In everyday life, we are always faced with the task of determining whether cer
This is a philosophical movement concerned with the study of conscious experience, from the point of view of the first person (Moran, 2000). There is emphasis on the intentionality of experience – that is, the idea that conscious experience is directed towards some phenomena, rather than being merely aimless. Such purposefulness is usually contained in the meaning that the first person ascribes to his or her experience. Human experience is said to be conscious, meaning that we are somehow usually aware of an experience as it is happening, as opposed to for example Sigmund Freud’s psychoanalytic view in which experience isn’t always conscious. Conscious experience is defined in broad terms, incorporating a wide range of factors including sensation, perception, objects, events, time, self, others, space, sequence, emotion, logic, and so on, with particular emphasis on the meanings of these experiences (two individuals may have exactly the same experience, yet attach completely different meanings). Historically, phenomenology has been a fragmented philosophy, with numerous variations emerging and becoming established especially since the early part of the 20th century, deriving from works of philosophers like Martin Heidegger, Jean-Paul Satre, Edmund Husserl, G.W.F Hegel, Max Scheler, and others. The basic tradition of Anglo-Saxon European philosophy as we know it has been dominated by phenomenology throughout the last century, and currently provides the philosophical basis for a major part of clinical studies, usually subsumed under the heading of qualitative research.
EXPERIMENTAL (SCIENTIFIC) APPROACH
Scientific experimentation forms part of the wider traditional positivist doctrine, developed by Auguste Comte during the early part of the nineteenth century (Coolican, 1994). Positivism dictates that only phenomena that can be quantified and measured, are worthy of scientific experimentation. Emerging from this philosophy is the hypothetico-deductive doctrine, which entails making observations, developing theories, formulating and testing predictions from those theories, and modifying or supporting the theory accordingly. This procedure is what many researchers refer to as the ‘scientific method’. Experimentation is often regarded as the ‘gold standard’ in scientific (clinical) research. It entails the deliberate manipulation of variables under controlled conditions, in order to establish causality, and important factor in clinical settings. Control is achieved primarily by random allocation of participants to conditions, effectively distributing any differences between people evenly across the conditions, and hence ‘balancing things out’. Many experiments are also conducted in a controlled environment, such as laboratory. Experimentation is underpinned by a number of assumptions, including the idea that people can be isolated from their social environment and treated as a group rather than as individuals. Furthermore, it is possible for the researcher to remain objective, remaining distant from the subject and hence having no influence on their behaviour.
Aims and Objectives
Phenomenological research is exploratory, seeking to understand people’s conscious experiences through that persons’ own viewpoint, what ever it may be.
By contrast experimentation focuses on testing specific hypotheses, which have usually been selected by the researcher, hence reflecting the researchers own perspectives, rather than those of the participant. For example, take the case of a patient who has recently being diagnosed as anorexic. She is receiving treatment but there is a need for research to establish whether the treatment is having the desired effect. Phenomenology will focus on the patient’s own conscious experience of anorexia and recovery, and the meaning she attaches to these experiences. For example, the individual may view anorexia as a devastating experience with feel that she is not recovering despite her treatment. The whole experience may have created a sense of revulsion about her condition and pessimism about the recovery. The phenomenologist will try to explore – to use Husserl’s Greek terms – her “noesis” or intentional act of consciousness (e.g. her beliefs and feelings) and “noematic”, meaning the object or phenomena (anorexia, recovery). By contrast, the experimenter will aim to test hypotheses that the treatment is or isn’t effective in eliciting recovery, which will be appraised in quantifiable terms, such as changes in body-mass index, blood sugar levels, and blood pressure. Given the different aims/objectives (i.e. exploration, hypothesis testing), the experimenter and phenomenologist could arrive at completely different conclusions. For example, the patient may feel and believe they are not getting better albeit experimental (medical) parameters suggest otherwise.
