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Ethical decision making

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Ethical decision making a comparison of individuals and groups
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Hogling, Arthur W
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English
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xii, 157 leaves : illustrations, forms ; 29 cm

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Public institutions -- Management -- Moral and ethical aspects ( lcsh )
Group decision making -- Moral and ethical aspects ( lcsh )
Decision making -- Moral and ethical aspects ( lcsh )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Bibliography:
Includes bibliographical references.
General Note:
School of Public Affairs
Statement of Responsibility:
by Arthur W. Hogling.

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|University of Colorado Denver
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Auraria Library
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ocm28863924
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LD1190.P86 1993d .H64 ( lcc )

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Full Text
ETHICAL DECISION MAKING:
A COMPARISON OF INDIVIDUALS AND GROUPS
by
Arthur W. Hogling
B.A., Drake University, 1970
M.Ed., Kent State University, 1974
A thesis submitted to the
Faculty of the Graduate School of the
University of Colorado at Denver
in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
Public Administration
1993


This thesis for the Doctor of Philosophy
degree by
Arthur W. Hogling
has been approved for the
Graduate School
of Public Affairs
by
Dat


1993 Arthur Hogling
All rights reserved.


Hogling, Arthur W. (Ph.D., Public Administration)
Ethical Decision Making: A Comparison of
Individuals and Groups
Thesis directed by Professor E. Sam Overman
ABSTRACT
Ethics and human rights committees are being
used in ever increasing numbers to address ethical
issues in public institutions. These multi-
disciplinary committees provide a forum for review
and decision making. Such structures are now found
in many hospitals and a growing range of public
organizations. Though typically voluntary, such
committees are required by law in the case of
Colorado's programs for people with developmental
disabilities. In this context, they are known as
human rights committees (HRC's).
Despite the law, most ethical decisions in this
field continue to be made independently by
professionals, advocates, families and the general
iii


public. As a result, a debate has arisen as to
whether the outcome of the decision process differs
between these two groups, HRC's and informed
individuals.
This study examined differences concerning
ethical decisions made by HRC's, professionals,
client rights advocates, family members and the
general public. Specifically, the decisions of
these groups were compared to see if significant
differences existed in ethical decision making
outcomes. Hypothetical cases describing actual
ethical dilemmas were presented to each group and
individual. The data generated was tested with non-
parametric techniques and chi-square.
The findings of this study indicate there are
significant differences between the ethical
decisions made by HRC's, family members and the
general public. Professional's decisions also
differed from the general public's, indicating
support for the separatist thesis. The decisions of
advocates were similar to those of HRC's.
iv


I
The form and content of this abstract are approved.
I recommend its publication.
v
i


ACKNOWLEDGEMENTS
Special thanks are due Shirley Peer for her
invaluable contribution of editing, typing and good
will regarding this thesis.
Critical to the degree's completion was a value
for higher education and life-long learning
established by my parents- who despite being unable
to fulfill their educational dreams, encouraged me
in mine.
To my sister, Clare Jones, Ph.D., who led the
way and most importantly, to my wife, Sydney
Bernard-Hogling, whose support, caring and intellect
were paramount in its completion.
vi
i


CONTENTS
CHAPTER
1. INTRODUCTION...............................1
Ethical Decision Making in the
Public Sector ........................... 1
Human Rights and Ethics Committees. ... 4
Purpose of the Study. ....................8
Questions................................11
Hypothesis............................12
Definitions and Operational Terms ... .13
General Limitations ...................15
The Nature of Ethical Decisions. . .15
Committee Nomenclature................16
Data Limitations .....................16
Organization of the Dissertation.........17
Summary..................................18
2. REVIEW OF THE LITERATURE..................19
Introduction.............................19
The Emergence of Ethical Decision
Making Committees........................19
The Growth of Ethics Committees..........23
The Development of Human Rights
Committees...............................24
vii


Growth of Human Rights Committees . .28
Colorados Human Rights Committees. . .29
A Theoretical Foundation for Human
Rights Committees.................30
Decision Making Group Research...........32
Group Decision Making Superior to
Individual.............................33
Individual Decision Making
Superior to Group......................40
A Theory of Group Processes for
Decision Making...........................42
The Separatist Thesis..................43
Gender Based Decision Making..............45
Values in Decision Making ................48
Summary...................................58
3. RESEARCH DESIGN AND PROCEDURES.............60
Introduction..............................60
Research Design...........................60
Sample Description........................62
General................................62
Human Rights Committees................62
Advocates..............................63
Professionals..........................64
Families...............................65
viii


Members of the Public.................65
Instrumentation and Observational
Methodology...............................67
Pilot Study...........................68
Data Collection...........................70
Variables.............................71
Statistical Procedures....................72
Summary...................................74
4. RESULTS OF THE STUDY......................75
Comparison of Demographic Variables . .75
Gender................................77
Years of Education....................78
Ethics Training.......................79
Developmental Disabilities Training. .80
Advocacy Training.....................81
Relative with Developmental
Disabilities..........................82
Age...................................83
Test of the Hypotheses...................84
Hypotheses............................. .86
Summary..................................93
ix


5. SUMMARY....................................94
Summary of the Study......................94
Summary of Findings and Conclusions . .95
Areas for Further Consideration .... 102
APPENDIX
A. Cover Letter..............................106
B. Instructions for Individuals ............ 108
C. Instructions for Groups and Human
Rights Committee Data Sheet...............110
D. Survey Document and Individual
Data Sheet................................113
E. Participating Human Rights Committees. 122
BIBLIOGRAPHY ................................. 124
X


TABLES
Table
3.1 Summary of Sample Size....................66
4.1 Results of chi-square test of
significance - Sex........................77
4.2 Results of chi-square test of
significance - Education .................78
4.3 Results of chi-square test of
significance - Ethics training............79
4.4 Results of chi-square test of
significance Developmental disabilities
training...................................80
4.5 Results of chi-square test of
significance - Advocacy training..........81
4.6 Results of chi-square test of
significance Relative with developmental
disabilities...............................82
4.7 Results of chi-square test of
significance - Age........................83
4.8 Results of Kruskal Wallis One-way
Analysis of Variance.......................85
4.9 Results of One-way Analysis of Variance. .86
xi


FIGURE
Figure
4.1 Mean Ranks for Total Scores by Group


CHAPTER 1
INTRODUCTION
Ethical Decision Making in the Public Sector
A core problem in the study of public
administration has been the making of ethical
decisions by organizations and individuals.
Recently, this topic has emerged as a cutting edge
issue in our profession.
From the time the Wilsonian notion of a
separation between politics and administration was
discarded, we have come to recognize that the
practice of public administration is interwoven with
values and ethical issues. Herbert Simon (1944, 29)
argued that when studying administrative science,
the basic unit to be evaluated should be that of
decision making. He believed decisions were
influenced in a complex way by both factual and
ethical considerations. In his classic work,
Administrative Behavior Simon (1976, 47-49) stressed
that moral questions became an element of every
decision. Earlier, Chester Barnard (1938) reached a
similar conclusion. He recognized that


administrative decisions were strongly affected by
the environment in which they took place. He
believed that when decisions were made, they were
heavily influenced by individual and group values.
A related position is taken by Frederick Mosher
(1968). Mosher feels that in the modern world, one
must accept the conclusion that administrative
decision making activities significantly influence
public policy and legislative agendas. He believes
decisions are made outside of perceived processes
and often reflect individual values. Despite
Wilson's preference for the contrary, it is
impossible to separate public administration from
personal, ethical and political influences.
Dwight Waldo (1981, 103-109) also recognized
this central concern in our discipline. He accepted
the dilemma and reasoned that, since it exists,
administrators should be equipped with practical
methodologies which would assist them in making
ethical decisions. He called for "navigational
instruments" and "ethical maps" by which public
servants could chart their way through moral
2


ambiguity. Although he suggested several areas in
which to seek such instruments, Waldo did not
specify particular mechanisms.
Recently, Paul Dokecki and Richard Zaner et al.
(1986) placed this dilemma in a contemporary
context. They posited that the methodologies and
tools traditionally available to ethical decision
makers have been far outstripped by advances in
biomedical and psychoeducational technology. Today,
machines perform life saving measures for patients
who, until recently, would have died. Entire
populations, such as the profoundly handicapped,
have emerged with increasingly complex service
needs. Modern skills and techniques for saving
lives have "developed much beyond our understanding
of the ethical dimensions of their use" (Dokecki et
al. 1986, 18). Decision making mechanisms which
worked in the past are no longer viable. Dokecki
and his colleagues point out a tremendous gap
between modern techniques and the philosophical
understanding. They propose that scholars and the
academic community take the lead in developing
3


