Influences of past moral behavior on future behavior: A review of sequential moral behavior studies using meta-analytic techniques.

Experimental research on sequential moral behavior (SMB) has found that engaging in an initial moral (or immoral) behavior can sometimes lead to moral balancing (i.e., switching between positive and negative behavior) and sometimes to moral consistency (i.e., maintaining a consistent pattern of positive or negative behavior). In two meta-analyses, we present the first comprehensive syntheses of SMB studies and test moderators to identify the conditions under which moral balancing and moral consistency are most likely to occur. Meta-Analysis 1 (k = 217 effect sizes, N = 31,242) revealed that engaging in an initial positive behavior only reliably resulted in moral licensing (i.e., balancing) in studies that measured engagement in negative target behaviors (Hedges' g = 0.25, 95% CI [0.16, 0.44]) and only resulted in positive consistency in foot-in-the-door studies using prosocial requests (Hedges' g = -0.44, 95% CI [-0.59, -0.29]). Meta-Analysis 2 (k = 132 effect sizes, N = 14,443) revealed that engaging in an initial negative behavior only reliably resulted in moral compensation (i.e., balancing) in studies that measured engagement in positive target behaviors (Hedges' g = 0.27, 95% CI [0.18, 0.37]). We found no evidence for reliable negative consistency effects in any conditions. These results cannot be readily explained by current theories of SMB effects, and so further research is needed to better understand the mechanisms that drive moral balancing and consistency under the conditions observed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychiatric Hospitals and the Ethics of Salutogenic Design: The Return of Moral Architecture?

ABSTRACT: Bioethicists have long been concerned with the mistreatment of institutionalized patients, including those suffering from mental illness. Despite this attention, the built environments of health care settings have largely escaped bioethical analysis. This is a striking oversight given that architects and social scientists agree that buildings reflect and reinforce prevailing social, cultural, and medical attitudes. Architectural choices are therefore ethical choices. We argue that mental health institutions are fertile sites for ethical analysis. Examining the ethics of architecture calls attention to the potential for hospitals to hinder autonomy. Additionally, such examination highlights the salutogenic possibilities of institutional design, that is to care, nurture, and enhance patient and provider well-being.

A mixed-methods analysis of moral injury among healthcare workers during the COVID-19 pandemic.

During the COVID-19 pandemic, healthcare workers faced grave responsibilities amidst rapidly changing policies and material and staffing shortages. Moral injury, psychological distress following events where actions transgress moral beliefs/ expectations, increased among healthcare workers. We used a sequential mixed methods approach to examine workplace and contextual factors related to moral injury early in the pandemic. Using a Total Worker Health® framework, we 1) examined factors associated with moral injury among active healthcare professionals (N = 14,145) surveyed between May-August 2020 and 2) qualitatively analyzed open-ended responses from 95 randomly selected participants who endorsed moral injury on the survey. Compared to inpatient hospital, outpatient (OR = 0.74 [0.65, 0.85]) or school clinic settings (OR = 0.37 [0.18, 0.75]) were associated with lower odds of moral injury; while group care settings increased odds (OR = 1.36 [1.07, 1.74]). Working with COVID+ patients (confirmed+ OR = 1.27 [1.03, 1.55]), PPE inadequacy (OR = 1.54 [1.27, 1.87]), and greater role conflict (OR = 1.57 [1.53, 1.62]) were associated with greater odds of moral injury. Qualitative findings illustrate how outside factors as well as organizational policies and working conditions influenced moral injury. Moral injury experiences affected staff turnover and patient care, potentially producing additional morally injurious effects. Worker- and patient-centered organizational policies are needed to prevent moral injury among healthcare workers. The generalizability of these findings may be limited by our predominantly white and female sample. Further research is indicated to replicate these findings in minoritized samples.

Opioid Epidemic Grief and Characterological Harm Reduction.

