Medicine, Health Care and Philosophy

, Volume 7, Issue 1, pp 41–53 | Cite as

What is the role of empirical research in bioethical reflection and decision-making? An ethical analysis

  • Pascal Borry
  • Paul Schotsmans
  • Kris Dierickx
Article

Abstract

The field of bioethics is increasingly coming into contact with empirical research findings. In this article, we ask what role empirical research can play in the process of ethical clarification and decision-making. Ethical reflection almost always proceeds in three steps: the description of the moral question,the assessment of the moral question and the evaluation of the decision-making. Empirical research can contribute to each step of this process. In the description of the moral object, first of all, empirical research has a role to play in the description of morally relevant facts. It plays a role in answering the “reality-revealing questions” (what, why,how, who, where and when), in assessing the consequences and in proposing alternative courses of action. Secondly, empirical research plays a role in assessing the moral question. It must be acknowledged that research possesses “the normative power of the factual,” which can also become normative by suppressing other norms. However, inductive normativity should always be balanced out by a deductive form of normativity. Thirdly, empirical research also has a role to play in evaluating the decision-making process. It can rule out certain moral choices by pointing out the occurrence of certain unexpected consequences or effects. It can also be useful, however, as a sociology of bioethics in which the discipline of bioethics itself becomes an object of research.

empirical ethics empirical research ethical methodology medical ethics meta-ethics 