ethical methodologies to assist decision makers in
coping with these growing conflicts.
Current events also demonstrate that ethical
decision making is developing as a valid, urgent and
important issue in our profession. Weekly, the
popular press raises questions concerning the moral
underpinnings of our government. Weighty ethical
dilemmas are presented for public debate. Such
topics as dignified death, living wills, right to
life, euthanasia, imperiled newborns, ethical codes
for bureaucrats and professional behavior are
becoming common.
Scholarly literature and practice also reflect
this trend. Practitioners debate these issues and
professional ethical codes are emerging with
increasing frequency.
Human Rights and Ethics Committees
In the center of this growing issue, a new
ethical decision making methodology appears to be
emerging. At a truly phenomenal rate, human rights
and ethics committees have developed. They were
first noted by rare citations in the professional
4


literature of the early seventies. Today, they
exist in many American hospitals, the majority of
public institutions for persons with disabilities
and are even beginning to be seen in public schools.
Known by a variety of names, these bodies are
rapidly becoming a significant method through which
ethical decisions are made in complex organizations.
Their development appears as controversial as the
subjects with which they deal.
Critics contend that the committees intrude on
individual patient's rights. Others believe that
they adopt positions far distant from societal
norms. Some doctors argue that the committees are
unnecessary because good physicians have always
incorporated ethical reflections and patient wishes
in reaching difficult decisions (Siegler 1986).
This position is common in England, which reportedly
has only two ethics committees and where there is a
very strong sense that doctors have complete
clinical autonomy: "a necessary corollary is that
they should take complete responsibility for their
clinical actions, and that such responsibility
5


should not be diluted by allowing a committee to be
involved in making decisions" (Lloyd 1988).
However, this view may be changing. Richard
Nicholson, a British pediatrician and editor of the
Bulletin of the Institute of Medical Ethics, calls
for controlled studies, "to see whether hospital
ethics committees really do serve a useful purpose
in improving patient care" (Lloyd 1988).
The key research question raised by ethical
scholars is, do these committees achieve different
decision outcomes than the results which would be
achieved by authoritative individuals acting alone?
This study will attempt to resolve this issue.
The answer to such a question would be of
interest to physicians, ethicists and practitioners
who believe todays ethical decisions are much too
complex for individuals to make alone and are best
made through consultation with committees. For
certain types of decisions, research suggests the
group process can yield different outcomes than
those made by individuals (Herbert and Yost 1979).
A large body of research in the social psychology
6


literature debates the advantages of group versus
individual decision making and will be examined in
the literature review section. It indicates groups
are influenced by such factors as group opinion, the
ability to review and reject poor decisions, the
possession of greater amounts of information,
factors inherent in the social structure of groups,
and the effects of pooling. These elements compose
the advantages seen by many in the democratic
assumptions of plurality and consensus.
Little is known about how these elements relate
to ethics committees and how they reach decisions
despite their increasing use and tremendous
expansion.
Also absent is information comparing the
positions adopted by such committees with the views
of informed practitioners, society in general,
knowledgeable patients and advocacy groups and the
families of the involved individual. There is a
need for much greater understanding about the
activities of these committees and the nature of the
process they use to achieve their decisions.
7


The research studied ethics committees and
their decisions, processes and outcomes. It is
considered important to determine if committee
decisions significantly differ from those made
independently by practicing professionals. Human
rights committees decisions are also compared to
those reached by other groups and individuals making
decisions in the same arena. Implications about
their role as a public sector methodology for
resolving ethical issues are suggested.
Purpose of the Study
Public administrators, human service
professionals and health care practitioners are
among those confronting ethical dilemmas with
growing frequency. Modern technology has
increasingly contributed to patient and client
controversies, the resolutions of which are often
beyond the capacity of existing decision making
methodologies (Bader 1982; Dokecki and Zaner 1986;
Summers 1987; Hiller 1990). An emerging problem
solving strategy is the increasing use of human
rights committees (HRC's). Minimal research exists
8


concerning the nature of the decisions made by such
groups.
The purpose of this study is to evaluate the
uniqueness of ethical decisions made by human rights
committees. The problem is to determine if the
ethical decision choices made by human rights
committees vary significantly from those of the
general public, informed practitioners, family
members and professional advocates.
Numerous researchers have demonstrated that
groups make different and superior decisions to
individuals (Wheeler and Jordon 1929; Shaw 1932;
Marple 1933; Thorndike 1938; Preston 1941; Eysenck
1941; Kelley and Thibaut 1954; Lorge and Solomon
1955; Tuckman and Lorge 1962; Holloman and Hendrick
1971). Theorists (Hall, Mouton and Blake 1963;
Collins and Guetzkow 1964) have attempted to explain
the difference as being due to special charac-
teristics inherent in groups.
This body of research was conducted almost
exclusively using experimental designs in which an
empirically correct answer was known, i.e.,
9


mathematical problems. Only rarely was research
undertaken involving value based outcomes such as
those associated with ethical decision making. In
decisions of this nature, it is very difficult to
determine if the outcomes selected by groups are
"better" or simply different.
The work of ethical theorists (Firth 1952; Fost
1976; and Fost and Cranford 1985), suggests that
groups convened in the category of ethics committees
would make "better" decisions because of objectively
superior qualities such as impartiality, lack of
self interest and dispassion. If these theories are
correct and ethics committees demonstrate different
outcomes from individuals, it could be said the
results are superior. Without validation of these
theories, however, one can only say that the results
are different.
This study, therefore, seeks to provide
empirical information regarding the efficacy and
usefulness of these committees. If it was found
that HRC's make decisions which are different than
those of other types of groups or individuals, it
10


would suggest qualitative differences exist in the
ethical decision making process. The nature of such
distinctions and their degree of disparity is
important information for consumers of a human
rights committee's services. Outcomes shown to be
significantly different coupled with a belief that
such differences reflect merit could lead to the
increased use of these committees. If their
decisions were fundamentally the same, alternative
methods might be more efficient. This study
demonstrates whether significant quantitative
differences exist between ethical decisions made by
human rights committees and other entities.
Questions
In an effort to determine if there were
significant differences in the ethical decision
making outcomes between the decisions made by human
rights committees compared to those made by
individuals, in cases involving antonomy and
paternalism, the following hypotheses were developed
for this investigation.
11


Hypotheses
HI: There is a significant difference between
the ethical decisions made by human rights
committees compared to those made by a
sample of paid advocates.
H2: There is a significant difference between
the ethical decisions made by human rights
committees compared to those made by a
sample of informed practitioners
(professionals).
H3: There is a significant difference between
the ethical decisions made by human rights
committees compared to those made by a
sample of the public.
H4: There is a significant difference between
the ethical decisions made by human rights
committees compared to those made by
family members of persons with
disabilities.
12


Definitions and Operational Terms
Ethical Decision: Any decision which affects other
people [and] has ethical implications. (Josephson
1991).
Ethical Decision Making: The process of evaluating
and choosing among alternatives in order to perceive
and eliminate options and select the best
alternative (Josephson 1991).
Family Members; Individuals whose child or sibling
is a person with developmental disabilities. Family
members as defined in this study are not employed as
professionals or advocates.
General Public: A statistical group which includes
individuals who do not have a direct professional
relationship or daily contact with the client/
patient type identified in the instrumentation case
studies.
Human Rights Committees: Third-party mechanisms
established by Colorado Law (CRS 27-10.5, Bradford,
1985) to safeguard the rights of developmentally
disabled persons receiving services. Colorado
Department of Institutions regulations (6.3.2.1)
13


state such committees shall, to the extent possible,
be comprised of, but not limited to, a minimum of
two (2) professional persons trained in the
application of behavior management techniques at
least one of whom shall not be an employee of or
consultant to services provided by the designated
community centered board, and three (3)
representatives of persons receiving services, their
parents, legal guardians or authorized
representatives.
Practicing Professionals; Individuals with
professional training related to developmental
disabilities. They are presently employed in
occupations in which they directly or indirectly
provide services to individuals with developmental
disabilities. They may include psychologists,
psychiatrists, special education teachers,
occupational therapists, physical therapists,
rehabilitation technicians and social workers.
Professional Advocates: Individuals whose employment
duties include providing full or part time advocacy
services to individuals with developmental
14


disabilities. They are workers in agencies whose
role is not primarily direct service provision.
General Limitations
The Nature of Ethical Decisions
A longstanding debate in the field of ethics is
the issue of whether one can truly know if a
decision is right or wrong. One school holds that
rationality can prevail while the other reflects the
doctrine of emotivism, the tenet that all evaluative
judgements and, more specifically, all moral
judgements are nothing but expressions of attitude
or feeling and...are neither true or false
(MacIntyre 1981). This concept is mirrored in the
choice of hypothetical cases for the study. They
reflect values and do not necessarily have a
"correct" answer. In this way, they depart from the
vast majority of cited social psychology studies
where an empirically determinable answer is
employed. This is both a strength and a limitation
in that a different dimension, decision making which
15


contains a value referenced base, is being
evaluated.
Committee Nomenclature
In practice, the names of ethics committees
vary widely. This researcher has noted over twenty-
five variants. "Ethics committee" is a commonly
understood generic name for committees of the type
being studied. Human rights committees (HRC's) are
one specific sub-categorization and generally refers
to ethics committees associated with facilities for
persons with developmental disabilities. In this
study the name "ethics committee" and "human rights
committee" are used interchangeably. However, it is
the subgroup human rights committees which were
examined.
Data Limitations
The scope of this study was limited to the
State of Colorado. All participants resided in the
state at the time of instrument presentation.
16


