Luppo Kuillman

Chapter 5 108 ABSTRACT Background: In this study, we examined the predictive values of a moral deliberate, and paternalistic attitude on health professionals’ propensity of yielding to pressure. In these hypothesized positive and negative relationships, we further sought to ascertain whether moral disengagement plays a pivotal role when individuals deviate from moral standards, rules, and regulations when yielding to pressure.  Aim(s): This study’s primary aim was to assess the predictive value of a moral deliberative and paternalistic attitude on yielding to pressure when health professionals are confronted with moral conflicts.  Method: This validation study was cross-sectional and was based on a convenience sample of Dutch nurse practitioners and physician assistants respectively. The MSQ- DELIB and MSQ-PATER scales indicate a moral deliberate or paternalistic attitude. These scales were assumed to have a predictive value towards the degree of yielding to pressure. Yielding to pressure was measured by two vignettes in which respondents were faced with a moral conflict (vignette 1: prescribing unindicated antibiotics, and vignette 2: discharging a difficult patient from the hospital).  Results: Only moral deliberation was a significant predictor of yielding to pressure. However, we found a positive effect for vignette 1 (in which the pressure came from the patient), while we found a negative relationship in vignette 2 (in which pressure came from the patient’s environment). Paternalism did not affect yielding to pressure in either vignette.  Conclusion: This study suggests that moral deliberation makes healthcare professionals receptive to pressure exerted by patients to break moral standards but more resilient against doing so when this pressure comes from other sources than the patient. However, further research is needed to find more conclusive evidence for this differential effect.