The authors used a mixed-methods case analysis approach for the purpose of this study to develop causal theories as it could be unethical to use a causal analysis approach. The method applies tailored methods adopted from a case study design approach. They relied on the coded cases and applied the causal theories to establish the motive, means, and opportunity in evaluating the ethical wrongdoings ( DuBois et al., 2019) . For this study, the authors used the MMO criminal law theory. Their causal coding majorly focused on motivation.
They used a between-subjects design for this study focusing on the motivation to commit three ethical violations. There were cases involving Improper Prescribing of Controlled Substances (IPCS), Unnecessary Invasive Procedures (UIP), and Sexual Abuse Of Patients (SAP). For each case, the motivation was accessed, and then results were presented in the cluster or groups of cases under the three violations.
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The mixed-method, case-based approach to establish ethical violations suffered limitations that could undermine internal validity. It was not easy to ascertain the frequency with which the enlisted typologies appear. Though the selected research design for this kind of research undertaking was the best approach given that experimental or causal research designs could be unethical. The authors identified seven valid typologies to validate the results given that some variables were missing from the published data on the cases they selected that could complicate data analysis ( DuBois et al., 2019) . Therefore, the authors analyzed the dataset of 280 cases to identify notable factors in all cases. They also established the factors that separate the categories of cases. It is also worth pointing out that the study design also helped improve internal validity as it helped give a rich description of the cases.
For each ethical violation, the authors did a cross-case analysis to categorize the typologies of the cases. Qualitative and hierarchical cluster analyses were applied in examining how the variables demonstrated linkages with the cases. These statistical methods were instrumental in finding the typologies and tabulate data on MMO.
Reference
DuBois, J. M., Anderson, E. E., Chibnall, J. T., Mozersky, J., & Walsh, H. A. (2019). Serious ethical violations in medicine: A statistical and ethical analysis of 280 cases in the United States from 2008–2016. The American Journal of Bioethics, 19(1), 16-34. https://doi.org/10.1080/15265161.2018.1544305 .