Organization of the Dissertation
This thesis is composed of five chapters.
Chapter 2 provides a review of the literature that
is relevant to the conduct and scope of this
project. It includes a discussion of the social
psychology research dealing with small group
decision making. It also summarizes the history and
current status of human rights committees.
Theoretical propositions put forth by Collins and
Guetzkow (1964) and their relevancy to this study
will be discussed. Gender based distinction in
decision styles are reviewed. Value based decision
making is discussed.
The study methodology is described in Chapter
3. Addressed are procedures used, the research
design, instrumentation and data collection. The
statistical tests applied are listed and
methodological limitations are discussed.
Chapter 4 presents the results of the analysis
in relation to the hypotheses. These are discussed
as appropriate.
17


Chapter 5 addresses the study's conclusion and
includes summary observations. It discusses
implications for ethical decision making, the
relationship of human rights committees and suggests
areas for further study.
Summary
Chapter 1 identified ethical decision making as
a core issue in public administration. It discussed
the emerging use of human rights and ethics
committees in the decision making process. It
raised the question of potential differences between
the decision making achieved by differing groups and
individuals. General hypotheses to be tested in
this study were stated.
In addition, Chapter 1 operationally defined
the most frequently used terms in this study and
those included in the hypotheses. The identified
terms should lead to a better comprehension of the
investigation.
The chapter concluded with the delimitations of
the study. It described the sample studied and
demographic data.
18


CHAPTER 2
REVIEW OF THE LITERATURE
Introduction
This chapter will survey what is known about
committees involved with ethical decision making.
It will examine the history and role of human rights
committees. Colorado's statutorial required
committees will be reviewed. A theoretical
foundation for these committees will be described.
Consideration will be given as to how groups make
decisions as compared to individuals. Accordingly,
the social-psychology research relating to this
variable will be examined in detail. Theoretical
propositions based on the body of literature will be
presented. The concepts of the separatist thesis
will be explored as will the implications of
decision making in a gender specific context.
Finally, the meaning of values in decision making
are examined.
The Emergence of Ethical Decision Making Committees
The use of committees for decision making has a
long tradition in health care. Robertson (1984, 6)
points out that "hospital medical affairs
traditionally have been governed by credentialing,
19


tissue, mortality, pharmacy, therapeutics, records
and other committees. Committees dealing with
professional ethics and discipline are an integral
feature of medical society regulation of
physicians. In the 1950*s, constrained abortion
policies led to the development of review
committees. Their task was to decide when abortions
were medically justified (Rodman 1974). Around
1960, improved hemodialysis procedures led to new
life saving treatment methods for kidney patients.
Early equipment designs and high cost limited the
number of individuals who could undergo the
procedure. To make the difficult decision of who
should receive the treatment, a committee was formed
to review individual cases. It became known as the
"life and death" committee and was the focus of a
national controversy (Hosford 1986).
In the mid 1960's, concern arose regarding the
practices of some medical researchers who may have
been employing questionable procedures with their
human subjects. This resulted in the U.S.
Department of Health, Education and Welfare in 1966
20


requiring the formation of multidisciplinary
Institutional Review Boards (IRB). These committees
assured that researchers were aware of required
procedures such as obtaining informed consent (Fost
and Cranford 1985). IRB's became a familiar model
upon which many committees were later established.
In 1971, the U.S. bishops urged the creation of
medical-moral committees in Catholic hospitals.
Ethical and Religious Directives for Catholic Health
Facilities (1983), described such committees as "an
integral part of a much longer institutional effort
to implement Catholic ideals and principles.
Hospital based ethics committees were described
legally by the Supreme Court of New Jersey in their
1976 decision regarding Karen Ann Quinlan. Miss
Quinlan was in a persistent vegetative state due to
an overdose of drugs. Her parents desire to
disconnect her from a respirator led to the
involvement of the legal system. In its response,
the Court endorsed the recommendation of Dr. Karen
Teel, who suggested in a Bavlor Law Review article
(1975) that physicians have access to ethics
21


committees which could share decision making
responsibility. This well publicized case became a
stimulus to the development of many hospital ethics
committees (Fost and Cranford 1985).
In 1982, a child born with Down Syndrome died
after his parents refused treatment for related
complications. Known as Babv Doe (Federal Register
1983; [March 17]; 9630-9632), this case and similar
ones which followed led to a presidential commission
on medical ethics (Dine 1988). The following year,
the commission issued a report, Deciding to Forego
Life-Sustaining Treatment (1983), which states
hospitals "should explore and evaluate various
formal and informal administrative arrangements for
review and consultation, such as ethics committees,
particularly for decisions that have life or death
consequences" and to "promote effective decision
making" for mentally incompetent patients and for
handicapped newborns.
Disabled infants were viewed by the Department
of Health and Human Services as being protected by
the 1973 Rehabilitation Act. In 1984, the
22


department issued rules requiring hospitals to
create infant-care review committees. Although
these rules were later dissolved by the U.S. Supreme
Court, they had a strong effect upon further
committee development (Dine 1988).
The Growth of Ethics Committees
Ethics committees are becoming increasingly
common in health care institutions. Younger (1983)
found that, in 1981, less than 1% of hospitals
surveyed reported having committees which involved
themselves in ethical decision making. In response
to a similar survey in 1983, Guidi found 16% of
hospitals in a three state area that reported having
ethics committees. A 1983 survey undertaken by the
American Hospital Association's National Society for
Patient Representatives found 26% of respondent
hospitals reported having ethics committees
(Hospitals 1985). The survey was repeated in 1985
and 60% of hospitals reported having committees.
The researchers also related that many hospitals
without committees planned to establish them. In
1983, 15% of hospitals said they planned to
23


establish them and in 1985, 31% said they would
establish committees in the near future.
Ethics committees can also be found in nursing
homes. A 1990 study found 30% of nursing homes have
them and 40% say they plan to develop one soon (Long
Term Care News. 1990). Sixty-six percent were
formed within the last two years. Membership
averages twelve individuals who are typically
physicians, nurses, administrators, social workers
and clergy.
The Development of Human Rights Committees
Parallel to the emergence of ethics committees,
has been a variant known as human rights committees
(HRC). These committees are very similar to ethics
committees, but typically specialize in issues
concerning persons with developmental disabilities.
It is perhaps understandable that this population
has emerged with a specialized form of ethics
committee in that their cases seem to be the subject
of many ethical dilemmas. They were the individuals
in the baby doe incidents, the children that came
before the infant review boards, the people who were
24


abused in institutions, and often the subject of
many of the classic bioethics case studies i.e.,
Willowbrook hepatitis studies (Review of Infectious
Diseases 1986), case of Joseph Saikewicz
(Superintendent of Belchertown v Saikewicz 1977).
Also, they were the subject of decisions concerning
birth defects, the quality of life, competency or
informed consent.
While today's services for this group follow a
psychoeducational model, for many years they were
viewed as ill and served through a medical model.
The early treatment of choice was state hospitals,
staffed by medical personnel. The committee
decision making element of the medical model
continues to have its parallels in current practice.
Individuals served often have their programming
developed by individual habilitation teams or
individualized education program teams.
Historically, the earliest reference chronicled
by Robertson (1984) concerns medical decision making
committees spawned by the eugenics movement of the
1920's. These committees were usually composed of
25


physicians and required to review decisions
concerning sterilization of the "feebleminded."
Modern human rights committees appear to be first
mentioned in the landmark "right to treatment" case,
Wvatt v. Sticknev (344 F Supp. 387 1972). A suit
was filed in 1970 on behalf of the terminated
professional employees of Alabama's mental
hospitals. Shocking circumstances in these
facilities caused the case to be expanded into a
vehicle for reforming grossly substandard
institutional conditions. Federal Judge Frank M.
Johnson ordered numerous reforms and declared that
the residents of the institutions had a "right to
treatment" (Mahan et al. 1975). This right soon
proved to be a difficult right to implement. The
judge appointed a "human rights committee" at each
institution. Their charge was to "guarantee that
residents were afforded constitutional and humane
habilitation." Further, the committee was "to
review all research proposals and all habilitation
programs, to advise and assist residents who allege
that their rights have been violated, and... to
26


