Luppo Kuillman

Chapter 2 52 to scales that ran from 0 to 100. An overall score was computed that measured the degree to which the respondents indicated the importance of including ethical aspects in their care. A Principal Component Analysis with Varimax rotation demonstrated the EAS to be unidimensional with factor loadings of 0.74, 0.79, 0.70, and 0.75, respectively. Reliability analysis yielded an acceptable internal consistency reflected by a Cronbach’s alpha of 0.72. Higher scores of the EAS indicate a higher disposition to adhere to and advocate ethical standards in care. Moral Disengagement Scale (MDS) Within the framework of moral agency, Bandura introduced the mechanisms of moral disengagement to assess individuals’ behavior which is in contradiction with their ethical principles without experiencing any form of guilt or shame. The Moral Disengagement Scale (MDS) measures the degree of disengagement of moral self- sanctions from inhumane conduct. Bandura et al. developed the 32-item Moral Disengagement Scale (MDS). Psychometric testing by Bandura et al. demonstrated a unidimensional scale with a Cronbach’s alpha of 0.83. For our study, we modified items in the perspective of general healthcare. The scale’s Cronbach’s alpha of 0.85 in our study was consistent with the findings by Bandura et al. and indicated that translation and adaptation did not affect the internal consistency of the scale. An index score was calculated using the same algorithm as employed for the MSQ. The MDS is an indicator with a continuum ranging from 0 to 100. The lower-end scores reflect the degree of respondents’ self-censure, i.e. moral self-control, meaning one refrains from behavior that violates the own moral standard, and the high-end scores indicate a high propensity to morally disengage. Defining Issues Test (DIT-N2) The Dutch short-form version of the DIT was used to test the discriminant validity of the MSQ-PATER and MSQ-DELIB subscales. In the DIT (short form) being used, participants were presented with three standard scenario-based moral dilemmas: “Heinz and the drug,” “The escaped prisoner,” and “The newspaper.” Each scenario was followed by eight statements that were meant to evoke the respondent’s deliberations in solving the dilemma.