always without conscious choice. Some of us use one way predominantly, a second way les often and so forth; others vary their approach to ethical decision making depending on a variety of factors. Yet again, this occurs naturally or subconsciously and normally not deliberately or wi th specific intent.

3. One source of potentially irresolvable moral conflict occurs when two parties argue or negotiate their positions from different moral approaches. Agreement or consensus often may occur only when discussion ensues from within the same moral approach.

4. When presenting one's moral position or recommendation, it is helpful to substantiate or justify it with three arguments - a principled argument, a consequence argument and a virtue/character argument. It may well be difficult to articulate a moral sentiment argument. In this way, you have better assurance that you have addressed the moral perspectives and concerns of your group.