Soft Skills Are Hard Skills-A Historical Perspective.

The increasingly swift changes in the field of medicine require a reassessment of the skills necessary for the training of technically qualified doctors. Today's physicians also need to be capable of managing the complex issue of personal relationships with patients. Recent pedagogical debates have focused on so-called "soft skills", whose acquisition is presented in literature as a quite recent addition to medical studies. Moreover, the historical investigation of deontological texts dating from the mid-nineteenth century back to the Hippocratic Oath shows that medicine has always discussed the need to integrate technical expertise in medicine with specific personal and relationship-based skills. Debates have often circled around whether these "soft skills" could actually be taught or how they could be successfully transmitted to training physicians. The belief that defining medicine is more complex than defining other similar sciences and that the instruments to be used in the relationship with patients cannot be limited to those provided by technical aspects shows a new awareness. Today, this view is often stated as an innovative realization on the part of doctors with regard to the complexity of training and action in a delicate area in which they are entrusted with the management of the balance of the system that is the human body.

The need for a unified ethical stance on child genital cutting.

The American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and other largely US-based medical organizations have argued that at least some forms of non-therapeutic child genital cutting, including routine penile circumcision, are ethically permissible even when performed on non-consenting minors. In support of this view, these organizations have at times appealed to potential health benefits that may follow from removing sexually sensitive, non-diseased tissue from the genitals of such minors. We argue that these appeals to "health benefits" as a way of justifying medically unnecessary child genital cutting practices may have unintended consequences. For example, it may create a "loophole" through which certain forms of female genital cutting-or female genital "mutilation" as it is defined by the World Health Organization-could potentially be legitimized. Moreover, by comparing current dominant Western attitudes toward female genital "mutilation" and so-called intersex genital "normalization" surgeries (i.e. surgeries on children with certain differences of sex development), we show that the concept of health invoked in each case is inconsistent and culturally biased. It is time for Western healthcare organizations-including the American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and World Health Organization-to adopt a more consistent concept of health and a unified ethical stance when it comes to child genital cutting practices.

The challenges of ethical behaviors for drug supply in pharmacies in Iran by a principle-based approach.

BACKGROUND: Pharmacists as the trustee of pharmacy services must adhere to ethical principles and evaluate their professionalism. Pharmacists may sometimes show different unethical behaviors in their interactions, so it is essential to understand these behaviors. The present study aimed to determine the challenges of ethical behaviors based on a principles-based approach in the area of drug supply in pharmacies. METHODS: This qualitative content analysis was conducted in Kerman in 2018. A number of key players in the field of medication supply were selected using snowball sampling to interview. An effort was made to select samples with maximum variation. Exclusion criteria include having less than 3 years of work experience in pharmacy and supervision, not willing to participate in the interview, and not participating in the interview for 3 times. The participants in this study consisted of pharmacy technicians (n = 5), patients (n = 6), pharmacists (n = 8), inspectors of insurance companies (n = 4), and inspectors of food and drug administration (n = 3). Data were analyzed using directed content analysis by Maxqda software version 10 (VERBI Software, Berlin, Germany). The principles of "Beauchamp and Childress Ethics" theory including autonomy, beneficence, non-maleficence, and justice were selected as the main principles. RESULTS: After data analysis, 8 main categories and 26 subcategories were obtained. The main categories include patient privacy, patient independence, communication principles, patient-centered services, drug supplier, patient harm avoidance, supervision, and distributive, procedural, and interactional justice. The subcategories include increasing patient awareness, culturizing prescription, and rational drug use, confidentiality and privacy, and pharmacist-patient relationship/communication, which were the main ethical challenges in the area of drug supply at pharmacies. CONCLUSIONS: According to a principle-based approach, the greatest challenges were related to two principles of autonomy and beneficence. The policymakers in the healthcare system should emphasize patient independence, patient privacy, and patient-centered services. The results of this study can be used as a tool to introduce ethical challenges to policymakers and develop educational contents, the chart of professional ethics in pharmacies, and accreditation measures of pharmacies.

[Ethical support units: benefits and limits of externalised ethics in times of crisis]. / "Cellules éthiques de soutien", apports et limites d'une éthique externalisée en temps de crise.

This health crisis has revealed the difficulties, but also the creativity of the caregiving teams. In this context, assisting health professionals through the creation of an ethical support unit is valuable. However, the implementation of such a unit requires reflection with the definition of the resulting limits. Two questions are raised: is it really possible to externalise ethical reflection? Is there such a thing as ethics of crisis?

Respect for patient autonomy as a medical virtue.

