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Applications of biomedical R&D currently imply substantial societal concerns. This paper explores, based on semi‐structured interviews with scientists in Norway, how biomedical researchers experience and tackle such concerns in their daily work. It shows how ritualised routine responses to dislocatory moments help maintain order in the daily work of the interviewed scientists; they do not address directly but instead smooth over concerns by a ritualised way of using ethics. This may foreclose substantive reflection and function as a stabiliser for 'business as usual'. Overall, the current way of responding to concerns as described by the interviewees may contribute to a depoliticisation of important issues. The paper contributes to sociological work on ethics by linking it to recent discussions on Responsible Research and Innovation (RRI) and by the empirical research presented. The insights can also help improve science policies such as RRI. [ABSTRACT FROM AUTHOR]

It is no surprise that bioethics and sociology developed an adversarial relationship: bioethicists value the clear descriptions of ethically charged situations provided by social scientists, but doubt the ability of those trained in social science to logically derive and discern ‘the good’. For their part, social scientists – experts in observing and collecting data about the way the world is– find bioethicists ignorant of the ways elegantly crafted solutions to ethical problems get altered when incarnated in varied social and cultural settings. This discipline-centred self-affirmation can be a satisfying exercise, but it offers nothing to the project of promoting more moral medicine and health care. The articles collected in this volume demonstrate the value of collaboration between social scientists and bioethicists. Focusing on four themes found in recent sociological research in bioethics – ethics of research, the creation of moral boundaries, bioethics and social policy, and the bioethical imagination – this anthology offers practical models of co-operative work where the strengths of each discipline are brought together to advance our understanding of bioethical issues and to show the way toward just and effective social policy. [ABSTRACT FROM AUTHOR]

This paper examines the emerging bioethical debate on assisted reproductive technology (ART) in Ireland, which is shaped by the long-standing contentious issue of abortion and the constitutional protection afforded to the ‘unborn’. The focus of the paper is on the way in which the terms of this debate are shaped and constrained by the historical relations of power between church, state and medicine. Since the representation of Ireland as a post-Catholic, plural republic is becoming increasingly mainstream to cultural and political discourse, we pay particular attention to how the Catholic Church embraces bioethics as a meta frame or code for refocusing questions of values, beliefs and meanings to sustain the ideal of Ireland as a ‘pro-life’ and essentially Catholic nation. The Catholic Church is not simply asserting its voice of dissent in the context of public debate as one voice amongst a plurality of other voices, but to shape the emerging debate as a powerful, institutional actor. The opportunity to do so is afforded by the lack of public debate on bioethical issues and the exceedingly slow pace at which bioethics is moving towards an institutionalised framework in Ireland. These events can be explained by the legacy of the social power of the Catholic Church in Ireland and the direct and indirect influence it has long exercised over public policy vis-à-vis the state and its institutions, including medicine. There are two interconnected threads to the contextual analysis presented in our case study: first, the legacy of the social power wielded by the Catholic Church, and its slow and incremental demise reflected in the pace of secularisation in Ireland and the privatisation of morality; second, the emergence of a bioethical regulatory debate on ART, which is mired in the abortion controversy. Our analysis focuses on a number of key contradictions and tensions in the way in which the key institutions of church, state and medicine navigate their own positions vis-à-vis a bioethics debate, and how this constrains public participation. [ABSTRACT FROM AUTHOR]

This paper argues for the importance of a broad sociological engagement with bioethics. It begins by considering why sociologists should be interested in bioethics and then goes on to explore the cognitive critique of bioethics developed by ethnographers. Some of these authors have also suggested that a more robust bioethics might emerge through the incorporation of the tools of ethnographic analysis. In this paper, it is argued that this is an important claim which needs to be analysed further and that Foucault's concept of discursive formations provides a useful framework for doing so. Once bioethics is redescribed as a discursive formation, the paper explores the challenges and obstacles that sociology and ethnography face in their attempt to open up a space for themselves in bioethics. The paper concludes by suggesting that sociologists and ethnographers need to reflect on the ways in which they might democratically secure legitimacy for their own claims in the field of social ethics. [ABSTRACT FROM AUTHOR]

Change in the way new drugs are developed, including the privatisation of clinical trials, has altered the arrangement and roles of healthcare professions. In this paper I examine one aspect of this change: the role of research coordinators in the conduct of contract research in the United States. My focus on coordinators highlights the ethical conflicts embedded in clinical trials. I describe the ways in which coordinators experience and contend with the conflict between research and care and show how their construction of ethics is distinct from institutional conceptions formally associated with human subjects research. My analysis demonstrates how the coordinators’ focus on ethics is a response to their role conflict and an attempt to reinsert individualised care into the context of research. [ABSTRACT FROM AUTHOR]

