Methods in Medical Ethics

Patricia Loomis Marshall and Barbara A. Koenig

In recent years, qualitative research approaches, including ethnographic methods, have been used to examine issues in medical ethics such as decisions at the end of life (Orona, Koenig, and Davis 1994; Koenig 1997; Hern et al. 1998); decision making in neonatal intensive care units (Anspach 1993; Levin 1986; Lock 1995); human organ and tissue replacement therapies (Sharp 1995; Hogle 1999; Marshall and Daar, 2000); informed consent (Kaufert and O'Neil 1990; Barnes et al. 1998); and human genetics (Bosk 1992; Rabinow 1999; Rapp 1999; Press and Browner 1998).

Ethnography refers to the description of cultural systems, or an aspect of a culture, based on fieldwork in which the investigator is immersed in the ongoing, everyday activities of the designated cultural community for the purpose of describing the social contexts, networks, relationships, and processes relevant to the topic under consideration. In its broadest articulation, ethnographic inquiry focuses attention on beliefs, values, rituals, customs, and behaviots of individuals interacting within socioeconomic, religious, political, and geographic environments.

In their reviews of the foundational schema of bioethics, anthropologists who typically take an ethnographic approach have criticized work in medical ethics for its lack of attention to the lived experience of illness, suffering, and death (Marshall 1992b; Kleinman 1995; Muller 1994; Marshall and Koenig 1996). Kleinman (1995) argues that an anthropological—in particular an ethnographic—approach to medical ethics has the potential to expand conventional perspectives through cultural analysis of moral conflicts found within unique local worlds. Marshall, Koenig, Levin, Brown, and other anthropologists illustrate how ethnographic approaches to ethical questions can both elicit and help clarify the uncertain, ambiguous, and contextual features that are intrinsic to problematic moral issues that arise in clinical care and medical research (Koenig 1988; Marshall 1996; Marshall et al. 1998b; Levin 1999; Brown 1994).

In the field of medical ethics, there is a heightened awareness of the importance of ethnographic attention to moral dilemmas encountered in the social worlds in which scientific technologies are conceived and applied. A small number of scholars (Hoffmaster 1992; Jennings 1990; Conrad 1994) have begun to challenge ethicists to incorporate ethnographic approaches in their philosophical research. Hoffmaster (1992,1421), for example, argues that, [What is needed is a different brand of moral theory, one that is more closely

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