Nathan Emmerich

Well-founded social fictions: a defence of the concepts of institutional and familial habitus

This article engages with Atkinson’s recent criticisms of concepts of collective habitus, such as ‘institutional’ and ‘familial’ habitus, in order to defend their conceptual utility and theoretical coherence. In so doing we promote a flexible understanding of habitus as both an individual and a collective concept. By retaining this flexibility (which we argue is in keeping with the spirit of Bourdieuian philosophy) we allow for a consideration of the ways in which the individual habitus relates to the collective. We argue that, through recognition of the complexity of the interrelated habitus of individuals, collective notions go beyond individualist accounts that perceive only the relational aspects of the individual with the social field. Our approach allows us to consider social actors in relation to each other and as constitutive of fields rather than as mere individuals plotted in social space. These arguments will be woven through our responses to what Atkinson calls the three fatal flaws of institutional and familial habitus: namely, homogenisation, anthropomorphism, and substantialism.

Bourdieu’s collective enterprise of inculcation: the moral socialisation and ethical enculturation of medical students

This paper introduces the idea of enculturation to sociology as a compliment to socialisation in the context of Bourdieu’s ‘collective enterprise of inculcation’ and social theory. Enculturation is positioned as a concept that can be used to address formal education as a factor in social reproduction. Following a discussion of socialisation and enculturation and their interrelation, they are further examined in the context of medical education. In particular, I focus on the moral and ethical aspects of medical education and the social or professional reproduction of medical students. I differentiate between ‘medical morality’ or ‘ethos’ and ‘medical ethics’ or ‘eidos’, arguing that the reproduction of the former is predominantly a matter of socialisation whilst the reproduction of the latter is a primarily a function of enculturation. Nevertheless I make clear that any eidos is not independent of the ethos in which is exists and that, therefore, any medical ethics is dependent on the socio-cultural institution of medicine and its moral ethos. Utilising the concepts of eidos and enculturation in Bourdieuan social theory facilitates a focus on the neglected cognitive aspects of social life, including explicitly pedagogic activities, and provides for a degree of indeterminacy or ‘freedom’ in a theoretical perspective that has been criticised for its deterministic implications.

LITERATURE, HISTORY AND THE HUMANIZATION OF BIOETHICS

This paper considers the disciplines of literature and history and the contributions each makes to the discourse of bioethics. In each case I note the pedagogic ends that can be enacted though the appropriate use of the each of these disciplines in the sphere of medical education, particularly in the medical ethics classroom.(1) I then explore the contribution that both these disciplines and their respective methodologies can and do bring to the academic field of bioethics. I conclude with a brief consideration of the relations between literature and history with particular attention to the possibilities for a future bioethics informed by history and literature after the empirical turn.

Elective ventilation and the politics of death.

This essay comments on the British Medical Associations recent suggestion that protocols for Elective Ventilation (EV) might be revived in order to increase the number of viable organs available for transplant. I suggest that the proposed revival results, at least in part, from developments in the contemporary political landscape, notably the decreasing likelihood of an opt-out system for the UKs Organ Donor Register. I go on to suggest that EV is unavoidably situated within complex debates surrounding the epistemology and ontology of death. Such questions cannot be settled a priori by medical science, bioethics or philosophical reflection. As Radcliffe-Richards suggests, the determination of death has become a moral question, and therefore, now extends into the political arena. I argue for the conclusion that EV, and wider debates about organ donation and the constitution of the organ donation register, are matters of ‘biocitizenship’ and must, therefore, be addressed as ‘biopolitical’ questions.

A Sociological Analysis of Ethical Expertise: The Case of Medical Ethics

This article outlines a theoretical and conceptual account for the analysis of contemporary ethical or “bioethical” expertise. The substantive focus is on the academic discipline of bioethics—understood as a “practical” or “applied” ethics—and its relationship to medicine and medical ethics. I draw intellectual inspiration from the sociology of science and make use of research into the idea of “expertise” per se. In so doing, I am attempting to move the debate beyond the limitations placed upon it by philosophical or meta-ethical analysis and develop a perspective than can be used to address the sociological reality of (bio)ethical expertise. To do so, I offer the terms ethos and eidos to provide a basic conceptual framework for the sociological analysis of “morality” and “ethics.” I then turn to an exegesis of Collins and Evans’s account of ubiquitous, contributory, and interactional expertise and situate these topics in relation to academic bioethics and medical practice. My account suggests a particular understanding of the kinds of relationships that “bioethics” should seek to foster with the social fields it endeavors to not only comment on but also influence.

