THE MORAL REASONING AND THE ROLE OF EMOTIONS IN THE DECISION-MAKING PROCESS. A PILOT RESEARCH WITH CLINICAL ETHICS CONSULTANTS.

Since the early 2000s, Greene and his collaborators (2001; 2005; 2008) analyzed the moral reasoning, with also the support of neuroimaging techniques, in order to test the hypothesis that the deontological and utilitarian approaches are guided by two distinct and independent processes. They concluded that deontological judgments (e.g. disapproving of killing one person to save several others) are driven by automatic emotional responses, while utilitarian judgments (e.g. approving of killing one to save several others) are led by controlled slow cognitive processes based on the cost-benefits analysis. Despite other evidence seems to agree with Greene’s dual-process model (e.g. Moore et al., 2008; Suter and Hertwig, 2001; Zhang et al., 2017b), moral dilemma research cannot determine whether the obtained effects reflect differences in the strength of a single moral inclination, or in the joint operation of two distinct predispositions (Conway and Gawronski, 2013). In any case, literature agrees that emotions have an influence on moral reasoning and the decision-making process. Clinical Ethics Consultants assist healthcare providers in patient care, facilitating the ethical decision-making of doctors and hospital policymakers, and improve patient welfare. Clinical ethics committees have been established in many institutions in numerous countries during the last decades (McGee et al. 2001; Glasa, 2002; Slowther et al., 2004; Fox et al., 2007; Hajibabaee et al., 2016) and are critical in assisting physicians in resolving conflicts through an attentive mediation that is mindful of the interests, rights, and responsibilities of all those involved (Fletcher and Siegler, 1996). In many countries, especially in the U.S.A., the opinion of ethics consultants has significant weight in deciding the next course of medical care, and in turn, plays a role in determining patient outcomes. Thus, given that clinical ethics consultation services are now worldwide and play a fundamental role in final medical decisions in case of ethical conflicts, it is important to understand how the cognitive and emotional processes are utilized by consultants during the moral reasoning and decision-making process. After analyzing in-depth the literature regarding this topic, emotions and reactions of clinical ethics consultants (CECs) during and after case deliberation have been explored with the use of a semistructured interview. Later, a pilot experiment composed of a survey of six moral dilemmas and a self-report questionnaire that measure both positive and negative emotions was sent to participants. The aim was to investigate whether the emotions and feelings influenced the election of a deontological or utilitarian answer. Finally, data were discussed, with a proposal to improve the training of next generations of CECs that consider the role of emotions.