Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-28T10:05:51.374Z Has data issue: false hasContentIssue false

Toward a Social Bioethics Through Interpretivism: A Framework for Healthcare Ethics

Published online by Cambridge University Press:  25 August 2023

Ryan J. Dougherty*
Affiliation:
Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, TX, USA
Joseph J. Fins
Affiliation:
Weill Cornell Medicine, Division of Medical Ethics, New York, NY, USA
*
Corresponding author: Ryan J. Dougherty; Email: ryan.dougherty@bcm.edu

Abstract

Recent global events demonstrate that analytical frameworks to aid professionals in healthcare ethics must consider the pervasive role of social structures in the emergence of bioethical issues. To address this, the authors propose a new sociologically informed approach to healthcare ethics that they term “social bioethics.” Their approach is animated by the interpretive social sciences to highlight how social structures operate vis-à-vis the everyday practices and moral reasoning of individuals, a phenomenon known as social discourse. As an exemplar, the authors use social bioethics to reframe common ethical issues in psychiatric services and discuss potential implications. Lastly, the authors discuss how social bioethics illuminates the ways healthcare ethics consultants in both policy and clinical decision-making participate in and shape broader social, political, and economic systems, which then cyclically informs the design and delivery of healthcare.

Type
Research Article
Copyright
© The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Boatright, D, Berg, D, Genao, I. A roadmap for diversity in medicine during the age of COVID-19 and George Floyd. Journal of General Internal Medicine 2021;36:1089–91CrossRefGoogle Scholar.

2. Mithani, Z, Cooper, J, Boyd, JW. Race, power, and COVID-19: A call for advocacy within bioethics. American Journal of Bioethics 2021;21:11–8CrossRefGoogle Scholar.

3. Abedi, V, Olulana, O, Avula, V, Chaudhary, D, Khan, A, Shahjouei, S, et al. Racial, economic, and health inequality and COVID-19 infection in the United States. Journal of Racial and Ethnic Health Disparities 2021;8:732–42CrossRefGoogle ScholarPubMed.

4. Mladenov, T, Brennan, CS. Social vulnerability and the impact of policy responses to COVID-19 on disabled people. Sociology of Health and Illness 2021;43:2049–65CrossRefGoogle ScholarPubMed.

5. Deivanayagam, TA, English, S, Hickel, J, Bonifacio, J, Guinto, RR, Hill, KX, et al. Envisioning environmental equity: Climate change, health, and racial justice. Lancet 2023;402:6478 CrossRefGoogle ScholarPubMed. Epub 2023 May 29.

6. Buchanan L, Bui Q, Patel JK. Black Lives Matter may be the largest movement in U.S. history. The New York Times 2020 July 3.

7. Saric I. The global impact of Black Lives Matter. Axios 2021 May 21.

8. Fins, JJ. Bioethics, Ukraine, and the peril of silence. Cambridge Quarterly of Healthcare Ethics 2023;32(1):13 CrossRefGoogle ScholarPubMed.

9. Fox, RC. Moving bioethics toward its better self: a sociologist’s perspective. Perspectives in Biology and Medicine 2016;59:4654 CrossRefGoogle Scholar.

10. Grzanka, PR, Brian, JD, Shim, JK. My bioethics will be intersectional or it will be [bleep]. American Journal of Bioethics 2016;16:27–9CrossRefGoogle ScholarPubMed.

11. Overstreet, NM. Toward critical bioethics studies: Black feminist insights for a field “reckoning” with anti-Black racism. The Hastings Center Report 2022;52:S57S9 CrossRefGoogle ScholarPubMed.

12. Ahola-Launonen, J. The evolving idea of social responsibility in bioethics: A welcome trend. Cambridge Quarterly of Healthcare Ethics 2015;24:204–13CrossRefGoogle ScholarPubMed.

13. Turner, JH. The Institutional Order: Economy, Kinship, Religion, Polity, Law, and Education in Evolutionary and Comparative Perspective. Longman, NY: Longman Pub Group; 1997 Google Scholar.

14. Conrad, P, Schneider, JW. Deviance and Medicalization: From Badness to Sickness. Philadelphia, PA: Temple University Press; 1992 Google Scholar.