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Research Questions & Hypotheses
Phenomenological questions typically exploratory, asking how an individual has consciously experienced a phenomenon, such as illness or disease. There are no hypotheses. The question can take any one of several forms, depending on the area of phenomenology. For example, existential phenomenology will inquire about the persons’ experience of free choice (e.g. in selecting their treatment), generative phenomenology will explore the meaning of the phenomena to the individual with reference to historical factors (e.g. the way a disease has historically been interpreted in their society), while a transcendental phenomenology will ask about the person’s conscious experiences completely excluding questions about the external environment (e.g. how the disease is experienced, regardless the hospital environment, treatments, and other external factors). Experimental questions are often more precise, asking whether there is a relationship between two or more variables. The question is usually accompanied by testable hypotheses, which specify whether or not a relationship exists and the direction (i.e. positive or negative) of the relationship. So, for example the experimenter will ask whether a particular intervention will cure the illness, accompanied by a hypothesis (e.g. the intervention significantly improves health outcomes). Unlikely phenomenology, the experimental approach rarely involves exploratory or open-ended questions as it is a requirement that all variables (independent and dependent) are specified a priori. However, statements of hypotheses can be “two-tailed” whereby the precise relationship expected between two variables is left “open” (i.e. not specified).
Phenomenological research is typically unstructured, with no specific ‘design’ or ‘format’. The researcher is at liberty to proceed as they see fit, merely ensuring that they conform to the basic tenets of philosophy, notably emphasising the first-person and targeting their conscious experience. The setting is usually realistic or naturalistic, so for example, no attempt is made to ‘remove’ the patient from their natural environment. Experimental research is traditionally highly structured. There are specific designs available to the researcher, each with set parameters or protocols. Randomisation of subjects to conditions is critical, to minimise the counfounding effects of nuisance variables. Therefore it is essential to recruit a sample of individuals who serve as participants. They can either be exposed to all conditions of the experiment, leading to a within-groups design, or assigned to just one of the conditions, creating a between-groups design. Independent and dependent variables must be specified clearly, so that there is no uncertainty about the conditions being manipulated, the direction of causality, and outcome measures. The setting is typically artificial – for example a laboratory – with a low degree of realism. It is important to point out that some phenonemonological research assumes that conscious experience is a function of neurological activity in the brain, known as neurophenomenology. This overlap with physiological sciences means that an experimental design may be used to establish the authenticity of certain aspects of conscious experience (e.g. determining whether an experience of motor activity is accompanied by electrical activity in the appropriate regions of the brain).
Data is typically collected using one-to-one interviews between the researcher and the participant, rather similar to private sessions between a patient and their psychiatrist or psychotherapist. The interviews are typically open-ended, thereby “letting things show themselves”, to use Heidegger’s terms. Data collection in experimentation may involve one or more techniques including observational methods (participant and non-participant observation, role playing and simulation, the diary method, and naturalistic observation), interviews and surveys (psychometric tests, structured/semi-structured interviews, clinical method). Whatever technique is used, the goal is to generate quantitative data which would allow mathematical assessments of reliability and validity, and also statistical analysis. Reliability relates to the consistency of a participants responses, while validity indicates whether the appropriate phenomenon of interest is being measured in the first place. Questions in interviews and surveys are typically close-ended, so that the participant can only respond using a pre-determined range of options provided by the experimenter.
