Luppo Kuillman

Chapter 5 112 With regard to yielding to pressure, one can imagine that every healthcare professional has an internal standard that prohibits deviation from moral action. After all, moral action is dictated by rules and regulations in addition to professional ethos, or rather, the inner feeling of the way it ought to be. Nonetheless, when the force is too strong to resist, and someone yields to the pressure, moral disengagement mechanisms may facilitate the healthcare professional to construe a new, convenient ‘truth’.   For example, when pressured into prescribing antibiotics without an indication, healthcare professionals may tell themselves that prescribing this desired medication unindicated is a minor issue compared to the action of other colleagues who violate opioid regulations. They may also tell themselves that patients are illegally buying antibiotics online already, so the healthcare professional may better prescribe them when the patients insist. Such “excuses” that a health professional can tell him- or herself can render the ethical misconduct as unrelated to the own moral standards against deviating from medical rules, regulations, or even professional ethos. This thought helps the healthcare provider prescribe to the belief that nothing is done wrong.  Considering the above example, it is clear that the interrelated mechanisms of moral disengagement facilitate unethical behavior. On this basis, we expect that professionals scoring high in moral deliberation, that is, those who tend to go along with patient’s demands, can only do so if they can justify the morally questionable behavior for themselves. So, only those who are also prone to moral disengagement will be able to go along with the patient’s demands. In other words, moral deliberation will only increase yielding to pressure when moral disengagement is high, and not when it is low. For this, we hypothesize the following:  ■ H3 : Moral deliberation and moral disengagement will interact to predict yielding to pressure in a way that moral deliberation will positively predict yielding to pressure when moral disengagement is high rather than low.   We have no reason to expect that paternalism’s influence on yielding to pressure is moderated by moral disengagement. After all, we expect paternalists to be unreceptive to pressure. Therefore, the paternalists may not have any inclination to deviate from their self-convinced course of action, and do not need to use moral disengagement mechanisms.