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Moral dilemmas, moral reasoning, and genital herpes

Journal of Sex Research, Summer, 1997 by Terri D. Conley, Rosemary A. Jadack, Janet Shibley Hyde

Sexuality and morality are closely interwoven. For example, in many religions, including traditional Judaism and Christianity, sexual behaviors can determine whether a person is considered moral or immoral (Kelly, 1992). As a result of this association, sexual decisions may often be viewed as moral choices. This bond between sexuality and moral decisions has intensified in recent years, because the choices an individual makes can determine whether that person, or his or her sexual partner, acquires an incurable or even fatal sexually transmitted disease (STD). People who have acquired STDs are often viewed as immoral because of the disease itself or what they did to acquire it (Bruce & Bullins, 1989). These issues highlight the importance of understanding moral thought regarding STDs.

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Issues surrounding genital herpes and other STDs provide a rich arena for examining moral reasoning. Each time a person who is infected with an STD begins a new sexual relationship, he or she may be faced with a dilemma of whether to tell the person about the disease and risk rejection, humiliation, loss of confidentiality about the disease, and other adverse effects, or to refrain from discussing the disease with the potential partner and jeopardize the health of the partner (Jadack, Keller, & Hyde, 1990). An individual who is not infected with a disease may face issues of whether to bring up the topic of STDs and risk hurting the partner's feelings, stay silent about his or her concerns, or remain celibate to avoid contracting a disease. Understanding how people reason in these situations is crucial because there is evidence that many people who have STDs are opting to avoid telling their sexual partners about the disease (Perry, Ryan, Fogel, Fishman, & Jacobsberg, 1990; VanderPlate & Aral, 1987). In the interest of health promotion, these issues are, therefore, of vital importance. Issues surrounding genital herpes provide a particularly good arena for understanding moral decision making surrounding sexuality. Because it is an episodic, incurable, and sexually transmissible condition, persons who have genital herpes are frequently faced with powerful moral dilemmas that relate to sexuality. Therefore, our goals for the study were to examine moral reasoning of persons with genital herpes, which may help define the nature of moral reasoning as it relates to conflicts associated with herpes and other STDs, and to test the theoretical perspectives that define the moral domain as they pertain to conflicts about the experience of STDs.

Conceptual Frameworks

Two theoretical perspectives have been examined extensively and have spurred discussion and debate regarding moral development and reasoning: Kohlberg's cognitive-developmental theory of moral reasoning (Kohlberg, 1969, 1984) and Gilligan's perspectives on moral development (Gilligan, 1982; Gilligan & Attanucci, 1988).

Moral stage theory. Kohlberg (1969, 1984) proposed three levels and six stages of moral development. The pre-conventional level consists of Stage 1, in which the individual is motivated primarily by the avoidance of punishments, and Stage 2, which involves more of an emphasis on maximizing rewards to the self. The conventional level of moral reasoning is comprised of Stage 3, in which the individual is motivated by the anticipation of actual or imagined disapproval of others, and Stage 4, in which moral reasoning is based upon the avoidance of dishonor or guilt. Finally, in the post-conventional level, the individual is motivated by a desire to maintain self-respect and the respect of others (Stage 5) or by universal ethical principles (Stage 6).

Kohlberg believed that an individual's moral reasoning is based upon a number of factors, including age and educational level, and that individuals advance through stages invariably and in a fixed order. Colby, Kohlberg, Gibbs, and Lieberman (1983) provided support for Kohlberg's theory in their longitudinal study of 58 men.

Kohlberg also assumed that people reason consistently across situations. Thus, if an individual progresses to a certain stage, it is predicted that he or she will use the structure of reasoning associated with that stage to solve all conflicts. Therefore, Kohlberg did not believe that people will reason differently depending upon their situational context (Kohlberg, 1984).

However, Kohlberg's theory has been widely criticized. A major criticism has been the level of abstraction of the moral dilemmas that Kohlberg used in his research on these issues. Many dilemmas to which Kohlberg's participants responded were quite far removed from the experience of most people; therefore, Kohlberg's findings have been criticized for being unrealistic and artificial (Gilligan & Attanucci, 1988; Walker, 1984). However, Walker, deVries, and Trevethan (1987) found that participants' moral reasoning stage scores were consistent across real-life (i.e., those that participants generated from their experiences) and hypothetical dilemmas (i.e., those provided by researchers). This suggests that Kohlberg's stage model of moral reasoning may be more applicable across a variety of abstract and real-life dilemmas than critics might expect.

Health Care Industry

Moral dilemmas, moral reasoning, and genital herpes

Journal of Sex Research, Summer, 1997 by Terri D. Conley, Rosemary A. Jadack, Janet Shibley Hyde

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