This article considers what it might mean to do the moral work of grieving during an opioid epidemic. Becoming callous, bitter, or resentful are harms we can suffer to our characters when grieving losses, especially at epidemic scale. This article suggests how appreciating beauty can play roles in grieving that could help mitigate these harms.

Understanding the moral cognition of aggression: Longitudinal serial effects of personal relative deprivation and hostility on within-person changes in civic moral disengagement.

Moral disengagement is an important aggressive and moral cognition. The mechanisms of changes in moral disengagement remain unclear, especially at the within-person level. We attempted to clarify this by exploring the serial effects of personal relative deprivation and hostility on civic moral disengagement. We conducted a three-wave longitudinal survey with 1058 undergraduates (63.61% women; mean age = 20.97). The results of the random intercept cross-lagged panel model showed that personal relative deprivation at Wave 1 and hostility at Wave 2 formed a serial effect on the within-person changes in civic moral disengagement at Wave 3, and the longitudinal indirect effect test showed that the within-person dynamics in hostility at Wave 2 acted as a mediator. The results of multiple group analysis across genders further showed that the longitudinal indirect role of hostility at Wave 2 was only observed for men, but not for women, which indicates the moderating effect of gender. These findings facilitate an understanding of the mechanisms of aggressive cognitions at the within-person level and offer implications for the prevention and intervention of aggression from the perspective of moral cognition.

Inconsistent advice by ChatGPT influences decision making in various areas.

The ChatGPT technology is increasingly becoming a part of our daily lives and is starting to be utilized in various decision-making contexts. The current study builds upon prior research, demonstrating that people's moral decision-making is influenced by ChatGPT across three perspectives, as evidenced by two studies (total n = 1925). The findings suggested that ChatGPT advice impacted decision-making similarly to expert advice, although not all decisions were susceptible to influence, particularly those based on negative emotions. Additionally, ChatGPT advice affected decisions beyond moral judgments, but no effect was observed when the advice recommended immediate low rewards. Moreover, individuals with a higher tendency for personal fear of invalidity were more likely to be influenced by both expert and AI advice, but this was not related to trust in AI.

Comparing First-Year Engineering Student Conceptions of Ethical Decision-Making to Performance on Standardized Assessments of Ethical Reasoning.

The Defining Issues Test 2 (DIT-2) and Engineering Ethical Reasoning Instrument (EERI) are designed to measure ethical reasoning of general (DIT-2) and engineering-student (EERI) populations. These tools-and the DIT-2 especially-have gained wide usage for assessing the ethical reasoning of undergraduate students. This paper reports on a research study in which the ethical reasoning of first-year undergraduate engineering students at multiple universities was assessed with both of these tools. In addition to these two instruments, students were also asked to create personal concept maps of the phrase "ethical decision-making." It was hypothesized that students whose instrument scores reflected more postconventional levels of moral development and more sophisticated ethical reasoning skills would likewise have richer, more detailed concept maps of ethical decision-making, reflecting their deeper levels of understanding of this topic and the complex of related concepts. In fact, there was no significant correlation between the instrument scores and concept map scoring, suggesting that the way first-year students conceptualize ethical decision making does not predict the way they behave when performing scenario-based ethical reasoning (perhaps more situated). This disparity indicates a need to more precisely quantify engineering ethical reasoning and decision making, if we wish to inform assessment outcomes using the results of such quantitative analyses.

AI Through Ethical Lenses: A Discourse Analysis of Guidelines for AI in Healthcare.

