HEALTH ETHICS
knowledgeable but, instead, answered the questions differently
Unit IV – Foundation of an Ethical/Moral Life
Moral Development
(Human values development)
Humans have the innate capacity to acquire ethical beliefs.
But the value system that we develop is dependent upon the
cultural framework in which we live.
We are born into this world without a prescribed set of rules
for what we should do in any given situation, value
development is a product of our interaction with our cultural
environment.
Piaget > Foremost theorists in value
Kohlberg development.
> Both stressed that value
development is intimately tied
to the indeividuals’s cognitive
and psychomotor deveopment
Product of the sociocultural environment in which we live and
develop.
Leininger & Tripp-Reimer
- speak of culture in terms of values, beliefs, customs
and behaviors that are learned within and shared by a
group of interacting persons.
- because values are learned within the context of a
particular culture, moral values are culturally relative
Fowler (1981)
- notes that “we are formed in social communities and
that our ways of seeing the world are profoundly
shaped by the shared images and constructions of our
group or class”
PIAGET’S Stages of Cognitive Development
Swiss biologist and psychologist Jean Piaget (1896-1980) is
renowned for constructing a highly influential model of child
development and learning.
Piaget's theory is based on the idea that the developing child
builds cognitive structures--in other words, mental "maps,"
schemes, or networked concepts for understanding and
responding to physical experiences within his or her
environment. Piaget further attested that a child's cognitive
structure increases in sophistication with development,
moving from a few innate reflexes such as crying and sucking
to highly complex mental activities.
He was mainly interested in the biological influences on “how
we come to know.”
Piaget believed that what distinguishes human beings from
other animals is our ability to do “abstract symbolic
reasoning.”
 While working in Binet’s test lab in Paris, Piaget became
interested in how children think.  He noticed that young
children's answers were qualitatively different than older
children. 
This suggested to him that the younger children were not less
than their older peers because they thought differently.
 This implies that human development is qualitative (changes
in kind) rather than quantitative (changes in amount).
STAGES:
I. SENSORIMOTOR (birth to 2 years)
Amoral Phase
- preverbal
- through physical interaction with his or her
environment, builds a set of concepts about reality and
how it works thru SENSES & MOVEMENT
A. Object permanence
- child does not know that physical objects remain in
existence even when out of sight.
B. Problem Solving/Logic
- thru physical interaction with environment, child
builds a set of concepts about reality thru:
a. senses
b. movement
- development proceeds from reflex activity (crying
and sucking) to imagining and solving problems thru
sense and movement
C. Self-centeredness.
- child is totally self-centered
- predominance of the ID
> Child responds to environment by using all senses, and
coordinating simple motor actions.
2. PREOPERATIONAL (2 – 7 years)
Egocentric Stage (Self Loving)
A. Language development (verbal)
B. Egocentrism
- unable to take the point of view of other people, have
difficulty taking another prople’s perspective
- e.g. 3D mountain scene
- assume that how they view reality is how others view it
also.
C. Use of Symbols
- ↑d playing and pretending
- able to use an object to represent something else
- e.g. a broom is a horse.
D. Role Playing
- play the role of being “mommy”, “daddy”, “teacher”,
One of the famous techniques egocentrism involved using a three-
dimensional display of a mountain scene. Children are asked to choose
a picture that showed the scene they had observed. Most children are
able to do this with little difficulty. Next, children are asked to select a
picture showing what someone else would have observed when
looking at the mountain from a different viewpoint.
Invariably, children almost always choose the scene showing their
own view of the mountain scene. According to Piaget, children
experience this difficulty because they are unable to take on another
person's perspective.
“doctor”
E. Conservation

