A dialog on common morality in medical ethics in a pluralist setting in Iran: a qualitative content analysis
-
Ladannaz Zahedi
,
Bagher Larijani
,
Mohsen Javadi
,
Shahin Aawani
,
Seyed Abdosaleh Jafari
,
Kobra Joodaki
,
Roya Rashidpouraie
,
Saeedeh Saeedi Tehrani
Abstract
The concept of common morality is fundamental in medical ethics, and lack of universal content and characteristics of common morality is a product of its multifaceted nature. This study aimed to identify the ideas and experiences of academic faculties regarding common morality in a pluralistic setting to promote conceptual knowledge and strengthen moral reasoning and ethical decision-making.The study was conducted using a qualitative method, employing semi-structured in-depth interviews with thirteen faculty members who were selected purposively. In order to assess their ideas and experiences, the transcripts of the interviews were analyzed using the content analysis method through directed and conventional approaches. The interviews were coded manually.Two themes were reflected in the interviews: ontology and epistemology of common morality.The study indicates that the debate about the subjective or objective dependence of common morality questions the coherence of Beauchamp and Childress' common morality (CM) theory, as common morality is the result of various individual and social factorthat influence moral thinking and decision-making in pluralistic environments. Additional studies are needed in order to investigate the effect of cultural, social, theoretical, ideological and individual factors on promoting clinical ethical reasoning and decision-making skills.
Annonymose. Moral Anti-Realism. [cited on 2023]; Available from: https://plato.stanford.edu/archives/win2021/entries/moral-anti-realism/
Annonymose. Moral Realism. [cited on 2023]; Available from: https://plato.stanford.edu/archives/sum2021/entries/moral-realism/
Ayars A, Nichols S. Rational learners and metaethics: universalism, relativism, and evidence from consensus. Mind & Language. 2019; 35(1): 67–89.
Bach MC. When the universal is particular: a re-examination of the common morality using the work of Charles Taylor. Med Health Care and Philos. 2022; 25: 141–51.
Christen M, Ineichen C, Tanner C. How "moral" are the principles of biomedical ethics? a cross-domain evaluation of the common morality hypothesis. BMC Med Ethics. 2014; 15: 47.
Baker R. Principles and duties: a critique of common corality theory. Cambridge Quarterly of Healthcare Ethics. 2022; 31(2): 199–211.
Kelsen H. Absolutism and relativism in philosophy and politics. The American Political Science Review. 1948; 42(5): 906–14.
Olaru B. Common morality, moral dilemmas, and hermeneutic ability. Revista Romana de Bioetica. 2010; 8: 45-54+124.
Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 7thed. USA: Oxford University Press; 2013.
Azambuja LEO de, Garrafa V. A teoria da moralidade comum na obra de Beauchamp e Childress. Revista Bioética. 2015; 23(3): 634–44.
Ekmekci PE, Folayan MO. A theoretical framework for ethical decision-making during public health emergencies. Acta bioethica. 2022; 28(1): 105–16.
Roque-Sanchez MV, Macpherson I, Roque-Sanchez MV, Macpherson I. An analysis of the ethics of principles, 40 years later. Revista Bioética. 2018; 26(2): 189–97.
Rhodes R. Why not common morality? Journal of Medical Ethics. 2019; 45(12): 770–7.
Lewis J, Holm S. Patient autonomy, clinical decision making, and the phenomenological reduction. Health Care Philos. 2022; 25(4): 615-27.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15(9): 1277-88.
Elo S, Kyngas H. The qualitative content analysis process. Journal of Advanced Nursing. 2008; 62(1): 107–15.
Kyngas H, Mikkonen K, Kaariainen M. The Application of Content Analysis in Nursing Science Research. Switzerland: Springer; 2020.
Loh J. Inquiry into issues of trustworthiness and quality in narrative studies: a perspective. The Qualitative Report. 2013; 18(33), 1-15.
O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014; 89(9): 1245–51.
