Philosophical framework

To develop our conceptualisation of moral experience, we draw on the conception of the human sciences articulated by Taylor.15 Building on the work of Heidegger16 and Gadamer,17 Taylor has argued for an ontological shift in our understanding of human phenomena. In contrast to physical, chemical or biological phenomena that arguably exist in a relatively fixed manner regardless of how we conceive them, understanding human agency involves the discernment of phenomena in terms of their broader meaningfulness.15 This process involves seeking to understand how they matter to the agent, which is in part shaped by the systems of meaning the agent is socially embedded within. Thus we regard moral experience as a contextualised experiential phenomenon that is best understood from the subjective perspective of the person living the phenomenon within his or her local social context. In contrast, a positivist framework would construe a phenomenon in mechanistic objective terms.

Within this contextualised subjectivist consideration of the human sciences, Taylor has elaborated a moral framework which is particularly helpful in developing the conception of moral experience we are advancing here. Moral matters are rooted in a person's moral ontology—that is, the underlying commonly implicit beliefs held by a person or a group of persons. In this way the person as a moral agent stands against a background ‘horizon of significance’ constituted by the context that the agent resides within and the sociohistorically-based moral order within which meaning is rooted for her or him.18 Subjective experience is rooted in horizons of significance that shape how things matter to individual persons and individual experience is enacted within a particular context of meanings—what Geertz has described as ‘webs of significance’.19 Historical, cultural and social processes continually affect the value assigned to various aspects of everyday life. Highly-held ‘goods’ within social communities—expressed in terms of beliefs and values—are derived from their shared background horizon of significance. Each person is ‘thrown’ within particular horizons of meanings against which he or she continually assesses how things matter.16

Although moral experience involves a sense of how things matter in relation to a person's value reference systems, this framework strives to understand the perspective of individual experience within that local social world. How a person thinks and feels about particular phenomena are shaped in relation to surrounding conceptions of the good. Taylor argues that the human agent enacts ‘personal’ choices and actions in light of the meaningful context within which the agent resides.18 The surrounding community or society elaborates its own relative order of various ‘goods’ by discerning which actions or modes of life are morally higher through processes of ‘distinctions of worth’.20 Agents cannot stand outside their respective horizon of significance and their corresponding moral framework.21

Human experience entails a continual appraisal of how individual concerns stand in relation to the local moral context. The conception of moral experience we develop below is rooted in this philosophical framework. Moreover, understanding phenomena within this framework entails hermeneutical interpretation.16 17 20 22 Hermeneutics refers to the ‘science or art’ of interpretation.17 23 Hermeneutic ‘interpretation is an attempt to make clear, to make sense of an object of study… The interpretation aims to bring to light an underlying coherence or sense’.22 (p. 16) Hermeneutical interpretation seeks clarity by identifying the object in which clarity is sought, distinguishing this underlying clarity from its presenting expression and specifying the subject for whom the underlying clarity is meaningful. Interpretation entails a ‘hermeneutical circle’, examining ‘part-whole’ relations, seeking the sense of the whole through an examination of its parts that is continually related back to the whole. For moral matters this involves seeking the underlying sense—that is, the agent's moral ontological horizon of significance corresponding with the moral matter in question. Horizons shape human agency. A person's identity and sense of worth is rooted in the background horizon of significance.18 Examining one's respective horizon of significance through hermeneutical interpretation helps to clarify where an agent stands in relation to the good.

The development of a conceptualisation of moral experience and the discussion of subjective experience presented here intersect with ideas in the philosophy of emotions.24–26 A detailed analysis of these intersections, however, is beyond the scope of this paper.

Elaborating a conception of moral experience

We propose the following conceptualisation of moral experience:

Moral experience encompasses a person's sense that values that he or she deems important are being realised or thwarted in everyday life. This includes a person's interpretations of a lived encounter, or a set of lived encounters, that fall on spectrums of right-wrong, good-bad or just-unjust.