In one conservation experiment, equal amounts of F.
liquid are poured into two identical containers. The
liquid in one container is then poured into a different
shaped cup, such as a tall and thin cup, or a short and
wide cup. Children are then asked which cup holds the
most liquid. Despite seeing that the liquid amounts
were equal, children almost always choose the cup that
appears fuller.
Piaget conducted a number of similar experiments on
conservation of number, length, mass, weight, volume,
and quantity. Piaget found that few children showed
any understanding of conservation prior to the age of
five.
Logic
- do not yet understand concrete logic
- cannot mentally manipulate information
- unable to take the point of view of other people,
Concrete – belonging to immediate experience of
actual things or events
- specific/particular III.
- real/tangible
CONCRETE OPERATIONAL (7-11 years)
Heteronomous Stage (more relativistic)
- see relationships, aware of viewpoints, understand
cause and effect.
1. Morality of Constraint
- children enter a period of behavior described as
morality of constraint
- rules are taken very seriously.
- regard rules as fixed/absolute
- believe that rules are handed down by adults or by
God and that one cannot change them
- children tend to view behavior as right or wrong.
- assume everyone views behavior in a similar way,
basing their belief on an admiration or fear of adults
who appear to be all knowing and powerful
- e.g. Do not steal
- reasoning: Stealing is against the law
2. Problem Solving
- can make conclusions, solve concrete problems
- e.g. math equations
O+O=OO
1+1=2
3. Logic
- Piaget determined that children were fairly good at
the use of inductive logic
- inductive logic: from specific experience to a general
principle
e.g. living things (grow and breathe)
- have difficulty using deductive logic, which involves
using a general principle to determine the outcome of
a specific event
- begin thinking logically about concrete events, but
have difficulty understanding abstract or hypothetical
concepts.
4. Reversibility
- awareness htat actions can be reversed.
- e.g. being able to reverse the order of relationships
bet. Mental categories. (Dog=Labrador=animal)
IV. FORMAL OPERATIONAL (11 years - adulthood)
Autonomous Stage
1. Logic
- ABSTRACT REASONING: develop the ability to
think about abstract concepts
- instead of relying solely on previous experiences,
children begin to consider possible outcomes and
consequences of actions
e.g. Do not steal
Reasoning in earlier stage: Stealing is against the law
Reasoning now: “If I steal, what will happen to the
person from whom I stole from. He will
experience great loss. He will be sad.”
- DEDUCTIVE LOGIC becomes important
- requires the ability to use a general principle to
determine a specific outcome
- involve hypothetical situations and often required in
science and math
- child becomes capable of imagining scenarios for
which there are no rules and begins to actively engage
in rule making
- rules are not sacred and absolute but are devices which
humans use to get along cooperatively
- more relativistic when it comes to rules
- understand that it is permissible to change rules if
everyone agrees
e.g. Stealing is bad
But: relate it to the case of Robinhood
2. Problem Solving
- earlier stages: trial and error
- now: logical and methodical
- able to quickly plan an organized approach to solving a
problem
- lives in present and nonpresent.
- can use formal logic and scientific logic.
KOHLBERG’S THEORY OF MORAL
DEVELOPMENT
Level I
Preconventional Level (2 to 7 years)
- egocentric focus – individual is focused on personal
satisfaction
- the child responds to the preveailing cultural values of
right and wrong, good or evil.
Stage 1
Punishment and Obedience Orientaton (2 to 5 years)
- rules are obeyed in order to avoid punishment
- the child has no real understanding of the values
themselves and accepts the authority of others
- the physical consequences of the actions determine the
rightness or wrongness, regardless of the attribution of
value.
- e.g. A child will avoid doing action X so as not to be
punished
- therefore, “not doing action X” is viewed good by
them.
- assume that powerful authorities hand down a fixed set
of rules which he must unquestioningly obey.

