The value of metaphorical reasoning in bioethics: An empirical-ethical study

Background: Metaphors are often used within the context of ethics and healthcare but have hardly been explored in relation to moral reasoning. Objective: To describe a central set of metaphors in one case and to explore their contribution to moral reasoning. Method: Semi-structured interviews were conducted with 16 parents of a child suffering from the neurodegenerative disease CLN3. The interviews were recorded, transcribed, and metaphors were analyzed. The researchers wrote memos and discussed about their analyses until they reached consensus. Ethical considerations: Participants gave oral and written consent and their confidentiality and anonymity were respected. Findings: A central set of metaphors referred to the semantic field of the hands and arms and consisted of two central metaphors that existed in a dialectical relationship: grasping versus letting go. Participants used these metaphors to describe their child’s experiences, who had to “let go” of abilities, while “clinging” to structures and the relationship with their parent(s). They also used it to describe their own experiences: participants tried to “grab” the good moments with their child and had to “let go” of their child when (s)he approached death. Participants, in addition, “held” onto caring for their child while being confronted with the necessity to “let go” of this care, leaving it to professional caregivers. Discussion: The ethical analysis of the findings shows that thinking in terms of the dialectical relationship between “grasping” and “letting go” helps professional caregivers to critically think about images of good care for children with CLN3. It also helps them to bear witness to the vulnerable, dependent, and embodied nature of the moral self of children with CLN3 and their parents. Conclusion: Metaphorical reasoning may support the inclusion of marginalized perspectives in moral reasoning. Future studies should further explore the contribution of metaphorical reasoning to moral reasoning in other cases.