Marion Danis, Laura Hanson, and
Joanne M. Garrett
-Empirical research in medical ethics is useful to test the effectiveness of interventions deemed valuable on theoretical grounds. When researchers wonder whether ethical reasoning can influence clinical action, or whether ethical guidelines can influence clinical outcomes, they can utilize a range of research methods, from observation and description of interventions to an experimental approach in which an intervention is planned, conducted, and monitored for an expected outcome. In this chapter we focus on the experimental approach. We will emphasize the unique aspects of experimental research that tests whether an intervention is able to affect outcomes with moral significance.
An experimental design should be used when the investigator's goal is to determine whether human knowledge, attitudes, or behaviors can be changed, and whether doing so leads to some valued good. Research questions appropriate for this design might include, for example, the following: Can an educational program improve medical students' knowledge and practice of obtaining informed consent? Does the clinical use of pain scores, in conjunction with vital signs, result in an increased proportion of patients receiving satisfactory pain relief? Or, do programs that teach clinic staff to respect cultural diversity increase access to services for minority patients attending primary care clinics? The investigator who seeks to answer such questions using experimental methods will design an intervention and then evaluate its effect on specified, relevant outcomes. In the course of this chapter, these questions will serve to illustrate issues in the design of experimental research in medical ethics.
While the chapter is meant to help those who are interested in conducting experimental trials do so more effectively, it is also intended to be useful to the nonexperimentalist, by making them aware of the important insights that such research yields for the discipline of medical ethics as a whole. The experimental research that demonstrated the limited effectiveness of written advance directives serves as an important example of just how important experimental studies are in testing widely held beliefs in medical ethics (Danis 1991; Schneiderman 1992). Anyone with an interest in medical ethics who wishes to have a well-rounded understanding of the discipline should appreciate what experimental research can contribute and know how to critically evaluate this type of research.