Personal Obligation Research Articles

‘The onus is on me’: primary care patient views of Medicare‐funded team care in chronic disease management in Australia

This study investigated the views of primary care patients in receipt of Medicare-funded team care for chronic disease management (CDM) in Australia. A qualitative study using a repeat in-depth interview design. Twenty-three patients (17 female), aged 32-89, were recruited over a six-month period from two purposively selected general practices: one urban and one regional practice in Queensland, Australia. Semi-structured interviews were conducted with participants 6 months apart. An interview guide was used to ensure consistency of topics explored. Interviews were recorded and transcribed, and a thematic analysis was conducted. Patients in this study viewed the combined contributions of a GP and other health professionals in team care as thorough and reassuring. In this case of Medicare-funded team care, patients also saw obligations within the structured care routine which cultivated a personal ethics of CDM. This was further influenced by how patients viewed their role in the health-care relationship. Aside from personal obligations, Medicare funding got patients engaged in team care by providing financial incentives. Indeed, this was a defining factor in seeing allied health professionals. However, team care was also preferential due to patients' valuations of costs and benefits. Patients are likely to engage with a structured team care approach to CDM if there is a sense of personal obligation and sufficient financial incentive. The level of engagement in team care is likely to be optimized if patient expectations and preferences are considered in decisions.

Predicting scientists’ participation in public life

This research provides secondary data analysis of two large-scale scientist surveys. These include a 2009 survey of American Association for the Advancement of Science (AAAS) members and a 2006 survey of university scientists by the United Kingdom's Royal Society. Multivariate models are applied to better understand the motivations, beliefs, and conditions that promote scientists' involvement in communication with the public and the news media. In terms of demographics, scientists who have reached mid-career status are more likely than their peers to engage in outreach, though even after controlling for career stage, chemists are less likely than other scientists to do so. In terms of perceptions and motivations, a deficit model view that a lack of public knowledge is harmful, a personal commitment to the public good, and feelings of personal efficacy and professional obligation are among the strongest predictors of seeing outreach as important and in participating in engagement activities.

College Men, Unplanned Pregnancy, and Marriage: What Do They Expect?

We conducted a qualitative content analysis of written responses from 148 college men to questions about pregnancy resolution and marriage in the event of an unplanned pregnancy. We used Marsiglio's (1991) concepts of procreative consciousness and responsibility as a source of theoretical sensitivity during data analysis. Men's written comments were analyzed using a modified version of the grounded theory method of open, axial, and selective coding. Three distinct groups emerged: “I expect to raise my child” (86.5%); “I don't expect to raise the child” (10.1%); and “I expect to let my partner decide” (3.4%). Several subgroups also emerged among men who intended to raise the unplanned child: Yes, I expect to get married; “No, I don't expect to get married”; “I don't know if we'd marry”; and “My partner and I would coparent.” Across subgroups, conditional variations and reasons underlying expectations were noted. Much variability was observed in men's descriptions of their procreative responsibility. A majority expressed high expectations for personal obligation and responsibility if involved in an unplanned pregnancy. Future research on men's sexual and reproductive health and procreative consciousness and responsibility are discussed.

Is climate change an ethical issue? Examining young adults’ beliefs about climate and morality

Moral philosophers argue that climate change poses an ‘ethical problem’ for humanity and thus that humans have moral obligations to respond. Little empirical research has explored whether non-philosophers agree with these conclusions. This is unfortunate, because non-experts’ moral intuitions (or lack thereof) about climate change likely hold important implications for willingness to engage cognitively, emotionally and behaviorally with the issue. After reviewing the moral philosophical position on climate change, I present results of two studies conducted with a total of 922 U.S. undergraduate students that explored beliefs about the ‘ethics of climate change.’ Forty-five percent of the students sampled stated unequivocally that climate change represents a moral or ethical issue; a full quarter of students said it was not an ethical issue and roughly 30% were unsure. Participants’ beliefs regarding the causes of climate change were predictive of intentions to perform pro-environmental actions, and this relationship was fully mediated by ascriptions of personal moral obligation to respond. Implications and directions for future research are discussed.

Gender Differences in Response to Experimental Forgiveness Prompts: Do Men Show Stronger Responses Than Women?

