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Surprising complexity

A researchers’ journey in unraveling the ethics of co-creation

Rabab Chrifou is a Marie Curie doctoral fellow within the Health CASCADE project. Her research focuses on the ethical aspects of co-creation within public health. The main aim of her research is to gain insights into the dynamics that shape the (ethical) behaviour of those involved in co-creation and to develop tools and methods for proper reflections and questions that may lead to more ethical consciousness and action at the beginning, during and after the co-creation trajectory. 

Soon after I began studying the connection between ethics and co-creation in public health, I realized that there are at least two ways to position the role of ethics: ethics as ‘well-established knowledge’, or ethics as ‘knowledge in-progress’. Initial conversations with researchers in the field suggested that ethics in co-creation or participatory research is known for the biggest part and that there is not much new to discover. There are indeed numerous ethical guidelines that support academics to conduct  research in an ethical way. 

However, despite existing ethical guidance, I was left with a feeling of emptiness and a conviction that there is more beneath the surface. And indeed, the more I read about ethics, the more I was impressed by the plethora of ethical perspectives, theories, and positions that shape human thinking and behaviour. And here is where the complexity of the connection between ethics and co-creation started to show up.

Ethics as a research topic is generally not considered a normative, exact, natural, or social science. Rather, it is considered a philosophical science that studies what is considered one of the most important aspects of the life-activity of humans: morality and morals (i.e. human behaviour and how they decide whether actions are ‘right’ or ‘wrong’) (Drobnickij, 1975). Nevertheless, science and ethics are deeply intertwined as they both require researchers to be consistent and to justify their actions that influence the physical world (Copland, 2003). 

Although modern science is believed to have shifted from the concept of generating knowledge through contemplation, to generating knowledge through technical interventions in controlled conditions (Gethmann, 2001) – it seems that within co-creation, knowledge-generation through both contemplation and technical interventions are important. The way persons approach knowledge generation is intrinsically linked to their moral reasoning. Hence the combined ways of approaching knowledge-generation in co-creation is characterized by differences in moral reasoning. 

Following this insight it can be suggested that persons involved in co-creation do not necessarily think the same or depart from the same normative or meta-ethical position. Nor are the interests and intentions the same. I started wondering in what way moral reasoning, ethical positions and intentions shape the process, quality, and impact of co-creation – and more importantly – how to ensure a co-creation of high ethical standards. There are multiple ways to approach these questions and they can be empirical-based, theory-based or both. 

An empirical-based approach would be to look at values that stakeholders uphold and to depart from these values forming a ‘social contract’. This approach is often adopted within co-creation because it ensures the opinions and voices of everyone involved are heard. Values however manifest valences which means that they constitute ‘variable degrees of commitment or estimations of importance along a continuum’. Values are therefore not consistent, and persons will change the ranking of their values in different contexts (Ortmann, 2016). 

A theory-based approach would be to depart from existing ethical theories or positions such as deontology and utilitarianism, moral relativism, and moral realism. Although these theories can be helpful in navigating between right and wrong, multiple studies have shown that these theories are incomplete and do not provide comprehensive answers to daily ethical issues (Velasquez et al., 2021). Moreover, these theories are critiqued for being Western-centric and disregarding other systems of defining the ethical (Robinson, 2008).

So far my journey is characterized by curiosity. The position we ascribe to ethics in co-creation depends very much on our starting point. Do we rely on existing ethical guidelines to justify our actions, or do we trust our ‘gut’ feeling? What does ‘doing good’ and ‘doing bad’ mean to us in a particular situation and how is that decided? How do we know what is ethical? As a researcher I tend to tackle these questions by combining both theory and empirics to critically analyze moral reasoning, ethical issues, known and unknown ethical guidance. 

Securing ethical consciousness in the co-creation process through method development and in-depth knowledge on ethics is my approach to contributing to an ethical underpinning of co-creation within public health. 

  1. Copland (2003). Science and ethics must not be separated. Nature Correspondence.
  2. Drobnickij (1975). Chapter: Ethics. Springer Link.
  3. Gethmann (2001). Ethical Aspects of Long-term Responsibilities. International Encyclopedia of the Social & Behavioral Sciences.
  4. Robinson & Zhou (2008). Are traditional Western ethical theories still relevant in a cross-cultural and entrepreneurial business world?. Journal of Asia Entrepreneurship and Sustainability.
  5. Ortmann et al. (2016). Public Health Ethics: Global Cases, Practice, and Context. Public Health Ethics Analysis.
  6. Velasquez et al. (2021). A Framework for Ethical Decision Making. Markulla Center for Applied Ethics.

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