Themes

Moral conflict and moral dilemma

What is this about?

A moral conflict is a situation in which a person has two moral obligations, which cannot be met both at once. Behind these obligations lie conflicting values. Sometimes, the conflict can be resolved to the full satisfaction of the different parties involved, i.e. without leaving behind any regrettable remainder or residue. A moral dilemma is an irresolvable moral conflict, i.e. no fully satisfactory resolution is possible since all possible options for action leave behind a remainder that does not cease to be morally binding.

Why is this important?

Research integrity can involve a situation of moral conflict. This means that two courses of action are possible, which exclude one another. If one goes for one action, the alternative cannot be realized. Moreover, one has to choose between both actions; a third option, such as not making a choice, is not possible. An example is the choice between adding a person as an author to an article or not. There is no third option: either the person is made author, or not.

A moral conflict implies two conflicting values. In the case of authorship, these values might be gratitude (for a – albeit small - contribution) versus righteousness (acting in line with the authorship guidelines). Sometimes, moral conflicts can be resolved because one of the values clearly overrides the other. Thus, from a research integrity perspective, authorship requirements are more important than gratitude. In order to do justice to the value of gratitude, the person can be mentioned in an acknowledgement.

However, there are examples of situations in research where conflicts can be irresolvable, because the person who has to choose feels the obligation to do justice to two incompatible values. In such cases, one is confronted with a moral dilemma (1, 2). A moral dilemma is a conflict situation in which the choice one makes causes a moral harm, which cannot be restlessly repaired. Take the example of how to respond when a fellow researcher needs help, but refuses your assistance. In light of the value of care, you should at least try to convince her that support is needed. On the other hand, the value of autonomy might indicate that you should not impose yourself upon her. Whatever you decide to do, you do harm to one of the two values involved. If you choose to try and get her to accept support, she might feel being treated as an incompetent researcher. If you choose to let go, she might get in serious difficulty with her research.

For whom is this important?

Researchers, Supervisors, Research integrity trainers

What are the best practices?

Reflection on moral conflicts, and especially on moral dilemmas, is an important element of responsible research practice. Take for example Phase I trials that involve novel therapies for patients (so-called First-In-Human (FIH) Trials) (3). These trials involve a high degree of uncertainty in intervention development and possible outcomes. Although this step, hopefully, in turn, will make a Phase-III clinical trial in compliance with the basic epistemological and ethical requirement of therapeutic trials possible, it is a fact that so far no widely accepted standards for judgments of uncertainty, safety, and value of FIH trials have yet been formulated. Consequently, no selection of patients to be included in such trials can be said to be fully satisfactory, i.e. without the possibility of moral failure. Through acknowledging the possible existence of irresolvable moral conflicts in research, researchers will learn modesty, and thereby also protect themselves from being infected by the vice of hybris.

Reflection on moral dilemmas can be fostered by organizing Moral Case Deliberation (MCD) (4). In MCD, a morally troublesome situation is investigated by a group, guided by a facilitator. During the investigation, the conflicting values in the situation are examined in dialogue. This enables participants to become aware of, and reflect on the moral conflict involved. MCD specifically focuses on moral conflicts that cannot be restlessly solved, that is on moral dilemmas. The aim is to investigate different values of stakeholders in practice, and become aware that in making a choice, certain values will be harmed. This may result in the awareness that, although a choice is unavoidable, one should be open to the negative consequences of and take responsibility for them.

References

(1) Tessman, L. (2017). When doing the right thing is impossible. Oxford, New York: OUP

(2) Nussbaum M (1986). The fragility of goodness. OIxford: Oxford University Press

(3) Solbakk JH, Zoloth L. The Tragedy of Translation: The Case of ‘‘First Use’’in Human Embryonic Stem Cell Research. Cell Stem Cell, 2011, 8: 479-481.

(4) Stolper M., Molewijk B., Widdershoven G. (2016). Bioethics education in clinical settings: theory and practice of the dilemma method of moral case deliberation. BMC Medical Ethics, https://doi.org/10.1186 (0)6 -016 25 -0125 -1

Jan-Helge Solbakk, Guy Widdershoven contributed to this theme.

Latest contribution was August 20, 2019