With time,
consult with specialists as necessary."
the committee expanded its scope of duties and
investigated abuse reports. It also discussed and
confronted issues dealing with the residents' rights
to increased sexual freedom, the exercise of
religion, the right to vote and to obtain counsel.
The early experiences of the committee were reviewed
and recommendations made to increase the
effectiveness of future committees.
One recommendation concerned committee
membership. It was felt that, based upon the
committee's experience, a diverse membership
including physicians, attorneys, clergy and informed
citizens was most desirable.
As long-term health care facilities,
institutions for the disabled fall under the
regulation of the Federal Health Care Finance
Authority. In 1978, the regulations for these
facilities were revised to include the requirement
that all programs have human rights committees. The
requirements (Title 42, 18 442,413) are limited, but
call for an established human rights committee which
27


must meet regularly and include direct care staff as
appropriate. Reports shall include recommendations
and their implementation and must be filed.
Growth of Human Rights Committees
The use of human rights committees has expanded
at a phenomenal rate. First used in 1972 in
Alabama's institutions (Mahan et al. 1975), they
were reported to be in 91% of surveyed state
facilities by 1977 (Kemp 1978). A survey conducted
in 1981, revealed that 100% of responding facilities
had HRC's (Kemp 1983). This survey also revealed
some interesting demographics concerning the
committee's composition. Committee size varied from
4 to 35 with 9 or 10 members being the most common
size (39%). Sixty-four percent of the HRC's had 10
or fewer members, 27% had 11 to 20 members and 8%
had over 20 members. Seventy-five percent had
membership which was mixed staff and non-staff.
Eleven percent were all staff and 14% were all non-
staff .
Non-staff members were often selected because
they represented a certain criterion thought to be
28


desirable. This included parents of people with
disabilities, mentally retarded persons, attorneys,
social workers, educators and physicians.
A survey conducted in 1989 was sent to a broad
range of public residential facilities for persons
with mental retardation (Spreat and Lanzi 1989).
The respondents indicated that 97.7% of their
facilities had human rights committees. Committee
membership averaged 10.2 members with a range from 3
to 25 members. Membership characteristics were
diverse, including parents (14%), other (13%),
external mental retardation professionals (12%) and
advocates (10%). Thirty-three percent of the
members reported some expertise in applied
behavioral analysis and 11.5% had some form of
specialized medical training (e.g., physician,
registered nurse).
Colorado's Human Rights Committees
In 1985, Colorado law concerning institutional
and community services for people with developmental
disabilities underwent massive legislative revision.
The new law, The Care and Treatment of the Disabled
29


(SB-135, 1985) C.R.S. 27-10.5, contains extensive
additions concerning the rights of people with
developmental disabilities as well as including
numerous quality assurance and client protective
procedures. In this regard, it established the
requirement that each state facility or community
program operate a human rights committee.
A Theoretical Foundation for Human Rights Committees
It has been suggested that ethical decision
making would be enhanced if conducted by
hypothetical beings who were capable of making
decisions in an objectively superior way (Firth
1952). Firth has described these individuals as
"ideal ethical observers."
They must be:
1. Omniscient possessing all relevant non-
ethical facts.
2. Omnipercipient capable of having
extraordinary powers of imagination, the
ability to visualize several alternative
acts and their consequences in rapid
succession.
30


3. Disinterested having extreme
impartiality and freedom from self-
interest .
4. Dispassionate emotions are in check and
the observer is free of distorted
judgement.
5. Consistent use principles which can be
applied by others in similar situations.
These characteristics can serve as a model to
individual decision makers confronted with complex
ethical issues (Fost 1976).
The ideal nature of such qualities, however,
makes it unlikely any one person can possess all
these virtues or be independent enough to apply
them. Fost and Cranford (1985) believe that a
broadening of the decision making process can
enhance the likelihood of capturing the ideal
observer qualities. Ethics committees can be well
suited to this purpose. They point out that the
intent behind committees and board usage is the
belief that diverse viewpoints often lead to better
decisions.
31


"Ethics committees, according to this view, may
be more likely than individual physicians to arrive
at decisions that, in retrospect, will withstand
ethical scrutiny and legal challenge" (Post and
Cranford, 1985).
Decision Making Group Research
Small group decision making research has a long
and rich history extending back to an experiment
conducted by Triplett in 1898 (Hare 1962 has
catalogued 1,385 related studies). While this work
has generally been carried out in the realm of
social psychology, related studies have taken place
in education, administration and sociology.
Hopefully, this study will contribute to a sub area,
specifically the variance between group and
individual decision making. Here, the central
question has been, how does group decision making
differ from individuals?
The following sections review the classic
studies in this area. They divide the work by
outcomes. Studies in group one suggest group
decision making is superior to that of the
32


individual. This is the most frequent outcome.
Group two reviews those studies which indicate
individual decision making is superior to group
decision making. It will be noted there are fewer
with these results.
Both groups generally rely upon studies in
which rational decision making and problem solving
occurred. In most cases, there was a discernably,
measurably "correct" answer. Few of the studies
involved value based outcomes, most likely because
ethical analysis is inherently resistant to that
sort of qualification.
Group Decision Making as Superior to Individual
Eysenck (1941) demonstrated that he could
improve the validity of decisions which concern
aesthetic judgements. He did this by adding
additional individuals to nominal groups.
Preston (1938) accepted the fact that such
experiments show group decision making to be
superior. He attributed these differences to
statistical phenomena and sought to demonstrate that
interacting groups can produce substantially
33


better results than those which are statistically
manipulated.
Wheeler and Jordan (1929) sought to determine
if group decision superiority was a result of the
opinions of individuals being influenced by the
effects of a group opinion. Using a sample of
college students, they demonstrated that group
opinion indeed had a substantial influence upon
individual decision making.
Similar work by Marple (1933) also indicated a
tendency for individual decisions to be influenced
by group opinion. She showed that individual
opinions were susceptible to the influence of
perceived experts.
Shaw (1932) used college students to compare
the success of individuals and cooperating groups in
solving complex problems. She concluded that groups
obtained a much higher proportion of correct answers
than individuals. Her explanation for the
superiority of groups is based upon their rejection
of errors and ability to check suggested solutions.
34


Studies by Thorndike (1938) showed group
decision discussion led to a higher number of
correct answers to problems of fact in which the
correct answer was determinable. Interestingly,
Thorndike also noted improvement in the
correctiveness of value related answers, but not to
as great a degree as those in factual situations.
Kelley and Thibaut (1954) determined that group
decisions are superior to those of individuals.
They did not believe the difference could be
accounted for solely by the sum of constituent
individual decisions. The whole appeared to be
greater than the sum of the parts. They posited
that one reason for the enhancement could be found
in the social structure of groups themselves.
Lorge and Solomon (1955) reviewed earlier
studies of this phenomenon and concluded that the
superiority of groups in decision making may vary
upon the type of problem being considered.
At a later date, Lorge et al. (1958) surveyed
the majority of studies done between 1927 and 1957
which contrasted the quality of individual and group
35
S


performance in decision making. They summarized
these accumulated works as suggesting groups are
superior in problem solving. They cautioned,
however, that most studies have dealt with ad hoc
groups convened for experimental purposes. Such
groups may not reflect the same processes which
would occur with genuine groups of long standing.
Hall, Mouton and Blake (1963), accepted the
position that group decision making is superior to
that of individuals. They believed there are three
possible explanations for this phenomenon.
1. Products may be superior because of the
effects of pooling. In pooling, the
judgements of many non-interacting
individuals are combined statistically to
obtain group averages. These averages
represent the likelihood of correct
judgements occurring more frequently than
when they are used in the evaluation of
any single person.
36


