Abstract
This paper considers the utility of Ethnomethodology (EM) for the study of healthcare ethics as part of the empirical turn in Bioethics. I give a brief introduction to EM through its respecification of sociology, the specific view on the social world this generates and EM's posture of ‘indifference’. I then take a number of EM concepts and articulate each in the context of an EM study of healthcare ethics in professional practice. Having given an overview of the relationship and perspective EM might bring to the professional practice of healthcare ethics I consider whether and how such an approach could be deployed. Whilst an ethnographic study might be problematic I suggest a number of alternative methods through which such EM research could be accomplished. I conclude with the suggestion that, as a particular approach to sociological research, EM offers good deal of potential for the empirical study of healthcare ethics in practice which could result in an improved reflexive understanding of professional ethical practices in bioethics.
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Notes
Of course the opposite critique, an undersocialised conception of man, could easily be levelled at mainstream bio- and applied ethics. Consider discussion of the concept if personhood and autonomy in bioethics compared with identity and agency in the social sciences.
For current state of the art debate see [3].
Talcott Parsons was Garfinkel’s supervisor for his doctoral research and a considerable influence.
Garfinkel has acknowledged the work of Schutz to be of great importance to his development of EM.
This led to EM becoming caught up in a particular struggle occurring within American sociology at that time. For an accurate discussion of EM and phenomenology see [4].
See also the other papers on Zaner’s ‘Troubled Voices’ presented alongside this article [15] and in a special issue of Theoretical Medicine and Bioethics (2005, 26(1)) and Zaner’s responses.
Although these can be important topics for EM research particularly in STS or SSK research. Although the comparative element remains unpronounced as compared with the more traditional ethnosciences. See Lynch’s ‘epistopics’ for example [16].
One might, at this juncture, suggest a Kantian Transcendental Aesthetic could be invoked to support our embodied ethical sensitivity suggesting the possibility that an ethical EM could embody some philosophical moral theory. Certainly an EM could embody a formal moral theory, the EM of applied ethicist’s debates at conferences, for example. However I do not think this will, ultimately, prove to be a fruitful conflagration although I am grateful to an anonymous reviewer for suggesting the possibility.
Bracketing has been called the direct ancestor of EM indifference [17].
It might seem odd to suggest EM research might produce a thick description, a concept more usually applied to ethnographic research. However an EM description of the practice of healthcare ethics cannot but be a thicker account of socially located ethical (ethno)methodology than those given by applied ethics which, in its philosophical guise at least, values thinness.
Although EM has produced a freestanding method in Conversation Analysis.
The relevant concepts being ‘meaning-as-use’, ‘knowing-how and knowing-that’, and the performativity (doing) of speech acts, respectively: [18–20]. Within this view of language there is of course a deeply problematic implication regarding the relationship between thought (cognition) and language. It is certain that we think at least some of our thought in natural language(s) the implication being that in doing so we are communicating with ourselves and so at least some thinking is a social practice.
Of course the idea of communication encompasses a greater variety of acts than speech, speaking or language use. Whilst I do not go into this here non-verbal communication may be an important methodological part of human social practices, shaking hands with each other when meeting and leaving certain kinds of interactions for example. It is certain that we think at least some of our thought in natural language(s) the implication being that in doing so we are communicating with ourselves and so at least some thinking is a social practice. This is certainly the view I have come to hold. See [21].
One can, of course, hold a conversation with oneself. However the fact that one has a conversation with oneself indicated the dialogical, first and second person, nature of conversations per se.
As bioethics has long recognised [23].
Whilst Coulon [22] makes wide use of the term rational in regards accountability I prefer the term reasonable and so employ it in what follows.
For just the latest in the ongoing battle regarding dignity in bioethics see [26].
For a substantial survey and engagement with reflexivity in the social sciences see [27].
On the unbreakable connection between description (discourse) and the production of social events (practice) see [28].
Lynch also offers an illuminating survey of the varieties of reflexivity [30].
