Exploring the Ethical Decision-Making Processes of Community Care Providers

While there has been a recent shift away from isolated, institutionalized living conditions, persons with Intellectual Disabilities (ID) may still experience restricted access to choice when it comes to making decisions about the basic aspects of their lives. A tension remains between protecting individuals from harm and promoting their right to independence and personal liberties. This tension creates complex questions and ethical concerns for care providers supporting persons with ID. This study explored the ethical decision-making processes of care providers and specifically, how care providers describe the balance of protecting supported individuals from harm while promoting their right to self-determination. Semi-structured interviews were conducted with six care providers employed by a local community agency that supports young and older adults with ID. Data were analysed using thematic analysis and broader themes were developed following phases of open and selective coding. Results indicated that care providers described ethical decision-making processes as frequent, complex, subjective, and uncomfortable. All participants described the importance of promoting independent decision-making among the individuals they support and assisting supported individuals to make informed decisions. Participants also reported work colleagues and supervisors as primary sources of information when resolving ethical concerns. This suggests that complex ethical decision-making processes are being taken seriously by care providers and supervising staff. The results of this study are well-positioned to be applied to the development of a training program for frontline care providing staff supporting individuals in community care settings.

Subjective Ambivalence and the Expression of Anti-Gay Bias

Univalent attitudes toward gay people have been widely studied, but no research to date has examined ambivalent (i.e., torn, conflicted) attitudes toward gay people. However, the Justification-Suppression Model (JSM; Crandall & Eshleman, 2003) proposes that ambivalence leads to biased expressions through intrapsychic processes which facilitate biased expression, particularly in contexts presenting strong justifications for expressing prejudice and weak pressures to suppress prejudice. I test these implications in the context of bias toward gay people. In Study 1, the measurement of ambivalence is examined in terms of both subjective ambivalence (i.e., the reported experience of “torn” attitudes) and calculated ambivalence (i.e., mathematical conflict between positive and negative attitude components). I find that higher subjective ambivalence is only associated with more negative attitudes toward gay people (and not positive attitudes toward gay people), and that higher subjective ambivalence predicts less gay rights support even after taking negative and positive attitudes toward gay people into account. Further, higher subjective ambivalence is associated with ideological opposition to gay people and more negative intergroup emotions (e.g., intergroup disgust). These findings suggest it is valuable to examine the unique component of subjective ambivalence separate from univalent negativity. Because calculated ambivalence measures are mathematically dependent upon a univalent negative measure, they cannot be examined separately from negativity. Therefore, subjective ambivalence is the focus of Study 2. The main goals of Study 2 were to determine why and when subjective ambivalence is related to bias. I examined the extent to which the negative relation between subjective ambivalence and opposition to anti-gay bullying can be accounted for by lower intergroup empathy and lower collective guilt, which may facilitate the expression of bias in keeping with the JSM. The relation between subjective ambivalence and anti-gay bullying opposition was examined within four social contexts based on a 2 (high vs. low offensiveness) x 2 (normatively unjustified vs. normatively justified) manipulation. I expected that higher subjective ambivalence would be most strongly related to lower intergroup empathy and collective guilt when there are the strongest justifications for bias expression, and that lower intergroup empathy and collective guilt would lead to less opposition to anti-gay bullying. Higher subjective ambivalence predicted less anti-gay bullying opposition. After accounting for positivity and negativity, the direct effect of subjective ambivalence was no longer significant, yet subjective ambivalence uniquely predicted intergroup empathy, which in turn predicted less anti-gay bullying opposition. These findings provide evidence that subjective ambivalence is largely negative in nature, but also presents evidence for a unique component of subjective ambivalence (separate from univalent attitudes) associated with low intergroup empathy and negativity. In contrast to previous research, I found very little evidence for the context-dependency of subjective ambivalence. Further research on subjective ambivalence, including subjective ambivalence toward other social groups, may expand our understanding of the factors leading to biased expressions.