2. Another explanation for the superiority of
groups can be derived from the beneficial
effects of interaction. Groups meeting
face to face can share, through discussing
a wide variety of facts, interpretations
and opinions which lead to superior
results. This position holds that the
various psychological factors present in
an interacting group result in better
decisions.
3. A third explanation is that group
superiority is due to the effects of
compromise. Through a bargaining process,
a group decision is reached which reflects
a negotiated outcome and not the
integration of the best ideas of
individual members.
Hall, Mouton and Blake (1963) conducted a study
to see if the decisions of interacting groups were
superior (i.e., more correct answers) to the pooled
judgement of individuals. They determined that
pooled scores are superior or equal to the
37


individual scores in most cases. Pooled scores are,
in turn, inferior to the product of group
interaction. They conclude that there is an element
within interaction per se which has a positive
effect upon decision quality which is greater than
that attributable solely to the effects of
compromises or the statistical compromises of
individual errors.
Tuckman and Lorge (1962), sought to empirically
determine if a group's effectiveness in problem
solving was a function of the ability of a group's
best member or of its interaction. They concluded
groups were superior due to the fact that the size
of groups increased the probability of that group
containing the correct answer over any one
individual. They also suggest that group
superiority could be a function of successful group
dynamics which would be enhanced through tradition
building.
Holloman and Hendrick (1971), studied group
size to see if it was a factor in quality of
decision making. They found very small groups
38


(three or less) made the least accurate decisions.
Groups of six had the most accurate decisions,
although not significantly different from groups of
twelve and fifteen.
Goldman et al. (1961) concluded that existing
research concerning the productivity of groups
versus individuals was not definitive. They did
note that there appeared to be some differences
between the pooled work of individuals and the works
of those same people working as a cooperative unit.
They questioned if the disparities were due to the
social context or structure of the group. In a
laboratory setting, they sought to replicate the
common arrangements which exist when groups convene
to work on problems. Groups were evaluated under
varying conditions of motivation and leadership.
Variation included rewards for leaders with high
performance. They concluded increased performance
was not obtained when one member of a group was
designated the leader and given special
compensation. Results indicated that groups were
most successful when all subjects were working for
39


equal reward and where there was not a leader who
would receive an extra reward.
Coleman et al. (1958) believed that groups are
indeed superior to individual problem solving and
the difference can be found in group motivation
levels.
Individual Decision Making Superior to Group
Marquart (1955) reexamined the classic study of
Shaw (1932) which found a strong advantage of group
work over individual work. In a study which
reevaluated Shaw's data, Marquart found a slight
advantage for groups over individuals, but not at a
significant level. Very similar results were
obtained by Marquart in a new study which paralleled
the original research. Shaw found no significant
differences between groups and individuals when the
comparison was between the best work of an
individual in a group and the work of the group.
Marquart suggested that the perceived superiority of
groups becomes more evident when the tasks to be
accomplished are more complex and beyond the work
capabilities of an individual.
40


Taylor, Berry and Block (1958) studied the
quality of problem solving by groups and of
individuals who used brainstorming methodology. The
results indicated that group performance was
remarkedly inferior to that of individuals. The
researchers concluded that group participation
inhibits problem solving which requires creative
thinking. It should be noted that problems being
tested were those which involved logically correct
solutions.
Dunnette et al. (1963) also evaluated the
values of individual problem solving versus group
problem solving in a brainstorming format. He found
that individual problem solving yielded more ideas
than that produced by group brainstorming
approaches. He concluded that there was an element
in participation which caused certain inhibitory
influences on problem solving.
Campbell (1968) also studied individual versus
group problem solving. His intention was to
determine if real groups (already existing) make
better decisions than either individuals or ad hoc
41


groups which are brought together for a single
decision making event. He determined that group
participation and discussion did not generate better
decision scores, but rather tended to be inhibitory.
Standing work group results were inferior to that of
both ad hoc groups and individuals. He noted that
findings of this type may be dependent upon the type
of problem being explored.
A Theory of Group Processes for Decision Making
Collins and Guetzkow (1964) sought to build an
inductive theory of small group decision making.
Their efforts relied substantially upon the type of
empirical studies described in the previous
literature survey. Their goal was to develop a
theory which over arched the many investigations of
the group decision making process and would serve as
a propositional base for future researchers and
practitioners. Several of these propositions relate
to the proposed research project. Specifically:
2.1.C Group will be efficient when the
critical demands of the task
emphasize the gain (a) from a
42


duplication of effort and/or (b) from
the division of labor.
2.2. B The accuracy and quality of the final
group product will be increased
through the elimination of inferior
individual contributions.
2.2. C The social weighing given to the
majority opinion (i.e., conformity)
frequently causes the better
alternatives to be chosen.
2.6. Group members may collectively
achieve more than the most superior
members are capable of achieving
alone.
The Separatist Thesis
This research project seeks to explore ethical
differences which possibly exist between individuals
and groups. Such differences may be particularly
divergent in the case of professionals. The expert
nature and unique role these individuals occupy in
our service systems has led to the proposition that
they have a different ethic than the general public.
43


Labeling this phenomenon as the "separatist thesis,"
Gewirth (1986) describes professionals as having
certain rights and duties which are different from
those found in other realms of moral responsibility.
The genesis of these special duties may be the
obligation one acquires in having accepted the role
of professional (Freedman 1978). Taking on a
helping role brings with it a set of "ought to's" to
which the general public may be less sensitive. Or
are such differences more a matter of degree than
kind? It has been argued that professionals are
following more general obligations but applying them
in extreme circumstances (Martin 1981). This debate
was addressed empirically by Overman and Foss
(1991). They evaluated the separatist thesis using
a large sample of professionals (physicians) and
citizens. Both groups were surveyed on key ethical
dimensions. Their findings demonstrated support for
the separatist thesis, particularly in personal and
directly relevant ethical choices, less so on more
global and abstract dimensions. The authors make a
44


strong call for further examination of professional
ethics, particularly in public administration.
These dimensions of professional and public
decision making were also addressed in this study.
The design allowed for an empirical comparison of
the ethical choices of each group and comment will
be present regarding the separatist thesis.
Gender Based Decision Making
A knowledgeable observer has suggested that
ethics committees follow a classic feminist problem
solving paradigm (Abrams 1990). Such a paradigm has
been described by Gilligan (1982). Its elements
include an awareness of the connection between
people, responsibility for one another and a
perception of the need for response. Key elements
include communication as a mode of conflict
resolution, morality arising from the recognition of
relationships and a conviction that resolutions to
dilemmas will follow from its compelling
representation (1982, 30). This is contrasted with
a masculine model which takes a more judicial tone
and in which problems are resolved through logical
45


deduction and an appeal to principle and
polarization. This dichotomy has become known as
the distinction between an ethic of care and an
ethic of justice (Gilligan 1988).
Research by Haan (1977) supports this model.
It indicates moral judgements of women differ from
those of men by their greater connection with
feelings of empathy and moral judgement. Women's
judgements are described as concerned with real as
contrasting to hypothetical judgements.
Noddings (1984) elaborates on this distinction.
"One might say that ethics has been discussed
largely in the language of the father: in
principles and propositions, in terms such as
justification, fairness, justice. The mother's
voice has been silent. Human caring and the memory
of caring and being cared for...have not received
attention."
Noddings argues that for the male principle
based approach to succeed in totality, its
principles would need to be applicable in all
situations. She believes they have been useful, but
46


only as guidelines. A caring, feminine approach
allows for a non-rule bound solution, which can be
very helpful in the abstract dimension of ethical
dilemmas.
This work conflicts with the impartialist moral
viewpoint as put forth by Kohlberg. Although
criticized for gender bias, ethnocentricity and
philosophical orientation, his has been a dominant
conception of morality in contemporary Anglo-
American moral philosophy (Blum 1988).
What is important about Gilligan's overall
viewpoint is that it confronts a bias that has
suggested feminist ethics are inferior to those of
males. "In societies where male standards are
considered normative, those female values have been
viewed not only as secondary, but somehow defective:
based on emotion rather than reason, intuition
rather than logic; ultimately incapable as Sigmund
Freud suggested of shaping ethical judgements"
(Toufexis 1990). Freud wrote (1925) that women
"show less sense of justice than men, that they are
less ready to submit to the great exigencies of
47


life, that they are more often influenced on their
judgements by feelings of affection or hostility."
"For women this level of what is ethically normal is
different from what it is in men."
Anastasia (1990) comments on these recent
studies. She believes they demonstrate that "far
from being deficient, women are as fully developed
psychologically as men, and their ethical judgements
are equally valid."
This conclusion is supported by the empirical
results obtained by Burton et al. (1991). They
found only minimal differences between male and
female attorneys when evaluated upon care and
justice measures.
An empirical demonstration of this position is
also possible in the study. Demographic data
identifies ethical decision making choice by several
variables, including gender.
Values in Decision Making
This section discusses values and decision
making in a general public administration context.
Decision making has long been viewed as the essence
48


of higher level public administration (Rosenbloom
and Goldman 1986). Decision making involves a
process with distinct phases. An analytical phase,
a design phase and a decision phase. These phases
are addressed by policy analysts in their work of
influencing, recommending and implementing public
policy. In a public administration context, policy
analysts often are key decision makers, or at least
highly influential in decision outcomes. Dunn
(1983) defines policy analysts to include managers,
administrators, planners and evaluators. As Murray
(1986) points out, it would be difficult to "over
emphasize" that decision making organized by these
analysts is a value laden process resulting in value
based choices. Values are clearly a major component
and influence in public decision making. How much
they should be involved is a matter of increasing
debate.
This section will provide an overview of public
policy decision making and then explore what has
come to be known as the value-rationality debate.
49