After recalling interpersonal offenses, undergraduates (106 women, 79 men) were assigned to a control condition or one emphasizing a forgiveness motivation: personal benefit, moral obligation, or goodwill. All three forgiveness conditions facilitated men's forgiveness, although the goodwill condition was most effective. Women's responses did not differ across conditions. Another study of undergraduates (106 men, 112 women) revealed that relative to men, women put more effort into forgiveness before the study, and they were more likely to view forgiveness as a process requiring healing. Study 2's findings may partly explain why men show greater response than women to experimental forgiveness prompts.

Praise, blame, obligation, and DWE: Toward a framework for classical supererogation and kin

Continuing prior work by the author, a simple classical system for personal obligation is integrated with a fairly rich system for aretaic (agent-evaluative) appraisal. I then explore various relationships between definable aretaic statuses such as praiseworthiness and blameworthiness and deontic statuses such as obligatoriness and impermissibility. I focus on partitions of the normative statuses generated (“normative positions” but without explicit representation of agency). In addition to being able to model and explore fundamental questions in ethical theory about the connection between blame, praise, permissibility and obligation, this allows me to carefully represent schemes for supererogation and kin. These controversial concepts have provided challenges to both ethical theory and deontic logic, and are among deontic logicʼs test cases.

The Irreducibility of Personal Obligation

It is argued that claims about personal obligation (of the form “s ought to ϕ”) cannot be reduced to claims about impersonal obligation (of the form “it ought to be the case that p”). The most common attempts at such a reduction are shown to have unacceptable implications in cases involving a plurality of agents. It is then argued that similar problems will face any attempt to reduce personal obligation to impersonal obligation.

The moderating effect of conformism values on the relations between other personal values, social norms, moral obligation, and single altruistic behaviours

Three studies predicted and found that the individual's conformism values are one determinant of whether behaviour is guided by other personal values or by social norms. In Study 1 (N=50), pro-gay law reform participants were told they were either in a minority or a majority in terms of their attitude towards the law reform. Only participants who were high in conformism values conformed to the group norm on public behaviour intentions. In studies 2 (N=42) and 3 (N=734), participants played multiple choice prisoner's dilemma games with monetary incentives. Only participants who considered conformism values to be relatively unimportant showed the expected connections between universalism values and altruistic behaviour. Study 3 also established that the moderating effect of conformism values on the relation between universalism values and altruistic behaviour was mediated through experienced sense of moral obligation.

We Have Seen the Enemy and It Is Not David McCullough

have just completed a four-year term as editor of Common-place, an on-line journal whose aim is to reach beyond the usual circles of academic historians. That ambition is driven by the idea that there is an amorphous but potent history community out there, defined not by the credentialing apparatus of the academy but by the pure, democratizing force of personal interest and civic obligation. And that community, we would like to believe, has an appetite for carefully argued, industriously researched, and well-crafted history writing. As I hang up my electronic editor’s red stylus, I find myself wondering if this ideal audience is a fiction, invented by a history profession that, like any church, constantly struggles to square its mission to serve a flock with the cloistered, privileged position of its clergy. In part, my sense comes from Common-place itself. With the exception of the occasional genealogist or secondary school teacher, the bulk of our readers ap

Herman Kalman Gold, MD

Dr Herman K. Gold, Associate Professor of Medicine, Harvard Medical School, Boston, Mass, died on March 1, 2008, at the Massachusetts General Hospital (MGH) of complications related to acute myelogenous leukemia. He was 67 years old. Dr Gold served for 37 years as staff physician and interventional cardiologist in the Department of Cardiology at MGH and was responsible for groundbreaking research in the use of fibrinolytic agents and subsequently glycoprotein IIb/IIIa inhibitors in the treatment of myocardial infarction. Dr Gold was born in Newport News, Va, the son of Jonah and Miriam Gold. His life was from early childhood shaped by medicine, a recognition of the role it played in saving his own life, which drove his passion, hope, and tireless energy in the pursuit of medical advances and clinical excellence to save others. Two indelible childhood events fueled his desire to become a physician. As a child, he contracted scarlet fever. During wartime, penicillin was rationed, and the family was only able to obtain enough for a few doses. He recalled that every night, his parents would boil his urine to collect enough penicillin for the next day’s treatment. Later, at the age of 9, he contracted bulbar polio, which prevented him from swallowing properly for nearly 2 years. These two experiences imprinted in him an appreciation for good health and a feeling of personal obligation as a physician to try sometimes unconventional treatments in an effort to cure patients’ ills. Dr Gold received his BS from the College of William and Mary in 1961. It was there he …