Respect for patient autonomy is an important and indispensable principle in the ethical practice of clinical medicine. Legal tenets recognise the centrality of this principle and the inherent right of patients of sound mind - properly informed - to make their own personal medical decisions. In the course of everyday medical practice, however, challenging cases may result in ethical dilemmas for the patient, the physician, and society. Resolution of these dilemmas requires a thorough understanding of the underlying principles that allow the clinician to make informed decisions and to offer considered therapeutic options to the patient. We argue in this paper that there is also need for a transition of moral competency from understanding principles to attaining virtue in the classic Aristotelian tradition. Achieving moral virtue is based on a lifetime of learning, practising, and watching how others, who have achieved virtue, act and perform their duties. We further claim that learning moral virtue in medical practice is best realised by incorporating the lessons learnt during daily rounds where frank discussions and considered resolutions can occur under the leadership of senior practitioners who have achieved a semblance of moral excellence.

Stigmatization and denormalization as public health policies: some Kantian thoughts.

The stigmatization of some groups of people, whether for some characteristic they possess or some behavior they engage in, will initially strike most of us as wrong. For many years, academic work in public health, which focused mainly on the stigmatization of HIV-positive individuals, reinforced this natural reaction to stigmatization, by pointing out the negative health effects of stigmatization. But more recently, the apparent success of anti-smoking campaigns which employ stigmatization of smokers has raised questions about whether stigmatization may sometimes be justified, because of its positive effects on public health. Discussion of the issue so far has focused on consequences, and on some Kantian considerations regarding the status of the stigmatized. In this article, I argue that further Kantian considerations regarding the treatment of the general public (the potential stigmatizers) also count against any public health policy involving stigmatization. Attempts to encourage stigmatization are likely to fail to appeal to the rational decision-making abilities of the general public, and the creation of stigmatized groups (even if they are stigmatized for their voluntary behavior) is an obstacle to the self-improvement of members of the general public.

Social class and moral judgment: a process dissociation perspective.

Do social classes differ in moral judgment? Previous research showed that upper-class actors have a greater inclination toward utilitarian judgments than lower-class actors and that this relationship is mediated by empathic concern. In this paper, we take a closer look at class-based differences in moral judgment and use the psychometric technique of process dissociation to measure utilitarian and deontological decision inclinations as independent and orthogonal concepts. We find that upper-class actors do indeed have a greater inclination toward decisions consistent with utilitarian principles, albeit only to a quite small extent. Class-related differences are more pronounced with respect to deontological judgments, in so far as upper-class actors are less inclined to judgments consistent with deontological principles than lower-class actors. In addition, it is shown that class-based differences in utilitarian judgments are mediated by cognitive styles and not so much by empathic concern or moral identity. None of these potential mediators explains class-based differences in the inclination toward deontological judgments.

A Meta-Analytical Assessment of the Effect of Deontological Evaluations and Teleological Evaluations on Ethical Judgments/Intentions.

Deontological and teleological evaluations are widely utilized in the context of consumer decision-making. Despite their use, the differential effect of these distinct types of evaluations, and the conditions under which they hold, remains an unresolved issue. Thus, we conduct a meta-analysis of 316 effect sizes, from 53 research articles, to evaluate the extent to which deontological and teleological evaluations influence ethical judgments and intentions, and under what circumstances the influence occurs. The effect is explored across three categories of moderators: (1) contextual elements of the ethical issue, (2) stakeholders, and (3) methodological characteristics of primary studies. We find that the overall effect of deontological evaluations on ethical judgments and intentions is stronger than for teleological evaluations; however, the magnitude of the effect is contingent on several moderators. Deontological evaluations are weaker in offline consumer contexts and stronger when there are financial implications of the ethical issue. Conversely, the effect of teleological evaluations is relatively stable across ethical consumer contexts. Teleological evaluations are stronger from a utilitarian perspective than from an egoist one. Furthermore, the effect of deontological evaluations is weaker, but the effect for teleological evaluations is stronger, when the decision-maker has a personal relationship (as compared to an organizational relationship) with the victim of the unethical act. Findings validate the effect of both deontological and teleological evaluations on ethical judgments and intentions and highlight their importance in consumers' ethical decision-making. Implications for developing programs to prevent consumer unethical behavior are discussed.

An Asymmetric Effect: Physical and Simulated Confederate's Mere Presence Induce a Preference for Deontological Over Utilitarian Judgment.

