Table 7 Methodological elements of analyzing normative ethical information

 Ethical issues/topics/dilemmas

Overarching category for actions or situations where something has to be considered because of ethical reasons (or principles and values), or is an object of ethical research (e.g., justice in regard to disabled persons; data protection when using ambient assisted living technology; risk-benefit assessment in clinical trials; dilemmas in triage situations)

1. “The objective of the present work was to identify studies (documents, books, journals, or individual articles) that deal with disability with reference to justice and rights, in the light of the ICF. An attempt was also made to assess in statistical terms the presence of these topics in research on disability” [32]

2. “Studies were completely searched for, read and assessed according to the script made of data with the characteristics of the study and to the ethical issues raised. Ethical aspects approached were raised in the selected articles and the empirical characteristics were interpreted and organized. Analysis was performed comparing the ethical dilemmas found and that reflected upon nursing practice, based on the literature.”[33]

 Ethical arguments/reasons

Normative justifications or refutations for moral claims or action plans (e.g., reasons why post-trial access should be endorsed; arguments for not telling a patient of incidental findings; arguments for allowing sexual contacts of institutionalized elderly persons).

1. “(1) What are the primary positions addressing conscientious objection to act on end-of-life procedures? and (2) upon what arguments are these positions based?” / “We analyzed the twenty-eight articles using our guiding questions and searched out common patterns in position and argumentation.” [34]

2. “To survey the main objections to the RCT and its alternatives.” [35]

 Ethical principles/values/norms

Normative and theoretical concepts that summarize or describe specific ideas about ethical behavior or define a prerequisite for ethical judgement (e.g., the concept of “informed consent,” the principle of respecting patient autonomy, the ban on reproductive cloning)

1. “[…] to assemble a reliable and comprehensive account of the facts of the matter and to identify and clarify concepts that are relevant to the valuation of the ethical implications of those facts’ […]” [36]

2. “Our review identified nine different ethical frameworks outlining circumstances in which a health professional is justified in overriding parents’ medical decision-making for children. Each framework was centred on a different moral concept, such as harm or best interests. […] [12]

Ethical approach

Explanation

Example

 Principlism

Widely accepted ethical approach put forward especially by T. Beauchamp and J. Childress that defines four mid-level principles that are prima facie binding: respect for autonomy, beneficence, non-maleficence, and justice

1. “Every source identified through the database queries was assessed for the presence of material related to each of the 4 specific ethical principles […].” [37]

2. “We collected data for each of the four ethical principles and reported major and minor themes separately […]” [38]

 Pluralistic approach

Any approach that does not utilize one specific theory, but uses various theories/ approaches that can consist of principles/norms/values, etc.

“In order to capture the empirically grounded aspects of health care on which DRGs are likely to have an influence, as well as to present these aspects in light of a normative framework of ethical values, we systematically analysed the results from research on DRGs (step 1) in light of the review of ethical frameworks (step 2), and vice versa. […]”. [39]

Procedure for information extraction

Explanation

Example

 Coding and categorizing

Qualitative method where information is marked under a specific “heading” (coding) and is later subsumed under more broader topics (categorizing)

1. “We made notes on each publication related to the descriptive categories and assigned each a qualitative code. […] The publications were then categorized according to decade […], ethical approach […], component of morality, topic or ethical principle […], and primary role of the audiologist as described in the literature […]” [40]

2. “From every included document we retrieved the quotes that contained recommendations or opinions on living kidney donation by minors and each quote was assigned one or more codes.” [41]

 Collecting

Descriptively adding instances of the sought information without (substantial) coding and without categorizing (though possibly sorting)

1. “Articles available were screened for definitions […], definitions were extracted using the extraction tabloid […]. This resulted in a list of ends and means constitutive for PM.” [42]

2. “S.N. collected the provided arguments in the papers and recorded them in an argumentative scheme.” [43]

 Close reading

Hermeneutical method of analyzing a text by examining in detail structure, wording, argumentation, style, etc., and repeating this multiple times

1. “All the articles included were read carefully and analysed for ethical reflection and discussion regarding AT use in the home environment. […]” [44]

2. “Papers were read, then reread taking notations about authors’ decisions about treatment of participants; whether or not, according to the authors, participants should be protected, based on ethical principles or established professional guidelines; the historical context of changes in Internet technology and research practices; and the authors’ professional disciplines.” [45]