Forest Managers' Spiritual Concerns

AbstractA connection with nature is the core motivational factor that inspires 12 forest managers to carry out their daily work. This has been ascertained through qualitative research into the structure of the emotional perceptions of Dutch forest managers. Three domains or clusters of concepts have been identified: 1) the intra-personal process, 2) the relation between the manager and the management object, and 3) the relation between the manager and the transcendental. The most prominent expressive element arising from all three clusters is 'connectedness'. Positioned in Frijda's motivation-theoretical approach, connectedness in an individual's dispositional constellation can be defined as a so-called 'source concern' (a standard which transcends the everyday situation). Inherent to this concern is a certain sensitivity to external impressions, which can in turn initiate a process of transformation in consciousness or behaviour. As such, connectedness can be an emotional experience in concrete situations and manifest itself as an initiator for change: a change of cognition or world perspective, becoming embedded in the transcendental (self-transcendence), or a personal obligation to bring this connectedness about in everyday practice. In addition, connectedness as a concern represents a goal, an ultimately desired situation, which emerges in the second domain, where quality and ethical value form the two targets (for forest management). In reality these source concerns are insatiable. Nevertheless, managers want to make a contribution to their realisation. They find their motivation in the third domain, 'Immanent-Transcendent Reverence', where we observe the source concern of connectedness embedded in forms of transcendence focused on an immanent and/or transcendental entity ('nature', 'the cosmos', 'creation'). Connectedness with an ultimate source creates an 'ultimate concern' and as such, it is the central line of motivation that prompts people to manage forests. Personal and professional actions are embedded in this larger whole, which transcends the individual.

Poverty, Exclusion and Social Conflict in the Schoolbooks of Argentina during the First Peronist Period

From 1952 onwards, following the approval of the ‘Second Five‐year Plan’, a series of profound changes took place in the Argentinean national curriculum and in its schoolbooks. Some authors have pointed out that such changes implied the use of the educational system as an ‘agency for indoctrination’. Other authors have emphasized, on the other hand, the—at least partial—processes of democratisation implied in those changes. This paper aims to analyse, as part of the vast educational transformations that occurred during this period, the new visibility that was acquired by subjects, classes and social processes which were practically absent in the curricular contents before the Peronist government, as well as the new type of treatment they received. At the same time, the inclusion of new subjects and points of view implied, in a more or less explicit manner, the recognition of the existence of social relations of domination and inequality, which were no longer presented as ‘the nature of society’, but as a field of conflicts concerning political values such as justice, freedom, democracy or authoritarianism. While Peronist values questioned the previous political and social order and allowed the possibility of reflecting on other models of society, the regime’s curricular contents aimed to transmit and inculcate the populist political ideology that was preached by the government, transforming the schoolbooks into a contradictory mosaic of images of social mobilization and disciplinary acceptance, of criticism and passiveness, of personal participation and collective obligation.

Softlifting: Exploring Determinants of Attitude

Softlifting, or the illegal duplication of copyrighted software by individuals for personal use, is a serious and costly problem for software developers and distributors. Understanding the factors that determine attitude toward softlifting is important in order to ascertain what motivates individuals to engage in the behavior. We examine a number of factors, including personal moral obligation (PMO), perceived usefulness, and awareness of the laws and regulations governing software acquisition and use, along with facets of personal self-identity that may play a role in the development of attitudes and therefore intentions regarding this behavior. These factors are examined across multiple settings expected to be pertinent to our survey respondents: home, work and school. Personal moral obligation and perceived usefulness are significant predictors of attitude across all settings. Past behavior is a significant predictor of intention across all settings, and a significant predictor of attitude in the home setting. We find evidence that awareness of the law causes a less favorable evaluation of softlifting in the school setting only, but has little effect in the home and work settings. As in previous studies, attitude is a significant predictor of intent. We do not find indications that one’s personal self-identity influences one’s attitude towards the behavior and the intention to perform it, except in the case of legal identity, where marginally significant effects are found in the work environment.