People may behave differently in a shared physical context due to the mere presence of others. The study examined whether individual moral judgments were subject to the confederate's presence. Experiment 1 supported the hypothesis that the confederate's presence, relative to the control group, increased deontological judgment, disapproving of sacrificing a person's lifetime or interest for preserving the greater good of others. Experiment 2 investigated whether the results extend to mental space. The result revealed that simulating a positive interaction with the confederate significantly increased the preference for deontological judgments relative to the control group. However, the effect disappeared if the participants were required to simulate only the person from the scenario that did not include any additional background contexts. These results demonstrated that the confederate's physical presence and simulated confederate's presence always preferred deontological judgments over utilitarian judgments. The findings suggested that the asymmetric moral effect occurred in the physical realm and mental space.

Deontological Guilt and Moral Distress as Diametrically Opposite Phenomena: A Case Study of Three Clinicians.

Feelings of guilt are human emotions that may arise if a person committed an action that contradicts basic moral mores or failed to commit an action that is considered moral according to their ethical standards and values. Psychological scholarship distinguishes between altruistic guilt (AG) and deontological guilt (DG). AG results from having caused harm to an innocent victim, either by acting or failing to act, whereas DG is caused by violating a moral principle. Although physicians may be expected to experience frequent feelings of guilt in their demanding and intensive work, it is surprising to find that this issue has not been explored in the professional literature on medical ethics. To that end, we conducted a qualitative study that included personal in-depth interviews with Sunni Muslim gynaecologists. These doctors provide underground infertility care and perform religiously forbidden treatments involving sex selection and gamete donation. They opened their hearts and spoke about the emotionally taxing pangs of conscience they suffer. Analysing their narratives led us to characterize their feelings of guilt as DG. We discuss the causes for their plight and the way they cope with it, compare DG to the concept of moral distress, and call for future research on clinicians' feelings of guilt and pangs of conscience.

Ethical Orientation and Research Misconduct Among Business Researchers Under the Condition of Autonomy and Competition.

The topics of ethical conduct and governance in academic research in the business field have attracted scientific and public attention. The concern is that research misconduct in organizations such as business schools and universities might result in practitioners, policymakers, and researchers grounding their decisions on biased research results. This study addresses ethical research misconduct by investigating whether the ethical orientation of business researchers is related to the likelihood of research misconduct, such as selective reporting of research findings. We distinguish between deontological and consequentialist ethical orientations and the competition between researchers and investigate the moderating role of their perceived autonomy. Based on global data collected from 1031 business scholars, we find that researchers with a strong deontological ethical orientation are less prone to misconduct. This effect is robust against different levels of perceived autonomy and competition. In contrast, researchers having a consequentialist ethical orientation is positively associated with misconduct in business research. High levels of competition in the research environment reinforce this effect. Our results reveal a potentially toxic combination comprising researchers with a strong consequentialist orientation who are embedded in highly competitive research environments. Our research calls for the development of ethical orientations grounded on maxims rather than anticipated consequences among researchers. We conclude that measures for ethical governance in business schools should consider the ethical orientation that underlies researchers' decision-making and the organizational and institutional environment in which business researchers are embedded.

The Role of Childhood Experiences in the Development of Disgust Sensitivity: A Preliminary Study on Early Moral Memories.

Objective: Disgust is a basic emotion evolved to safeguard our omnivorous species from contagion. Although the factors eliciting disgust typically involve concerns related to physical contamination, physical disgust responses are also prompted by moral transgressions, (i.e. cannibalism, pedophilia, betrayal). The link between the general propensity to experience disgust (i.e. "Disgust Sensitivity") and morality, in particular in the deontological domain, is supported by an increasing amount of data on clinical and non-clinical sample. Evolutionistic explanations of this link posit that disgust evolved to indicate the presence of a threat to the integrity of the individual not only in the physical domain but also in the social and moral domain.In addition to the evolutionary point of view, this link could also be better investigated in terms of individual development. To the best of our knowledge, literature is scarce regarding which early experiences are associated to high DS. Therefore, this study aims to explore the content of early memories associated with disgust. Based on the strict link between disgust and morality, we hypothesized an association between DS and early memories of moral criticism. Method: 60 non-clinical participants filled in measures of DS. They were then presented with an auditory disgust induction, after which they recalled early memories through the technique of the "affect bridge". 10 independent raters assessed the emotional content of the memories on visual-analogical scales. Results: Results showed a positive association between disgust sensitivity and the propensity to experience deontological guilt. There was also a significant positive association between disgust sensitivity and moral memories, in particular relating to early experiences of being the object of contempt, moral criticism, anger, and of being held responsible. Conclusions: These data directly support the centrality of early morally-loaded interpersonal experiences in the development of DS, confirming the link between disgust and morality also at the level of individual historical development.