Decision making has often been categorized in
various models or representations. These have been
described (Murray 1986) as rational, political and
legal models. The rational (or analytic) model
involves three distinct phases of decision making
which are explicitly performed. These include an
analytic phase (information gathered), a design
phase (options developed) and a choice phase
(alternatives selected). This is a problem solving
model in which the problem is carefully thought
through. It can be difficult to apply in the
complex realities of administrative life.
Organizational goals may be unclear or conflict.
Outcomes may not be appropriate in terms of
practice.
These flaws have often led to the use of a
political or incremental model (Lindbloom 1959).
This approach uses successive limited comparisons.
Here the method involves building upon the current
situation, step-by-step and by small degrees. It
stresses the need for decision makers to be
responsive to the political context and the groups
50


which make up its community. In this context, the
test of a good decision is whether there is
consensus or agreement supporting the policy and its
implementation. Decisions may not be optimum, but
they are at least satisfactory.
A third model employs a legalistic approach.
"In a country with a strong rule of law tradition"
the legal process stands as a third and
theoretically discrete means of decision making
(Lowi 1969). In this approach, formally enacted law
and regulation become the basis of decision making.
Yet within this formal system resides a large degree
of discretionary fluidity. Adjudication is
employed, an approach which seeks to protect the
rights of the individuals involved and to assure
that they are not treated unfairly or arbitrarily.
Rosenbloom and Goldman (1986) point out that
"adjudication is especially useful where the
legislature cannot agree or establish a
comprehensive policy, where there is
a need to make adjustments on a continued basis...
and where flexibility is desired."
51


Colorado's legally established human rights
committees would appear to fall into this model when
they review individualized cases of rights
restrictions.
These decision making approaches each have
positive and negative aspects. An interesting
effort to combine their individual advantages was
suggested by Etzioni (1967). Known as "mixed-
scanning," it includes adjudication, incrementalism
and the rational comprehensive approach. A decision
maker employing this method would seek contextual
information as well as certain specific detail.
These techniques are useful to the decision
maker confronting a policy issue. All are also
complicated by the influence of values upon them.
Values may be viewed broadly or in a restricted
manner. In an expanded form, values can include
desires, wants, likes, pleasures, needs, interests,
preferences, duties and perceived moral obligations
(Pepper 1958). Dunn (1983) points out that because
of this extreme breadth of scope, policy analysis
can address an enormous range of public objects
52


judged to be good and bad, right and wrong, just and
unjust. Policy in this broad sense may be defined
as "the authoritative allocation of values" (Easton
1953). Dunn also describes a narrower view of
values. In this context, values incorporate
assumptions, decision rules and other standards of
assessment in terms of which evaluative and
advocative claims are made.
Rohr (1978) believes that values rest on three
considerations. Ethical values should be derived
from the salient values of the regime, these values
should be normative for bureaucrats and they are
reflected in public law. He defines value as a
pattern of attitudes or behavior which occurs with
some frequency. It must have a history either
personal or societal before it becomes a "value."
The consideration of values in either context
has not always been considered an important endeavor
for policy analysts. The philosophy of logical
positivism, a doctrine claiming to interpret natural
science, has denigrated systematic valuative
discourse as meaningless (MacRae and Wilde 1976).
53


Its proponents argued for the dismissal of ethical
principles from the recognized discourse of social
science. Valuative assertions were viewed as
"meaningless" or "metaphysic." MacRae explains
logical positivism's devaluation of ethics as due to
the separation of the valuative realm from the
factual. Rein (1983) describes this as the Fact-
Value dilemma. "Conventional thought holds that
knowledge should involve the separation of fact and
value. This is thought to be a way that reason can
understand reality without distortion." Policy
analysts, however, have repudiated this concept.
Tong (1986) believes that most policy experts have
rethought the relationship between fact and value
and no longer see themselves as technicians who
eschew politics. They believe their "occupational
world is inhabited not by pure facts, but by value
laden facts and fact laden values." Positivistic
policy science is being seen as a matter of
generating statistics, enumerating facts, cataloging
information whereas interpretive policy science is
becoming a persuasive medium. This approach
54


involves human subjects being studied as acting
subjects rather than behaving subjects (Jennings
1987) The analysts become interpreters of facts.
The methodology employed here is qualitative.
Jennings believes human behavior and culture become
"texts" to be studied in terms of their meaning to
the agents within them and affected by them. The
actions and intentions of these agents are
interpreted in context of the rules and norms under
which they were developed. These elements also must
be seen in relation to a coherent, interconnected
whole. As such, this form of analysis is clearly
value laden.
While analysis is strongly value ladden,
applying ethical evaluation in the process can be
very difficult. Political and institutional factors
work to complicate the application. Professional
and political interests of analysts and policy
makers are threatened (Amy 1984). Ethics applied to
policy analysis generates political and professional
incompatibility. When policy analysts interpret the
world, they should be well aware that their personal
55


beliefs and selectivity enter in. Also, when they
refer to cultural conventions and "institutional
facts," that these have been influenced by
traditions and norms of their developers.
Greater attention to ethics could help in this
arena. The need to develop a specific code of
ethics for policy analysts has been suggested
(Benveniste 1984). Such a code would assist policy
makers through such difficult areas as clarifying
disclosure, defining collective interests,
establishing norms for stakeholder participation and
operating under inappropriate pressure. Applying
such principles would help achieve a balance between
conflicts caused by personal interest and pressure
from their principles.
A direct application of Benveniste's call for a
code of ethics could be an ethical code for ethics
committees. As their role evolves, it would appear
to be a necessary and logical development to assist
them in their difficult work.
Interpretive policy analysis has tremendous
promise. Its proponents (Tong 1986) believe it can
56


lead to new social goals for public policy and to a
greater comprehension of the sociological and
cultural ramifications of governmental activity.
In this context, human rights committees can be
seen as interpreters of public policy. They have
been created by courts and legislatures, and
complicated organizations to operate in the gray
area of moral dilemma. Policy makers may have
intuitively recognized it is an impossible task to
prescribe correct decisions in value areas. Hence,
such committees represent an acknowledgement that
each dilemma must be determined upon its individual
merits.
A decision made by an individual includes the
risk of reflecting only that person's point of view.
Legislative structures, imbued in the tradition of
pluralism and debate, recognize the value of
consensus and varying points of view. As such, it
may be very natural that they turn to the mechanism
of the committee when creating legislation in
ambiguous areas.
57


The central hypothesis of this research tests
this proposition. If an individual's values differ
from group's, a case can be made that a phenomenon
is occurring based upon a unique element of the
group experience. Significant differences would be
seen between the ethical decisions made by human
rights committees compared to samples of advocates,
informed practitioners (professionals), the public
and family members of persons with disabilities.
Summary
Chapter 2 reviewed the literature related to
human rights committees and their origin. Related
theories and studies were examined. In summarizing
this research and relating conclusions to this
study, several points can be made.
1. Human rights committees are a relatively
new phenomenon, with little empirical
foundation.
2. Multi-member organizations (groups) seem
to make decisions differently than
individuals.
58


3. The separatist thesis can be tested by
this research.
4. Gender differences in problem solving and
ethical analysis may be observable in this
proj ect.
5. Values heavily influence ethical decision
making.
59


