Medicine, Health Care and Philosophy

, Volume 22, Issue 4, pp 573–582 | Cite as

In search of good care: the methodology of phenomenological, theory-oriented ‘N=N case studies’ in empirically grounded ethics of care

  • Guus TimmermanEmail author
  • Andries Baart
  • Frans Vosman
Scientific Contribution


This paper proposes a new perspective on the methodology of qualitative inquiry in (care) ethics, especially the interaction between empirical work and theory development, and introduces standards to evaluate the quality of this inquiry and its findings. The kind of qualitative inquiry the authors are proposing brings to light what participants in practices of care and welfare do and refrain from doing, and what they undergo, in order to offer ‘stepping stones’, political-ethical insights that originate in the practice studied and enable practitioners to deal with newly emerging moral issues. As the authors’ aim is to study real-life complexity of inevitably morally imprinted care processes, their empirical material typically consists of extensive and comprehensive descriptions of exemplary cases. For their research aim the number of cases is not decisive, as long as the rigorous analysis of the cases studied provides innovative theoretical insights into the practice studied. Another quality criterion of what they propose that should be called ‘N=N case studies’ is the approval the findings receive from the participants in the practice studied.


Care ethics Qualitative research design Methodology Empirical ethics N=N case studies Quality criteria 



  1. Alvesson, Mats, and Dan Kärreman. 2007. Constructing mystery: Empirical matters in theory development. Academy of Management Review 32 (4): 1265–1281.CrossRefGoogle Scholar
  2. Alvesson, Mats, and Dan Kärreman. 2011. Qualitative research and theory development: Mystery as method. London: SAGE Publications.CrossRefGoogle Scholar
  3. Anderson, Rosemarie. 2004. Intuitive inquiry: An epistemology of the heart for scientific inquiry. The Humanistic Psychologist 32 (4): 307–341.CrossRefGoogle Scholar
  4. Baart, Andries. 2001. Een theorie van de presentie [A theory of presence]. Utrecht: LEMMA.Google Scholar
  5. Baart, Andries, and Guus Timmerman. 2016. Plädoyer für eine empirisch begründete Ethik der Achtsamkeit, Präsenz und Sorge [Plea for an empirically grounded ethics of care]. In Praxis der Achtsamkeit [Practice of care], eds. Elizabeth Conradi, and Frans Vosman, 129–146. Frankfurt/New York: Campus Verlag.Google Scholar
  6. Baart, Andries, and Frans Vosman. 2011. Relationship based care and recognition: Part one: Sketching good care from the theory of presence and five entries. In Care, compassion and recognition: An ethical discussion, eds. Carlo Leget, Chris Gastmans and Marian Verkerk 183–200. Leuven: Peeters.Google Scholar
  7. Baart, Andries, and Frans Vosman. 2015a. Een lastige familie die niet lastig is: Verslag van een onderzoek dat te denken geeft [A difficult family being not difficult: Report of a study that gives food for thought]. In De patiënt terug van weggeweest [The comeback of the patient], eds. Andries Baart, and Frans Vosman, 181–205. Amsterdam: SWP.Google Scholar
  8. Baart, Andries, and Frans Vosman, eds. 2015b. De patiënt terug van weggeweest: Werken aan menslievende zorg in het ziekenhuis [The comeback of the patient: Working on professional loving care in hospitals]. Amsterdam: SWP.Google Scholar
  9. Bronk, Kendall Cotton. 2012. The exemplar methodology: An approach to studying the leading edge of development. Psychology of Well-being: Theory, Research and Practice 2 (5): 1–10.Google Scholar
  10. Charmaz, Kathy. 2006. Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks CA [etc.]: SAGE Publications.Google Scholar
