Common Values in Healthcare slide

Developing Moral Sensibility and Moral Sensitivity

In her two follow-up sessions to the keynote, Robyn Dean helped participants think about how we, as a field, can develop our capacity as practice professionals for ethical decision-making.  The framework she shared comes from James Rest who shares these four components of moral development:

  • Moral sensitivity (interpreting the situation)
  • Moral judgment (decision making skills)
  • Moral motivation (value conflict, non-moral distractions)
  • Moral implementation (logistical, timeliness)

In her thesis, she explains more of the research and data she collected on the level of interpreters scales on the Defining Issues Tests which assesses what tacit moral schemas underlie a person’s decisions.  (According to her data, sign langauge interpreters fared at half the level of moral philosophers who were at the top, and much closer to senior high school students than average adults.)  Her suggestion is not that a particular cohort was ill-prepared, but that our field is ill-prepared to help practitioners move to having post-conventional schema in ethics.

The way out of this, she suggests, is for us to move our professional values into the place where we have currently posited our metaphors.  Instead of our preoccupation with role (or role-space) or metaphorical models which are designed to describe our actions, we need focus on the professional values which are actions are supposed to carry out and our metaphors are supposed to point to.

To me, this is very hopeful because I think that as we identify our professional values, it can help us to line them up with other professional values – such as healthcare – so that we can be more collaborative find our way to Post-Conventional Schema in our ethical decisions making.  Here’s a listing shared of some professional values:

Values of Interpreting:

  • Accuracy
  • Neutrality
  • Confidentiality
  • Fidelity
  • Respect for consumers & colleagues
  • Professional
  • Autonomy/Agency
    • Positive and negative obligation
  • Self-determinancy
  • Transparency
  • Values of the Context in which the situation takes place

Service Profession’s Values

  • Autonomy
  • Non-maleficence
  • Beneficence
  • Justice

Values in Healthcare

  • diagnosis before treatment
  • patient perception
  • rationing limited resources
  • patient partnership, education, and compliance
  • informed consent
  • not practicing outside of one’s area of expertise
  • teamwork/collaboration

 Certainty and Ambiguity

In developing moral sensitivity, a really important skill that we need to develop is moving from certainty to ambiguity.  In many of the responses in her research, comments demonstrated certainty on the part of the interpreter about the motivations of participants when our work may actually be better served by appreciating the ambiguity and asking more questions in response.

Codes of Ethics

This plays out also in our understandings about the purpose of a code of ethics.  Dean suggests that professional codes are designed to explain the boundaries of ethical behavior. All of the shades of grey of ethical behavior within that boundary isn’t the concern of the code. For me, what this means that the process of putting reflection-in-actoin means being able to work within that grey area with humility and an eye toward upholding our professional values and connecting them with the values of our consumers.

Suggested Resource

A foundational book in healthcare settings is:

Principles of bio-medical ethics: by Beauchamp & Childress.

There was much more that took place in these two sessions – and I look forward to digesting more of it.  I invite you to join in the discussion and use the comment box below to share your questions or thoughts about what happened in here.

1 reply
  1. Karen Malcolm says:

    Robyn’s presentations on ethics are always so well researched and stimulating. She really emphasized the need in case analysis to look at the moment-to-moment decisions we make
    . I appreciated her comments on the way that many interpreters who talk about being an ally/advocate are presuming (unconsciously often) that the doctor or healthcare provider is doing something AGAINST the Deaf patient. Robyn also provided a very detailed discussion on the use of the term “role”, and how what we need to look at instead is the values that the interpreter is expressing.

    Robyn has an article in the international Journal of Translation and Interpreting, 2014, entitled Condemned to repetition? An analysis of problem-setting and problem solving in sign language interpreting ethics.

    Robyn identified some of the influences on the interpreter’s moral sensitivity:
    -ambiguity of people’s needs in the setting
    -familiarity with situation and/or people in it
    -time allowed for interpreting
    -susceptibility to pressure
    -sheer number of elements in the situation
    -presupposition and prior expectations that blind a person to notice or think about certain aspects

    It’s difficult to summarize all that Robyn presented, because I need to spend more time synthesizing the concepts and examining my own practices and expectations. Thank you Robyn Dean, for your dedicated work!

Comments are closed.