Fickle Judgments in Moral Dilemmas: Time Pressure and Utilitarian Judgments in an Interdependent Culture.

In the trolley problem, a well-known moral dilemma, the intuitive process is believed to increase deontological judgments, while deliberative reasoning is thought to promote utilitarian decisions. Therefore, based on the dual-process model, there seems to be an attempt to save several lives at the expense of a few others in a deliberative manner. This study examines the validity of this argument. To this end, we manipulate decision-making time in the standard trolley dilemma to compare differences among 119 Japanese female undergraduates under three conditions: intuitive judgment, deliberative judgment, and judgment after a group discussion. The current results demonstrate that utilitarian judgments decreased from 52.9% in the intuition condition to 43.7% in the deliberation condition and 37.0% after the discussion. Additional analysis suggests that the decrease in utilitarian judgments may be related to psychological unwillingness to assume responsibility for the lives of others rather than to an increase in deontological judgments. Finally, these results are discussed from an adaptationist perspective.

Guilt Feelings in Obsessive Compulsive Disorder: An Investigation between Diagnostic Groups.

Guilt plays a role in various forms of psychopathology. However, different types of guilt might be involved in different mental disorders. Obsessive-compulsive (OC) patients are prone to a type of guilt in which the violation of an internalized moral norm is necessary and sufficient, whereas data suggest that depression might be linked to more interpersonal types of guilt. However, the extent to which a specific guilt phenomenology is involved in each condition is yet to be determined. Here we assessed the association between different types of guilt and different diagnostic groups. Two clinical samples (33 OCD and 35 non-OCD) filled in the Moral Orientation Guilt Scale (MOGS) along with other OCD and depression measures. Regression was employed to test group differences in the MOGS subscales and to test the influence of MOGS subscales on OCD and depression levels. Results confirm that different types of guilt might be implicated in different psychopathological conditions. Specifically, moral norm violation guilt is more present in OC patients than in other disorders. Depression seems to be associated with different guilt feelings depending on the psychopathological condition, specifically in non-OC patients, with types of guilt involving a "victim", supporting the accounts viewing interpersonal guilt as involved in the emergence of depressive symptomatology and hyper-altruistic behavior as a vulnerability factor for depression.

Anticipatory Stress Increases Deontological Inclinations: The Mediating Role of Emotional Valence.

Previous studies have explored the differences in moral judgments under normal situations and acute stress using the Trier Social Stress Test (TSST). The present study examined whether anticipatory stress (i.e., induced by an anticipated speech) could elicit similar effects and further explored the mediation of emotional responses between acute stress and moral judgments with a process-dissociation approach. Fifty-three undergraduate students (20 males and 33 females) were randomly assigned to the stress and control groups. In the first stage, they were instructed to prepare a public speech (the stress group) or just recall events during the previous vacation (the control group). In the second stage, they reported emotional valence and arousal for each moral dilemma in a set of 12 moral dilemmas, followed by judgments on moral acceptability of the agent's action. The manipulation check confirmed that anticipatory stress was reliably induced, as indicated in both self-reported and physiological data. The traditional dilemma analysis revealed that participants in the stress group would make fewer utilitarian judgments than those in the control group. The process dissociation (PD) analyses further revealed that the stress group exhibited higher deontological inclinations than the control group, but no significant differences in utilitarian inclinations. Emotional valence played a mediating role in the association between stress and deontological inclinations. To sum up, our study extended the investigation of the relationship between acute stress and moral judgment to anticipatory stress, clarified its distinct impact on deontological and utilitarian inclinations, and revealed the mediating effect of emotional valence.

Effects of Primary and Secondary Psychopathy on Deontological and Utilitarian Response Tendencies: The Mediator Role of Alexithymia.

