Academic journal article Journal of Allied Health

Impact of the Konstanz Method of Dilemma Discussion on Moral Judgment in Allied Health Students: A Randomized Controlled Study

Academic journal article Journal of Allied Health

Impact of the Konstanz Method of Dilemma Discussion on Moral Judgment in Allied Health Students: A Randomized Controlled Study

Article excerpt

The objective of the study was to determine the effect of the Konstanz method of moral dilemma discussion (KMDD) on moral judgment in allied health students. The study employed the Moral Judgment Test, translated from English into Thai and validated in 247 students, as an moral judgment instrument. The scale satisfied four validity criteria: preference hierarchy, quasi-simplex structure of stage preference, affective-cognitive parallelism, and positive correlation between education and moral competence score (C-index). Test-retest reliability at a 1-month interval was 0.90. To investigate the impact of the KMDD, 83 pharmacy technician and dental nursing students were asked to participate in the study. The subjects were randomly assigned into control (n = 41) or experimental (n = 42) groups. The experimental group participated in a 90-min KMDD once a week for 6 consecutive weeks. Students in the control group also met once a week for 6 weeks to discuss the topics not related to ethics. All subjects completed the Moral Judgment Test before and after the intervention and again 6 months later. Split-plot ANOVA of the C-indexes at the beginning revealed that the experimental and control groups were not different (20.57 ± 13.45 and 24.98 ± 16.12). However, the experimental group scored significantly higher than the control group did after the intervention (35.18 ± 10.96 and 24.20 ± 14.70) and 6 months later (33.00 ± 11.02 and 23.67 ± 14.35). The KMDD appears to be a practical and effective intervention for developing moral judgment in allied health students. The effect on moral judgment remains at least 6 months after the intervention. J Allied Health 2006; 35:101-108.

MORAL JUDGMENT competence is "the capacity to make decisions and judgments which are moral (i.e., based on internal principles) and to act in accordance with such judgments."1 Kohlberg's theory has been dominant in guiding the investigation of the impact of education on moral competence. In his theory, moral development proceeds through six stages within three levels.2 The first two stages are the preconventional level. At this level, moral reasoning is based on one's own interests and those of others one cares for. Stages three and four are the conventional level. The basis of reasoning here is the concern to maintain the social order. Moral judgments are guided by meeting the expectations of others or the authority and obedience to rules. At stages five and six, the postconventional level, the reasoning is based on the universal principles for making choices among alternative courses of action that would be held by any rational moral individual. A central emphasis in the postconventional level is on principles for choosing the most just options for individuals in society.2

There is a significant and positive association between principled moral judgments and general moral behavior, such as resistance to cheating, peer pressure, and unlawful or oppressive authority; "whistle blowing" on corruption; the keeping of contractual promises; nonaggression; and helping behaviors.3 Moral judgment also has been found to be positively linked to community involvement, a sense of civic responsibility,4 as well as ethical behavior in professions such as accounting,5 dentistry,6 and medicine.7 The positive relationship between moral judgment and clinical performance has been reported repeatedly in physicians,8 nursing students,9 dentists,6 physical therapy students,10 and pharmacists."

Thus, it appears that moral judgment is consistently associated with moral action. Growth in moral reasoning should enhance the possibility of moral action. However, moral reasoning alone may be insufficient to determine moral behavior. Rest12 suggested that using principled reasoning to judge moral issues is only one of four components leading to moral action. The other three components are 1) moral sensitivity-i.e., being able to recognize that a moral dilemma exists; 2) moral motivation-i. …

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