Application of Kohlberg Heinz Dilemma in Nursing Practice

Written by Brandon L.
February 08, 202416 min read

Created by philosopher Lawrence Kohlberg, the Heinz dilemma is an intriguing experiment that has been used for decades to explain human behavior and how people make moral decisions. It examines the various stages of moral reasoning. As a nursing student, this dilemma is an essential component that will broaden your understanding of what it means to be morally upright.

Get ready for an engaging learning experience by our nursing writers about Kolberg Heinz's dilemma, and the six different stages of moral reasoning shaping human behavior.

What is Moral Development

This is the gradual development of a person's understanding of what is right and wrong. It affects all aspects of a person's life, from consciousness, religious values, and social attitudes to certain behaviors.

Heinz Dilemma

Lawrence Kohlberg developed a moral development theory as a way to explain how children and adults develop a sense of right and wrong. To achieve this,  he posed the following dilemma was posed to children as part of an experience to explain moral development.

In Europe, there was a man called Heinz whose wife was dying from a special kind of cancer. Doctors told them that she needed a particular drug to save her life. The drug was a form of radium that was newly discovered by a local chemist. Heinz went with $200 to buy the drug, but the chemist said it wasn't enough and that he needed $2000 since it was expensive to make. Since Heinz didn't have any other money on him, he went to those he knew to borrow the money but could only get $1,000. Heinz went back to the store and told the chemist that he could only afford half the cost, but the chemist refused to sell him the drug. He pleaded to be allowed to pay the money since his wife needed it urgently, but the chemist stood his ground. As his last resort, Heinz broke into the store, stole the drug, and gave it to his wife.

Heinz's story led Kohlberg to ask a series of questions:

  1. Should Heinz have stolen the drug? If yes, why?
  2. Would there be any difference in the story if Heinz had not loved his wife?
  3. Would it change anything if the wife was a stranger?

So, how do you answer the Heinz dilemma? Using the stages of development.

Piaget’s Theory of Development

Kohlberg's stages of development were influenced by Swiss psychologist Jean Piaget's findings on moral development theory, which fit into a two-stage theory of development. According to Piaget's theory, young children of age 10 think about ethical dilemmas one way, while older children consider them differently.

Young children view rules as something fixed and obsolete. That they are designed and ordered by those in authority, such as God or parents, and cannot be altered. On the other hand, older children believe that rules can be changed if everyone agrees with them. They think that rules are tools necessary to allow people to get along.

At the same time, younger moral thinking changes. They base their moral judgments on the consequences of decisions, whereas older children base them on the intentions behind the decisions. 

Kohlberg Method

Kohlberg's method is a stage theory. In other words, everyone goes from one stage to another. However, movement through these stages is not natural. It occurs when a person matures and notices inadequacies in their own actions. The stages theory states that a person in stage one cannot understand the moral reasons for stage 2.

Kohlberg’s theory of moral development is divided into three levels and six stages.

  1. pre-conventional morality (0-9 years)
  2. Conventional morality(10-15years)
  3. Postconventional morality (16years and above)

pre-conventional morality (0-9 years)

Stage 1. Obedience and Punishment Orientation

This stage is similar to Piaget's stage 1 of moral development, where a child believes that those in power create rules that cannot be changed. According to young children's minds, powerful authorities hand down rules that must be followed without any question. When young kids were told the story of Heinz, they said that Henz was at fault for choosing to steal the drug and gave the following reasons: it is unlawful, and it is bad to steal. They explained further by saying that those who steal get punished.

According to Kohlberg, even though some young children can oppose theft because it is bad and against the law, some support Heinz's actions. However, those who support such actions will still have stage 1 reasoning. For instance, children in the Heinz experiment who supported the actions said, "Heinz was right to steal it because he asked first, and it's not like he stole something big, so he doesn’t deserve to get punished."

Kohlberg referred to this stage as the Preconvention stage because young children are not yet members of society. In its place, they view morality as something that is beyond them. Only those in authority can make rules and punish those who break them.

