Reflective equilibrium and empirical data: Third person moral experiences in empirical medical ethics

Bioethics

Volumn 24, Issue 9, 2010, Pages 490-498

  De Vries, Martine ^a   Van Leeuwen, Evert ^b  

^a LEIDEN UNIVERSITY MEDICAL CENTER   (Netherlands)

^b RADBOUD UNIVERSITY MEDICAL CENTER   (Netherlands)

Author keywords

Credibility; Empirical data; Moral experiences of people in a practice; Reflective Equilibrium

Indexed keywords

ADOLESCENT; ARTICLE; CHILD; EMPIRICAL RESEARCH; ETHICS; HUMAN; INFORMED CONSENT; INTUITION; LEGAL ASPECT; MEDICAL ETHICS; MORALITY; NEOPLASM; NETHERLANDS; PARENTAL CONSENT; PATIENT PARTICIPATION; PEDIATRICS; THEORETICAL MODEL;

ADOLESCENT; CHILD; EMPIRICAL RESEARCH; ETHICS, MEDICAL; HUMANS; INFORMED CONSENT; INTUITION; MODELS, THEORETICAL; MORALS; NEOPLASMS; NETHERLANDS; PARENTAL CONSENT; PATIENT PARTICIPATION; PEDIATRICS;

EID: 77957868374     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2009.01721.x     Document Type: Article

References (38)

