Luppo Kuillman

General Introduction 19 1 standard. In other words, it’s about people using cognitive mechanisms convincing themselves that what they are doing is morally acceptable. All of this with the sole purpose to “reconstruct” or “reframe” their own morally dubious behavior to justify it. Bandura proposed that this moral control selectively can be activated or disengaged (Bandura, 1990). This self-influence or control is seen by Bandura as a continuous process motivating and regulating the moral conduct. Bandura proposed that there were eight mechanisms involved in the interplay behind the perpetration of inhumanities: (a) moral justification, (b) euphemistic labelling, (c) advantageous comparison, (d) displacement of responsibility, (e) diffusion of responsibility, (f) distorting consequences, (g) attribution of blame, and (h) dehumanization. Each of the aforementioned mechanisms are represented by a subset of four items. Carroll reported that moral disengagement was negatively correlated with the level of moral reasoning (estimated with the N2 score), indicating that lower disengagement (more self-censured behavior) is correlated with higher levels of moral reasoning (Carroll, 2009). Also, Dineen explored moral disengagement of medical providers as a contributing factor in ethical decision-making, in the continued reality that clinical practices often perpetuate the inadequate treatment that may occur by “progressive disengagement of self-censure” (Dineen, 2012). In this doctoral thesis in all chapters reporting about the conducted studies the propensity of moral disengagement has been incorporated as an explanatory variable, albeit with different hypotheses. As an indicator of moral disengagement, we have adapted the original moral disengagement scale (MDS) by rephrasing its 32 items in such a way that they were more appealing to our respondents, all working in the perspective of Dutch healthcare. Psychometric assessment by Bandura and colleagues demonstrated a unidimensional scale with a Cronbach’s alpha of 0.83. Initially, this questionnaire was developed to measure moral disengagement among children and young adolescents. Our modified moral disengagement scale has a Cronbach’s alpha of 0.85. The psychometric properties of the scale that was used in the several studies as reported in the Chapters 2, 3 and 5 in this doctoral thesis- was consistent with the findings by Bandura and colleagues and demonstrated that translation and adaptation had not affected the internal consistency of the scale.