Graham J, Haidt J, Koleva S, Motyl M, Iyer R, Wojcik SP, et al. Moral foundations theory. Advances in Experimental Social Psychology. 2013; 47(47): 55–130.
Neog B. An understanding of common morality. [cited on 2023]; Available from: http://liu.diva-portal.org/smash/get/diva2:23930/FULLTEXT01.pdf
Ahmadi, H. Assessment of Larijani’s View on the Semantics and Ontology of Moral Obligation. Practice of Wisdom. 2017; 8(30): 35-58.
Annonymose. "ontology". Encyclopedia Britannica, [cited on 2023]; https://www.britannica.com/topic/ontology-metaphysics.
Hofweber T. Logic and Ontology, The Stanford Encyclopedia of Philosophy. Springer; 2021.
Hathcoat J.D, Meixner C, Nicholas M.C. In Pranee Liamputtong (ed.), Handbook of Research Methods in Health Social Sciences. Springer Singapore; 2019. p. 99-116.
Beauchamp T. A Defense of the Common Morality. Kennedy Institute of Ethics Journal. 2003; 13(3): 259-74.
Schwartz M.S. Universal moral values for corporate codes of ethics. J Bus Ethics. 2005; 59: 27-44.
Annonymose. Realism. [cited on 2023]; Available from: https://plato.stanford.edu/archives/win2021/entries/realism/
Annonumose. The sefinition of morality. [cited on 2023]; Available from: https://plato.stanford.edu/archives/fall2020/entries/morality-definition/.
Voo TC. Editorial comment: the four principles and cultural specification. European Journal of Pediatrics. 2009; 168(11): 1389-9.
Gert B, Culver CM, Clouser KD. Common morality versus specified principlism: reply to Richardson. J Med Philos. 2000; 25(3): 308-22.
Brand-Ballard J. Consistency, common morality, and reflective equilibrium. Kennedy Inst Ethics J. 2003; 13(3): 231-58.
Turner L. From the local to the global: bioethics and the concept of culture. J Med Philos. 2005; 30(3): 305-20.
Marshall P, Koenig B. Accounting for culture in a globalized bioethics. J Law Med Ethics. 2004; 32(2): 252-66.
Miller JG. Cultural diversity in the morality of caring: individually oriented versus duty-based interpersonal moral codes. Cross-Cultural Research. 1994; 28(1): 3-39.
Tibi B. Islamic Law/Shari’a, Human Rights, Universal Morality and International Relations. Human Rights Quarterly. 1994; 16(2): 277-99.
Matsui S, Laynne de Oliveira Machado I, Garrafa V. A contribution of the Bioethics of Intervention to rethinking the concept of “principle”. Revista Bioética. 2018; 26(4): 514-22.
Turner L. Bioethics in a multicultural world: medicine and morality in pluralistic settings. Health Care Anal. 2003; 11(2): 99-117.
Sullivan LS. Uncovering Metaethical Assumptions in Bioethical Discourse across Cultures. Kennedy Inst Ethics J. 2016; 26(1): 47-78.
Annonymose. Relativism. [cited on 2023]; Available from: https://plato.stanford.edu/archives/spr2022/entries/relativism/
Gordon JS. Clinical Ethics Consultation. Routledge; 2016.
Annonymose. Glossary index. [cited on 2023]; Available from: www.qualityresearchinternational.com.
Hills MD. Kluckhohn and Strodtbeck's Values Orientation Theory. Online Readings in Psychology and Culture. 2002; 4(4).
Awad E, Dsouza S, Shariff A, Rahwan I, Bonnefon JF. Universals and variations in moral decisions made in 42 countries by 70,000 participants. Proc Natl Acad Sci U S A. 2020; 117(5): 2332-7.
Klenk M. Moral Philosophy and the ‘Ethical Turn’ in Anthropology. ZEMO 2019; 2: 331–53.
Heyes C. Is morality a gadget? Nature, nurture and culture in moral development. Synthese. 2019; 198(5): 4391-414.