15. Wilkinson, R, Marmot, M. Social Determinants of Health: The Solid Facts, 2nd ed. Copenhagen, Denmark: World Health Organization; 2003 Google Scholar.

16. Clarke, AE, Friese, C, Washburn, RS. Situational Analysis: Grounded Theory After the Interpretive Turn, 2nd ed. Thousand Oaks, CA: SAGE Publications Ltd; 2018 Google Scholar.

17. Metzl, JM, Hansen, H. Structural competency: theorizing a new medical engagement with stigma and inequality. Social Science and Medicine 2014;103:126–33CrossRefGoogle ScholarPubMed.

18. Foucault, M. Security, Territory, Population: Lectures at the Collège de France 1977–1978, 1st ed. New York, NY: Palgrave Macmillan; 2009 Google Scholar.

19. Foucault, M. Madness and Civilization: A History of Insanity in the Age of Reason. New York, NY: Vintage Books; 1971 Google Scholar.

20. Foucault, M. The History of Sexuality: An Introduction. New York, NY: Vintage Books; 1990 Google Scholar.

21. Foucault, M. The Birth of the Clinic: An Archaeology of Medical Perception, 3rd ed. Oxford, UK: Routledge; 2012 CrossRefGoogle Scholar.

22. Rose, N. The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century. Princeton, NJ: Princeton University Press; 2007 CrossRefGoogle Scholar.

23. Gollaher, DL. Dorothea Dix and the English origins of the American asylum movement. Canadian Review of American Studies 2013;23(3):149176 CrossRefGoogle Scholar.

24. Scull, A. Decarceration: Community Treatment and the Deviant. New Brunswick, NJ: Rutgers University Press; 1984 Google Scholar.

25. Rissmiller, DJ, Rissmiller, JH. Open forum: Evolution of the antipsychiatry movement into mental health consumerism. Psychiatric Services 2006;57:863–6CrossRefGoogle Scholar.

26. Mechanic, D, McAlpine, DD, Rochefort, DA. Mental Health and Social Policy: Beyond Managed Care, 6th ed. Boston, MA: Pearson Higher Education; 2014 Google Scholar.

27. Dougherty, RJ. The Psychological management of the poor: Prescribing psychoactive drugs in the age of neoliberalism. Journal of Social Issues 2019;75:217–37CrossRefGoogle Scholar.

28. Floersch, J. Meds, Money, and Manners: The Case Management of Severe Mental Illness. New York, NY: Columbia University Press; 2002 CrossRefGoogle Scholar.

29. Braslow, JT. The manufacture of recovery. Annual Review of Clinical Psychology 2013;9:781809 CrossRefGoogle ScholarPubMed.

30. Latalova, K, Kamaradova, D, Prasko, J. Violent victimization of adult patients with severe mental illness: A systematic review. Neuropsychiatric Disease and Treatment 2014;10:1925–39CrossRefGoogle ScholarPubMed.

31. Torrey, FE, Kennard, AD, Eslinger, D, Lamb, R, Pavle, J. More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States. Arlington, VA: Treatment Advocacy Center; 2010 Google Scholar.

32. Mayor Adams Announces Plan to Provide Care for Individuals Suffering From Untreated Severe Mental Illness Across NYC. The Official Website of the City of New York. 2022.

33. Waitzkin, H, Britt, T. A critical theory of medical discourse: How patients and health professionals deal with social problems. International Journal of Health Services 1989;19:577–97CrossRefGoogle ScholarPubMed.

34. Burstow, B. Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting. New York, NY: Palgrave Macmillan; 2015 CrossRefGoogle Scholar.

35. DuBrul, SA. The Icarus Project: A counter narrative for psychic diversity. Journal of Medical Humanities 2014;35:257–71CrossRefGoogle Scholar.

36. Brodwin, P. The coproduction of moral discourse in U.S. community psychiatry. Medical Anthropology Quarterly 2008;22:127–47CrossRefGoogle ScholarPubMed.

