Cognitive Moral Development and Decision-Making

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A couple recent Tips of the Week discussed certain issues around ethics. This week’s Tip focuses on a component of that, called cognitive moral development. Cognitive moral development (CMD) describes the mechanisms persons use to arrive at a particular decision or behavior. CMD is said to progress through several stages, beginning in one nearly infant-like in that the person makes judgments based solely on their most primal of needs without regard to anyone else or in respect to any repercussions. This proceeds to doing exactly what is being told of you regardless of the greater good, then upward to forming relationships, and then to a broad consideration of total societal welfare to the extent possible when making a decision.

Lee et al examined CMD; more specifically, they used it as a framework to evaluate moral disengagement among pharmacists, specifically in treating patients with lifestyle diseases.1 They codified moral disengagement into 8 components: moral justification (eg, certain patients won’t benefit from counseling, anyway); displacement of responsibility (eg, I'm not obligated to provide counseling when corporate management demands higher prescription volumes); diffusion of responsibility (eg, I only play a small part in patient nonadherence); attribution of blame (eg, some patients deserve their fate); dehumanization (eg, nonadherent patients are mentally weak); euphamastic labeling (eg, smokers can be labeled as light smokers); advantageous comparison (eg, other patients need more attention than these patients); disregard or distortion of consequences (eg, this disease actually isn’t as bad as people assume). The authors point out what might seem obvious to readers in that this compromises quality of care, but they provide additional nuance into how this type of thinking if too common could jeopardize community sanction for pharmacists and result in increased government interference; that even just a minority of pharmacists behaving this way can risk the chances that the profession will be recognized as health educators and get reimbursed for pharmacy services, and how often times in the long run the morally disengaged pharmacist can actually end up with poorer quality of work life and burnout more quickly than a pharmacist who is actively engaged and gets charged from doing so.

Additional information about Ethical Decision Making can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Lee C, Segal R, Kimberlin CR. Reliability and validity for the measurement of moral disengagement in pharmacists. Res Social Adm Pharm. 2010;14:297-312. 

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California

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Go to the profile of Shane Desselle
7 months ago

Have you ever found yourself using any of these excuses as “justification” for what you have done, or didn’t do?