Ellemers N, van der Toorn J, Paunov Y, van Leeuwen T. The psychology of morality: a review and analysis of empirical studies published from 1940 through 2017. Pers Soc Psychol Rev. 2019; 23(4): 332-66.
Luft A. Theorizing moral cognition: culture in action, situations, and relationships. Socius; 2020: 6.
Kaiser FG, Wilson M. The Campbell paradigm as a behavior-predictive reinterpretation of the classical tripartite model of attitudes. European Psychologist. 2019; 24(4): 359–74.
Hall L, Johansson P, Strandberg T. Lifting the Veil of Morality: Choice Blindness and Attitude Reversals on a Self-Transforming Survey. PLoS ONE. 2012; 7(9): e45457.
Csordas JT. Morality as a cultural system? Current Anthropology. 2013; 54: 523 - 46.
Hadarics M, Kende A. Politics turns moral foundations into consequences of intergroup attitudes. Social Psychology. 2021; 52(3): 185-96.
Ayala FJ. The difference of being human: morality. proceedings of the national academy of sciences. 2010; 107(Supple.2): 9015–22.
Farias M, van Mulukom V, Kahane G, et al. Supernatural belief is not modulated by intuitive thinking style or cognitive inhibition. Sci Rep. 2017; 7(1): 15100.
Khushf G. A framework for understanding medical epistemologies. J Med Philos. 2013; 38(5): 461-86.
Sosa E. Epistemology. USA: Princeton University Press; 2017.
Haidt J. The emotional dog and its rational tail: a social intuitionist approach to moral judgment. Psychol Rev. 2001; 108(4): 814-34.
Kahneman D, Frederick S. Representativeness revisited: attribute substitution in intuitive judgment. In Gilovich T, Griffin D, Kahneman D.eds. Heuristics and Biases: The Psychology of Intuitive Judgment Cambridge; 2002. p. 49–81.
Haidt J, Graham J. When morality opposes justice: conservatives have moral intuitions that liberals may not recognize. Soc Just Res. 2007; 20(1): 98-116.
Leeuwena F, Koenig BL, Graham J, Parkd JH. Moral concerns across the United States: associations with life-history variables, pathogen prevalence, urbanization, cognitive ability, and social class. Evolution and Human Behavior. 2014; 35(6): 464-71.
Wheeler MA, McGrath MJ, Haslam N. Twentieth century morality: the rise and fall of moral concepts from 1900 to 2007. PLoS ONE. 2019; 14(2): e0212267.
Annonymose. Moralfoundations.org. [cited on 2023]; Available from: https://moralfoundations.org/
Al Bar MA, Chamsi Pasha H. The sources of common principles of morality and ethics in Islam. In: Contemporary Bioethics. Cham (CH): Springer; 2015. PMID: 29809384.
Mangini M. Rationality and ethics between western and Islamic tradition. Religions. 2018; 9(10): 302.
Rauprich O. Common morality: comment on Beauchamp and Childress. Theor Med Bioeth. 2008; 29(1): 43-71.
Leonard N. Epistemic dilemmas and rational indeterminacy. Philos Stud. 2020; 177: 573-96.
Ajzen I, The social psychology of decision-making; In. Higgins ET, Kruglanski AW. Social Psychology: Handbook of Basic Principles. New York: Guilford Press; 1996.
Bentahila L, Fontaine R, Pennequin V. Universality and cultural diversity in moral reasoning and judgment. Front Psychol. 2021; 12: 764360.
Chen Q, Su X, Liu S, Miao K, Fang H. The relationship between moral sensitivity and professional values and ethical decision-making in nursing students. Nurse Educ Today. 2021; 105: 105056.
Ricou M, Marina S. Decision making and ethical reasoning in psychology. Psychology in Russia: State of the Art 2020; 13(1): 2-10.
| Files | ||
| Issue | Vol 16 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jmehm.v16i3.12972 | |
| Keywords | ||
| Principle-based ethics; Common morality; Clinical reasoning; Cultural diversity; Qualitative research. | ||
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