While the technologies that enable Artificial Intelligence (AI) continue to advance rapidly, there are increasing promises regarding AI's beneficial outputs and concerns about the challenges of human-computer interaction in healthcare. To address these concerns, institutions have increasingly resorted to publishing AI guidelines for healthcare, aiming to align AI with ethical practices. However, guidelines as a form of written language can be analyzed to recognize the reciprocal links between its textual communication and underlying societal ideas. From this perspective, we conducted a discourse analysis to understand how these guidelines construct, articulate, and frame ethics for AI in healthcare. We included eight guidelines and identified three prevalent and interwoven discourses: (1) AI is unavoidable and desirable; (2) AI needs to be guided with (some forms of) principles (3) trust in AI is instrumental and primary. These discourses signal an over-spillage of technical ideals to AI ethics, such as over-optimism and resulting hyper-criticism. This research provides insights into the underlying ideas present in AI guidelines and how guidelines influence the practice and alignment of AI with ethical, legal, and societal values expected to shape AI in healthcare.

Schadenfreude or empathy? Children's emotional responses to the physical pain and pleasure of prosocial and antisocial others.

Adults' emotional reactions to the pain and pleasure of others are influenced by the moral character of those individuals. However, it remains unclear whether children's emotional responses also show such selectivity. To investigate this, we compared 4- to 8-year-old children's emotional responses to the physical pain and pleasure of prosocial versus antisocial puppets. In Study 1, children reported unhappiness after witnessing the pain of the prosocial and antisocial puppets but reported less unhappiness after witnessing the pain of the antisocial puppet. In Study 2, children reported happiness after witnessing the pleasure of both puppets but reported being less happy for the antisocial puppet. These results suggest that children are less likely to empathize with antisocial individuals. Meanwhile, children did not display Schadenfreude (pleasure at others' pain) or Gluckschmerz (displeasure at others' pleasure) toward antisocial individuals in our studies. Moreover, the selectivity of children's emotional responses disappeared after we manipulated the physical competence rather than the moral character of the puppets in Study 3. Our findings help to reveal the moral selectivity of emotional responses to others' pleasure and pain during early childhood.

Robust memory of face moral values is encoded in the human caudate tail: a simultaneous EEG-fMRI study.

Moral judgements about people based on their actions is a key component that guides social decision making. It is currently unknown how positive or negative moral judgments associated with a person's face are processed and stored in the brain for a long time. Here, we investigate the long-term memory of moral values associated with human faces using simultaneous EEG-fMRI data acquisition. Results show that only a few exposures to morally charged stories of people are enough to form long-term memories a day later for a relatively large number of new faces. Event related potentials (ERPs) showed a significant differentiation of remembered good vs bad faces over centerofrontal electrode sites (value ERP). EEG-informed fMRI analysis revealed a subcortical cluster centered on the left caudate tail (CDt) as a correlate of the face value ERP. Importantly neither this analysis nor a conventional whole-brain analysis revealed any significant coding of face values in cortical areas, in particular the fusiform face area (FFA). Conversely an fMRI-informed EEG source localization using accurate subject-specific EEG head models also revealed activation in the left caudate tail. Nevertheless, the detected caudate tail region was found to be functionally connected to the FFA, suggesting FFA to be the source of face-specific information to CDt. A further psycho-physiological interaction analysis also revealed task-dependent coupling between CDt and dorsomedial prefrontal cortex (dmPFC), a region previously identified as retaining emotional working memories. These results identify CDt as a main site for encoding the long-term value memories of faces in humans suggesting that moral value of faces activates the same subcortical basal ganglia circuitry involved in processing reward value memory for objects in primates.

When Life-Supporting Interventions Lead to Moral Distress.

Moral distress can impact nurses and the care team significantly. A profession dedicated to the principles of caring and compassion is often subjected to patients receiving futile treatment. With the proliferation of extreme life-prolonging measures come the difficulties in the withdrawal of those medical modalities. If a prognosis is poor and care is perceived as curative rather than palliative, providers may often feel conflicted and distressed by their interventions. The American Association of Colleges of Nursing has expressed growing concern about an increase in the use of inappropriate life-support treatments related to futile care. The compelling case of a severely beaten 69-year-old homeless man who had cardiac-arrested and was resuscitated after an unknown amount of down-time, provides the contextual framework for this report. Ethical conflicts can become very challenging, which inevitably increases the suffering of the patient and their caregivers. Research findings suggest that health care organizations can benefit from enacting processes that make ethical considerations an early and routine part of everyday clinical practice. A proactive approach to ethical conflicts may improve patient care outcomes and decrease moral distress.