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References

  1. Adair, V. and A. Purdie: 1996, ‘Donor Insemination Programs with Personal Donors: Issues of Secrecy’, Human Reproduction 11(12), 2558–2563.PubMedGoogle Scholar
  2. Amuzu, B. et al.: 1990, ‘Pregnancy Outcome, Health of Children and Family Adjustment of Children after Donor Insemination’, Journal of Obstetrics and Gynaecology 75(6), 899–905.Google Scholar
  3. Arnold, R. and L. Forrow: 1993, ‘Empirical Research in Medical Ethics: An Introduction’, Theoretical Medicine 14(3), 195–196.CrossRefPubMedGoogle Scholar
  4. Beauchamp, T.L. and J.F. Childress: 20015, Principles of Biomedical Ethics. New York: Oxford University Press.Google Scholar
  5. Berger, D. et al.: 1986. ‘Psychological Patterns in Donor Insemination Couples’, Canadian Journal of Psychiatry 31, 818–823.Google Scholar
  6. Borry, P., P. Schotsmans and K. Dierickx: 2005, ‘The Birth of the Empirical Turn in Bioethics’, Bioethics 19 (to be published).Google Scholar
  7. Bosk, C.L.: 1999, ‘Professional Ethicist Available: Logical, Secular, Friendly,’ Daedalus 128(4), 47–68.Google Scholar
  8. Brewaeys, A. et al.: 1993, ‘Children from Anonymous Donors: An Inquiry into Homosexual and Heterosexual Parents Attitudes’, Journal of Psychosomatic Obstetrics and Gynaecology 14(Suppl.), 23–35.PubMedGoogle Scholar
  9. Brewaeys, A.: 1996, ‘Review. Donor Insemination: The Impact on Child and Family Development’, Journal of Psychosomatic Obstetrics and Gynaecology 17(1), 1–17.PubMedGoogle Scholar
  10. Brewaeys, A.: 2001, ‘Review: Parent-Child Relationships and Child Development in Donor Inseminations Families’, Human Reproduction Update 7(1), 38–46.CrossRefPubMedGoogle Scholar
  11. British Medical Association: 1999, Withholding and Withdrawing Life-Prolonging Treatment, Guidance for Decision Making. London: BMA.Google Scholar
  12. Brody, B.A.: 1990, ‘Quality of Scholarship in Bioethics’, Journal of Medicine and Philosophy 15(2), 161–178.PubMedGoogle Scholar
  13. Brody, B.A: 1993, ‘Assessing Empirical Research in Bioethics’, Theoretical Medicine 14(3), 211–219.CrossRefPubMedGoogle Scholar
  14. Burggraeve, R.: 1989, ‘Grondlijnen van een ethische methodologie in pastoraal perspectief’, Collationes 19(4), 404–431.Google Scholar
  15. Burggraeve, R.: 1992, Zinvol seksueel leven onderweg, concrete probleemvelden en belevingswijzen. Leuven: Acco.Google Scholar
  16. Callahan, D.: 1980, ‘Shattuck Lecture — Contemporary Biomedical Ethics’, The New England Journal of Medicine 302(22), 1228–1233.PubMedGoogle Scholar
  17. Chochinov, H.M. et al.: 2002, ‘Dignity in the Terminally Ill, A Developing Empirical Model’, Social Science and Medicine 54(3), 433–443.CrossRefPubMedGoogle Scholar
  18. Christie, R.J. and C.B. Hoffmaster: 1986, Ethical Issues in Family Medicine. New York: Oxford University Press.Google Scholar
  19. Clements, C.D.: 1985, ‘Bioethical Essentialism and Scientific Population Thinking’, Perspectives in Biology and Medicine 28(2), 188–207.PubMedGoogle Scholar
  20. Clouser, K.D. and B. Gert: 1990, ‘A Critique of Principlism’, Journal of Medicine and Philosophy 15(2), 219–236.PubMedGoogle Scholar
  21. Cook, D.J.: 1997, ‘Health Professional Decision-Making in the ICU, A Review of the Evidence’, New Horizons 5(1), 15–19.PubMedGoogle Scholar
  22. Cook, R. et al.: 1995, ‘Disclosure of Donor Insemination: Parental Attitudes’, American Journal of Orthopsychiatry 65(4), 549–559.PubMedGoogle Scholar
  23. Dalla-Vorgia, P. et al.: 1992, ‘Attitudes of a Mediterranean Population to the Truth-telling Issue’, Journal of Medical Ethics 18(2), 67–74.PubMedGoogle Scholar
