Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)

Graduate Group


First Advisor

Sarah H. Kagan


Delivering quality maternal-child healthcare is compromised when clinicians moralize pregnant or lactating persons’ actions. Clinicians are professionally charged with ensuring quality care delivery. However, they commonly moralize substance use and other similarly stigmatized actions during pregnancy and lactation. As a result, pregnant or lactating persons and their infants experience suboptimal health outcomes. Improving health outcomes in this population necessitates understanding how clinicians come to moralize substance use during pregnancy and lactation. Dimensional analysis in the mode of emergent fit, an interactionist qualitative mode of inquiry, was used to uncover the circumstances under which clinicians moralize substance use in maternal-child symbiosis. The findings of this emergent fit dimensional analysis form a situation specific theory that reveals clinicians moralize substance use in maternal-child symbiosis when they lack self-perceived competence and capacity to provide care to parents. These circumstances exist within the process of the Moral Energy Reflex, which is driven by the condition of “The Truthfulness Factor” and results in the consequence of Reflection on Redirection. The condition, process, and consequence of the phenomenon are conceptually bounded within the context of Unacceptability Uncertainty. All of the dimensions of moralizing substance use during maternal-child symbiosis are understood through the perspective of Am I a “Good Enough” Clinician? Understanding moralization as a process actively formed by the person moralizing provides important new insight into the clinical phenomenon of moral judgment. These findings suggest directions for future inquiry and offer implications for education, practice, and policy.


Available to all on Thursday, January 11, 2024

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