The phenomenological method assumes first-person familiarity with the particular experience of interest to the researcher. Data analysis essentially entails description of a conscious experience exactly as it is lived by the participant and presented to the researcher, who does not interfere. The researcher may then attempt to interpret the experience from their particular phenomenological perspective. For example, hermeneutical phenomenologists, such as Heidegger, will try to make sense of the experience by placing it in a social and linguistic context (e.g. who else is involved, and how do the parties communicate). By contrast a naturalistic constitutive phenomenologist will relate the experience to nature, seeking out links with natural environment (e.g. climate, culture, ecology). Regardless of their area of phenomenology, it is essential for the researcher to analyse the type of experience presented, identifying any unique features for further investigation. More recently, data analysis may entail a logico-semantic approach that aims to identify the truth of an experience (e.g. “this disease can be cured”) and the conditions necessary to satisfy an intention (e.g. “I will feel better if I take my medicine”). Phenomenologists also use modern techniques for analysing qualitative data, such as thematic analysis, typologies, quotations, and so on. Data analysis in experimentation requires the use of statistical tests in order to establish the “significance” of any observed changes in the dependent variable, following manipulation of the independent variable. Usually, a ‘level of significance’ is set, depicting a specific probability (e.g. .05) that observed differences between groups or conditions occurred by chance. Typically, the probability of chance must be equal to or less than the chosen significance level in order for the test results to be regarded as significant. There is no attempt by the experimenter to “impose” any interpretation or subjective analysis on the data without the use of statistical tools, which introduce some mathematical objectivity. However, the likelihood of obtaining significant results is often affected by analytic and methodological considerations, such as the sample size and the sensitivity of the chosen statistical test. Furthermore, results that are statistically significant may nevertheless have little or no clinical significance, for example in terms of Quality Life Years, and morbidity and mortality rates.
Table 1 Differences between phenomenological and experimental approaches (selected issues)
|Research Question||Exploratory||Hypothesis testing|
|Subject Matter||Conscious experience||Quantifiable phenomena|
|Clinical Application||Detailed insight||Efficacy|
CLINICAL PRACTICE Phenomenological and experimental approaches both have an important role to play in clinical practice. Nevertheless, each method may offer very different perspectives on the same medical quandary, or may be more suited to certain problems rather than others. Consider the effectiveness of nurse-led thrombolysis on patients present at an Accidence & Emergency unit with cardiac symptoms. A phenomenological approach would be suitable for obtaining detailed insights into nurses feelings about their effectiveness in administering the procedure, their confidence, doubts, anxieties, suspicions, resentments, and other feelings and beliefs that may explain their clinical competence or otherwise. This may provide managers and consultants with valued ideas about how to support nurses, hence improving service delivery. By contrast the experimental approach will be more amenable to establishing the clinical effectiveness of nurse-initiated thrombolysis, for example in terms of the percentage of fatalities and door-to-needle times. A & E units could be randomly assigned to a condition in which nurses implement thrombolytic procedures, or a control condition in which the intervention is performed by busy consultants. Patient satisfaction rates and hospital delays could then be compared across both conditions using statistical procedures. Although phenomenology and experimentation approach the problem differently, findings from both paradigms will have some clinical benefit if service delivery is ultimately improved.
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tain actions are right or wrong. Ethics can thus be defined as a branch of philosophy that addresses issues of morality. Ethics is also referred to as moral philosophy. Moral philosophy is the systematic study of the nature of morality (Furrow 1). Questions involving such concepts as good and evil, right and wrong, vice and virtue are addressed in this systematic study. Such questions include; what I ought to do in a certain situation? How I ought to live? Ethics is a coherent discipline in philosophy that strives to answer some practical questions that form a basis of establishing the guiding principles and values of an individual or society.
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Gensler (3) outlines two major branches of moral philosophy or ethics namely: Metaethics is the branch that attempts to study the nature and the methodology of moral judgments. Questions to be addressed under this branch include; what do ‘good’ and ‘ought’ mean? Are there moral truths and how can we justify or rationally defend beliefs about right or wrong? A metaethical view of morality has two parts; one part is concerned with the nature of moral judgments which is often the definition of ‘good’, the other part is about the methodology usually outlining how to select moral principles.
Gensler (3) states that normative ethics studies principles about how to live. It asks questions like; what are the basic principles of right and wrong? What are the basic human rights? And is abortion right or wrong? Normative ethics is further classified into two levels; normative theory which looks for the very general moral principles and applied normative ethics which studies moral questions about specific areas like abortion, lying, euthanasia and surrogacy.
Why study ethics?