  11. Christen, Markus, Carel van Schaik, Johannes Fischer, Markus Huppenbauer, and Carmen Tanner, eds. 2014. Empirically informed ethics: Morality between facts and norms. Heidelberg: Springer.Google Scholar
  12. Davies, Rachel, Jonathan Ives, and Michael Dunn. 2015. A systematic review of empirical bioethics methodologies. BMC Medical Ethics 16 (1): 15. Scholar
  13. Dingler, Catrin. 2016. Relationale Subjektivität – zur Theoriegeschichte der Care-Ethik [Relational subjectivity: A history of care-ethical theory]. In Praxis der Achtsamkeit [Practice of care], eds. Elizabeth Conradi, and Frans Vosman, 93–113. Frankfurt/New York: Campus Verlag.Google Scholar
  14. Gilligan, Carol. 1982. In a different voice: Psychological theory and women’s development. Cambridge, MA: Harvard University Press.Google Scholar
  15. Gilligan, Carol. 1986. Reply by Carol Gilligan. Signs 11 (2): 324–333.CrossRefGoogle Scholar
  16. Glaser, Barney G., and Anselm L. Strauss. 1967. The discovery of grounded theory: Strategies for qualitative research. Chicago IL: Aldine.Google Scholar
  17. Hennink, Monique M., Bonnie N. Kaiser, and Vincent C. Marconi. 2017. Code saturation versus meaning saturation: How many interviews are enough? Qualitative Health Research 27 (4): 591–608.CrossRefGoogle Scholar
  18. Hirschauer, Stefan. 2008. Die Empiriegeladenheit von Theorien und der Erfindungsreichtum der Praxis [The empirical weight of theories and the inventiveness of practice]. In Theoretische Empirie [Theoretical empirics], eds. Herbert Kalthoff, Stefan Hirschauer, and Gesa Lindemann, 165–187. Frankfurt: Suhrkamp.Google Scholar
  19. Ives, Jonathan, Michael Dunn, Bert Molewijk, Jan Schildmann, and Kristine Bærøe, et al. 2018. Standards of practice in empirical bioethics research: Towards a consensus. BMC Medical Ethics 19 (1): 68.CrossRefGoogle Scholar
  20. Klaver, Klaartje, Eric van Elst and Andries Baart. 2014. Demarcation of the ethics of care as a discipline. Nursing Ethics 21 (7): 755–765.CrossRefGoogle Scholar
  21. Lindemann, Gesa. 2008. Theoriekonstruktion und empirische Forschung [The construction of theory and empirical research]. In Theoretische Empirie [Theoretical empirics], eds. Herbert Kalthoff, Stefan Hirschauer, and Gesa Lindemann, 107–128. Frankfurt: Suhrkamp.Google Scholar
  22. Lindemann, Gesa. 2009. Introduction: Thinking the social from the perspective of its borders [transl. of Einleitung: Das Soziale von seinen Grenzen her denken]. In Das Soziale von seinen Grenzen her denken, ed. Gesa Lindemann 13–35. Weilerswist: Velbrück Wissenschaft. Accessed 27 Feb 2018.
  23. Luria, Zella. 1986. A methodological critique [of In a Different Voice (1982) by Carol Gilligan]. Signs 11 (2): 316–321.CrossRefGoogle Scholar
  24. Malterud, Kirsti, Volkert Dirk Siersma and Ann Dorrit Guassora. 2016. Sample size in qualitative interview studies: Guided by information power. Qualitative Health Research 26 (13): 1753–1760.CrossRefGoogle Scholar
  25. Melançon, Jérôme. 2014. Thinking corporeally, socially, and politically: Critical phenomenology after Merleau-Ponty and Bourdieu. Bulletin D’Analyse Phénoménologique 10 (8): 1–28.Google Scholar
  26. Nicolini, Davide. 2012. Practice theory, work, and organization: An introduction. Oxford: Oxford University Press.Google Scholar
  27. Ralph, Nicholas, Melanie Birks, and Ysanne Chapman. 2015. The methodological dynamism of grounded theory. International Journal of Qualitative Methods 14 (4): 1–6.CrossRefGoogle Scholar
  28. Reichertz, Jo. 2007. Abduction: The logic of discovery of grounded theory. In The SAGE handbook of grounded theory, eds. Antony Bryant, and Kathy Charmaz, 214–228. Los Angeles: SAGE Publications.CrossRefGoogle Scholar
