It is present in our lives, whether we look upon it as primarily social or primarily personal. A hint of an answer can be derived from the psychological studies of 3ean Piaget and Lawrence Kohlberg which have shown that in most groups of adults there are persons at different levels of development in ethical thinking, corresponding to the phases through which a child must pass to full moral maturity. The small child tends to make decisions on the basis of the immediate consequences of an action, or rewards and punishments. The growing child begins to make decisions more and more on the basis of social approval of parents or peers. Conformity to group norms becomes paramount, and satisfactions can be delayed and suffering incurred to achieve approval of others.
Moral maturity is marked by an increasing internalization and independence of such moral judgment.
Decisions are now made on the basis of personal standards, and the standards of society became subject to criticism. The adult acts primarily for self-approval even at the cost of disapproval by the group. It seems that most ethical controversies are carried on largely at the second of these levels. The debaters each proceed on the assumption that the value system of their group, whether it be that of a social class, a professional elite, or a church, is self-evident and they make little or no effort to understand the viewpoint of opponents who live within other, competing value systems. This mind set has been demonstrated by various groups within the field of health care as they disagree over ethical issues.