Revision as of 11:39, 27 June 2021

Instructions

04 - Moral Case Deliberation: A Method for Analysing Cases in Research Ethics and Research Integrity

Instructions for:TraineeTrainer

Goal

Members of The Embassy of Good Science have developed a set of six user-friendly, accessible methods for analysing research ethics and research integrity cases.

These methods have been identified, adapted and presented so that they can be appropriated by all users, without prior philosophical knowledge, in local contexts.

Requirements

The key aim for the case analysis method described here is that it can be appropriated by all users, without prior philosophical knowledge, in local contexts.

In order to apply this method in the analysis of specific cases, it is advised that RECs, RIOs and IRBs engage with the regulatory frameworks and normative standards that apply to their respective organizations in the form of codes of ethics, codes of conduct, funding body standards and, if applicable, broader national and international research ethics and research integrity regulatory documents.

Duration (hours)

2

For whom is this important?

ResearchersEthics committee membersResearch Integrity OfficersResearch integrity trainers

Steps

1Introduction

2Evaluation

3Presentation of the case

4Formulating the moral question and the dilemma

5Clarification in order to place oneself in the situation of the case presenter

6Analyzing the case in terms of perspectives, values and norms

7Looking for alternatives

8Making an individual choice and making explicit one’s considerations

9Dialogical inquiry

10Conclusion

What is this about?

Moral Case Deliberation (MCD) aims to combine reflection on concrete cases with procedures to foster moral learning. In MCD in health care settings, patients, family members and health care staff discuss a moral question. MCD can be regarded as a form of Clinical Ethics Support (CES) or REC assessment in health care and biomedical research, helping health care professionals to reflect on their actual ethical questions and reasoning, and to find answers in acute cases. MCD is about listening and asking the right questions, rather than convincing the other, and postponing one’s own judgements in the interests of being open to other viewpoints.

The validity and reliability of knowledge claims and moral judgments are constructed and examined within the practice itself. In the end, the reliability and validity of the judgments are determined in experience and in the practice of daily life. The MCD facilitator or the MCD participants can refer to existing theories and concepts, as well as existing normative frameworks (such as policies, laws, professional codes etc.). The point is, however, that ethical issues are not defined beforehand, but are derived from practice.

In MCD, the moral problem under consideration is always a concrete moral issue, experienced by one of the participants. This issue is presented as a case (for example, concerning a treatment decision with an individual patient). The case is analysed not by applying general moral concepts or principles but by investigating the values and norms of the stakeholders. In a MCD, different viewpoints are examined. The initial aim is not to decide which perspective or answer is right, but to ask open and critical questions in order to elaborate assumptions behind the perspective and find out how they are applicable to the case at hand.^{^[1]}

^[1] Stolper M, Molewijk B, Widdershoven G. Bioethics education in clinical settings: theory and practice of the dilemma method of moral case deliberation. BMC Med Ethics 2016;17(1):45.

Why is this important?

Though MCD is primarily designed to examine clinical cases, given that many research ethics deliberations – e.g. the work of RECs when assessing research protocols – take place before the research in question, this methodology could be used to assess research ethics dilemmas as well. Also, an MCD can be undertaken by a single individual – for example, by considering ‘imaginary’ research ethics committees and other stakeholders as part of a ‘virtual’ deliberation. Since such imaginary and empathy-based techniques are considered to be important aspects of our ethical thinking – in thought experiments, for example – MCD might be a useful tool for such assessments.

1

Introduction

During the first step, the aim and procedure of MCD is explained by the facilitator. The facilitator addresses issues such as the nature of MCD, the context surrounding the MCD, the aim of the meeting, mutual expectations (e.g. open and honest communication) and the steps in the method.

2

Presentation of the case

This step focuses on the experience of the case presenter. The presenter is asked to describe a concrete personal situation in which he or she experienced the moral issue at stake. The case presenter is asked to provide a short but thick description of the facts of the situation. Facts can include the ‘feelings’ he or she experienced since feelings can be a useful indicator of the moral discomfort of the presenter and can often implicitly refer to certain values.

3

Formulating the moral question and the dilemma

In this step, the case presenter’s underlying moral question is made explicit. By formulating his/her moral question, the other participants can better understand what is at stake and what (morally) matters for the case presenter. Furthermore, to make the moral question more concrete, the case presenter is asked to formulate the situation in terms of a dilemma: what are the concrete choices available in this situation?

4

Clarification in order to place oneself in the situation of the case presenter

The fourth step aims to foster a clear understanding of the situation so that participants can ‘put themselves in the shoes’ of the case presenter. Clarification aims to (re)construct as clearly as possible the situation presented by the case presenter in order to investigate the moral dilemma. Within MCD, participants try to answer the dilemma with which the case presenter is faced.

5

Analyzing the case in terms of perspectives, values and norms

The participants make a list of the relevant stakeholder perspectives, and, for each perspective, identify the values related to the dilemma and the possible actions that realize a specific value (we call this value a ‘norm’). The analysis of the perspective of the case presenter will lead to the identification of values and norms that support or undermine different options.

6

Looking for alternatives

The aim of this step is to brainstorm in order to get a view on possible courses or actions which lie beyond the dilemma.

7

Making an individual choice and making explicit one’s considerations

This step involves the formulation of the personal views, values, norms, arguments and choices in relation to the case. The participants express their own views of what they consider to be right.The facilitator might ask the participants to individually address the following points:

a) It is morally justified that I choose option … (A, B or an alternative).

b) Because of…. (which value or norm?)

c) Despite of…. (which value or norm?)

d) How can you limit the damage of your choice mentioned under (c)?

8

Dialogical inquiry

In this step, similarities and differences between the individual considerations are examined. Sometimes, two participants make a different choice based on the same value. Alternatively, participants may choose the same option based on different values or norms. Identifying similarities and differences may lead to better understanding and a better insight of what is at stake in a specific case.

9

Conclusion

In this step, participants are invited to draw conclusions and develop a plan for action. The facilitator returns to the moral question formulated at the start of the MCD and asks the group to make explicit their conclusions. Reaching consensus is not necessary; the conclusion can also be that there is a plurality of ideas with different practical implications.

10

Evaluation

Lastly, learning experiences and the outcome are evaluated.