Luppo Kuillman

Chapter 5 110 to pressure” inflicted by the emotionally driven, steadfast, compelling patient. Once the healthcare professional yields to pressure (s)he abandons the route of moral action. This reaction of yielding under patient pressure is not something new. It is also a known pitfall in the interaction between patients and doctors. In a study by Little et al. (2004), the degree of perceived pressure appears to be an important predictor of whether someone eventually yields under pressure from the patient (Little et al., 2004). For example, one can imagine a situation where the next of kin of a terminally ill patient claims a novel type of chemotherapy to prolong the life of a beloved one, whereas to the clinician’s knowledge, this will only severely impact the quality of the short, remaining life (Kuuppelomäki & Lauri, 1998). The conflict between the wish to be perceived by the family as a good, involved clinician is opposed to the professional duty of alleviating a patient’s suffering. With moral conflicts that have a smaller (perceived) impact, such as the moderately ill patient who persists in getting antibiotics without having any legitimate indication, viewing this as his/her right (Björnsdóttir & Hansen, 2002), can also be experienced as a moral conflict. In such a situation, on the one hand, the demands of the patient are in conflict with the generic responsibility of healthcare providers to prevent antibiotic resistance, and on the other, the desire to keep a good understanding with the patient.   In conflicts such as the above, the factors that make a healthcare professional more likely to resist yielding to pressure and make an ethically and medically justified choice for the right course of moral action are varied. In this paper, we focus on specific attitudes of the healthcare provider that may determine this moral action, namely: moral deliberation, paternalism, and the propensity to disengage morally.   Moral deliberation and paternalismas predictors of moral action  In an earlier study, we found that health professionals adhere to one of the two types of attitudes when encountering a patient: moral deliberate (MSQ-DELIB), and paternalistic (MSQ-PATER) attitude (L. Kuilman, Jansen, Mulder, Middel, & Roodbol, 2020). We defined moral deliberation as a type of medico-ethical decision-making act to help patients determine the best health-related values that can be realized in the clinical situation after considerable deliberation. Healthcare providers with a high propensity towards moral deliberation are often focused on patient’s wishes rather than professional norms and values. On the other hand, paternalism entails