Abstract
Physicians, nurses, and other clinicians readily acknowledge being troubled by encounters with patients who trigger moral judgments. For decades social scientists have noted that moral judgment of patients is pervasive, occurring not only in egregious and criminal cases but also in everyday situations in which appraisals of patients' social worth and culpability are routine. There is scant literature, however, on the actual prevalence and dynamics of moral judgment in healthcare. The indirect evidence available suggests that moral appraisals function via a complex calculus that reflects variation in patient characteristics, clinician characteristics, task, and organizational factors. The full impact of moral judgment on healthcare relationships, patient outcomes, and clinicians' own well-being is yet unknown. The paucity of attention to moral judgment, despite its significance for patient-centered care, communication, empathy, professionalism, healthcare education, stereotyping, and outcome disparities, represents a blind spot that merits explanation and repair. New methodologies in social psychology and neuroscience have yielded models for how moral judgment operates in healthcare and how research in this area should proceed. Clinicians, educators, and researchers would do well to recognize both the legitimate and illegitimate moral appraisals that are apt to occur in healthcare settings.
Highlights
In 1926 Francis Peabody ended his most celebrated lecture with the oft-repeated conclusion, “the secret of caring for the patient is caring for the patient” [1]
This review will survey these literatures and the scant empirical data from physician and nurse researchers that are relevant to moral judgment, highlighting the variation that emerges from diverse combinations of patients, clinicians, tasks, and settings, as well as the most promising research strategies
While incomplete, the research base leaves no doubt that clinicians make moral judgments of their patients
Summary
In 1926 Francis Peabody ended his most celebrated lecture with the oft-repeated conclusion, “the secret of caring for the patient is caring for the patient” [1]. “The nurses always know the patients’ stories: the accidents, tragedies, and sorrows that brought them to the hospital, their family constellations, and their clashes with others and, on occasion, with the criminal justice system. In the surgical ICU, as Cassell documents, it was the patients who reaped the most obvious negative consequences of clinicians’ judgments. The role of moral judgment is largely unrecognized in the literatures on healthcare communication, caring, empathy, trust, disparities, and education. This review will survey these literatures and the scant empirical data from physician and nurse researchers that are relevant to moral judgment, highlighting the variation that emerges from diverse combinations of patients, clinicians, tasks, and settings, as well as the most promising research strategies
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