Contractualist tendencies and reasoning in moral judgment and decision making.

The social-contract tradition of Hobbes, Rousseau, Kant, and Rawls has been widely influential in moral philosophy but has until recently received relatively little attention in moral psychology. For contractualist moral theories, ethics is a matter of forming, adhering to, and enforcing (hypothetical) agreements, and morality is fundamentally about acting according to what would be agreed by rational agents. A recent psychological theory, virtual bargaining, models social interactions in contractualist terms, suggesting that we often act as we would agree to do if we were to negotiate explicitly. However, whether such contractualist tendencies (a propensity to make typically contractualist choices) and forms of reasoning (agreement-based cognitive processes) play a role in moral cognition is still unclear. Drawing upon virtual bargaining, we develop two novel experimental paradigms designed to elicit incentivized decisions and moral judgments. We then test the descriptive relevance of contractualism in moral judgment and decision making in five preregistered online experiments (n = 4103; English-speaking Prolific participants). In the first task, we find evidence that many participants show contractualist tendencies: their choices are "characteristically" contractualist. In the second task, we find evidence consistent with contractualist reasoning influencing some participants' judgments and incentivized decisions. Our findings suggest that a propensity to act as prescribed by tacit agreements may be particularly important in understanding the moral psychology of fleeting social interactions and coordination problems. By complementing the rich literature on deontology and consequentialism in moral psychology, empirical approaches inspired by contractualism may prove fruitful to better understand moral cognition.

When You Think of and Identify Yourself as a Nurse, You Will Become More Deontological and Less Utilitarian.

This study aims to examine how the activation of the role of nursee and professional identification as a nurse can influence moral judgments in terms of deontological and utilitarian inclinations. In Study 1, a priming technique was used to assess the impact of activating the nursing concept on moral reasoning. Participants were randomly assigned to either a nursing prime or neutral prime condition. By using a scrambled-sentence task, participants were prompted to think about nursing-related or neutral thoughts. Following the priming task, participants were asked to respond to 20 moral dilemmas. The process dissociation approach was employed to measure the degree of deontological and utilitarian tendencies in their moral reasoning. In Study 2, participants completed the nursing profession identification scale and the moral orientation scale before engaging in moral judgments similar to those in Study 1. The findings revealed that priming the concept of being a nursee resulted in an increase in deontological clinical inclinations while having no significant effect on utilitarian inclinations. Additionally, a positive correlation was observed between identification with the nursing profession and deontological clinical inclinations, whereas a negative correlation was found with utilitarian inclinations. Deliberation orientation acted as a complete mediator in the relationship between nursing professional identification and deontological tendencies and as a partial mediator for utilitarian tendencies.

Children's voices on their values and moral dilemmas when being cared and treated for cancer- a qualitative interview study.

BACKGROUND: Childhood cancers affect about 350 children every year in Sweden and are life-threatening diseases. During the treatment period, situations arise that can become morally challenging for the child. When knowing children's values and morally challenging situations in childhood cancer care, targeted ethics support could be developed and used in care. AIM: To explore children's values and moral dilemmas ​​when undergoing cancer treatment. METHODS: This is a qualitative study based on empirical data. The data collection was conducted through three focus group interviews and six individual interviews with children between 10 and 18 years (n = 16). A content analysis methodology was used to generate themes. Children who were/have been treated for cancer at three childhood cancer centres in Sweden were invited to participate. The study was approved by the Swedish Ethical Review Authority. The children's participation was based on voluntariness and consent/assent. FINDINGS: During the analysis, five themes of values emerged: Personal relationships, Bodily ease and identity, Feeling in control and being involved, Positive distractions and Right care that is needed. Their moral dilemmas were thematized into: Should I consider others or not? Should I rest or not? and Should I refuse treatment or not? CONCLUSION: Children undergoing cancer treatment want to have personal relationships with healthcare professionals. Their moral dilemmas were about questioning their own physical and psychological well-being against their expectations, the values of others and the treatment required. Further research is needed to understand how to deal with moral dilemmas in children undergoing cancer treatment.

