Construction of the social world

Social constructionism is an expansive field of social theory and methodology that starts from the basic idea that meaning making happens in and through social processes. This means taking the perspective that people actively construct the social world they live in through the use of language and other social practices. Seeing the role of language in this way is a radical challenge to a more conventional assumption that language is merely a tool of interaction, a channel of reporting objective facts of the world or “a mirror to the soul.” Social constructionism as a theory instead views language as the constitutive element of what can be thought and said, by whom and in what kinds of contexts. The use of language is thereby not seen as the channel of articulating an objective world outside the language; instead, language is seen as constituting the very reality that people observe in a certain time and place as solid and real. Language is, thus, viewed as a pre-condition for thought as well as a form of social action (Berger & Luckmann 1966; Burr 1995; Lock & Strong 2010; Edwards & Potter 1992; Potter 1996).

An important remark to make is that social constructionism should not be thought of as a theory within the “nurture side” of the great nature versus nurture debate (in short, the question of whether peoples’ lives are determined more by their social surroundings or their individual genes). Social construction steps outside both of these dimensions and claims that it is the dynamic flow of the social process that brings both our conceptions of individuals as well as our social environments into being. Social constructionists are, hence, anti-essentialist in their view that they assume there to be no “true essence” inside

things but that things are a result of the way they are talked and thought about. (Burr 1995, 5–6.) The key tenet of social constructionism, thus, holds that our knowledge about the social world, including the understanding of human beings and ourselves, is ”a product of human thought rather than grounded in an observable, external reality.” This is not a new or original view in itself—philosophers Kant, Marx and Nietzsche (although different in other respects) took this view, and this understanding of social construction is reflected in key sociological concepts of the 20th century, such as ideology and false consciousness (Burr 2015, 222).

An important distinction should be made here between the social world and the natural world. I do not attempt to make the claim that there would be no natural laws whatsoever—such as to claim that an apple would not fall from the tree if it was not talked about as falling. The epistemological view that I take still holds there to be natural realities that would stay the same regardless of their social construction—a person who is dead would remain (physically) dead no matter which way we talk about her. However, as a bioethics-oriented scholar, I cannot help mentioning at this point the curiosity of brain death, a concept that only appeared in the medical discourse after the development of organ transplantation in the 1960s. One may ask if brain death did not exist before this, or was it only defined after the need to categorize an ethical way—a boundary—to identify potential organ donors?

This illustrates the way in which even terms that appear most naturalized and objective—such as death itself—can still include a dimension of social construction. (For more about the construction of brain death, its connection with organ donation and the controversy surrounding it, see Truog 2007;

Miller & Truog 2008 & 2012.)

Therefore, I view that the way people see the world is not an either-or situation, as if to suggest that the world is either a social construction or a natural reality; I hold that it is both. However, the social construction I refer to concerns the social rather than the natural world, as I take the view that whenever there is social meaning making in defining objects of the world, social construction occurs. Jorgensen and Phillips (2002, 9) propose a useful metaphor that helps to think about difference between the social and natural reality with the example of a river overflowing its banks. The flood

is a material reality when a river floods: it drowns everybody who is in the wrong place, regardless of their perspective, yet as people start to interpret the flood, a variety of constructions emerge. As a natural phenomenon, it can be interpreted as a meteorological condition caused by a heavy downpour or a consequence of global warming. Others would see it as political mismanagement: a failure to build appropriate dykes. Some would, however, see the flood as a manifestation of God’s will—perhaps viewing it as God’s anger over our sins or as a sign of Armageddon’s arrival. The river flooding, therefore, causes different worldviews and interpretative frameworks to emerge. Suggestions about what courses of action should be taken are likely to be very different whichever way the event is interpreted. (Ibid.)

In this thesis, I understand healthcare ethics and its many professional forms as a social construction. I view these professional constructions not only as reflecting the views that professionals have about ethics but also as constituting their views about ethics by guiding the ways in which they talk about ethics. Like a flashlight pointing a circle of light and leaving other areas in the dark, professional constructions guide what kinds of questions the professionals ask about ethics and the ways in which different kinds of situations raise (or do not raise) ethical thinking in them.

Hence, based on the social constructionist theory, I hold that the way professionals understand ethics in the healthcare context is not a result of recording objective facts about things or their inner essences. Rather, it means taking the view that what has become to be understood as professional ethics in a healthcare profession is a collection of historical, social and cultural ways of talking about the profession and organizing its practices in relation to its task and its interconnection with other surrounding healthcare professions. This kind of social constructionist worldview, however, challenges the view that ethics would simply be objective and rational—and thereby appearing the same for everybody—by suggesting that ethics is, in fact, constructed differently from different viewpoints. My aim is to unpack the social constructions of the different ways of looking at ethics in the healthcare setting to create an understanding of the topic that extends over the limits of different professional cultures.