CHAPTER 3
RESEARCH DESIGN AND PROCEDURES
Introduction
This chapter will examine the research
methodology and procedures used in the study.
This involves the presentation of a range of
ethical cases to individuals and groups who will
then decide their degree of agreement with
specified decision choices. The chapter will also
discuss the ethical case selection, pilot study,
description of the samples, research design and
statistical procedures.
Research Design
This project applies a quasi-experimental
research design. According to Cook and Campbell
(1979), "quasi-experiments are experiments that
have treatments, outcome measures and experimental
units, but do not use random assignments to create
the comparisons from which treatment-caused change
is inferred. The comparisons depend on
nonequivalent groups that differ from each in many
60


ways other than the presence of the treatment
whose effects are being tested." Nachmias and
Nachmias (1981) point out that "whereas these
designs are weaker on internal validity than are
experimental designs, they provide considerably
more internal validity than do pre-experimental
designs. Unlike experimental designs that rule
out the effects of influences other than exposure
to an independent variable or a stimulus, quasi-
experimental designs do not require randomization
and often depend on the possibility that
influences other than the treatment can be ruled
out by additional empirical evidence and data
analysis techniques."
Mauch and Birch (1983) describe how research
can "legitimately embrace a variety of forms of
scientific investigation." They describe fourteen
types of research and point out that "frequently
more than one of these find use in the same
investigation." Their taxonomy, in addition to
quasi-experimental designs, includes opinion
polling, correlational predictive and analytical
61


analysis. There are elements of each of these in
this study.
Sample Description
General
All sample participants were residing in
Colorado at the time of instrument presentation.
Human Rights Committees
The human rights committees selected for this
study were those established under the Colorado
Revised Statute 27-10.5 (Bradford 1985). They
were operated by community service agencies for
the developmentally disabled and by state run
regional centers. The executive directors and
superintendents of these programs were contacted
by the researcher. They were asked to seek the
cooperation of their human rights committee with
this project. Instruments were sent to the
designated administrative contact for presentation
to the committees. The study was placed on the
agenda of the human rights committee, usually at
62


the next meeting following their agreement to
participate.
Of 22 agencies contacted, 11 participated
(one agency had two committees). See appendix E
for a list of participating committees. This
represents 54.5% of human rights committees
operating in the State of Colorado. Other
researchers studying such committees (Kemp 1978;
Jordon 1983) reported less success in gaining
access. The main reason for human rights
committees not participating may be due to the
standard of confidentiality under which these
committees are accustomed to working.
Advocates
Advocates are individuals employed by client
rights organizations. This is a relatively small
group. It is estimated there are now more than 25
of these individuals in Colorado. An advocate
pool was created by interviewing the Executive
Director of the Colorado Association of Retarded
Citizens. The Director had years of experience
working within advocacy systems and personally
63


knew most of the individuals within the state who
fit the category criteria of individuals who were
paid to work as advocates for persons with
developmental disabilities. Identified
individuals were sent instructions and the
instrument by the researcher. Of 18 instruments
sent, 15 were returned. This represents an 83.3%
response rate.
Professionals
Professionals filling the study criteria of
formal disability training and employment as
service providers, were sought by the volunteer
assistants from public school special education
programs and agencies for the developmentally
disabled. If they agreed to participate, they
were sent instructions and the study instrument by
the researcher. Of 32 professionals receiving the
instrument, 29 responded. This represents a 90.6%
response rate.
64


Families
Families with a developmentally disabled
member were located throughout Colorado by-
contacting professional special education staff
members of various public school systems and
agencies for the developmentally disabled. These
individuals were asked to contact persons meeting
the criteria to see if they were willing to
participate in this study. If they agreed, they
were forwarded the instrument and instructions by
the researcher. Of 48 families provided with the
instrument, 26 responded. This represents a 54.1%
response rate.
Members of the Public
Members of the public were solicited
throughout Colorado by volunteer research
assistants. For example, participation was sought
from those attending public meetings. The
requirements of the project were explained and
names and addresses were obtained from those
willing to participate and forwarded to the
researcher. A packet was then mailed to each
65


individual. It contained a cover letter (appendix
A), instructions (appendix B), the survey document
and an individual data sheet (appendix D), and a
stamped return envelope.
Care was taken to select individuals who did
not overlap with individuals in other categories.
The test instrument also included questions which
screened for overlap. In situations where this
was noted, those individuals were not included in
the study. Of 34 provided with the materials, 31
responded. This represents a 91.1% response rate.
Sample Size
TABLE 3.1
Summary of sample size.
CATEGORY N=
Families 26
Public 31
Professionals 29
Human Rights Committees 11
Advocates 15
66


Instrumentation and Observational Methodology
This research project involved the
presentation of case studies containing ethical
content to targeted individuals and groups. The
field of ethics has a long tradition of employing
this type of method to study ethical dilemmas
(Freeman and McDonnell 1987). Case studies can be
a useful tool for providing to subjects controlled
information in a consistent format. Desirable
cases for this research were ones which involved
persons with disabilities. Seven cases were
selected from the literature. These were similar
to actual cases that a human rights committee in
the sample could encounter. The seven cases were
reviewed and approved by a committee member who
has extensive experience with the type of cases
human rights committees confront in field
situations.
The content of the cases dealt with moral
decisions involving autonomy, protecting the
vulnerable, liberty and paternalism. These
variables were sought because they realistically
67


represent those encountered in providing services
to persons with severe disabilities. They reflect
the type of dilemma actual human rights committees
encounter.
Essentially what is being measured is the
balance of restriction of freedom versus liberty.
Gutmann and Thompson (1984) describe a continuum
which exists between complete liberty and
societies restriction of present freedom of
choice. They view it as a hard choice which must
be made between competing goods and a dilemma of
process. As such, these cases represent classic
ethical dilemmas.
Pilot Study
The seven case studies, along with
instructions, response sheets and a cover letter,
were presented as a pilot study to individuals and
groups similar to those in the final study. Since
it was known operating human rights committees are
a small sample to draw upon, it was determined
using them in the pilot study would substantially
reduce those available for the formal study.
68


Therefore, behavior management review committees
were substituted. Behavior management review
committees are similar to human rights committees
in size, function and role. As with human rights
committees, they are required by State of Colorado
regulation. They differ in that their membership
contains agency employees and that they serve as
"in house" review mechanisms.
Case managers were substituted for advocates.
They were chosen because their duties include
advocacy roles. Again, this was done because of
the small pool of advocates available for the
formal study. Individuals and groups used in the
pilot study were not used in the formal study.
The pilot testing was useful for refining the
instrument and selecting the three case studies
which were used in the formal study (appendix D).
The cases selected were chosen because they
elicited the widest range of responses. This was
desirable because it suggested these cases
contained several possible choices and dilemmas
for the decision makers. Individuals
69


participating in the pilot study were also asked
to review the instructions for clarity, to point
out grammatical or technical errors they
encountered and to make any comments they wished
concerning the use of the instrument.
Data Collection
Instrument Presentation
An effort was made to present the instrument
to all sample participants in as consistent a
manner as possible. Participants were solicited,
asked to follow the instructions in the
instrument, and to work independently. They were
specifically told not to discuss the case studies
and the dilemmas they contained until after they
had decided upon their answers and recorded them.
The instrument, appendix D, included three final
case studies in which an ethical choice was
described. Participants were asked to use a scale
to rank if they strongly agreed, agreed, disagreed
or strongly disagreed with the choice that was
indicated in the case study. Results were
converted to a four point scale. Subjects were
70


also asked to briefly explain the reasoning for
their decision. Responses were returned to the
researcher in stamped, pre-addressed envelopes.
In situations where instruments were returned with
incomplete information or obvious
misunderstandings occurred, such responses were
not included. Results were included where an
answer was missing but could be obtained by a
follow up contact.
Variables
Dependent
In this study, the dependent variables were
the ethical choices. Multiple choices for each of
the three presented cases were provided to the
participants. These were strongly agree, agree,
disagree and strongly disagree.
Independent
The explanatory variables were group
membership. Groups varied according to assumed
level of sophistication in subject related
knowledge, ethical training and availability of a
71


formal decision making process. The groups were
the general public, family members, professionals,
human rights committees and advocates.
Statistical Procedures
A standard set of statistical procedures and
tests have been used in the conduct of the
analysis phases of this study. All analyses were
computer run using SPSSx /PC + V4.1.
Frequencies were run to identify
characteristics and generate percentages within
the variables. These descriptive statistics are
useful for reporting the distributions in the
various samples.
Cross-classification tables were created to
judge the influence of the independent variables
upon the dependent variables.
The chi-square has been used throughout the
analysis. It is a test for evaluating the level
of statistical significance attained by a
bivariate relationship in a cross-tabulation. The
output from the chi-square tests have been
reported standardly as the actual value of the
72


chi-square, the degrees of freedom and level of
significance.
Cramer's V was applied as a measure of
association. Such measures are recommended when
chi-square is used to provide information on the
strength of the association.
The Kruskal-Wallis one-way analysis of
variance of ranks has also been applied. It was
selected because the nature of the data was
ordinal rather than interval or ratio. It
indicates whether the samples are from different
populations or whether they represent the kind of
variations that are to be expected among random
samples from the same population.
The significance level (alpha) of .05 was
selected for this study. This means that if the
magnitude of difference between the treatment
groups may be expected to occur randomly less than
5 times out of 100, the difference is deemed to be
statistically significant.
73