Uptake of cervical cancer screening in The Netherlands is mainly influenced by women's beliefs about the screening and by the inviting organization

This study aims to examine the impact of women's characteristics (demographics, risk behaviour, and beliefs) on the uptake of cervical cancer screening, taking practice characteristics (demographic and organizational) into account. Routinely collected data of screening status were sampled from electronic medical records of 32 Dutch general practices. Additionally, a questionnaire was sent to a sample of 2224 listed women-1204 screened, 1020 unscreened. We used a step-by-step, logistic, multilevel approach to examine determinants of the screening uptake. Analyses of data for 1392 women (968 screened and 424 unscreened) showed that women's beliefs about cervical screening and attendance are the best predictors of screening uptake, even when demographic and organizational aspects are taken into account. Women aged 40-50 years who felt high personal moral obligation, who had only one sexual partner ever, and who were invited and reminded by their own general practice had the greatest likelihood of screening uptake. A non-response study was performed; the non-responders to the questionnaire (mainly unscreened) thought they had less risk of cervical cancer, were less motivated, less often intended to get future screening, and were more convinced that cervical cancer cannot be cured. To improve the uptake rate, we should focus on the personal moral obligation of eligible women, beliefs about the risks of cervical cancer, and available cures. Invitations and reminders within general practices enhance the uptake rate.

Nurses’ meaning of caring with patients in acute psychiatric hospital settings: A grounded theory study

Background The concept of caring is described as intangible, abstract, and invisible in nursing practice. This has translated into a view of caring as a personal choice or natural obligation rather than a deliberate process. While there has been movement to delineate caring within nursing in general, the psychiatric nurse's perspective on caring has been absent from theoretical works and measures constructed to describe nurse's work. Objectives To develop a substantive grounded theory of caring from the perspective of Registered Nurses working with patients in three Canadian acute psychiatric hospital settings. Design The qualitative research design of grounded theory methodology was used to develop a theory of caring. Settings Three urban, acute psychiatric hospital settings in Canada. Two were general hospitals and one was a psychiatric hospital. Participants Registered Nurses ( N = 17 ) licensed with the College of Nurses of Ontario. Method In-depth interviews with Registered Nurses were conducted using theoretical sampling. The data were analysed using constant comparative analysis. Results Protective empowering is the basic social psychological process that represents Registered Nurses’ caring with patients in acute psychiatric hospital settings. Nurses accomplish protective empowering through six main categories of: (1) respecting the patient; (2) not taking the patient's behaviour personally; (3) keeping the patient safe; (4) encouraging the patient's health; (5) authentic relating; and (6) interactive teaching. The six main categories were accomplished through 27 subcategories. In the theory of protective empowering, the goal is to help patients participate in activities contributing to convalescence, health, and/or quality of life. Conclusions The theory of protective empowering provides six main categories and 27 subcategories that can be transferred to funding formulas, patient health record documentation systems, nurse orientation and education programs, nurse role descriptions, and used in guiding discussions about organizational values of patient-centred care within a collaborative multidisciplinary context.

Medical ethics in prisons: Rules, standards and challenges

Health care practitioners in prison face the challenge of providing high standards of health care within the unique peculiarities and restraints of the prison environment. The strict adherence to principles of medical ethics by the prison health care staff and the knowledge and acceptance of these principles by the whole prison community not only results in ethical conduct but also yields practical professional advantages such as guidance in situations of conflict, promotion of confidence and avoidance of misunderstandings. The internationally consented conventions, declarations and recommendations relevant on medical ethics in prison are presented and their basic principles ‐ the primary task of the prison doctor, access to a doctor, equivalence of care, patient’s consent and confidentiality, preventive health care, humanitarian assistance, professional independence, professional competence ‐ are discussed. In addition, the personal obligation of the prison doctor for ethical reflection and decision making in individual ethical issues not covered by the quoted documents and in ethically controversial issues is emphasized. A training course and published guidelines for ethical conduct in prison health care are recommended.

The Americanization of Zionism, 1897-1948 (review)

