The Role and Importance of Case Studies in Bioethics
By Leslie Ann McNolty, Program Associate
What is a Bioethics Case Study?
Bioethics case studies are structurally similar to medical case studies, which are perhaps more familiar. Both begin with a description of the patient and presentation of their medical condition. Both present the diagnosis and treatment of the patient, although medical case studies typically include more technical detail. The primary difference between these two types of case studies is that, while medical case studies aim to systematically describe the diagnostic and treatment process, the focus of bioethics case studies is to identify and explore one or more ethical issues underlying the case.
What Role Do Case Studies Play in Bioethics?
One of the central tasks of bioethics is to identify ethical problems in healthcare and then apply moral principles to help resolve those problems. We cannot expect good outcomes in ethically challenging situations merely by relying on the good will of decent people to do the right thing. Consistent ethical action requires an analytical process to sort through the issues. Case studies are an important tool in this pursuit for several reasons.
First, the careful description of benchmark cases in bioethics can provide a roadmap for decision-making in future cases. For example, studying and understanding the relevant features, arguments and consensus in a paradigm case of a request to withdraw hydration and nutrition from a non-competent patient can guide clinicians and family members of a patient in a similar situation.1
Second, case studies can be a driving force in the development of new analyses and thought in bioethics. The comparison of new cases with established cases often directly guides decision-making; however, when new cases diverge from the precedent in morally significant ways, they demand new ethical analysis and arguments. In this way, case studies can refine bioethical thought through a series of cases which take up some of the same issues but feature different relevant circumstances.2
Third, case studies are an invaluable teaching tool in bioethics. Bioethics involves applying moral theories to real-world ethical dilemmas. Studying how related cases have been approached (and sometimes adjudicated) in the past helps students understand moral principles, how they come into play in particular situations, and how to think through conflicts between them. Furthermore, just as cases are considered in comparison and in series with one another in order to make progress in bioethics as a field, case studies can also be used by individuals to hone their personal ethical analysis skills.3
What Makes a Good Bioethics Case Study?
Good bioethics case studies are compelling. They engage people in thinking about ethical issues and encourage them to enhance their ethical skills.
They are based in clinical fact. While imaginary circumstances can be helpful when approaching more theoretical ethical questions, the practical nature of many bioethics issues often necessitates a factual foundation.4
A good case study will also provide rich details beyond the medical facts. Because ethical issues are the focus, the scope of facts relevant to a bioethics case is quite broad. In addition to health information about the patient, background information about their religious or value system, family relationships, lifestyle, and social status is necessary to understand the case. 5 There can also be legal issues that must be considered.
A good case study will clearly identify all the potential stakeholders and accurately describe their relationships to one another.
Good case studies ask questions. They should not give answers, present solutions, or signal the “best” outcome for a case.6 Instead, a good case study will highlight the important questions. These include but are not limited to:
• Which values and principles are at stake in this case?
• Who should decide?
• What is a fitting response?
• Given what can be done, what ought to be done?
• What is the moral warrant of each participant in the case?
• What social and moral norms are at work?
• Are there hidden social or professional biases here?
• Who has the most power in the situation?
• Who has the most to lose?
1. Jonson, A.R. (1986). Casuistry and Clinical Ethics. Theoretical Medicine, 7(1), 65-74: 72.
2. Jonson, 73.
3. Arras, John D. (1991). Getting Down to Cases: The Revival of Casuistry in Bioethics. The journal of Medicine and Philosophy, 16, 29-51: 37.
4. Arras, 37. 5
5. Davis, Dena S. (1991). Rich Cases: The Ethics of Thick Description. Hastings Center Report, 21(4), 12-16: 13-15.
6. Arras, 37.