Summary
Chapter 3 began with case studies to be used
in the study and told how they were selected. It
described the pilot study and how instruments were
presented to the samples in the formal study. A
discussion of the research design used in the
study indicated the design was quasi-experimental.
Finally, statistical procedures were reviewed.
74


CHAPTER 4
RESULTS OF THE STUDY
The compilation and analysis of the data are
included in this chapter. The chapter is organized
in the following order. First presented is a
comparison of the demographic variables involved.
Next, the general hypothesis and sub hypothesis are
analyzed. Decisions concerning the null hypothesis
are made. Finally, direction of the data is
discussed and demonstrated in a bar graph.
Comparison of Demographic Variables
Data was collected regarding key demographic
characteristics of the samples. These included age,
gender, years of education and if the participant
had a close relative with developmental disabili-
ties. Also noted were whether those involved had
advocacy training, developmental disabilities
training and/or specific ethics training. These
demographic variables were analyzed to determine if
difference in response was related to them. For
this purpose, the dependent variables were assigned
75


a value and totaled for all three case studies.
Total scores could range from three to twelve. Chi-
square and a cross tabulation were used. Variables
were categorized into five groups which follow.
These comparisons were conducted to establish
what other factors might be present in addition to
membership identity.
The outcomes demonstrate that education, ethics
and developmental disabilities had a significant
effect upon decision choice. It seems reasonable to
consolidate these into a large category of
educational activities. Background in these areas
clearly appears to influence decision outcome.
The variables of sex, age and the presence of a
disabled relative on the other hand, did not result
in significant difference among decision choices.
This suggests these variables did not influence
decision making.
Brief comment will be made regarding each
variable which will be elaborated in the summary
chapter.
76


Gender
Males and females were found not to differ
significantly in their total scores, i.e., there was
no correlation between sex and agreement with
ethical decision making. Similar results for both
sexes brings into question the ideas of theorists
who believe that males and females have a differing
ethic. It does not support the Freudian notion of
an inferior female ethic. There is a weak level of
association regarding all cases. Cramer's V equals
.23501.
TABLE 4.1
Results of chi-square test of significance
Sex.
Chi- square Ipiiueiiiii Signifi- cance S/NSa
Pearson 8.78618 4 .06667 NS
aS/NS = significant or non-significant at confidence
level, alpha = .05
77


Years of Education
Years of education were found to be
significantly related to the total agreement/
disagreement score. There is weak level of
association with a Cramer's V of .25728.
Individuals with less education tended to agree,
while those with more education tended to disagree.
This suggests additional education may be related to
sophistication in decision making.
TABLE 4.2
Results of chi-square test of significance --
Years of Education.
Chi- square df Signifi- S/NSa
Pearson 20.78519 8 .00774 S
aS/NS = significant or non-significant at confidence
level, alpha = .05
78

1


Ethics Training
Ethics training was found to be significantly
related to the total agreement/disagreement score.
The Cramer's V of .29278 indicated there is a weak
level of association.
A review of expected values with actual results
indicates those with ethics training tended to
disagree more. Speculation again suggests those
with additional education may have greater
sophistication in decision making. These findings
would also seem to support the theories that ethics
can be taught.
TABLE 4.3
Results of chi-square test of significance Ethics
Training.
Chi- square S/NSa
Pearson 13.54361 4 .00890 S
aS/NS = significant or non-significant at confidence
level, alpha = 0.5
79


Developmental Disabilities Training
Developmental disabilities training was found
to be significantly related to the total agreement/
disagreement score. There is a weak level of
association based on a Cramer's V of .29232. In
general, individuals with developmental disabilities
training tended to disagree, while those without
training agreed. This finding is similar to
previous ones in which training or education is a
component. In all such cases, education seems to be
a critical variable in the outcome.
TABLE 4.4
Results of chi-square test of significance
Developmental Disabilities Training.
Chi- square j||||j||;|l||^ Signifi- liahdiiiiiiiii S/NSa
Pearson 13.50154 4 .00907 S
aS/NS = significant or non-significant at confidence
level, alpha = .05
80


Advocacy Training
Advocacy training was found to be significantly
related to the total agreement/disagreement score.
There is a weak level of association based on a
Cramer's V of .33930.
A review of the expected values compared to
actual counts revealed those with advocacy training
tended to disagree at higher levels than those
without advocacy training. This result follows the
pattern of advanced training and education resulting
in differing results.
TABLE 4.5
Results of chi-square test of significance
Advocacy Training.
Chi- square Value df Signifi- li!^ S/NSa
Pearson 18.18953 4 .00113 S
aS/NS = significant or non-significant at confidence
level, alpha = .05
81


Relative with Developmental Disabilities
Having a relative with developmental
disabilities was not significantly related to the
total agreement/disagreement score. A Cramer's V of
.22547 shows there is a weak level of association.
Social experience with persons with
disabilities would appear to differ from the more
formal knowledge gained through systematic training.
TABLE 4.6
Results of chi-square test of significance
Relative with Developmental Disabilities.
Chi- square Value lliliil! Signifi- cance S/NSa
Pearson 8.03219 4 .09041 NS
aS/NS = significant or non-significant at confidence
level, alpha = .05
82


Age
Age was categorically measured. It was not
significantly related to the total agreement/
disagreement score. Non-significance on this
variable may be influenced by the adult stature of
all sample members.
TABLE 4.7
Results of chi-square test of significance
Age.
Chi- Square df Signifi- S/NSa
Pearson 2.13014 4 .71184 NS
aS/NS = significant or non-significant at confidence
level, alpha = .05
83


Test of the Hypotheses
A prime purpose of this research was to analyze
differences between the decision making of human
rights committees and other individual decision
makers. It was hypothesized that there are
significant differences between the ethical
decisions made by human rights committees compared
to those made by decision making individuals.
For research purposes, this was developed as a
null hypothesis. To comply with the Kruskal-Wallis
one-way analysis of variance by ranks, it is stated
as:
Ho: There is no significant difference in
ethical decisions between groups.
The Kruskal-Wallis test demonstrates a
significant difference between groups at the chosen
alpha level on the total scores. Therefore, the
null hypothesis may be rejected.
84


The rejection of the null hypothesis indicates
that, indeed, human rights committees make decisions
which differ from individuals. When individuals and
human rights committees are presented with a series
of ethical choices, the human rights committee
reached significantly different conclusions on all
cases.
TABLE 4.8
Results of the Kruskal-Wallis one-way
analysis of variance by ranks for total scores.
Cases Chi-Square Significance S/NSa
109 47.3800 .0001 S
85


Hypotheses
Since the general hypotheses demonstrated that
significant differences exist amongst variables,
tests of the hypothesis were conducted to locate
where such differences occur. For this purpose, a
one-way analysis of variance was undertaken. This
statistical technique tests the null hypothesis that
several means are equal.
TABLE 4.9
Results of one-way analysis of variance.
Group Mean P P P A H
U A R D R
B R 0 V C
L E F 0
I N E c
C T S A
S S T
I E
0 S

mm
m m
its m
l Public 5.8966
2 Parents 5.2308 -
3 Professionals 6.8519 - * -
4 Advocates 10.3333 * * * -
5 Human Rights 9.0833 * * *
Committees
Denotes pairs of group significantly different at
the .050 level.
86


Hypothesis HI stated:
HI: There is a significant difference between
the ethical decisions made by human rights
committees compared to those by a sample
of paid advocates.
For research purposes, this was stated as a
null hypothesis.
Hlo: There is no significant difference between
ethical decisions made by human rights
committees and paid advocates.
The results of the one-way analysis of variance
demonstrate that there is not a significant
difference between the ethical decisions of human
rights committees and paid advocates at the chosen
alpha level. The null hypothesis, therefore, cannot
be rejected.
In this study, advocates exhibited a similar
morality to that of the human rights committees.
This is an interesting finding. It is not
consistent with all other results which demonstrate
significant difference between all other individual
categories and the human rights committees. This
87


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