Luppo Kuillman

Chapter 3 72 to a desire to deliver the same standard of quality care - may evoke moral dilemmas. The curriculums used to train healthcare professionals addresses professionalism to some extent, by way of courses including clinical ethics. The literature makes note of such courses in training programs for professionals such as nurses, physical therapists, pharmacists and medical doctors. However, these courses largely emphasize moral reasoning (Self et al. 1993, Duckett et al. 1997, Dieruf 2004, Prescott et al. 2014). The outcomes of our study provide evidence that training programs can only increase moral reasoning strategies to a certain extent. After all, the level of moral reasoning is a function of the Stability personality type and personality is largely stable over a person’s lifespan (McCrae & Costa Jr 1999) (p. 145). Therefore, another way to foster principled moral reasoning among healthcare professionals would be to use the Big Five as a selection tool and select for the Stability personality type when hiring personnel. It is now common to include personality assessments in job application procedures. Selecting people with the Stability personality type might be of special importance in disciplines that are known to have a difficult moral climate (e.g., palliative care, intensive care). Another important finding in this study is that the relationship between Stability and moral reasoning is mediated by moral disengagement. Considering that disengagement from moral self-control is “malleable to external influences over time” (Paciello et al. 2008), something could be done to “unlearn” people’s tendency to morally disengage. In this view, it is advisable, in ethics courses, to counter the force of moral disengagement by practicing health practitioners (especially those who score low on the factor Stability) to morally engage instead. This is in line with the Aristotelian view that, although virtues are character traits, virtues are trainable. More specific, according to Aristotle, by practicing virtue, individuals acquire virtue (Urmson 1988). This practicing is a rational process and involves finding a balance between extremes (for example, finding the balance of “honesty” between the extremes of “secrecy” and “talkativeness” and finding the balance of “courage” between the extremes of “cowardice” and “rashness”) (Larkin et al. 2009). Thus, in ethical training courses, students and healthcare professionals can not only be made aware that disengaging frommoral self-control is non-virtuous (as it can cause harm and create a pathological basis for professional conduct) but can also be trained into mechanisms of moral engagement by practicing virtuous behaviors. This could be done by training in programs using simulation exercises (e.g., with standardized patients).