Stage 2
Instrumental Relativism Orientation (5 to 7 years)
(Egoism)
Instrumental
- serving as a means/agent/tool
- conformity to rules is viewed to be in our own interest
because if provides for rewards
- child behaves because it benefits him
- the child will begin to direct his/her activities toward
the satisfaction of personal needs, rather than the needs
of others
Relativism
- there is not just one right view that is handed down by
authorities
- different individuals have different viewpoints
- since everything is relative, each person is free to
pursue his/her individual interests
- what is right for a person, is what meets his own self
interest
Level II
Conventional Level (7 to 12 years)
- There is a transitional phase between stage 4 & 5 in which emotions begin to be recognized as a component of moral reasoning.
This transition includes an awareness of personal subjectivity in moral decision making and a recognition that social rules can be
arbitrary and relative
focused more on social conformity
- child conforms to societal expectations of family,
group, or nation in order to win the approval of
authority figures
Stage 3
Interpersonal Concordance Orientation (7 to 9 years)
(concordance = state of agreement)
- stage of pleasing others
- concern about the reactions of others is a basis for
decisions and behavior
- being good in order to maintain relations is important
- includes a form of good boy/good girl orientation as the
child seeks to conform to expected social conventions
- good behavior pleases or helps others; one earns
approval by being nice and having good intentions.
- “good behavior” means having good motives and
interpersonal feelings such as love, empathy, trust and
concern for others
- works best in 2-person relationships with family
members/close friends
Stage 4 Law and Order Orientation Stage (10 to 12)
- stage of respecting others
- individual becomes more broadly concerned with
society as a whole
- emphasis is on obeying laws, respecting authority,
performing one’s duties so that the social order is
maintained
- focus becomes fixed on rules, social order and respect
for authority
- right behavior consists of doing one’s duty, social
order, and showing respect for authority
- we conform to laws and to those in authority because of
duty, both out of respect for them, and in order to avoid
censure
- fulfilling our role in society and living up to
expectations of others are important
- GUILT is more of a motivator than fear of punishment
(Level 1)
- e.g. Robinhood – still cannot condone theft (What
would happen if we all started breaking laws whenever
we felt we had a good reason? -> CHAOS  society
couldn’t function no social order)
- have a conception of the function of laws for society as
a whole – a conception which far exceeds the grasp of
the younger child.
- obey laws over personal intention
Level III
Post Conventional (12 and up)
- focus: universal moral principle (person lives according
to a principle that is universally agreed upon and what
is considered appropriate for life
- development of a social contract and autonomous
decisions apart from outside authorities.
Stage 5
Social Contract/ Legalistic Orientation (12 to 15)
- the relativity of some societal values is recognized
- moral decisions derive from principles that support
individual rights and transcend particular societal rules
such as equality, liberty and justice.
- child establishes a social-contract orientation and
attempts to confirm to the everchanging values and
demands of society.
- Actions that contribute to the well-being of others is
viewed as good.
- But if actions harm others, this is viewed as bad.
 - Believes in obligation, duty, law and follows the law
because it is legally and morally right.

Stage 6
Universal Ethical Principle Orientation (16 ↑)
Personal Conscience Stage

- internalized rules and conscience reflecting abstract

principles of human dignity, mutual respect, and trust
guide decisions and behaviors
- persons at this level make judgments based on impartial
universal moral principles, even when these conflict
with societal standards
- abstract qualities such as justice and respect for the
rights and dignity of others become important, and
one’s conscience becomes the final arbiter in regard to
ethical dilemmas
- the individual subscribes to a set of abstract, but
universal principles such as:

Justice
Humane reciprocity
Respect for dignity
Equality

- the individual is essentially morally autonomous and

decides what is right thru personal conscience

Kohlberg model proposes a linear movement thru

hierarchal stages, whereby each stage presupposes
having completed the prior stage and is the basis for
the subsequent stage. It is the pattern of a person’s
utilization of a particular level or reasoning that
determines the stage, noting that each successive
stage requires more advanced levels of moral
reasoning.

Research shows that:

1. Not everyone moves thru all the stages.

2. Few people actually progress to the post-conventional
level.
3. Women seem to plateau in Stage 3
4. Most men never move beyond Stage 4