Realizing bioethics' goals in practice: ten ways "is" can help "ought".

Bioethics has been criticized for lacking relevance and for being naive. Its principles and modes of justification are better suited to handling clinical matters at the bedside or policy issues related to new technologies than for grappling with arguably more profound moral problems like racism and human rights. (1) Moreover, bioethical analyses often assume an implausible degree of rationality in human motivation and action. (2) Getting from an ideal vision of the good to an embodiment of those ideals in practice depends as much on structural factors like power, money, and socialization as on espoused values and ideals. It is not a coincidence that as these criticisms have been voiced, interest has been growing in the relationship between the social sciences and the bioethical enterprise. It is now well established that the social sciences have a lot to contribute to bioethics. (3) One cannot define "the good"--and it might even be dangerous to try--without understanding context, intentionality, and outcomes, all of which the social sciences provide. No one writing today would claim that empirical observations and normative analyses are wholly separate enterprises, wherein the social sciences simply serve bioethics' interests. Writing in the Hastings Center Report a few years ago, Robert Zussman observed that there are more normative assumptions and motives in social science research than social scientists acknowledge and more need for empirical, descriptive research than ethicists originally conceded. (4) In the same issue, James Lindemann Nelson questioned the orthodox model of how "is" relates to "ought," according to which empiricists supply the facts; moral philosophers, theologians, and humanists provide the values; and philosophers clarify relevant concepts and ensure valid argumentation. He criticized this view as too linear because "it keeps 'is' and 'ought' on their respective sides of the fence," and he called instead for "inverting the common wisdom about the relations between the normative and the descriptive." (5) But exactly how does empirical research in the social sciences relate to normative analysis? This essay is an attempt to give a more precise answer to that question. My goal is to reflect on the ways in which empirical research in the social sciences--both quantitative and qualitative--can be deployed to serve bioethics' goals. My method is inductive and personal. I have worked as a social scientist doing research on values questions and moral uncertainty in medicine and health care with the goal of helping bioethics grapple with challenges in end of life care, organ donation, pain management, public health, and genetics. My work--including this essay--is therefore squarely located in what Raymond De Vries recently called the "social sciences in bioethics," which he distinguished from "the social sciences of bioethics." (6) Social scientists who work in bioethics describe people's opinions, uncover how organizations work, or describe the impact of bioethical policies, thereby providing essential context to help bioethicists do their work. Sociology of bioethics is not interested in helping bioethics; instead, it studies it. Social scientists at this end of De Vries' continuum ask questions like: What were the social, political, historical, and economic factors that gave rise to the field? Is bioethics' real function to critique or to legitimize medicine? In this essay, I look back at some of my own work in bioethics with an eye toward discerning the sorts of relationships to normative analysis that my research has exemplified, and I will try to infer a kind of taxonomy of the ways in which empirical research and bioethics can constructively relate. Since I am a social scientist of a particular bent--one who specializes in behavior change research--most of my work has involved needs assessments and intervention design and evaluation, aimed at making improvements in individual and organizational behavior. …