Luppo Kuillman

Chapter 2 30 professionals adopting a paternalistic attitude are less likely to engage in dialogue regarding treatment options or the health beliefs of patients. They are more likely to decide what is best for the patient based on their own self- presumed professional knowledge and evidence-based practice. Health professionals who have adopted a deliberate attitude that takes the opinions and wishes of patients into account must reflect on their decisions in the light of the patient’s views (Abma, Molewijk, & Widdershoven, 2009). BACKGROUND Regardless of whether health professionals cope with moral dilemmas through either a deliberate or paternalistic attitude, moral dilemmas arising within interactions must necessarily be resolved through an ethical decision-making process. For example, James Rest captures this ethical decision-making process in the “four- component model of moral behavior” (FCM). The FCM states that moral decision- making is influenced by moral sensitivity, moral reasoning, moral motivation, and moral character. In this model, Rest conceptualizes moral sensitivity as the first and essential precursor in ethical decision-making, defining it as “a combination of one’s recognition of moral issues, and how one reacts and processes these issues from an affective perspective within a social context” (Rest, 1986). Lützén and colleagues (Lützén, Nordström, & Evertzon, 1995) defined the concept of moral sensitivity (MS) in theoretical terms as “a personal attribute involving the ability to recognize a moral conflict, a contextual and intuitive understanding of a person’s vulnerable situation and insight into the ethical consequences of decisions made on behalf of another person.” They operationalized this concept of moral sensitivity using the Moral Sensitivity Questionnaire (MSQ) in study populations consisting of psychiatrists (Lützén, Johansson, & Nordstrom, 2000) and psychiatric nurses (Lützén, Evertzon, & Nordin, 1997). Based on their results, they reported six dimensions (i.e., latent variables). With reference to exploratory analysis, Lützén and colleagues label these dimensions as follows: 1) interpersonal orientation, 2) structuring moral meaning, 3) expressing benevolence, 4) modifying autonomy, 5) experiencing moral conflict, and 6) having confidence in medical knowledge (Lützén et al., 1997). In a methodological and statistical appraisal of the results as published, however, a weak structure emerges as a result of three observations. First, factor loadings (correlations between items and the underlying construct) were too low, as items should be sufficiently correlated (factor loading ≥.40) with the target dimension