Luppo Kuillman

The predictive values of a Deliberative and a Paternalistic Attitude 111 5 that a clinician, in his/her decision making, has a preference for arguments based on rules and regulations. Decisions are established through the interplay between the clinician’s opinion, medical knowledge, experience, colleague’s opinions, while completely ignoring the will of the patient. Paternalistic healthcare providers will be less interested in engaging with patients.   We assume that during moral conflicts, yielding to pressure would depend on both deliberation and paternalism. When someone has a moral deliberate attitude, there is a high tendency to be maximally focused on the patient’s wishes and be more sensitive to appeals from the patient or his/her environment. The result is that the health care professional may be more tempted to give in to the pressure at the cost of medical standards, guidelines, and professional ethos. We, therefore, hypothesize that:  ■ H1 : Moral deliberation has a positive relationship with a high risk of yielding to pressure.In contrast, when a healthcare provider has a more paternalistic stance (s)he wants to adhere to the rules and professional standards at all times. Therefore, it is not likely that paternalists will go along with the desires of the patient’s desire and yield to pressure.   ■ H2 : Paternalism has a negative relationship with a low risk of yielding to pressure.   The dark side of yielding to pressure: moral disengagement Although moral deliberation contributes to yielding to pressure at the cost of medical standards and guidelines, this may not come without personal costs for the health practitioner. Complying with a patient’s request against the moral rules can threaten the healthcare provider’s self-image. In order for persons to come this far, they need to deal with this somehow. One way to do this is moral disengagement.  Moral disengagement can be defined as a process of cognitive reframing of conduct as being morally acceptable without the necessity of changing one’s moral standards (Bandura, 1999). There are various ways to reframe immoral acts into moral ones: downplaying the harmful consequences, using euphemisms to make it sound less bad, or shifting the responsibility for the behavior to someone else (Bandura, Barbaranelli, Caprara, & Pastorelli, 1996a). These moral disengagement ways make it easier for people to deviate from moral standards, rules, and regulations without feeling guilty (Kish-Gephart, Detert, Treviño, Baker, & Martin, 2014).