  24. Daniels, N.: 1979, ‘Wide Reflective Equilibrium and Theory Acceptance in Ethics’, Journal of Philosophy 76, 256–282.Google Scholar
  25. Demyttenaere, K.: 2000, ‘Anxiety and Depression in Subfertility’, in: M. Steiner, K.A. Yonkers and E. Eriksson (eds.), Mood Disorders in Women. London: Martin Dunitz, pp. 371–382.Google Scholar
  26. De Vries, R. and J. Subedi (eds.): 1998, Bioethics and Society. Constructing the Ethical Enterprise. New Jersey: Prentice Hall.Google Scholar
  27. Dierickx, K.: 1999, ‘Adolescents and Carrier Testing: Attitudes and Ethical Presuppositions’, in: A. Thompson and R. Chadwick (eds.), Genetic Information: Acquisition, Access and Control. New York: Kluwer Academic Publishers, pp. 175–182.Google Scholar
  28. Dierickx, K. and P. Schotsmans et al.: 1998, ‘Belgian Doctors' Attitudes on the Management of Patients in Persistent Vegetative State (PVS), Ethical and Regulatory Aspects’, Acta Neurochirurgica 140(5), 481–489.CrossRefPubMedGoogle Scholar
  29. Englert, Y.: 1994, ‘Artificial Insemination of Single and Lesbian Women with Donor Semen’, Human Reproduction 9(11), 1969–1971.PubMedGoogle Scholar
  30. Evans, J.H.: 2001, Playing God? Human Genetic Engineering and the Rationalization of Public Bioethical Debate. Chicago and London: University of Chicago Press.Google Scholar
  31. Fetters, M.D. and H. Brody: 1999, ‘The Epidemiology of Bioethics’, The Journal of Clinical Ethics 10(2), 107–115.PubMedGoogle Scholar
  32. Fox, R.C. and J.P. Swazey: 1984, ‘Medical Morality Is not Bioethics — Medical Ethics in China and the United States’, Perspectives in Biology and Medicine 27(3), 336–360.PubMedGoogle Scholar
  33. Fox, R.C.: 1990, The Sociology of Medicine, A Participant Observer's View. New Jersey: Prentice Hall.Google Scholar
  34. Fox, R.C. and R. De Vries: 1998, ‘Afterword: The Sociology of Bioethics’, in: R. De Vries and J. Subedi (eds.), Bioethics and Society. Constructing the Ethical Enterprise. New Jersey: Prentice Hall, pp. 270–276.Google Scholar
  35. Fulford, K.W.M.: 1989: Moral Theory and Medical Practice. Cambridge: Cambridge University Press.Google Scholar
  36. Gallagher, E.B. et al.: 1998, ‘To Enrich Bioethics, Add One Part Social to One Part Clinical’, in: R. De Vries and J. Subedi (eds.), Bioethics and Society. Constructing the Ethical Enterprise. New Jersey: Prentice Hall, pp. 166–191.Google Scholar
  37. Golombok, S. et al.: 1995, ‘Families Created by the New Reproductive Technologies: Qualities of Parenting, Social, and Emotional Development of the Children’, Child Development 66(2), 285–298.PubMedGoogle Scholar
  38. Golombok, S. et al.: 1996, ‘The European Study of Assisted Reproduction Families: Family Functioning and Child Development’, Human Reproduction 11(10), 2324–2331.PubMedGoogle Scholar
  39. Guttmann A. and R.D. Guttmann: 1993, ‘Attitudes of Healthcare Professionals and the Public towards the Sale of Kidneys for Transplantation’, Journal of Medical Ethics 19(3), 148–153.PubMedGoogle Scholar
  40. Hoffmaster, B.: 1992, ‘Can Ethnography Save the Life of Medical Ethics?’, Social Science and medicine 35(12), 1421–1431.CrossRefPubMedGoogle Scholar
  41. Holstug, Nils: 1993, ‘Human Gene Therapy: Down the Slippery Slope?’, Bioethics 7(5), 402–419.PubMedGoogle Scholar
  42. Hope, T.: 1999, ‘Empirical Medical Ethics’, Journal of Medical Ethics 25(3), 219–220.PubMedGoogle Scholar
  43. Jennings, B.: 1990, ‘Ethics and Ethnography in Neonatal Intensive Care’, in: G. Weisz (ed.), Social Sciences Perspectives on Medical Ethics. Philadelphia: University of Pennsylvania Press, pp. 261–272.Google Scholar
  44. Korff, W.: 1968, ‘Empirische Sociologie en Moraal’, Concilium 4(4), 8–24.Google Scholar
