Table 2 Excerpts of various responses to the 'Moral' Medical Judgment Vignette

   Stage 1: Obedience and Punishment Orientation

"I just don't think that it's a doctor's position to help somebody to die. It's against their ethical and legal responsibilities and to their patient...it would depend on what the rules and regulations of the governing bodies are..."

   Stage 2: Individualism and Exchange Orientation

"So, from a certain standpoint I do agree, because it's not the doctor that's really making the decision, he's just kind of complying with the patient's request...As long as he doesn't go around willy-nilly recommending euthanasia to a whole bunch of people with diseases like this. As long as he discusses the implications with the patient and the different possibilities that are available for things and the patient is well-aware of all the implications of the decisions."

Conventional Level

   Stage 3: Good Interpersonal Relationships Orientation

"Yes, I think you have to. If he has known her for 15 years he probably has quite a good relation with her and knows she truly wants to die. I don't know what the legal ramifications are yet in medicine, but there's quality of life and length of life issues and I think it's in this case, for sure that she has a right to die and if you can make her more comfortable, even though he is a medical doctor, I think that's totally appropriate."

   Stage 4: Maintaining Social Order Orientation

"No. I don't. I think that end of life palliative care is a very touchy subject, but I believe that most elderly folk, although they do express a wish to die at home, if they are supported by a family system and a social system that is adequate for their needs at that time, there should be no reason to introduce the idea of euthanasia."

Postconventional Level

   Stage 5: Balance of Social Contract and Individual Rights Orientation

"The right decision has multiple dimensions in that there are legal, moral, ethical aspects of whether it is right or wrong...I believe from a legal standpoint that he is wrong in his decision. Morally and ethically, I believe the decision should be left to the individual and if her decision was made at a point in her life where she was of sound mind and had received appropriate counselling from her physician, her family, children, relatives, and if they had explored and openly communicated her desire to terminate her life at whatever time she wanted to, then it would be the right decision."