Validity and Applicability of the Social Sciences to and for Bioethics

Barry Hoffmaster, ed. 2001. Bioethics in Social Context. Philadelphia: Temple University Press. 288 pp. Hardcover $69.50.

In this edited collection Barry Hoffmaster brings together philosophers, sociologists, geneticists, anthropologists, and specialists in social services and medical humanities who together convincingly argue that social science theory and methodology have valid and applicable roles for a revised bioethics. The central theme of the volume, articulated in depth in Hoffmaster's introduction and repeated to various degrees by each contributor, is that the traditional alliance between bioethics and philosophical abstractions is problematic when considered against the complexity and detail provided by social science theory and methodology. Contributors maintain that adherence to normative and justificatory work blinds bioethicists to the complex of social, political, and economic contexts that underlie the lived reality behind the issues under study.

To members of the choir, elements in this collection should sound like the Hallelujah Chorus. I am unsure, however, how others will read it. I assume that philosophical bioethicists, both those neutral and more reticent toward the social sciences, will question the authors on the interrelated points of validity and applicability, and so it is upon these two issues that I shall focus. By applicability I refer first to the degree to which the analyses discussed in this volume can be extended beyond the specific sites in question. Second, applicability refers to how contributors' conclusions might be pertinent to the normative role of bioethics. By validity I also refer to the fit between the question asked and the methodology and theory used to address that question. In other words, validity is not only measured by how conclusions are drawn from the data but from an examination of the initial framing of the problem and study design as well. I will first discuss how the contributors both implicitly and explicitly make arguments for the applicability of their approach. The second half of the review centers on the nature of validity in the social sciences, focusing on the critiques and benefits of ethnographic methodology for bioethics.

For the majority of contributors applicability does not refer to the ability of their conclusions to act as facts or as substantiation of abstract moral principles or normative rules. Instead, the applicability of their research lies in how their analysis illustrates the contextual underpinnings to patterns of thinking or acting. For example, sociologists Anspach and Beeson's essay presenting results from interviews with practitioners in neonatal intensive-care units shows that emotions cannot be discredited as either irrelevant or as barriers to practitioners' ethical decision making. Instead emotions are shown to integrally underlie moral principles. Similarly, social scientist Kaufman's presentation of narratives by practitioners of geriatric medicine illustrates how clinical-moral deliberation is a dynamic process dependent upon a multidimensional web of knowledge, circumstance, and institutional access and barriers. Kaufman posits that the personal dimension of narratives reflects larger social contexts and shared understandings of the cultural and power structures within medicine. Sociologist Beeson and geneticist Doksum's analysis of families' resistance to sickle-cell and cystic-fibrosis genetic testing similarly shows how individuals' logical and moral decision making is deeply influenced by historical and social processes. These authors argue that the preoccupation of bioethics with genetic-testing technology is incomplete, for it exists divorced from analyses of real-world application, use, and resistance to that technology.

Sociologist Halpern's essay on the history of normative bioethics and human experimentation illustrates the importance of attention to the fluidity of sociocultural processes. Halpern's compelling evidence that bioethicists have, through time, argued convincingly for a series of conflicting positions on human experimentation provides clear evidence of the need to heed Beeson and Doksum's call for attention to contextuality. Anthropologist Lock's cross-cultural essay makes a similar argument. Through her analysis of the problems surrounding brain death and transplantation in Japan, Lock believes that a contextualized understanding of an issue in another culture should stimulate...