(1) Background: The purpose of this study is to provide more nuanced insights into the effects of sub-dimensional levels of psychopathy on moral dilemma judgments. To this end, this study examined the effects of primary and secondary psychopathy on utilitarian and deontological response tendencies. Moreover, this study also explored the mediating role of alexithymia as well as the moderating role of gender in these effects. (2) Methods: A total of 1227 participants were recruited through the online questionnaire service wjx.cn. After deleting unfinished questionnaires, the remaining 1170 participants were included in the final data analysis. Each participant completed a demographic information questionnaire, the Levenson Self-Report Psychopathy Scale, the Toronto Alexithymia Scale-20, and six pairs of moral dilemmas. Descriptive and correlational analyses of study variables were conducted in SPSS 22.0. Mediation and gender difference analyses were conducted in AMOS 23.0. (3) Results: Primary psychopathy was negatively correlated with deontological response tendencies and uncorrelated with utilitarian response tendencies. By contrast, secondary psychopathy also correlated negatively with deontological response tendencies, but it correlated positively with utilitarian response tendencies. Mediation analysis revealed that alexithymia only mediated the relationship between secondary psychopathy and deontological response tendencies. Multi-group analysis revealed that there was no difference between females and males in the indirect effect model. (4) Conclusions: People with high primary psychopathy are less likely to reject harm in moral dilemmas. By contrast, people with high secondary psychopathy have high alexithymia, which causes them to be less concerned about avoiding harm, and they are more likely to maximize outcomes in moral dilemmas. These findings shed new light on the moral dilemma judgments of individuals with primary and secondary psychopathy.

The Interplay Between Absolute Language and Moral Reasoning on Endorsement of Moral Foundations.

Morality - the subjective sense that humans discern between right and wrong - plays a ubiquitous role in everyday life. Deontological reasoning conceptualizes moral decision-making as rigid, such that many moral choices are forbidden or required. Not surprisingly, the language used in measures of deontological reasoning tends to be rigid, including phrases such as "always" and "never." Two studies (N = 553) drawn from two different populations used commonly used measures of moral reasoning and measures of morality to examine the link between individual differences in deontological reasoning and language on the endorsement of moral foundations. Participants low on deontological reasoning generally showed less endorsement for moral principles when extreme language was used in the measures (relative to less extreme language).

Deontological Guilt and Disgust Sensitivity Modulate Moral Behaviour.

OBJECTIVE: Deontological Guilt (DG), and Altruistic Guilt (AG) emerge from the appraisal of violating an internalized rule or an altruistic principle, respectively. DG is strictly connected with Disgust Sensitivity and plays a key role in the development and maintenance of Obsessive-Compulsive Disorder (OCD). Previous studies investigated how DG affects responses to hypothetical moral dilemmas, however how DG and Disgust Sensitivity interact modulating moral behavior is still unknown. METHODS: STUDY 1. 46 healthy participants performed an ecological paradigm in which people can spontaneously decide to lie to obtain a reward (egoistic lie) or give it away (altruistic lie) after three emotional inductions: DG, AG or neutral. Furthermore, OCD traits, Morality, Guilt Propensity and Disgust Sensitivity were assessed by means of questionnaires. STUDY 2. 27 participants from the original sample were retested during the COVID-19 lockdown in Italy to ascertain whether the pandemic modified traits related to morality, disgust, guilt or OCD symptoms and whether these changes modulated moral behavior (measured by a task in which cheating was associated to higher pay-offs). RESULTS: STUDY 1. Compared to the neutral, after the DG induction participants produced less altruistic and more egoistic lies. This effect was stronger in participants with high Disgust Sensitivity. STUDY 2. During the COVID-19 lockdown participants became more sensitive to the Authority pillar of the Moral Foundations and more sensitive to Disgust: this increment in deontological morality affected (im) moral behavior depending on changes in Disgust Sensitivity. CONCLUSIONS: Our data suggest that people with high Disgust Sensitivity are more affected by deontological inductions which translate to higher immorality, supposedly by lowering their moral self-image. These results might have important clinical implications as they suggest that addressing Disgust Sensitivity in therapy, might also decrease the effect of guilt on patients' behavior.

Deontological or Utilitarian? An Eternal Ethical Dilemma in Outbreak.

Both deontological ethics and utilitarian ethics are important theories that affect decision making in medical and health care. However, it has been challenging to reach a balance between these two ethical theories. When there is a conflict between these two ethical principles in the medical context, the conflict must be addressed in order to reach an appropriate solution for patients and others involved. To demonstrate decisions made in terms of deontological ethics and utilitarian ethics, the study will use the film Outbreak as example to further understand these two ethics in relation to epidemiology and public health. The paper will also analyze film scenarios to examine how deontological ethics and utilitarian ethics are involved and strike a balance with different pearspectives to reach an appropriate public health solution. To reach more just solutions, it is essential to determine how to make wise decisions by balancing deontological ethics and utilitarian ethics. However, the decision-making process is complicated because any solution must consider not only medical ethics but also political, environmental, and military issues. In order to reach an appropriate public health decision, those involved should be inclined toward empathy and contemplate things from different ethical perspectives to deal with ethical/moral dilemmas and create greater beneficence and justice for patients and humanity at large.