The Moral Competence Test in healthcare education: a critique based on informal logic

The article critically examines Georg Lind's Moral Competence Test, which is often used to assess the moral abilities of healthcare professionals and students. Test results have purportedly shown that students' moral competence declines during their studies; they have also failed to demonstrate the effectiveness of most ethics education methods. Based partly on Kohlberg's theory of moral development, the test presents moral dilemmas followed by arguments for and against the protagonists' decisions. Each argument corresponds to one of Kohlberg's stages of moral development. Participants rate how acceptable each argument is. They are assumed to have high moral competence if they rate arguments from the same stage similarly. The article argues that the test is valid only if three conditions are met: first; the stages of arguments are clearly identifiable; second, rating arguments of the same stage similarly is necessary to be consistent; and third, the scoring method avoids arbitrary effects and reflects the underlying theory. The discussion raises serious doubts about whether these conditions are met. Kohlberg himself noted that stages are often difficult to identify from brief statements. In addition, an analysis of the arguments using informal logic reveals that rating arguments of the same stage similarly is often inconsistent or not required. Lastly, the scoring method is overly sensitive to insignificant changes and insensitive to significant ones. These findings call into question many studies that have used the test to evaluate healthcare students' moral competence or to assess ethics teaching methods.