37. See note 16, Clarke et al. 2018.

38. Bronfenbrenner, U. Ecological models of human development. In: Gauvain, M, Cole, M, eds. Readings on the Development of Children. New York, NY: Freeman; 1994. pp. 3743 Google Scholar.

39. Fox, RC, Swazey, JP. Medical morality is not bioethics - medical ethics in China and the United States. Perspectives in Biology and Medicine 1984;27:336–60CrossRefGoogle Scholar.

40. See note 11, Overstreet 2022.

41. Fins, JJ, Bacchetta, MD, Miller, FG. Clinical pragmatism: A method of moral problem solving. Kennedy Institute of Ethics Journal 1997;7:129–43CrossRefGoogle ScholarPubMed.

42. Pahwa, R, Dougherty, R, Kelly, E, Davis, L, Brekke, J. Is it safe?: Community integration for individuals with serious mental illness. Research on Social Work Practice 2022;32(7):826–38CrossRefGoogle Scholar.

43. Leblanc, S, Kinsella, EA. Toward epistemic justice: A critically reflexive examination of “sanism” and implications for knowledge generation. Studies in Social Justice 2016;10:5978 CrossRefGoogle Scholar.

44. See note 36, Brodwin 2008.

45. See note 10, Grzanka et al. 2016.

46. Berger, PL, Luckman, T. The Social Construction of Reality: A Treatise in the Sociology of Knowledge. New York, NY: Anchor Books; 1967 Google Scholar.

47. Rabinow, P, Sullivan, WM. In interpretive social science: a second look. In: Rabinow, P, Sullivan, WM, eds. Interpretive Social Science: A Second Look, 2nd ed. CA: University of California Press; 1987 Google Scholar.

48. See note 47, Rabinow, Sullivan 1987:13–14.

49. Charmaz, K. Constructing Grounded Theory, 2nd ed. Thousands Oaks, CA: SAGE Publications, Inc; 2014 Google Scholar.

50. See note 16, Clarke et al. 2018.

51. Creswell, JW, Poth, CN. Qualitative Inquiry and Research Design: Choosing Among Five Approaches, 4th ed. Thousands Oaks, CA: SAGE Publications, Inc; 2017 Google Scholar.

52. See note 16, Clarke et al. 2018.

53. See note 46, Berger, Luckman 1967.

54. Richardson, FC, Fowers, BJ. Interpretive social science: An overview. American Behavioral Scientist 1998;41:465–95CrossRefGoogle Scholar.

55. Carson, RA. Interpretive bioethics: The way of discernment. Theoretical Medicine 1990;11:51–9CrossRefGoogle ScholarPubMed.

56. Callahan, D. The social sciences and the task of bioethics. Daedalus 1999;128:275–94Google ScholarPubMed.

57. Kleinman, A. Moral experience and ethical reflection: Can ethnography reconcile them? A quandary for “The New Bioethics.” Daedalus 1999;128:6997 Google ScholarPubMed.

58. Turner, L. Bioethics and social studies of medicine: Overlapping concerns. Cambridge Quarterly of Healthcare Ethics 2009;18:3642 CrossRefGoogle ScholarPubMed.

59. Matheny Antommaria, AH. A gower maneuver: The American Society for Bioethics and Humanities’ resolution of the “taking stands” debate. American Journal of Bioethics 2004;4:W24W7 CrossRefGoogle Scholar.

60. Fins, JJ. Understanding and utilizing the convening power of ethics consultation. AMA Journal of Ethics 2016;18:540–5Google ScholarPubMed.

61. Ray, KS. It’s time for a Black Bioethics. American Journal of Bioethics 2021;21:3840 CrossRefGoogle ScholarPubMed.

62. Nelson, HL. Feminist bioethics: Where we have been, where we are going. Metaphilosophy 2000;31:492508 CrossRefGoogle Scholar.

63. Wahlert, L, Fiester, A. Queer bioethics: Why its time has come. Bioethics 2012;26:iiiv CrossRefGoogle ScholarPubMed.

64. Garland-Thomson, R. Disability bioethics: from theory to practice. Kennedy Institute of Ethics Journal 2017;27:323–39CrossRefGoogle ScholarPubMed.