The Americanization of Zionism, 1897-1948, by Naomi Cohen. Hanover and London: Brandeis University Press, 2003. 261 pp. $35.00. In The Americanization of Zionism, Naomi Cohen expands on a theme that has previously been explored both by herself and by scholars such as Ben Halpern and Melvin Urofsky: from its earliest years, has been shaped by uniquely factors that set it apart from traditional ideology of European Zionism. in United States was fashioned according to the needs of Jews in America, including their desire not to differ too much from the stand of government and the demands of public opinion (p. 1), she contends. This meant jettisoning such concepts as inevitability of massive antisemitism in diaspora and personal obligation of every Zionist to settle in Palestine. Most Jews have always regarded United States as their home, never believed that substantial antisemitism will erupt here, and never seriously considered relocating to Middle East. Nor would they want what Cohen calls American public opinion to suspect that they regard United States as a country that will eventually persecute them and drive them out. Cohen explains at start that The Americanization of does not purport to be a synthetic history of Zionism (p. 2). Rather, she presents eight separate episodes, some revolving around key events, others around key individuals, that illustrate her central theme. Every chapter features same crisp writing style and high level of scholarship that made her earlier books sparkle. It is impossible to finish any single section of book without gaining some fresh insight or new information. The book begins with a study of earliest U.S. Zionist monthly, The Maccabaean, exploring how it presented Zionist ideas to fledgling Zionist movement and how, in turn, it reflected perspective of emerging movement. Subsequent chapters deal with such disparate topics as unsuccessful attempt to build a Conservative synagogue in Jerusalem in 1930s, efforts by Jewish social worker Maurice Hexter to influence British policy in Palestine, conflicts between Zionists and State Department over immigration to Palestine during 1930s, ill-fated Jewish Conference, and 1940s debates over within Conservative Judaism's Jewish Theological Seminary. Her chapter on Reform Judaism's evolution from anti-Zionism to non-Zionism (that is, support for a Jewish refuge although not a sovereign state) brings into sharp focus multiplicity of factors at work in shaping that movement's attitude towards Palestine. England's Balfour Declaration, soon endorsed by U.S. government, legitimated Zionism in eyes of Reform rabbis (p. 62). If they did not have to fear dual loyalty accusations, Reform leaders could feel comfortable with idea of Palestine as a refuge for downtrodden European Jews, even if they were slow to embrace notion of Jewish territorial sovereignty. Later, rise of Nazism cemented Reform's acceptance of idea of Palestine as a haven for European masses. Self-preservation was also a factor: Reform rabbis had to face reality that by interwar years, most Jews were nationalist-minded eastern European immigrants (p. 62) (or their offspring) to whom a strongly anti-Zionist brand of Reform Judaism would not appeal. …

Effects of Culture, Gender, and Moral Obligations on Responses to Charity Advertising Across Masculine and Feminine Cultures

Two studies investigated the effects of charity advertising on perceptions of moral obligation to help others and gauged ad evaluation. This was done in cultures that were similar in individualism but differed in either masculinity (United States and Canada) or femininity (Denmark and Norway). Participants read appeals that solicited donations to charity by focusing on either egoistic or altruistic motives. In masculine cultures, men preferred the egoistic ad and women preferred the altruistic one. In feminine cultures, where women are agentic and men are allowed to be nurturing, the opposite was the case. Exposure to both types of ads activated a sense of personal obligation among men in feminine nations and women in masculine nations. However, their opposite‐sex counterparts reacted against these ads. Implications of these findings for an understanding of culture and sex differences in advertising effectiveness are discussed.

Foucault on Freedom and Capabilities

Within recent scholarship, a long-standing tendency to view Foucault as pessimistic about the possibilities of activism is now being reversed. For many contemporary commentators who emphasize the themes of personal agency, transgression and radical freedom in their assessment of his thought, Foucault offers new possibilities for political practice and for the pursuit of self-determination. However, an examination of Foucault’s work, particularly in the transitional period preceding his so-called ‘ethical’ writings, indicates his appreciation of basic human needs and functions that complicates the current understanding of Foucault as a philosopher of freedom. Particularly in his discussions of the ideas of ‘desubjectivation’ and ‘limit-experience’, Foucault’s work recognizes that prior conditions of psychological, economic and social ‘well-being’ are prerequisites for any subsequent performance of freedom. Examining this dimension of Foucault’s work reveals interesting points of convergence between his thought and the capabilities approach advocated by philosophers such as Amartya Sen and Martha Nussbaum. Like them, Foucault’s work recognizes that there are some minimal levels of human functioning below which talk of self-determination is misplaced. As such, political philosophy needs to be concerned with the grounds of personal and political obligation, no less than the limits and possibilities of freedom.

Mediation and the Construction of Contemporary Understandings of Health and Lifestyle

The practice of using media to promote the benefits of diet and exercise has been associated with the rise in prominence of a sense of personal obligation for one's own health. This article contributes to recent critiques of the emphasis being placed on individual responsibility for health. We argue that if health psychologists are to develop an adequately social understanding of our role in promoting health, then we must begin to examine the influence of our practices and agendas on public understandings. Extracts from research accounts are used to illustrate the pervasiveness of media health messages in everyday life and the prominence of a sense of individual responsibility.