Luppo Kuillman

Chapter 3 58 (Pauly et al. 2012). Factors contributing to moral-conflict-laden situations include: (a) manpower problems; (b) effects of increasing efficiency demands; (c) disturbed increasing hierarchical power; and (d) increasing lack of control over one’s own professional conduct (Burston & Tuckett 2013), (Sporrong et al. 2006). These factors may affect the patient-healthcare professional relationship and could lead to the onset of moral dilemmas in this relationship (De Haan 2001). BACKGROUND With the Four Component Model of Moral Behavior (FCM), coping with a moral dilemma is assumed as amulti-dimensional process where four factors simultaneously play a role in the decision-making process: a) moral sensitivity; b) moral reasoning; c) moral motivation; and d) moral character (Rest et al. 1999b). Moral sensitivity means that an individual recognizes that a decision has moral aspects and that he/ she can properly assess the interests and risks for a patient, the care provider and society. Moral reasoning means that an individual can process information to make a judgment about what action is morally right. Moral motivation entails the importance an individual attaches to enhancing patient interest and the moral character reflects the degree of the individual’s ego, strength and implementation skills to ultimately follow his or her intentions. In the current paper, we zoom in on the component of moral reasoning. Recognizing that individuals may differ in their level of moral reasoning, Kohlberg introduced moral reasoning as the manifestation of an inner-psychological and cognitive- developmental structure that governs action in situations where moral claims conflict (Kohlberg 1969). Theoretically, moral reasoning is divided into three stages: (a) pre-conventional stage, reflecting considerations characterized as personal-interest (maximizing rewards, obeying authority figures, conforming to perceived external norms and standards); (b) conventional stage, reflecting a perspective wider than self-interest where the importance of doing one’s duty and emphasizing legal, religious, or societal precepts are more prevalent in decision- making; and (c) post-conventional (principled) stage of moral reasoning emerging from self- chosen ethical principles that are logical, comprehensive and consistent in the perceptions of those who must make ethical decisions. These stages of moral reasoning were operationalized in the Defining Issues Test (DIT-N2 index) (Rest et al. 1997), which has become widely used.