Stage 2: Pleasure -seeking orientation

At this stage, children judge actions and behaviors based on how they fulfill individual needs. They realize that there are various views handed down by those in power. Different people have different viewpoints. For example, in the case of the Heinz dilemma, one might say that Heinz was right to steal the drug, but another would say that the chemist doesn't share the same viewpoint.

One child from Kohlberg's experiment said Heinz might steal the drug to heal his wife; however, if he wants to marry someone healthy and younger, he doesn't have to. Another child added that Heinz might steal the drug because he needs someone to take care of their children.

In other words, actions are determined by a person’s needs. What is right for Heinz is what meets his individual needs. Individuals are focused on fulfilling their own needs.

Children at this stage perceive punishment differently. In stage 1, children view punishments as proof of wrongness. In contrast, punishment is viewed as a risk that one should avoid.

Level II. Conventional Morality

Stage 3. Good Interpersonal Relationships

At this stage, children view morality as more than simple deals. They believe that people live up to the expectations of those around them, so they strive to behave in "good ways." They argue that Henz was right to steal as his heart was in the right place (saving his wife). They believe that if Heinz's intentions were good, then those of the chemist were bad. Subjects in the Kohlberg experiment emphasized the following terms to describe the chemist: selfish, greedy, and focused on himself.

Society defines good behaviors as those originating from those with good motives and interpersonal feelings like love and empathy. Thus, individuals are encouraged to be good to others and show kindness.

Stage 4. Law and Order

At this stage, an individual is focused on making moral decisions by considering society as a whole. The main emphasis is on respecting and obeying the laws and orders. It also involves everyone respecting authority and performing their duties in society to maintain social order.

In response to Henz's dilemma, participants agree that they cannot condone Henz's behaviors even though his intentions were good. They then pose the following question, “what would happen if everyone decided to break the law every time, they felt they had a good reason.”

Level III. Postconventional Morality

Stage 5. Social Contract and Individual Rights.

The biggest question at this stage is what makes a good society. People at this stage begin to account for other people's opinions, values, and beliefs. They believe that rules are necessary for ensuring law and order. People start viewing society as a social contract in which people enter to work freely towards the benefit of others.

People also agree that there should be consensus about the laws governing society instead of letting the majority rule. It is also believed that the rights of each individual should be respected and upheld.

Stage 6 – Universal Ethical Principles

The final stage of the Kohlberg moral development theory is universal ethical principles. People are guided by abstract reasoning and work towards the betterment of the society. They follow the rules of the law even if they sometimes conflict with them.

Members of the society suggest that they need to do the following:

However, they understand that democratic processes don't always result in outcomes that they like. For instance, the majority of people could vote for certain laws that hinder the lives of minorities. 

Kohlberg believes that there should be a higher stage that outlines the principles by which people achieve justice. He believes that humans are sacred beings and that they all have value. If people look at situations through the lens of another, they can achieve justice. In the case of the Heinz dilemma, participants in the Kohlberg experiment believe that Heinz was right to steal the drug to save a life, but he should surrender himself to the authorities for punishment since he broke the law.

Criticisms of Kohlberg's Theory of Moral Development

Kohlberg's moral development has faced a lot of criticism, with serval questions being raised. One such question is, "Does moral reasoning really lead to moral behavior?" Critics agree that the Heinz dilemma oversimplifies how complex it is to make decisions by just presenting two options: follow the law or save someone's life.

Critiques agree that there is a difference between knowing what ought to be done and a person's actions. And that the dilemma fails to capture the contextual factors involved when making ethical decisions in real life.

The Bottom Line

Kohlberg Heinz's dilemma is a thought-provoking moral conundrum challenging everyone, including nurses, to consider the balance between justice and a person's morality. The Heinz dilemma is founded on the main idea of whether one should prioritize their own moral beliefs or act out of compassion for someone they love and care about.  It raises important questions about the role of compassion, empathy, and justice in the decision-making process. Ultimately, Heinz's dilemma serves as a reminder that human actions have consequences. Thus, we should all think before taking any action.

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