  45. Kremer, J. et al.: 1984, ‘Psychosocial Aspects of Parenthood by Artificial Insemination Donor’, Lancet 8377, 628.CrossRefGoogle Scholar
  46. Leiblum, S. and A. Aviv: 1997, ‘Disclosure Issues and Decisions of Couples who Conceived via Donor Insemination’, Journal of Psychosomatic Obstetrics and Gynaecology 18(4), 292–300.PubMedGoogle Scholar
  47. Light, D.W. and G. McGee: 1998, ‘On the Social Embeddedness of Bioethics’, in: R. De Vries and J. Subedi (eds.), Bioethics and Society. Constructing the Ethical Enterprise. New Jersey: Prentice Hall, pp. 1–15.Google Scholar
  48. Maguire, D.: 19842, 1973, Death by Choice. New York: Doubleday & Company/Garden City.Google Scholar
  49. McHaffie, H.E. et al.: 2001, ‘Deciding for Imperilled Newborns: Medical Authority or Parental Autonomy?’, Journal of Medical Ethics 27(2), 104–109.CrossRefPubMedGoogle Scholar
  50. Molewijk, A.C. et al.: 2003, ‘Implicit Normativity in Evidence-Based Medicine. A Plea for Empirical Ethics Research’, Health Care Analysis 11(1), 69–91.CrossRefPubMedGoogle Scholar
  51. Nachtigall, R. et al.: 1998, ‘The Disclosure Decision: Concerns and Issues of Parents of Children Conceived through Donor Insemination’, American Journal of Obstetrics and Gynecology 178(6), 1165–1170.CrossRefPubMedGoogle Scholar
  52. Nielsen, A. et al.: 1995, ‘Psychological Aspects of Donor Insemination’, Acta Obstetricia et Gynecologica Scandinavica 74, 45–50.PubMedGoogle Scholar
  53. Olshansky, E.F.: 1987, ‘Identity of Self as Infertile: An Example of Theory-Generating Research’, Advances in Nursing Science 9, 54–63.PubMedGoogle Scholar
  54. Pellegrino, E.: 1995, ‘The Limitation of Emperical Research in Ethics’, Journal of Clinical Ethics 6(2), 161–162.PubMedGoogle Scholar
  55. Rawls, J.: 1972, A Theory of Justice. Oxford: Clarendon.Google Scholar
  56. Reiser, S.J. et al.: 1987, Devided Selves: A Case Approach to Mental Health Ethics. Cambridge: Cambridge University Press.Google Scholar
  57. Richter, J. et al.: 2001, ‘Doctors' Authoritarianism in End-of-Life Treatment Decisions. A Comparison between Russia, Sweden and Germany’, Journal of Medical Ethics 27(3), 186–191.CrossRefPubMedGoogle Scholar
  58. Royal College of Paediatrics and Child Health: 1997, Withholding of Withdrawing Life Saving Treatment in Children. A Framework for Practice. London: RCPCH.Google Scholar
  59. Rumbal, A. and V. Adair: 1999, ‘Telling the Story: Parents' Scripts for Donor Offspring’, Human Reproduction 14(5), 1392–1399.CrossRefPubMedGoogle Scholar
  60. Sabatelli, R.M. et al.: 1988, ‘Factors Mediating the Adjustement to Involuntary Childlessness’, Family Relations 37, 338–343.Google Scholar
  61. Schemer, M.: 2001, The Different Faces of Autonomy, A Study on Patient Autonomy in Ethical Theory and Hospital Practice. Doctoral dissertation, University of Amsterdam, The Netherlands.Google Scholar
  62. Sider, R.C. and C.D. Clements: 1985, ‘The New Medical Ethics: A Second Opinion’, Archives of Internal Medicine 145(12), 2169–2179.CrossRefPubMedGoogle Scholar
  63. Singer, P. et al.: 1990, ‘Research in Clinical Ethics’, Journal of Clinical Ethics 1(2), 95–99.PubMedGoogle Scholar
  64. Slote, M. 1995: ‘The Task of Ethics’, in: W. Reich (ed.), The Encyclopedia of Bioethics. New York: Simon & Schuster, pp. 720–727.Google Scholar
  65. Sox, H.C. et al.: 1990, ‘Using the Patient's History to Estimate the Probability of Coronary Artery Disease: A Comparison of Primary Care and Referral Practices’, American Journal of Medicine 89, 7–14.CrossRefPubMedGoogle Scholar
  66. Sugarman, J. et al.: 2001, ‘A Decade of Empirical Research in Medical Ethics’, in: J. Sugarman and D. Sulmasy (eds.), Methods in Medical Ethics. Washington DC: Georgetown University Press, pp. 19–28.Google Scholar
