Stadiality of moral development and the levels of doctor-patient relationship

FORMAT | Presented paper

LANGUAGE |Romanian

HOW TO CITE| SANDU, Antonio, Caras, A., & Nica, A. (2012). Stadiality of moral development and the levels of doctor-patient relationship. Prezentată la la A VIII-a Conferinţă Naţională de Bioetică cu participare internațională, 13-16 septembrie 2012, Cluj-Napoca.

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ABSTRACT

The central ethical problem: We propose to build a theoretical model regarding the doctor-patient relationship starting from the stadiality of moral development proposed by Kohlberg. He proposes an understanding of individual moral development as a gradual development of his moral conscience, starting from the heteronomous-autonomous distinction and implications of behavior on moral conduct and on agent capacity.
Methodology: We used a secondary analysis of data on the responses given in the interviews and focus groups held with patients with diabetes and their stakeholders, general practitioners caring for patients with diabetes and diabetes doctors. Individual and group interviews were conducted in Iaşi in July 2011-May 2012, and aimed at understanding the process of social construction of autonomy and responsibility of the diabetic patient, including through the doctor-patient relationship. The interviews were open and semi-open, thematic axes being formed on the model of appreciative interview. We used analysis of discourse, in a process of open coding and axial coding.
As results we could identify patterns of doctor-patient relationships to match with the stages described by Kohlberg, pre-conventional morality, contractualist morality, autonomy etc. Therefore, we constructed an array of patterns of doctor-patient relationship where the levels of moral development are understood as levels of social construction of autonomy. We don’t agree with the author’s opinion according to which the order of moral development stages is unvarying, as they are not covered by all people at the same age. We will identify communication patterns specific to an autonomous or heteronomous behavior that will be customized for the doctor-patient relationship. Contrary to Kohlberg, we believe that these stages can be simultaneous for an individual and does not indicate a level of moral self development. They are types of answers with which the moral self is updating in a moral situation or another.

KEYWORDS:

stadiality, doctor-patient relationship, moral development, autonomy.