Caring for quality of care: symbolic violence and the bureaucracies of audit.

BackgroundThis article considers the moral notion of care in the context of Quality of Care discourses. Whilst care has clear normative implications for the delivery of health care it is less clear how Quality of Care, something that is centrally involved in the governance of UK health care, relates to practice.DiscussionThis paper presents a social and ethical analysis of Quality of Care in the light of the moral notion of care and Bourdieu’s conception of symbolic violence. We argue that Quality of Care bureaucracies show significant potential for symbolic violence or the domination of practice and health care professionals. This generates problematic, and unintended, consequences that can displace the goals of practice.SummaryQuality of Care bureaucracies may have unintended consequences for the practice of health care. Consistent with feminist conceptions of care, Quality of Care ‘audits’ should be reconfigured so as to offer a more nuanced and responsive form of evaluation.

Confronting the quality paradox: towards new characterisations of 'quality' in contemporary healthcare.

This editorial introduces the special Biomed Central cross-journal collection The Many Meanings of ‘Quality’ in Healthcare: Interdisciplinary Perspectives, setting out the context for the development of the collection, and presenting brief summaries of all the included papers in three broad themes 1) the practices of assuring quality in healthcare 2) giving ‘space to the story’ 3) addressing moral complexity in the clinic, the classroom and the academy. The editorial concludes with reflections on some of the key messages that emerge from the papers which are relevant to policymakers and practitioners who seek to improve the quality of healthcare.

Whatever happened to medical politics

This paper argues the case for coming to see ‘medical politics’ as a topic or subject within medical education. First, its absence is noted from the wide array of paramedical subjects (medical ethics, history of medicine, the medical humanities, etc) currently given attention in both the medical education literature and in specific curricula. Second the author suggests that ‘the political’ is implicitly recognisable in the historical roots of medical ethics education, specifically in certain of the London Medical Groups activities, and also that the medical profession, or indeed any profession, cannot be understood as an apolitical form of social organisation either in its institutional or scientific (epistemic) forms. Some brief suggestions for introductory and advanced topics in medical politics are discussed and the degree to which medical politics ought to be taken seriously and delivered as part of medical education is considered. Ultimately the author concludes that medical politics might be considered a useful subject within medical education, but it is perhaps best understood as a perspective or approach that can contribute to the development of a more expansive perspective within the extant paramedical subjects.

Reframing Research Ethics: Towards a Professional Ethics for the Social Sciences

This article is premised on the idea that were we able to articulate a positive vision of the social scientists professional ethics, this would enable us to reframe social science research ethics as something internal to the profession. As such, rather than suffering under the imperialism of a research ethics constructed for the purposes of governing biomedical research, social scientists might argue for ethical self-regulation with greater force. I seek to provide the requisite basis for such an ‘ethics’ by, first, suggesting that the conditions which gave rise to biomedical research ethics are not replicated within the social sciences. Second, I argue that social science research can be considered as the moral equivalent of the ‘true professions.’ Not only does it have an ultimate end, but it is one that is – or, at least, should be – shared by the state and society as a whole. I then present a reading of confidentiality as a methodological – and not simply ethical – aspect of research, one that offers further support for the view that social scientists should attend to their professional ethics and the internal standards of their disciplines, rather than the contemporary discourse of research ethics that is rooted in the bioethical literature. Finally, and by way of a conclusion, I consider the consequences of the idea that social scientists should adopt a professional ethics and propose that the Clinical Ethics Committee might provide an alternative model for the governance of social science research.

Ethos, Eidos, Habitus A Social Theoretical Contribution to Morality and Ethics

This essay sets out a practice theory perspective on morality and ethics within a Bourdieuan frame. The terms ethos and eidos are developed as field level accounts of morality – the normative character or structure of a society of culture – and ethics or, rather, the collective socio-logic of ethical thinking. I then discuss the idea that, consistent with Bourdieu’s social theory, social structures – such as ethos and eidos – are ontologically complicit with the systems of dispositions constitutive of habitus. Following my discussion of this idea – that the structures of habitus (systems of dispositions) stand in a homologous relationship with the structures of the social fields within which they were developed – I turn to some recent research in moral psychology. I attempt to show that the view I have outlined can assist us in understanding the picture of morality and ethics emerging from this scholarship.