Minding some animals but not others: Strategic attributions of mental capacities and moral worth to animals used for food in pescatarians, vegetarians, and omnivores.

While moral concern for animals has become increasingly important for both consumer food choice and food policy makers, previous research demonstrated that meat eaters attribute lower moral status and mental capacities to animals raised for meat compared to non-food animals. The current research investigated whether this strategic flexibility in moral concern and mind perceptions also occurs when considering aquatic food animals and animals used for dairy and egg products, and the degree to which these concerns and perceptions are evident in pescatarians and vegetarians. We compared perceptions (mind attributions and moral concern) of land food animals versus aquatic food animals, and of animals in the meat versus dairy and egg industry between omnivores (n = 122), pescatarians (n = 118), vegetarians (n = 138), vegans (n = 120), and flexitarians (n = 60). Pescatarians scored lower than other dietary groups on moral concern and mind attribution for aquatic animals relative to farmed land animals. Unlike the other dietary groups, pescatarians and vegetarians scored lower on moral concern and mind attribution for dairy than beef cows and for layer chickens than broiler chickens. These findings demonstrate that pescatarians and vegetarians were flexible in their moral thinking about different types of food animals in ways that suited their consumption habits, even when the same animal was evaluated (e.g., dairy vs beef cows). This research highlights the psychological barriers that might prevent people from reducing animal product consumption and may need to be addressed in interventions to encourage transitioning towards more plant-based diets.

Exploring moral competence regression: a narrative approach in medical ethics education for medical students.

BACKGROUND: Studies from different countries report a stagnation or regression of moral competence in medical students between the first and the last year of their studies, and the value of various educational interventions remains uncertain. METHODS: We used Moral Competence Test (MCT) to measure C-scores of moral competence to determine the change in the MCT C-scores between the first- and the fifth-year medical students from two medical schools in the Czech Republic in the academic year 2022/2023 and to analyze factors associated with the C-scores (observational study). In addition, for the first-year students, we compared the results of the MCT before and after an intervention in medical ethics curriculum (interventional study). We used a cross-sectional and descriptive design for the observational study. Students completed the MCT, consisting of two moral dilemmas (Worker´s Dilemma and Doctor´s Dilemma), the results measured by the C-score, which represents moral competence. RESULTS: In total, 685 students participated in the observational study. Objective 1: based on the analysis of the C-score, we observed a decrease in moral competence between the first and the fifth-year medical students (p < .001). Objective 2: we did not observe a statistically significant effect of gender (p = .278), or self-rated religiosity (p = .163). Objective 3: in the interventional study, 440 students participated in the pretest and 422 students participated in the posttest. The test of statistical significance found no improvement in students' moral competence after the intervention (p = .253). CONCLUSION: Medical students show a regression in moral competence during medical education; it was lower in medical students in their fifth year, compared to the first-year medical students without the effect of gender, or self-rated religiosity. Although educational intervention consisting of multiple tools of medical ethics teaching (PBL, CBL, KMDD and StorED) did not lead to increase in moral competence, the longitudinal effect of such intervention remains to be seen.

Evidence for core social goal understanding (and, perhaps, core morality) in preverbal infants.

Spelke's What Babies Know masterfully describes infants' impressive repertoire of core cognitive concepts, from which the suite of human knowledge is eventually built. The current commentary argues for the existence of a core concept that Spelke claims preverbal infants lack: social goal. Core social goal concepts, operative extremely early in human development, underlie infants' basic abilities to interpret and evaluate entities within the moral world; such abilities support claims for a core moral domain.