Luppo Kuillman

Chapter 2 44 1992). The first factor identified in the current study was labelled the MSQ-PATER. Examination of the seven items of these scale reveals that they center on such themes as “following the rules,” “personal opinion about good care,” and “best treatment.” All of these themes are consistent with the general perception of paternalism, that is, one is acting in the patient’s best interest, while disregarding the patient’s will in the matter. In this light, we formulated the following operational definition of paternalism was formulated to capture the meaning of the MSQ-PATER: “The tendency toward paternalism in medical decision-making is activated by a clinician’s preference for arguments based on rules and regulations. Decisions are established through the interplay between the clinician’s own opinion, medical knowledge, and experience, as well as the opinions of others, while ignoring the will of the patient.” The second factor identified in the current study relates to the dimension of the professional relationship between the clinician and the patient, as indicated by affective, socio-cognitive considerations (e.g., consideration for “autonomy,” “relationship,” “giving respect,” and “providing patients with insight”). We combined these four items to form the MSQ-DELIB, which reflects “the clinician’s aim of helping patients to determine the best health-related values that can be realized in the clinical situation”.19 Such an aim requires morally sensitive reflection on the ethical consequences of decisions in treatment. It encompasses the desire to treat patients with the proper respect and to find meaningfulness in working with patients. A such, it is broadly consistent with the definition proposed by Lützén and colleagues: “the contextual and intuitive understanding of the vulnerability of a person’s situation and insight into the ethical consequences of decisions made on behalf of the person” (p. 474) (Lützén et al., 1997). Be that as it may, based on our content analysis, the items identified in Factor 2 provide no basis for adhering to Lützén’s concept of moral sensitivity. The items in Factor 2 do not reflect sensitivity for moral issues of the patient but rather represents an attitude towards moral dialogue. After the two newmeasurement scales were developed, they were tested for construct validity. These tests yielded favorable convergent and divergent outcomes thus indicating good construct validity. As hypothesized, the indicator of moral reasoning (DIT-N2) showed no significant correlation with the two new scales. This is in line with a review by Muriel Bebeau (Bebeau, 2002) positing that one could question whether the four components of the FCM should necessarily be correlated. Such questions are particularly justified in light of Bebeau’s view on this assumption: “Conclusions