Luppo Kuillman

Re-assessing the validity of the Moral Sensitivity Questionnaire 45 2 to date suggest that measures of the components are assessing abilities that are distinct from one another.” In addition, and more importantly, the two new scales do not measure a cognitive process but a morally deliberate and paternalistic attitude. Convergent validity is thus not something that should actually be expected. Once the MSQ-DELIB and MSQ-PATER were confirmed as valid scales—measuring moral deliberation and paternalism, respectively— we considered the question of why only 11 of the 30 items in the original MSQ (Lützén et al., 1997) addressed in this study were retained. Given that Lützén and colleagues propose a theoretical construct that includes 30 operationalized aspects that are presumed to measure the six domains of moral sensitivity, it is remarkable to note that, in a more recent study (Lützén, Dahlqvist, Eriksson, & Norberg, 2006), only 9 of those 30 items emerge as valid operationalizations for measuring the construct of moral sensitivity. The current study used the same pool of 30 items from the original physician’s version of the MSQ, and factor analysis was used in order to assess whether the items correlated with the underlying construct. Our results indicate a comparable reduction in the number of items. This suggests that the 9-itemMSQ of Lützén and colleagues may not actually measure moral sensitivity (Lützén et al., 2006). Moreover, our results provide evidence that the two new scales, which are based on the original items of the MSQ, measure levels of moral deliberation (MSQ-DELIB), and paternalism (MSQ-PATER) that are broadly in line with the findings of Falkum and Førde (2001). Our results also adds to Falkum and Førde as the scales in the current study are presented in the first person (e.g., “When I need to make a decision contrary to the will of a patient, I do so accordingly to my opinion about what is good care”), whereas Falkum and Førde (2001) present statements in the third person (e.g., “The physician expert should decide”). As such, the scales may be more likely to reflect a deliberate predisposition towards a paternalistic and moral stance, rather than any broader, general values concerning moral deliberation and paternalism. We do not wish to make any value judgement concerning whether a deliberate or a paternalistic attitude is better. Even though it may seem that we now regard a paternalistic approach as inappropriate within the clinician- patient relationship, it might be the case that this is a reflection of our contemporary culture. However, societies change, and it is possible that, in a future era, a paternalistic or a deliberate attitude is differently valued than it is now.