The contributions of sociology to medical ethics.

Medical ethics has not always been friendly territory for the social sciences; at least a few sociologists who have wandered across disciplinary borders for a tour report back on unfriendly natives.[1] I should acknowledge, from the first, that I am not among the unhappy visitors. This is not, however, so much because my own brief trips into medical ethics have been met with particularly friendly receptions as because I have been something of an accidental tourist without any great expectations that I would find the comforts of home in foreign territory. Medical ethics--or, more precisely, what might be called philosophical approaches to medical ethics--and social science approaches to medical ethics are characterized by very different purposes. In the first instance, medical ethics is an applied discipline. The social sciences, including, not least, sociology, are primarily academic disciplines. In making this claim, I am aware of its irony. Certainly, philosophical medical ethics, as it has been practiced in the United States, is given to frequent flights of fancy--grand abstractions and frank speculations--that seem far removed from any immediate application. Equally certainly, empirical sociology, particularly in its ethnographic mode, is marked by a preoccupation with the grubby details of life in hospitals and doctors' offices that often seems far removed from any higher analytic issues.[2] Nonetheless, philosophical medical ethics is fairly explicitly a branch of applied philosophy, and even its grandest abstractions are put to the service of formulating procedures and policies useful to "problems of therapeutic practice, health care delivery, and medical and biological research."[3] And it is very much in this spirit that medical ethicists have generated a great number of proposals, many later adopted, for the regulation of experimentation with human subjects, of procedures for allocating scarce organs, for allowing the termination of treatments, for ensuring informed consent, and much more. In contrast, sociologists tend to use even grubby details as a route to more analytic observations. Thus many of the sociologists who have dabbled in areas relevant to medical ethics have often disavowed any interest in the application of their researches to procedures and policies, stressing instead their implications for such abstruse matters as the sociology of the professions, "theories" of organizations, or the social organization of cognition. Ironically, then, it is the medical ethicists, trained in philosophy and theology and given to abstraction, who are often worldly, and it is the sociologists of medical ethics who are often curiously otherworldly. There is, of course, another, probably more conventional distinction between philosophical and social science approaches to medical ethics--that one is normative and the other empirical. But I am not entirely comfortable with this distinction. To be sure, philosophical approaches to medical ethics are typically more explicitly normative than are social science approaches. Similarly, social science approaches are typically far more explicitly empirical. Nonetheless, philosophical medical ethicists not only often incorporate empirical material into their analyses but have recently shown a growing inclination to do so. And while sociologists often seem almost embarrassed about acknowledging the normative aspects of their work, nonetheless, for those sociologists who study medical ethics, the normative implications of their work are often unavoidable, even if it is others who make them explicit. The difference between philosophical and social science approaches to medical ethics is somewhat subtler then than a stark contrast between the normative and the empirical would suggest. To be sure, the philosophers are generally less systematic on matters empirical than the social scientists. For the philosophers it is typically enough to know that a phenomenon exists, regardless of the distributions that often obsessively occupy the social scientists. …