MEDIDAS DE AHORRO ENERGÉTICO

My broad methodology for approaching the study of ethical aspects of practice is an amalgam of elements based on an Aristotelian conception of the relationship between the theory and practice. There are, of course, other methodological approaches that seek to provide a methodology for empirical ethics, the most popular of these are: reflective equilibrium and pragmatic hermeneutics. I shall briefly outline the main elements of these methodologies and discuss why I have used my approach in this study as opposed to these other methodologies.

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For a critique of Arras‟ views see (Schermer & Keulartz,2003). For an overview of the debate over the role of pragmatism in bioethics see (Tollefsen & Cherry,2003).

Reflective equilibrium

This is an approach in empirical ethics that attempts to integrate theory and practice (Musschenga, 2005. Van der Scheer et al, 2004). It is based on Rawls‟ notion of

reflective equilibrium that he used to build and provide justification for moral theories and principles. As Daniels defines it:

The method of reflective equilibrium consists in working back and forth among our considered judgments (some say our “intuitions”) about particular instances or cases, the principles or rules that we believe govern them, and the theoretical considerations that we believe bear on accepting these considered judgments, principles or rules, revising any of these elements wherever necessary in order to achieve an acceptable coherence among them. (2003)82

Beauchamp and Childress in The Principles of Biomedical Ethics use this method, uniting it with their version of a common morality theory, they state that: „Method in ethics properly begins with our “considered judgments”, the moral convictions in which we have the highest confidence and believe to have the lowest level of bias.‟(2001:398) These considered judgements are, as Rawls argues, subject to revision: „The goal of reflective equilibrium is to match, prune, and adjust considered judgments in order to render them coherent with the premises of our most general moral commitments.‟ (Beauchamp & Childress, 2001:398)

When applied to empirical ethics there are various ways of incorporating this into empirically answerable questions. The research would attempt to find out what were peoples‟ considered judgments. Once these judgments were mapped, as Musschenga (2005) notes, ethicists would be concerned with finding the right answers to practical

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See also Daniels (1996) a collection of essays addressing reflective equilibrium in theory and practice and van der Burg & van Willigenburg‟s (1998) edited collection.

problems and this could be done in various ways. The ethicist could aid the people whose views they had studied to formulate „a well considered judgment‟ that was consistent with their views and beliefs on other issues, or: „Empirical ethicists

[could] also use the method of reflective equilibrium for determining whether a set of principles that forms the core of an ethical theory is in alignment with the well- considered judgments of a particular community.‟ (Musschenga, 2005:481) An example of a research project in empirical ethics that used this methodology is Van Thiel & Van Delden (2001). They used the methods of reflective equilibrium to try and formulate guidelines on respecting autonomy in the nursing homes.83

There have been many criticisms of reflective equilibrium: some focusing on the philosophical problems with the claim that our considered moral judgments carry weight; problems with the vagueness of the concept of coherence; and that reflective equilibrium idealises human rationality – that in practice people will not modify their views in light of critical pressure (Daniels, 2003). There is not space to fully debate these issues, as they do not strike at the heart of the reason why reflective

equilibrium was not used in this study. The reason is that the research questions posed in the study described in this thesis were not answerable by employing this methodology. I did not set out to examine the ethical „considered judgments‟ of the clinicians and then to see if these could be revised to, eventually, form a coherent moral view. Reflective equilibrium, as a method, would have not answered my research questions.84 As Daniels says, „we do ethics to solve many different kinds of problems and that the methods we use plausibly vary with the problems we want to solve and the interests we have in solving them.‟ (1996:333) He goes on to say:

83 _{See Chapter One for an outline of this study.} 84

See detailed discussion of my research questions and the use of research methodologies to „fit‟ one‟s research questions in Chapter Four.

„There is no one thing we do that is always central to solving an ethical problem for there is no one paradigmatic ethical problem.‟ (emphasis in the original. 1996:339)

Therefore, this methodology was not appropriate for „solving‟ the ethical issues I wanted to examine.

Pragmatic Hermeneutics

The overriding aim of pragmatic hermeneutics is to not simply to find out what the moral beliefs of people are but to, „reconstruct the practice‟s internal morality.‟ (Musschenga,2005:482) Van der Scheer et al (2004) give an overview of this methodology that is a combination of pragmatism and hermeneutics as found in the work of John Dewey and Hans Georg Gadamer respectively. The significance of pragmatism is its theory of meaning. The meaning of a theory derives from the practical consequences of its usage, concepts and theories, „do not represent any a priori or absolute authority, but they owe their value to their mediation in achieving that for what they were intended to be. Thus, their value is determined by their context.‟ (Van der Scheer et al, 2004:93)85 Hermeneutics is the attention to communication and especially dialogue as a form of interaction, knowledge is always a matter of interpretation rather than objective truth (Widdershoven, 2005). This approach aims to, „make explicit the normative orientation in daily life.‟ (Van der Scheer et al, 2004:93). It is not merely descriptive but aims to see how specific practices can be improved, in so far as theories are used they are directly related to the practices under consideration. Hence, theories are valuable if they can do what they are supposed to do (i.e. a theory of autonomy could be evaluated by considering whether it actually promoted autonomy in particular situations).

Widdershoven & Sohl (1999) study is an example of this methodology. This study focussed on one case of supported employment and collected stories from all the participants. The overall aim was to improve concrete practical situations, by taking into account all the diverse elements that go to make up someone‟s experience of a supported work programme. In doing this, they argue that it is possible to see that some concepts such as integration and autonomy are too crude and that, „participants use concepts that are more subtle, and therefore might be more adequate to get hold of the intricate nature of processes of care for people with mental handicap.‟

(Widdershoven & Sohl, 1999:127) Hence, this method pays close attention to

participants‟ constructions and use of terms and their understandings of the situation.

This methodology would have been more fitted to answering my research questions than reflective equilibrium. However, a problem with this methodology is a similar one to the main criticism made against contextualist forms of ethics, that it gives a lesser normative role to ethical theory and this can reduce the critical force of ethical deliberation.86 This is a criticism made by Molewijk (2004) of Widdershoven & van der Scheer‟s (2004) pragmatic hermeneutic method. An important aspect of the methodological approach that I have proposed is that it seeks to both use and say something about ethical theory. Theory construction and criticism are central aims of my approach. Ethical theory is useful to criticise practices and to guard against any serious contraventions of particular principles, for example, liberty or equality.87

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See Chapter Two for criticisms of contextualism.

Thus, I would argue that in trying to integrate theory and practice in a more sustained way, for certain tasks, my approach has certain advantages.88

CONCLUSION

In this chapter I have given an account of my approach to the relationship between theory and practice and how this impacts on using empirical data in ethical

deliberation. From this I have developed a broad methodology that can be applied to examining ethical issues in practice. As will be seen later in the thesis this

methodology can produce not only theoretical contributions to the debate but practical suggestions for improving the practice under study. The next chapter will focus on the qualitative methods used in conducting my study of infertility

clinicians‟ approaches to ethical decision-making.

CHAPTER FOUR