Of course things are not so simple. Those who impersonate doctors often need some technical knowledge in order to accomplish the impersonation. Nevertheless it is the methodical accomplishment of the social role ‘doctor’ that is of greater relevance to the impersonation than the possession of some technical knowledge. Whilst every patient can immediately evaluate an individual’s methodical accomplishment of the social role ‘doctor’ very few patients can evaluate an individual’s technical medical knowledge. Thus it is the former which facilitates impersonation to a greater degree that the latter.
Academics bioethicists are usually designated lay members in REC’s and CEC’s, something I consider troubling, see [33].
Of course the patient may also be medically qualified and in that sense the requirement falls. However such an occurrence is likely to impact the (ethno)methodological accomplishment of the consultation and the patient would be required to methodologically accomplish the role of patient to a suitable degree.
Those who possess a commitment to the view of applied ethics might even be uniquely disqualified to conduct an EM study of the ethical aspects of healthcare practices. The account of healthcare ethics concepts and principles that they bring to the table may simply be too strong to allow the nature of the concepts in use to be fully appreciated. In addition, and as previously noted, applied ethics tends towards a methodological commitment to ideal language (analytic) philosophy whereas EM is founded on ordinary language philosophy. The applied ethicist must then undergo a ‘gestalt switch’ from an empiricist or scientistic view to a praxeological and constructionist view in order to bring a truly EM perspective to bear on ethics in healthcare practice. This is not something that can then be switched back to facilitate a handmaiden view of empirical research in bioethics. Finally adopting an ecumenical and indifferent perspective on healthcare practices which they are more used to subjecting to normative analysis might simply be beyond many philosophers. For examples of similar concerns regarding the role of the applied ethicists in public discourses see [38–40].
This is a general point as, given the perspective presented by EM, it is not clear what a contributory competence in regards healthcare ethics in practice might be over and above the interactional competence implied by engaging in discourse and dialogue.
Of course this does not render interviews ‘unnatural’ but merely points out that they should be understood as interviews prior to being understood as representational. See [41].
Rather than facilitating a kind of methodological transparency that would be the more usual aim of sociology. This approach is what Hammersley calls ‘methodology as technique’ [42].
On various methods in EM research see [43].
See also the current research project at CRESC (Manchester University) regarding the ‘Social Life of Methods’ and involving Law: http://www.cresc.ac.uk/our-research/cross-theme-research/social-life-of-methods. Accessed September 2011.
See, for example, ten Have’s discussion of Pool and euthanasia research [43] (pp. 120–122).
Schön is the originator of the reflective paradigm of professional practice and it is a perspective that has been widely taken up in medicine, particularly within medical education.
Of course this is not the correct historical, genealogical, or genetic picture of the development of medical and bioethics ethics, particularly in the UK medical profession, interest in ethics preceded bioethics as an academic discipline. Nevertheless the hierarchical arrangement is in favour of academic bioethics being the ground for formal methodologically rigorous discussion of ethical issues whilst the discussions of healthcare professionals are seen as compromised by practice.
Abbreviations
- EM:
-
Ethnomethodology
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Acknowledgments
This paper is a result of two presentations. The first was given at the Postgraduate Bioethics Conference held in January 2011 at the Wellcome Collection Conference Centre, Euston Road, London and sponsored by the Wellcome Trust, Foundation for the Sociology of Health and Illness, Cesagen, Wiley-Blackwell, Nuffield Bioethics and Queen’s University Belfast. The second at the Centre for Bioethics and Society (CBAS) at Kings College London in March 2011. I would like to thank both audiences for their comments and feedback as well as for the opportunity to present my work. I would also like to draw attention to Prof Sharrock’s podcast on ethnomethodology which I have found useful and is available from the Methods@Manchester website: http://www.methods.manchester.ac.uk/methods/ethnomethodology/index.shtml. Accessed March 2011.
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Emmerich, N. For an Ethnomethodology of Healthcare Ethics. Health Care Anal 21, 372–389 (2013). https://doi.org/10.1007/s10728-012-0202-7
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DOI: https://doi.org/10.1007/s10728-012-0202-7