Luppo Kuillman

Re-assessing the validity of the Moral Sensitivity Questionnaire 29 2 INTRODUCTION In Western health systems, two interesting shifts with regard to professional and patient responsibility have taken place over the last few decades. First, the professional responsibilityofmakingmedico-ethical decisions that exclusivelybelonged to the realm of medical doctors (MDs) has been extended to other health professions, including nurse practitioners (NPs) and physician assistants (PAs) (Maier, 2015; Merkle, Ritsema, Bauer, & Kuilman, 2011). Second, in the past, MDs guided their patients through the medical treatment process according to a strong paternalistic attitude. In current practice, the perspective has shifted towards emphasizing the central role of patients in healthcare (Siegler, 1985). Within the models of shared decision-making (SDM) that are now prevalent, assigning a central role to the patient is regarded as an ethical imperative. Such models of SDM are consistent with the four principles of ethics in care: respecting autonomy, propagating beneficence, avoiding harm, and achieving justice (Beauchamp & Childress, 2001). Medical decisions established through SDM have been shown to be associated with improved medication compliance, health- related quality of life, an increase in patients’ perceived control over their choices with regard to treatment options, and a decrease in healthcare utilization (Driever, Stiggelbout, & Brand, 2020). In the past, clinicians were accustomed to employing protocols and guidelines that were accepted as the gold standard for treatment. In contrast, computer-literate and empowered patients are adding a new dimension to the treatment relationship, thus potentially increasing the risk of tension and conflict (Jacobson, 2007). In light of such changes in the treatment relationship, tension is likely to arise between what a clinician regards as the best treatment option (or even what rules and regulations dictate that they propose) and the treatment that is perceived as the best in the eyes of the patient. Such tension could create a moral dilemma, which could be described as a situation in which for example there are conflicting opinions (between health professional and patient) regarding what is the best treatment option (De Haan, 2001). Health professionals may employ one of essentially two decision- making strategies or coping mechanisms to reduce dilemma-related stress: (i) a predominantly patient-centered, deliberate attitude focused on patient autonomy (Quill & Brody, 1996; Robinson, Callister, Berry, & Dearing, 2008) or (ii) a more dominant, clinical view, known as the “paternalistic approach” (Pellegrino, 2006; Siegler, 1985). Health