  29. Schmidt, Robert. 2012. Soziologie der Praktiken: Konzeptionelle Studien und empirische Analysen [Sociology of practices: Conceptual studies and empirical analyses]. Berlin: Suhrkamp.Google Scholar
  30. Taylor, Charles. 1989. Sources of the self: The making of the modern identity. Cambridge: Cambridge University Press.Google Scholar
  31. Timmerman, Guus, and Andries Baart. 2016a. Ongeregeld goed: De huisarts aan het ziek- en sterfbed van de eigen patiënt [Unregulated good: The general practitioner at the bedside of their sick and dying patient]. Research report. Utrecht: The Presence Foundation.Google Scholar
  32. Timmerman, Guus, and Andries Baart. 2016b. Präsentische Praxis und die Theorie der Präsenz [Practice and theory of presence]. In Praxis der Achtsamkeit [Practice of care], eds. Elizabeth Conradi, and Frans Vosman, 189–208. Frankfurt/New York: Campus Verlag.Google Scholar
  33. Timmermans, Stefan, and Iddo Tavory. 2016. Theory construction in qualitative research: From grounded theory to abductive analysis. Sociological Theory 30 (3): 167–186.CrossRefGoogle Scholar
  34. Tronto, Joan C. 1993. Moral boundaries: A political argument for an ethic of care. New York [etc.]: Routledge.Google Scholar
  35. Tronto, Joan C. 2013. Caring democracy: Markets, equality, and justice. New York: New York University Press.Google Scholar
  36. van Heijst, Annelies. 2011. Professional loving care: An ethical view of the healthcare sector [transl. of Menslievende zorg: Een ethische kijk op professionalisering. Kampen: Klement, 2005]. Leuven: Peeters.Google Scholar
  37. Vosman, Frans. 2018. The moral relevance of lived experience in complex hospital practices: A phenomenological approach. In Theological ethics and moral value phenomena: The experience of values, ed. Steven C. van den Heuvel, Patrick Nullens and Angela Roothaan, 65–92. New York: Routledge.Google Scholar
  38. Vosman, Frans, and Alistair Niemeijer. 2017. Rethinking critical reflection on care: Late modern uncertainty and the implications for care ethics. Medicine, Health Care and Philosophy 20 (4): 465–476.CrossRefGoogle Scholar
  39. Vosman, Frans, Jan den Bakker and Don Weenink. 2016. How to make sense of suffering in complex care practices? In Practice theory and research: Exploring the dynamics of social life, ed. Gert Spaargaren, Don Weenink and Machiel Lamers, 117–130. Abingdon: Routledge.Google Scholar
  40. Vosman, Frans, Guus Timmerman, and Andries Baart. 2018. Digging into care practices: The confrontation of care ethics with qualitative empirical and theoretical developments in the Low Countries, 2007–17. International Journal of Care and Caring 2 (3): 405–423.CrossRefGoogle Scholar
  41. Waldenfels, Bernhard 2011. Phenomenology of the alien: Basic concepts [transl. of Grundmotive einer Phänomenologie des Fremden. Frankfurt: Suhrkamp, 2006]. Evanston ILL: Northwestern University Press.Google Scholar
  42. Walker, Margaret Urban. 1989. What does the different voice say? Gilligan’s women and moral philosophy. The Journal of Value Inquiry 23: 123–134.CrossRefGoogle Scholar
  43. Wangmo, Tenzin, Sirin Hauri, Eloise Gennet, Evelyn Anane-Sarpong, Veerle Provoost, and Bernice S. Elger. 2018. An update on the ‘empirical turn’ in bioethics: Analysis of empirical research in nine bioethics journals. BMC Medical Ethics 19 (1): 6. Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Presence FoundationUtrechtThe Netherlands
  2. 2.Optentia Research Focus AreaNorth-West UniversityVanderbijlparkSouth Africa
  3. 3.University Medical Center UtrechtUtrechtThe Netherlands
  4. 4.University of Humanistic StudiesUtrechtThe Netherlands

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