Moral experience as a framework for enquiry in empirical bioethics

Moral experience can be used in empirical bioethics enquiry to provide an angle of vision to explore how individuals or groups live out the moral dimensions of a particular set of encounters. Given that this is a hermeneutical conception of moral experience, empirical research based on moral experience should be qualitative and interpretive. As such, not all methodological frameworks will be compatible with the conception of moral experience outlined here. For example, moral experience is inconsistent with a positivist research design. To achieve epistemological coherence within the project, and to match methodology and research question, the chosen approach should be oriented by a constructivist paradigm. Constructivism holds that knowledge is socially constructed, that researcher and researched-into co-create the study findings, and that a naturalistic and dialectic approach is necessary as no a priori theory will adequately capture the subjective phenomenon of interest.27 In addition, methodologies that are consistent with a hermeneutic approach will provide a close fit for enquiry into moral experience as we have conceptualised it here. A hermeneutic phenomenology such as interpretive phenomenology28 would be an obvious choice, but other options such as interpretive description29 and naturalistic enquiry30 could be considered. In addition, ethnographic approaches may also be consistent with an enquiry into moral experience as articulated here. Ultimately, the researcher should ensure that all aspects of the enquiry—including research objective and questions, theoretical underpinnings, methodology and methods of data collection and analysis—are compatible with each other.31

We describe two qualitative research projects that we have conducted to illustrate how we have used moral experience to orientate empirical enquiry.

Carnevale and colleagues conducted a study of the moral experience of families with a child living at home whose breathing was ventilator-assisted.32 Interviews were conducted with the children and family members as well as clinicians who provided care for these children. Observations were also done in the home setting. Data analysis revealed a range of themes that included confronting parental responsibility, seeking normality, conflicting social values, living in isolation, the voice of children and questioning the moral order. The overarching phenomenon that was identified through this analysis was that these families experienced both distress and enrichment on a daily basis. It became apparent that the moral lives of these families cannot be apprehended without acknowledging both the distress and enrichment that are key and intertwined facets of their moral experience. Challenging common conceptions of living at home with assisted ventilation that construe such lives as extraordinarily burdensome for both patients and their families, the study demonstrated that the difficulties they confronted were intertwined with under-recognised sources of fulfilment such as the enjoyment of everyday pleasures for the patient, caring for one's child as a parent and reciprocal exchanges of affection among siblings. For example, a major challenge for parents was the possibility of not providing the ventilated child the care and attention that he or she required—striving to be a good parent. Our hermeneutical analysis of families' difficulties sought to better understand how these mattered to each family, revealing that these difficulties were embedded in families' fundamental values and commitments.

In a second study Hunt examined the moral experience of Canadian healthcare professionals who participated in humanitarian work.33 Data included in-depth interviews, blogs and published narrative accounts. Analysis of the collected data illuminated key aspects of the moral experience of the participants including clarifying and examining motivations and expectations, the relationality of humanitarian work, addressing steep imbalances of power, acknowledging and confronting the limited horizon of what can be accomplished and recognising the ways that organisational structures shape the everyday moral experience of practitioners. The focus on moral experience allowed access to a wide range of experiences by the participants in which values that they deemed important were realised or thwarted. Participants discussed concerns ranging from the effect of security protocols on patient care, to the impact of a history of colonialism on modern humanitarian aid initiatives, to the crucial role of project teams as key reference points and sources of psychological support. The study provided insight into important features of the moral dimension of this field of healthcare practice, and the moral and social world of medical relief work.

Moral experience provides a valuable framework for empirical research in bioethics. An important question that arises for enquiries into moral experience and, indeed, for much empirical research in bioethics is the so-called is/ought problem34 35—that is, research that identifies how individuals act in particular circumstances, what they believe about a particular moral issue or how they experience an ethically significant situation does not necessarily provide an epistemological footing to critique or support social practices or beliefs. Researchers who conduct studies of moral experience must confront the issue of what to do regarding the normative implications of what is learnt. We acknowledge this challenge, but will not try to answer these questions here.

The inherently personal and subjective nature of moral experience leads to an inherent limitation for empirical enquiry that has examination of moral experience as its focus: what is accessible through an interpretive enquiry is always partial. The qualitative researcher who sets out to study the moral experience of individuals who share a common association to a phenomenon of interest (eg, all having the same diagnosis and facing similar treatment choices) should acknowledge that their ability as a researcher to access the moral experience of these persons will always be fragmentary and incomplete. Even a thoughtful nuanced enquiry into the moral experience of another will only allow the enquirer to access traces of that experience.