1. P. Borry, K. Dierickx & P. Schotsmans. The Birth of the Empirical Turn in Bioethics. Bioethics 2005; 19.1: 49-71. Because our research field is bioethics, we will mainly talk about this field.
2. P. Borry, P. Schotsmans & K. Dierickx. Editorial: Empirical ethics: A challenge to bioethics. Medicine, Health Care and Philosophy 2004; 7.1: 1-3.
3. J. Rawls. 1971. A Theory of Justice. London: Oxford University Press.
4. W. van der Burg & T. van Willigenburg. 1998. Introduction. In: Reflective Equilibrium. Essays in Honour of Robert Heeger. W. van der Burg & T. van Willigenburg, eds. Dordrecht: Kluwer Academic Publishers: 1.
5. For an overview of the various versions, see: Van der Burg & Van Willigenburg, op. cit. note 5, pp. 12-17.
6. This goal can be establishing a (modest) moral theory, selecting moral principles or deciding a specific moral problem.
7. T. van Willigenburg & F.R. Heeger. 1989. Justification of Moral Judgements: A Network Model. In: Societas Ethica Jahresbericht. Hannover: Societas Ethica: 53-61.
8. Van der Burg called this Network Model, supplemented with background theories, the wide or extended Network Model. See: W. van der Burg. 1991. Het democratisch perspectief. Arnhem: Gouda Quint.
9. Although we aim at a modest theory, we still talk about concrete cases. With 'concrete' we mean that we do elaborate on real persons in real situations. We don't hold a theoretical debate, but we deal with specific situations in which decisions have to be made that affect real people.
10. N. Daniels. Wide Reflective Equilibrium and Theory Acceptance in Ethics. J Philos 1979; 76(5): 256-282.
11. When elaborating on the input of persons other than the 'thinker', we talk about experiences rather than intuitions or considered moral judgments. This is to distinguish them from the judgments of the 'thinker'. In the paragraph on moral experiences we will come back to this preference.
12. We use MacIntyre's definition of 'practice': 'a practice is a coherent and complex form of socially established cooperative human activity' (A. MacIntyre. 1984. After Virtue. Notre Dame: University of Notre Dame Press: 187.)
13. J.J.M. van Delden. De herondekking van de praktijk. K&M: Tijdschrift voor Empirische Filosofie 1999; 23: 169-171. J.J.M. van Delden. 1993. Beslissen om niet te reanimeren. Een medisch en ethisch vraagstuk. Assen: Van Gorcum. Van Delden used the considered judgments of practitioners in the medical field in RE to construct a set of guidelines on do-not-resuscitate decisions.
14. Van Willigenburg & Heeger, op. cit. note 8, p. 61.
15. For a summary of these authors, see: Van der Burg & Van Willigenburg, op. cit. note 5, p. 15.
16. Adapted from: N. Daniels. 1996. Justice and Justification. Reflective Equilibrium in Theory and Practice. Cambridge: Cambridge University Press: 51.
17. On coherentism: Daniels, op. cit. note 11. For a summary of the different elements: W. van der Burg & T. van Willigenburg, ed. 1998. Reflective Equilibrium. Essays in Honour of Robert Heeger. Dordrecht: Kluwer Academic Publishers. See also: J.J.M. van Delden et al. 2005. Ethiek en Empirie. Theorie en methodologie van empirisch ethisch onderzoek. Maastricht: Océ Business Services, Universiteit Maastricht.
18. With this view we commit ourselves to a social basis for morality, instead of a psychological one.
19. R.M. Zaner. 1988. Ethics and the Clinical Encounter. Englewood Cliffs: Prentice Hall.
20. R. Audi. The axiology of moral experience. The Journal of Ethics 1998; 2: 355-375: 360.
21. M. Polanyi. 1967. The tacit Dimension. Garden City: New York.
22. The interview topics that structured the interviews were formulated after examining the relevant literature and after preliminary observational studies had been performed.
23. For these reasons, see also: J.J.M. van Delden JJM & G.J.M.W. van Thiel. 1998. Reflective Equilibrium as a Normative-Empirical Model in Bioethics. In: Reflective Equilibrium. Essays in Honour of Robert Heeger. W. van der Burg & T. van Willigenburg, ed. Dordrecht: Kluwer Academic Publishers: 254-5. Van Delden et al., op. cit. note 17, p. 45.
24. S. Reiter-Theil. Does Empirical Research Make Bioethics More Relevant? 'The Embedded Researcher' as a Methodological Approach. Med Health Care Philos 2004; 7(1): 17-29.
25. In most literature on RE, the terms considered judgments and moral intuitions are used synonymously. Some authors want to separate the two terms. See for instance: T. van Willigenburg. 1991. Inside the ethical expert. Kampen: Kok Pharos.
26. In our research, the data used to formulate the hypothetical equilibrium were obtained by a literature search and observations in the (outward) pediatric oncology clinic. From these data we formed a theoretical framework, from which eventually an empirical study could be developed into decision-making in pediatrics, the various moral experiences of the actors involved and the weight of parental authority and child assent.
27. American Academy of Pediatrics, Committee on Bioethics. Informed Consent, Parental Permission, and Assent in Pediatric Practice. Pediatrics. 1995; 95.2: 314-317.
28. The question of how to reconcile the perspective of a particular person on a subject with an objective view on the same subject is a fundamental issue in ethics, knowledge theory and theories on the relation of mind to the physical world. For an introduction, see: T. Nagel. 1986. The view from nowhere. New York: Oxford University Press.
29. See for example: Van der Burg & Van Willigenburg, op. cit. note 5, p. 8.
30. Van Delden et al., op. cit. Note 17, p. 44.
31. M.R. DePaul. 1993. Balance and Refinement. Beyond Coherence Methods of Moral Inquiry. London/New York: Routledge: 40.
32. For the reader of empirical ethical research it can sometimes be easy to see trough a biased selection. Certain respondents would be mentioned often, others never.
33. See for example: A.M. The. Emotie en inzicht; eigen onderzoekservaringen als data. Medische Antropologie 1999; 11.2:3 23-334; A.M. The. 1999. Palliatieve behandeling en communicatie. Een onderzoek naar het optimisme op herstel van longkankerpatiënten. Houten/Diegem: Bohn Stafleu Van Loghum.
34. An Institutional Review Board (IRB) is a group that has been formally designated to approve, monitor, and review biomedical and behavioural research involving humans with the alleged aim to protect the rights and welfare of the subjects.
35. J. Piaget. 1965. The Moral Judgment of the Child. New York: The Free Press. (I used this translation, which was originally published: London Routledge and Kegan Paul, 1932.)
36. We can learn a lot from the social sciences and their experience with the methodology of qualitative research. There is extensive literature on validity, reliability and generalizability. For an overview, see: N.K. Denzin & Y. Lincoln, eds. 2000. Handbook of qualitative research. Thousand Oaks: Sage Publications.
37. During our analysis, we used computer software (Kwalitan 5.0; V.A.M. Peters, Radboud University, Nijmegen) for multiple text management, including coding, locating, and retrieving key materials, phrases, and words.
38. See also: Van Delden et al., op. cit. note 17.