The Descriptive and the Normative in Bioethics
Bioethics in Social Context , Barry Hoffmaster, ed. Philadelphia: Temple University Press, 2001. Pp. vii + 234. Cloth $69.50; Paper $22.95.
In his introduction to Bioethics in Social Context , Hoffmaster remarks that the traditional practice of bioethics has been occupied with the moral rules, principles and theories that justify moral judgements, largely ignoring the messy details of the emotional, social, political and economic arrangements that give shape to bioethical dilemmas and the concrete ways in which people come to decisions and judgements about these matters. The current volume is aimed at rectifying this situation, reorienting traditional bioethics so that it confronts more fully the concrete situations in which bioethical dilemmas arise. To this end, Hoffmaster gives voice to nine original essays, written by social scientists engaged in the project of "the factual investigation of moral behavior and beliefs" (p. 1). Each essay details the importance of context in ethical decisions, and demonstrating how culture, emotions, personal obligations, families, institutional hierarchies, and even mass media influence both the identification of a moral problem and the rationale for decisions about that problem.
Following Hoffmaster's lead, the authors of the texts argue that the challenge for bioethics is to recognize and include these social processes in its normative analysis of ethical dilemmas and judgements. Reading the introduction and afterword by Hoffmaster, one gets the idea that the goals of this volume are loftier than just introducing ethicists to the sociological and ethnographic literature relevant to bioethical issues. Hoffmaster complains that the work of investigating the actual moral beliefs, codes, or practices of a society or culture is regarded as secondary to the normative enterprise of justification that traditionally occupies bioethics, when what is needed is a more fundamental reorientation in bioethics. He writes:
Rather than being a largely abstract endeavor, moral philosophy needs to attend more closely and more carefully to the times, the places, the structures, and the circumstances within which moral problems arise and to the people for whom they are problems. Moral philosophy also has to reconcile the objective demands of reason that make matters of morality matters of principle with the subjective personal judgement that is the source of both moral freedom and moral responsibility. In pursuing those goals, moral philosophy needs to draw upon and incorporate the insights of the social sciences. That is the way toward a conception of morality that does not segregate reason and experience, philosophers and social scientists, but rather assimilates them in ways that are more practically helpful and philosophically tenable (p. 226.).
The goal is to somehow integrate the descriptive work of the social sciences with the normative work of bioethics. Unfortunately, the essays within Bioethics in Social Context , with one notable exception, fall short of this goal. This volume excels in demonstrating the variety of social, cultural and institutional contexts of bioethical dilemmas. In so far as bioethics is concerned with coming to sound judgements about moral dilemmas, it certainly must include as rich a description and understanding of the embodied and contextual situation of the problem as possible. All bioethicists should see the need for the inclusion of such descriptive ethics. For this purpose, the collection of essays does a superb job. It, and other works like it, should be mandatory reading for anyone researching and writing on bioethical issues.
Where the texts fall short, however, is in exploring how, exactly, this contextualization of bioethics dilemmas and decisions is meant to be incorporated, especially in regards to the normative practice that is central to bioethics as both a philosophical and practical discipline. One would like to see the sociologists comment on how the differing discourses and competing epistemologies that they describe can be understood so that they reveal an improved, perhaps reoriented, less disembodied, form of decision making that bioethics can use to guide present and future cases. Even if a consensus on these issues is unlikely, some discussion of how one might adjudicate or incorporate the contrasting demands, say, of institutional structures and more concrete personal attachments would be helpful.
The one exception comes in the final essay of the collection, Bosk's "Irony, Ethnography, and Informed Consent." In this essay, Bosk turns his sociologist's eye on the practice of sociological ethnography in bioethics itself. Here he argues that there are certain inherent tensions between the goals and methods of ethnographic fieldwork and the normative work of bioethics. Bosk says many things about the ethical dilemmas that face ethnographers in bioethics, but at one point he argues that the methods of ethnography appear to undermine the very basis upon which bioethicists must work. Ethnographers must, to some extent, develop trusting relationships that they will eventually have to betray in the interpretation of the data. This is no surprise, since ethnographers typically have no lasting commitments to the workplace that he or she may study; they are something of an outsider who need not answer to the subject except in so far as professional ethics demands. Bioethicists, on the other hand, are typically insiders who must maintain relationships and uphold levels of confidentiality that the ethnographer is freer to transgress. In practice, then, the work of ethnography and the task of bioethics are inimical to one another. So it is difficult to see how the descriptive/interpretive goals of ethnography and the normative goals of bioethics will ever mesh successfully.
One reason for thinking that this is the case is that the job of sociologists and ethnographers in the empirical investigation of our moral life is primarily the description of the context in which moral problems arise and an interpretation of the various power structures that this context engenders. This requires that the ethnographer withhold judgement about ethical dilemmas in the service of his or her description and interpretation (at least as much as can be expected). Yet, at the very point where the ethnographer withholds judgement the bioethicists is charged with the job of making judgements or aiding others in coming to a sound judgement about a moral dilemma. The question remains, then, how to reconcile the demands of these contrasting disciplines.
Unfortunately, none of the essays in the collection have anything substantive to say about this dilemma. Perhaps this is asking too much from sociologists and anthropologists who may not be trained as bioethicists or moral philosophers. Nevertheless, in this respect the volume disappoints; it fails to bridge the gap between the descriptive and the normative in bioethics, between the objective demands of reason and the subjective personal judgements that are the stuff of bioethical dilemmas. Yet, even with this shortcoming Bioethics in Social Context is sure to become a valuable resource for both social scientists and ethicists alike.BRYAN BENHAM
University of Utah