The study of ethics and more specifically the development of major ethical theories can be traced back to the Ancient Greek philosophy propounded by such philosophers as Aristotle and Socrates. In the modern life, ethics has captured the attention of various philosophers in diverse fields who are progressing in an attempt to answer various questions that are raised by the contemporary moral issues. Thus some of the reasons for studying ethics include;
The study of ethics deepens our reflection on the ultimate questions of life. This reflection helps an individual to understand himself or herself better regarding the principles of some pertinent issues in life. Gensler (4) argues that if you have not wrestled with some of life’s deeper questions, then you are not a well-educated person. Ethics enables an individual to be an all-rounded person in life.
The study of moral philosophy can help us to think better about morality. Some issues arise especially in the modern world and individuals are faced with ultimate questions on the moral basis of those issues such as abortion. For instance individuals adopt different approaches in dealing with the issue of abortion, while the proponents maintain that the mother has the principal right to make decisions concerning her body, the opponents argue that the sanctity of life should be maintained at all times and that the growing foetus has a right to life which is a major basic human right. Thus Gensler (4) states that moral philosophy or ethics can improve our perspective, and make it more reflective and better thought out.
Another major reason of studying ethics or moral philosophy is to sharpen our general thinking processes. In philosophy we are able to learn very significant intellectual skills that guide our reasoning and thinking. Thus we can logically reason out concerning fundamental or ultimate questions in real life while critically evaluating the conflicting view points and consequently settle for decision that reflects on our values and principles as individuals.
Ethics is undoubtedly a very interesting subject to study. Ethics provokes some good or healthy debates with other people, especially if the two or more people naturally have conflicting view points on major issues of life. These interesting debates stimulate and sharpen our thinking and imagination enabling people to re-think our view point giving room for alter or improve our perspectives in future events.
History of ethics
The history of ethics can be traced to three periods of thoughts as outlined by Gensler et al (25) namely the ancient, medieval and the modern period of thought.
Ancient period of thought; philosophers who contributed to the development of ethics in this period include Socrates, Plato, Aristotle, Epicureans and stoics. In the west, philosophical inquiry into ethics began with the ancients Greeks. Greek ethicists inquired into how a person could use reason to achieve ‘the good life’ but they did not reach a consensus about what the good life is and the nature of the practical reason that can reach it. Socrates and Plato were concerned with act-oriented ethics which is primarily concerned with what we do. Aristotle (384-322BC), a student of Plato, modified a number of his Mentor’s idealistic and quasi-religious ethical views (Gensler et al 27). Aristotle is said to have rejected Plato’s ethical views and subsequently developed the aretaic, or virtue ethics. Gensler et al (27) argues that Aristotle proposed that virtue ethics is interested ultimately who we are despite our actions. Aristotle further clarified that virtue does not come naturally; an individual needs to be trained or educated to be virtuous. Virtue if of two types; Moral, which deals in part with the irrational part of the soul and the intellectual, which involves only the rational part of the soul. Gensler et al (28) argues that the highest form of virtue is found not in enjoying friends but in contemplating truth. During the period of Epicureans and stoics, philosophers became concerned with the practicalities of dealing with the political and social instability since in 323 BC, Greece fell into a significant decline leading to numerous battles for parts of the empire.
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Medieval period of thought: prominent philosophers in this period include St Augustine, St Thomas Aquinas, Duns Scotus and William of Ockham. The political and social instability in the ancient period of thought continued into this period as the philosophers got more interested into gaining a deeper insight into this issue. This led to the analysis of human actions by the philosophers. Augustine proposed that human freedom stemmed from the lack of causal influences while Aquinas believed that human freedom stemmed from the internal deliberation that causes our actions. Gensler et al (31) claims that Aquinas analyzed actions on the basis not only of their conformity to the natural law but also of their specific features; the object of an action defines the action (talking to a person), the circumstances consider the context in which the action takes place (in a lecture hall during a lecture), and the end is the act’s purpose (to ask the person a question about the lecture). All these three aspects of action must be proper for the act to be considered good. Both Scotus and Ockham maintained that the matters of moral judgement were settled ultimately not by reason but by faith. Thus Gensler et al ( 31) claims that their views reinforced a stronger sense of individual autonomy both in moral and political matters. Hence the medieval view on ethics was the belief in the existence of God and that eternal salvation should be the principal motivation for the ethical behaviour.
