Professional ethics, healthcare ethics, bioethics: Some conceptual

I will next clarify the use of some basic concepts of the thesis to avoid conceptual confusion. As great umbrella-like concepts, not everybody uses words such as healthcare ethics the same way; the way of defining the key

concepts is tightly bound to the framework of the thesis. Thus, providing further definition of the vocabulary is important for grasping both the framework and the findings of this thesis.

By the term professional ethics, I refer to the ways in which a given professional group defines its understanding of ethical professionalism.

I view the professional ethics of different professions as social traditions that have been formed around each profession’s task during its historical development. Thus, I approach professional ethics in this thesis as a social concept. Because of this approach, while ethics is typically associated with ethical principles, I do not study professional principles in this thesis. This is because it can be maintained that all the studied professions hold similar principles. They all put weight on advancing health with the widely accepted principles of healthcare ethics in mind: justice, beneficence, nonmaleficence and patient autonomy (Beauchamp & Childress 2012). Rather, I study the way people use principles in their practical theory for professional action—

their professional ethical worldviews. This worldview consists of the ways in which people in a certain profession interpret ethical principles to guide their moral thinking and their action in their professional roles. With these conceptual choices in mind, I study ethical understandings of the different professional groups using the idea of diversity: I do not expect to arrive at a universal theory but rather to make visible the differences between the groups and explore them with an element of comparison.

I use the term healthcare ethics as a theme that entails all the areas of ethics related to the healthcare context. Healthcare ethics is the object of my studies, with its many forms and professional cultures. I view it as an umbrella concept for all the ethical analysis, guidelines and considerations that holds the patient’s good in its focus in all healthcare professions. This includes different professions’ conceptions of ethics and all the different topics concerned with ethics, such as the ethics of end-of-life care or organ donation. Therefore, the term healthcare ethics is the most encompassing, as well as the most unspecific, concept in the ethics vocabulary of the thesis.

The term bioethics is perhaps the most foundational for the perspectives and findings of this thesis. I define the term as an academic and practical paradigm that emphasizes multidisciplinarity and pluralism in its ways of

approaching questions in healthcare ethics. In the way described before, I view the birth of bioethics in the 1960s and 70s as a paradigm shift from the more traditional profession-based ethos, especially in relation to medical ethics. (See Jonsen 1998 & 2000.)

This takes us to the concept of medical ethics that is probably the most likely term to cause conceptual confusion in this thesis. This is because I use the term both as a paradigm of healthcare ethics and as a concept under the title of professional ethics, referring to physicians’ ethical worldview.

Context reveals in which meaning I use the concept. Concerning the history of bioethics, I understand medical ethics as a paradigm comparable to bioethics. I approached the term as a professional ethics, a focus of interest for social scientific inquiry, when researching modern Finnish texts on medical ethics in the second substudy. Medical ethics, after all, is both: it is a way of thinking about ethics in healthcare as a profession-bound topic within the

“long tradition” (Jonsen 2000) of medical ethics, as well as a worldview for physicians’ everyday ethical practice: a professional ethics. I also use the phrase physicians’ ethics to refer to the latter on some occasions.

The following figure illustrates the use of the concepts in this thesis. First, everything falls under the grand theme of healthcare ethics. Second, the themes are separated into profession-based worldviews, which form the object of my social constructionist research, and paradigms, wider historical traditions under which the different ways of dealing with healthcare ethics can be located.

Figure 1. The key concepts of the thesis.

Another conceptual clarification concerns the terms ethics and morals.

The concept of ethics is typically separated from the concept of morals in philosophy. Ethics refers to theoretically systematic work that reflects on questions about defining the good and right⁷, whereas morals point to everyday moral life and people’s understandings. However, throughout this thesis, the two concepts do not stay categorically intact from each other in this way. As I study ethics in the empirical world, I delve into questions about how people talk about ethics and how they define it in talk and professional texts. Working on the topic from this angle, the concept of ethics becomes practically enmeshed with the concept of morals, because these words are often generally used as synonyms outside philosophy. Thus, while the word ethics cuts through my studies, a philosopher may be quick to add that what I am, in fact, writing about is the moral landscape of healthcare professions.

However, because the word ethics is used by informants and the texts that I study, I use the same language in this context to ward off unnecessary conceptual confusion.