  67. Taesdale, K and G. Kent: 1995, ‘The Use of Deception in Nursing’, Journal of Medical Ethics 21(2), 77–81.PubMedGoogle Scholar
  68. ten Have, H. and A. Lelie: 1998, ‘Medical Ethics Research between Theory and Practice’, Theoretical Medicine and Bioethics 19(3), 263–276.CrossRefPubMedGoogle Scholar
  69. Thomasma, D.C.: 1985, ‘Empirical Methodology in Medical Ethics’, Journal of the American Geriatrics Society 33(5), 313–314.PubMedGoogle Scholar
  70. Valentine, D.: 1986, ‘Psychological Impact of Infertility: Identifying Issues and Needs’, Social Work in Health Care 11(4), 61–69.CrossRefPubMedGoogle Scholar
  71. van Berkel, D. et al.: 1999, ‘Difference in the Attitudes of Couples whose Children Were Conceived Through Artificial Insemination by Donor in 1980 and in 1996’, Fertility and Sterility 71(2), 226–231.CrossRefPubMedGoogle Scholar
  72. van Delden, J.M. et al.: 1993, ‘Deciding not to Resuscitate in Dutch Hospitals’, Journal of Medical Ethics 19(4), 200–205.PubMedGoogle Scholar
  73. van Delden, J.J.M. and G.J.M.W van Thiel: 1998, ‘Reflective Equilibrium as a Normative-Empirical Model in Bioethics’, in: W. van der Burg and T. van Willigenburg (eds.), Reflective Equilibrium. Dordrecht: Kluwer Academic Publishers, pp. 251–259.Google Scholar
  74. van der Burg, W.: 1992, ‘The Slippery Slope Argument’, Journal of Clinical Ethics 3(4), 256–268.PubMedGoogle Scholar
  75. van der Burg, W. and T. van Willigenburg: 1998, Reflective Equilibrium, Essays in Honour of Robert Heeger. Dordrecht: Kluwer Academic Publishers.Google Scholar
  76. van der Scheer, Lieke, Ghislaine van Thiel, Johannes van Delden and Guy Widdershoven: 2003, ‘Theory and Methodology of Empirical Ethics’, in: Soren Holm and Monique Jonas (eds.), Engaging the World: The Use of Empirical Research in Bioethics and The Regulation of Biotechnology. The Netherlands: IOS Press, forthcoming.Google Scholar
  77. van Willigenburg, T. and F.R. Heeger: 1989, ‘Justification of Moral Judgments: A Network Model’, in: M. Otte (ed.), Societas Ethica. Jahresbericht. Hannover: Societas Ethica.Google Scholar
  78. van Willigenburg, T.: 1993, Ethiek in praktijk. Assen: Van Gorcum.Google Scholar
  79. Weisz, G. (ed.): 1990, Social Sciences Perspectives on Medical Ethics. Philadelphia: University of Pennsylvania Press.Google Scholar
  80. Wertz, D.C. and J.C. Fletcher: 1985, Ethics and Human Genetics: A Cross-Cultural Perspective. Heidelberg: Springer-Verlag.Google Scholar
  81. Wertz, D.C. and J.C. Fletcher: 1998, ‘Ethical and Social Issues in Prenatal Sex Selection: A Survey of Geneticists in 37 Nations’, Social Sciences and Medicine 46(1), 255–273.CrossRefGoogle Scholar
  82. Wertz, D.C.: 1998, ‘International Research in Bioethics: The Challenges of Cross-Cultural Interpretation’, in: R. De Vries and J. Subedi (eds.), Bioethics and Society. Constructing the Ethical Enterprise. New Jersey: Prentice Hall, pp. 145–165.Google Scholar
  83. Wertz, D.C. et al.: 2002, ‘Has Patient Autonomy Gone Too Far? Geneticists' Views in 36 Nations’, The American Journal of Bioethics (2) 4, In Focus, 1–25.Google Scholar
  84. Wright, J. et al.: 1991, ‘Psychosocial Distress and Infertility: Men and Women Respond Differently’, Fertility and Sterility 55(1), 100–108.PubMedGoogle Scholar
  85. Yu, V.Y.: 1997, ‘Ethical Decision-Making in Newborn Infants’, Acta Medica Portuguesa 10(2–3), 197–204.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Pascal Borry
    • 1
  • Paul Schotsmans
    • 1
  • Kris Dierickx
    • 1
  1. 1.Center for Biomedical Ethics and LawK.U. LeuvenLeuvenBelgium

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