Deskriptive und präskriptive Aspekte des Entscheidens im medizinischen und psychologischen Berufskontext : eine explorative Fragebogenstudie

Zusammenfassung:
Eine gelungene Berufsausübung im Gesundheitswesen erfordert ethische Kompetenzen. Die Voraussetzungen ihrer Erhebung wurden in der vorliegenden Arbeit anhand von N = 421 vollständigen Datensätzen untersucht, welche mittels eines sechs Dilemmata umfassenden Fragebogens an Probanden mit einem Altersdurchschnitt von 24,7 Jahren erhoben wurden. Es wurde angestrebt, mittels explorativer Faktorenanalyse über die manifesten Situationsmerkmalsbewertungen latente, entscheidungsbeeinflussende Werthaltungspräferenzen zu finden oder die intuitive Bewertung der Handlungsoptionen zu belegen. In den Daten konnten keine Einflüsse bewusster Werthaltungen gefunden werden. Hingegen stützen die Ergebnisse die Forschungsbefunde der jüngeren Forschung, die intuitiven Prozessen bei der moralischen Urteilsfindung eine dominierende Rolle zuschreibt. ---------- Summary:
(1) Can an ethically valuable decision be determined? (2) How are moral decisions made? (3) Is it possible to identify trans-situational factors by which moral decisions could be prognosticated? The following research project tries to answer these questions, focused on the paramount aim to create a test instrument with which the ethical competence of physicians and psychologists can be surveyed.
(re 1) The ethical discussion results in the insight that it is possible to determine and justify what an ethically valuable decision is. It follows the hierarchically ordered levels of expectations which arise from the will of the directly and indirectly affected persons. However, it cannot be justified in a generally accepted way why someone ought to act ethically in a valuable way. This claim of classical ethical theories for final justification is discussed using the examples of the deontological theory by Kant and the utilitarianism; it cannot be upheld and is thus being rejected. Afterwards, the principlism of Beauchamp and Childress, being based on the reflective equilibrium by Rawls, is outlined. It is argued that it is compatible with the theory of integrative ethics by Krämer and can be used for the ethical evaluation of decisions in the health care services.
(re 2) According to the results of research, the decision-making process, which is the object of the second question, is strongly influenced by intuition. Hence, reasoning presumably does not reflect the real process and actual causes of decisions. To answer the second question, two possible paths of decision-making are derived from already existing psychological theories. The first approach is deduced from the value theories and the theories of cognitive consistency. It implies that decisions are made consciously on the basis of values so that statements about the process of decision-making can be realistic. The second approach is substantially based on younger psychological research about moral decisions. It says that moral decisions are first and foremost made intuitively and that their reasoning is rather like post-hoc-rationalization. Therefore, such statements should not allow any conclusions about the actual process of decision-making. In order to test both approaches against each other, a test instrument was developed which allows to answer the third research question as well.
(re 3) The data collected for answering the third research question does not reveal any trans-situational factors by which moral decisions could be prognosticated. The test instrument created to gather the data contains six realistic case studies taken from the medical and psychotherapeutical professional practice. For every case study, the test persons are asked for a descriptive statement about the presumably executed action by oneself, as well as a prescriptive statement about the behavior expected from others. Furthermore, the test persons are asked for a rating concerning each individual piece of information presented in the case study whether the protagonist of the case study should assess it rather for or against the realization of the action. The pieces of information are conceived in such a way that they correspond to widely different values. The ratings of the individual units of information correlate substantially to the prescriptive and descriptive statements of the corresponding case study. In addition to that, the ratings of the individual units of information regarding one course of action also inter-correlate substantially. This is interpreted to the effect that the intuitive appraisal of the individual course of action decisively affects the assessments of the individual units of information on the specific course of action. To examine the data for trans-situational factors, a factor analysis about the ratings of the information of all case studies was calculated. However, the ratings do not correlate highly across situations even if the strong interrelation of the ratings of the units of information within the individual courses of action is partialled out. [...]
In summary, it seems promising [...]