No Longer “Handmaiden”: The Role of Social and Sociological Theory in Bioethics

Paton, Alexis

doi:10.3138/ijfab.10.1.30

Cited by 11 publications

(26 citation statements)

References 19 publications

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“…The account presented here has strong resonances with work that seeks to use sociological lenses to move beyond conventional bioethics (e.g. Frith , Haimes , Hedgecoe , López , Paton ) and especially Petersen's () advocacy for a ‘normative sociology’ in the area of health.…”

Section: Introductionmentioning

confidence: 99%

Managing ethical uncertainty: implicit normativity and the sociology of ethics

Cribb

2019

Sociology Health & Illness

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This article illustrates and discusses the idea of ‘implicit normativity’, and specifically its relevance to the management of ethical uncertainty. In particular I consider (i) the role implicit normativity plays in masking and containing potential ethical uncertainty and (ii) the contrast and boundary between implicit normativity and ‘overt ethics’ where ethical contestation – as well as particular processes and agents – are highlighted as salient. Using examples I show how the idea of implicit normativity can be applied not only to specific practices but also to whole fields of practice. The notion of ‘moral settlements’ – along with the explanatory role of the threat of ‘chaos’ – is introduced and elucidated to develop these points. I argue that attention to the management of ethical uncertainty shows the critically important contribution that an ambitious sociology of ethics can make to clinical ethics, including by helping to formulate and drive home questions about the ‘ethics of ethics’. The account presented here has resonances with work that seeks to use sociological lenses to move beyond conventional bioethics, including Petersen's (2013) call for a ‘normative sociology’.

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Section: Introductionmentioning

confidence: 99%

Managing ethical uncertainty: implicit normativity and the sociology of ethics

Cribb

2019

Sociology Health & Illness

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“…Using a sociological bioethics approach, the project examined female cancer patients’ experiences of making oncofertility decisions. A qualitative, one-to-one interview based study was designed, such that the lived experiences of those who participated in the study could be prioritised as the primary source of data (Brewer 2000 ; Mason 2002 ; Silverman 2004 ; Paton 2017 , 2018 ). The interviews were structured so as to focus on the social, clinical and ethical concerns of the patients.…”

Section: Methods and Methodologymentioning

confidence: 99%

“…In this way, the article and the research it reports, aligns itself with the empirical bioethics and sociological bioethics movement that was arguably inaugurated by Erica Haimes ( 2002 ) and has since undergone significant development. I have previously argued for the importance of viewing sociology as a constitutive discipline of bioethics in its own right (Paton 2017 , 2018 ), and this article can be considered as an extension of this perspective, serving as yet another example of how bioethics can be ‘done’ using sociology.…”

Section: Introductionmentioning

confidence: 99%

“…There have been, and continue to be, different understandings of autonomy in bioethics. Perhaps the most well-known and influential of these conceptions, developed by Beauchamp and Childress ( 2009 ), is sometimes called the traditional conception of autonomy (Paton 2017 , 2018 ). Advocating that autonomy ought to be respected, such accounts fuse ‘the Kantian concept of respect for persons with Mill’s quite different notion of liberty; that is, persons’ choice of action should not be obstructed unless those actions infringe upon the liberty of others’ (Jonsen 1998 , p. 335).…”

Section: Introductionmentioning

confidence: 99%

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About time: how time influences and facilitates patient autonomy in the clinical encounter

Paton

2018

Monash Bioeth. Rev.

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In this article I discuss the little examined relationship between time and patient autonomy. Using the findings from a study on the experience of premenopausal cancer patients making fertility preservation decisions during their treatment, I focus on how the patients in the study understood time, and how this understanding interacted with and influenced their decision-making. I then analyse in more depth the importance of time in patient decision-making, and the relationship of time to concepts of patient autonomy and decision-making in the field of bioethics more generally. Focusing on the relational conception of autonomy, I conclude that time is an integral part of patient autonomy which warrants further research, such that it can be better integrated into concepts of patient autonomy, and the policy and guidelines that they inform and influence.

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“…Montgomery [16], Kaldjian [15] and Toon [17] offer book-length studies arguing that phronesis plays an important role in medical decision-making. Although there has been a drive to theorise about the importance of empirically-informed ethics [23][24][25], including phronesis [26], attempts to study clinical-judgement as phronesis using empirical data are rare [27]. Notable exceptions are Jordens and Little [28], Little et al [29], Jones et al [30] and Conroy et al [31].…”

Section: Introductionmentioning

confidence: 99%

Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors

Conroy

Malik

Hale

et al. 2020

Preprint

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BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, sometimes referred to as the ‘executive virtue’, offers a way to navigate the practice virtues for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis -based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n=131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian and MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.FindingsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ collective practical wisdom, including the phronesis virtue. This study advances the existing theory on phronesis as a decision-making approach because only now a theoretical ‘collective practical wisdom’ exists. ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, our contribution in the form of a moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well.

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No Longer “Handmaiden”: The Role of Social and Sociological Theory in Bioethics

Cited by 11 publications

References 19 publications

Managing ethical uncertainty: implicit normativity and the sociology of ethics

Managing ethical uncertainty: implicit normativity and the sociology of ethics

About time: how time influences and facilitates patient autonomy in the clinical encounter

Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors

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