Sharing the table: Professions and the bioethics ethos

Understanding healthcare professions as social constructions is combined in my thesis with the more normative assertion that there is value in meeting ethical questions in a way that takes professional and social diversity into account. This bioethics ethos can be summed up to an image of people from different professions gathering together around the same table to talk about ethics, differing substantially from the more traditional model of each professional group having their own, profession-bound discussions.

Therefore, despite the fact that my research lens is constructionist and

7 The language and concepts of ethics are naturally much vaster and richer than suggested here. However, I use this simplistic language (the ”good and right”) to narrow down conceptual complexity, because philosophical ethics is not at the heart of this thesis. Thus, I do not attempt to suggest that defining what is good and what is right would simply be the center of ethics as an academic discipline. I hold that ethics is a multifaceted, critical and systemic inquiry of moral justifications and moral phenomena and cannot be reduced to these simple concepts.

therefore non-normative, my perspective on the topic has a normative quality, because throughout the work I highlight diversity and interprofessional dialogue as central values.

The reverse side of taking this viewpoint is raising a critique of an insular professional systems of ethics. I take a critical stand toward social systems that categorically raise some professional understandings of ethics above that of other professions, thereby creating a hierarchy in which professional status determines whether one is able to participate in ethical dialogue and decision-making processes in their professional role. I acknowledge that decision making must be based on hierarchy—after all, ultimately somebody must be in position to make the decision—but I hold that this does not have to include a hierarchy of moral knowing in which other professionals’ or stakeholders’ viewpoints are systematically and institutionally not heard in terms of their moral views. This is based on separating value decisions and moral discussions from expertise-based territory: There is a difference between making a medical decision based on a patient’s symptoms, on the one hand, and making an ethical decision based on views of the quality of life or a good way to die, on the other hand. The latter symbolizes value questions in which no profession alone can demonstrate having supreme expertise, since value questions cannot be solved by generating more expert information alone.

It should be noted that the tension between expert decision making and pluralistic or democratic decision making is much greater than what will be addressed here. This tension, in fact, is one of the oldest controversies in political and moral philosophy. Few would deny the importance of expertise, and yet, for there to be any reasonableness in pluralism and democracy, experts cannot make all the decisions for others. The central and difficult question, then, is where the line should be drawn. (See Lagerspetz 2008.) I am taking the view here that a rough line should be drawn between technical knowledge (in which expert agency is most needed and legitimate) and moral knowledge (in which at least some form of collective agreement and shared agency is necessary).

My study setting starts from the idea that professions construct their field of inquiry and professional lifeworld in and through social action that is

tied to the profession’s history, culture and position of influence in society.

Lifeworld is a concept used in philosophy and sociology that refers to the world experienced as a lived entity as opposed to theoretical or analytical interpretations of life. The concept of lifeworld includes everything that is self-evident and given for an individual, group or culture. Theoretically, the concept is wide and nuanced, and this theoretical scrutiny falls out of the scope of this thesis (for a deep understanding of the concept, see Husserl 1970; Habermas 1987b). As a starting point, I assume that the studied professions have formed themselves over a long period of time—through a historical and social process of negotiation—into the form in which they appear now, including the duties they take on and the expertise they bring to the table. This idea is extended to their professional understanding about ethics: taking the viewpoint of social constructionism, I view each profession as having formed an ethical worldview that guides their understanding of ethics in their healthcare roles. I strive in my studies to understand what kinds of taken-for-granted qualities are written into these worldviews. The end point of these inquiries is to bring the findings in this thesis together, figuratively, around the same “table,” equivalent to the bioethics ethos. This involves an aspiration to create understanding about the barriers that may prevent this kind of interprofessional ethical dialogue in order to cross them.

The next figure demonstrates the entanglement of bioethics and social psychology in this thesis. Social psychology is my original scientific discipline that shapes the theory and method of my studies. Combining these fields, the social construction of ethics in healthcare professions emerges as the substudies’ focus of interest.

Figure 2. The research focus lies between two disciplines, social psycholo-gy and bioethics.

I approach ethics as an empirical term packed with social meaning and moral rubric from this theoretical foundation. Toward the end of the thesis, my work also takes a more normative turn, because I use my empirical findings to consider practical implications for going further. This is not to argue that my empirical work would seamlessly lead to solid normative moral philosophical claims. Rather, my intention is to awaken the interest of others to discuss my research and views and to take the conversation further. My empirical work bears no normative rigor, but by deepening understanding about the nature of ethical diversity in healthcare, my inquiries open horizons toward asking questions about what should be done about the current situation.

Social scientific descriptive ethics studies can sometimes be understood as “mere” descriptive projects that may not necessarily offer relevant knowledge for philosophers (Hämäläinen 2016). I want to slightly push this traditional boundary to make the claim that my descriptive study also offers a viewpoint for philosophers’ considerations. Many reasons exist to think that descriptive studies could, in fact, enrich the work of philosophers and vice versa. Normative ethics is not only normative by its nature but is always in some way based on an interpretation of the abiding moral situation (ibid., 3). It is in this capturing of the moral situation that descriptive studies are essential and fruitful not only for social science but also for moral philosophy.

However, a descriptive study aiming at creating an articulation of the present

moral situation “involves covert normative emphases and implications that should awaken a philosopher’s critical instincts” (ibid.). Thus, whereas normative philosophy is not merely normative, descriptive ethics is neither just descriptive; rather, it connects to the kind of normative struggle and conceptual work that philosophers are particularly well prepared to deal with (ibid., 6).

It can be thought that by investigating the social construction of healthcare ethics, my research topic is constantly caught between the worlds of social science and philosophy. This juxtaposition puts the thesis in a place in which I occasionally sacrifice the scientific elegance of both academic fields in order to make claims that I find beneficial or insightful in relation to the topic.

This crossing of disciplinary and methodological consistency is done with deference to the late Daniel Callahan, one of the founders of bioethics as a field of study. He defined the rigor in bioethical inquiry to be less about disciplinary or methodological sophistication and more about “the rigor of unfettered imagination, an ability to see in, through and under the surface appearance of things, to envision alternatives, to get under the skin of people’s ethical agonies or ethical insensitivities, to examine things from many perspectives simultaneously” (Callahan 1973, 71).