Modern period of thought: philosophers use the term ‘modern’ to denote the enlightenment period which is approximately the seventeenth and eighteenth centuries. ‘Modern’ is contrasted with the ‘contemporary’ that roughly covers the last hundred years, the twentieth and the twenty-first centuries. Philosophers who made immense contributions in ethics during this period include; Thomas Hobbes, David Hume, Immanuel Kant and John Stuart Mill. Gensler et al (32) states that ethics in the modern age began with a movement from the other-worldly focus that dominated medieval ethics. Although these prominent philosophers of the time did not reject the existence of God, a medieval idea, they rejected the view that humans should look up to God as a guide to their actions. They equally disputed the medieval idea that eternal salvation should be the motivation for ethical behavior. To the modern philosophers, the purpose of ethics is not to instruct humans how best to love God, but, rather, to show humans how best to live together in this world (Gensler et al 32).
Major ethical theories
Some of the major ethical theories that have influenced modern thinking in the United States include; utilitarianism, Kantian ethics and Aristotelian ethics.
Utilitarianism also known as the consequentialist theory states that the consequences of an action of a given individual make an action moral or immoral. Hence, an action that contributes to beneficial consequences is considered right or moral while an action that results in harmful or destructive consequences is immoral or wrong. Driver (3) claims that the theory holds that an action or a law is right if only it produces the best outcome; only if it brings about the ‘greatest good for the greatest number’. To the proponents of this theory, any action is morally justified to the extent that it maximizes gains and minimizes the costs or harms. Some of the philosophers in support of this theory are Jeremy Bentham and John Stuart Mill. Bentham, an 18th century philosopher usually likened happiness with pleasure thus a good life and unhappiness with pain thus an unhappy life. Mill who was a 19th century philosopher, used his theory of utilitarianism to criticize laws that he felt were pointless and even harmful to society such as women’s suffrage (Driver 3). Hence it is clear that utilitarianism ethical theory maintains that an action is moral or right when the consequences are beneficial to the majority of the parties involved and not only the person doing that action. In addition, the consequences of such an action must be evaluated, not only the immediate consequences but also the short-term and long-term consequences.
Kantian ethics: this is a theory that stresses on the duties and rights in the moral evaluation of any human action. The proponent of this theory, Immanuel Kant has rejected the consequentialist proposition of considering the consequences of an action to determine whether it is moral or immoral. Kant argues that the motivation behind any human action is what matters in the moral evaluation of such actions and not the consequences. Thus actions that are moral or right are those done out of a sense of duty, which means that an individual does it since one recognizes that it is the right thing to do. Bennett (75) states that Kant used some famous formulations of categorical imperative i.e. the name he gives to the fundamental principle of morality. Kant believed in the respect of persons and thus people should never be treated as a mere means, but only ever at the same time as an end. We are able to know our duty since we are uniquely rational as human beings, a special nature that we posses that distinguishes us from animals. This theory maintains we should act morally depending on our rights and duties at all times and under all circumstances. Consequently moral actions promote the dignity and worth of other person, not using other persons for own purposes.
Aristotelian ethics: the most famous proponent of this theory is Aristotle who stressed on a virtuous life. Virtue ethics do not dwell on the principles or the rules governing our actions like the previous ethical theories but seeks a deeper insight in gaining knowledge on the kind of character that should be possessed by a moral human being. According to Aristotle, a moral virtue is the inclination to do the right thing and avoid doing wrong. This virtuous character does not come naturally but through thorough training and education, thus it is an achievement not a natural predisposition in a human being (Gensler et al 27). Courage, temperance, prudence and justice were considered by Aristotle as the most fundamental moral virtues.
In conclusion, the study of ethics is important since it helps us to evaluate our actions based on principles. This critical evaluation of ethical behaviour guides our thinking and action for future events. Ethics is an interesting subject that every person will enjoy studying since it sheds light into how we make decisions concerning the contemporary moral issues.