After a history of neglect, bioethicists have recently turned their attention to the topic of infectious disease. In this paper we link bioethicists’ earlier neglect of infectious disease to their under-appreciation of the extent to which the problem of infectious disease is related to social factors and thus to questions of justice. We argue that a social causation of illness model – well-known to sociologists of medicine, but incompletely understood by bioethicists – will improve future bioethical analysis of issues related to infectious disease. By emphasising the relationships between social and economic structures of inequality and health, the social causation model provides a richer approach to ethical issues associated with infectious disease than the more commonly used biomedical model. [ABSTRACT FROM AUTHOR]

In recent years international bioethics bodies have made prominent declarations about the uses of donated tissue and related information in genetic research 1 . Following the ‘legislative’ mode of bioethics 2 , these organisations have put forward a number of general principles with a view to promoting the fair and equitable use of donated tissue in such research. However, government policies in this field are shaped differently in different national regimes. In this paper, I use recent debates in the UK about a national genetic ‘biobank’ to illustrate how the shape and texture of policy discussions surrounding the use of donated blood for genetic research have been built upon a prior national consensus that regarded blood as a public good. [ABSTRACT FROM AUTHOR]

This article addresses the need to grasp the actual processing of health ethical issues in ethics organisations by analysing the work of the Finnish National Advisory Board on Social Welfare and Health Care Ethics (ETENE). ETENE's ethics is approached ethigraphically: the advisory board enacts ethics in its social life, through its own norms and values. It is asked how this internal ethics is performed in the board practice and how ethical debate eventually becomes bounded in this practice. Based on the analysis of the board members' textual reflections and on‐site observations of board meetings, ETENE's ethics appears as a tandem of a particular discussion culture and multi‐perspectivity: mutual recognition and respect among board members are nurtured in the meetings, and a tactful mode of reflection is established throughout all terms of office. This shared discussion culture enables ETENE's forte—weighing multiple perspectives—by preventing asymmetries and avoiding merely technical decision‐making procedures. Consequently, ETENE's ethics is not threatened by being externally bounded and formalised but is at risk of watering down endogenously, through the notable tactfulness of its discussion mode, which threatens to attenuate both substantial debate and the social shaping of board members' values in the discussion. [ABSTRACT FROM AUTHOR]

The authors comment on the article "The Concept of Medicalisation Reassessed," by J. Busfield which appeared in a previous issue. They talk about the contribution of the article to medical sociology, the failure of Busfield to elaborate or articulate upon the different dimensions and directions of medicalization, and issues concerning the merits of pharmaceuticalization.

Since the 1990s, the sociology of rationing has developed in explicit opposition to health economic and bioethical approaches to healthcare rationing. This implies a limited engagement with other disciplines and a limited impact on political debates. To bring the sociology of rationing into an interdisciplinary dialogue, it is important to understand the disciplines' analytical differences and similarities. Based on a critical interpretive literature synthesis, this article examines four disciplinary perspectives on healthcare rationing and priority setting: (1) Health economics, which seeks to develop decision models to provide for more rational resource allocation; (2) Bioethics, which seeks to develop normative principles and procedures to facilitate a just allocation of resources; (3) Health policy studies, which focus on issues of legitimacy and implementation of decision models; and lastly (4) Sociology, which analyses the uncertainty of rationing and the resulting value conflicts and negotiations. The article provides an analytical overview and suggestions on how to advance the impact of sociological arguments in future rationing debates: Firstly, we discuss how to develop the concepts and assumptions of the sociology of rationing. Secondly, we identify specific themes relevant for sociological inquiry, including the recurring problem of how to translate administrative priority setting decisions into clinical practice. [ABSTRACT FROM AUTHOR]

The oscillation between the promise and the disappointment of biobanks as techno‐scientific infrastructures for contemporary biomedical research is frequent in the literature. In this article, we analysed how the precariousness of biobanks is leading to shifts in the focus of biobanking in Spain, where there are calls for some practices to be rearticulated. Drawing upon fieldwork and interviews with biobankers, we looked at which practices are highlighted for change to make biobanks worth maintaining and keep them afloat. We analysed these practices to unpack the values biobankers deploy to make sense of biobanking and turn it into two worthiness criteria: social return and dynamism. These criteria are intertwined and revolve around ethically calibrating the accumulation and sharing practices, 'sharing but not too much'. The porosity of biobanking practices and legislation, not to mention over a decade of austerity measures make biobanks fragile scientific infrastructures in Spain. We examine how biobanking practices are shifting in Spain to stay in the precarious techno‐scientific present while challenging assumptions on cryopreservation and preparedness. Our local account highlights the relevance of further inquiries on shifts in biobanking to attend to which kinds of biomedical research and knowledge might be coproduced by such infrastructural reconfigurations. [ABSTRACT FROM AUTHOR]

With increasing frequency, the oldest members of US society are undergoing medical interventions aimed at prolonging life. Using cardiac care as a case study, this paper explores how a discourse of risk infuses and legitimates high-tech clinical treatments in late life. In particular, we examine how the diminishing risks associated with biomedical procedures produce a sense of medical possibility regarding life extension, and push the definition of 'old age' into a receding future. Simultaneously, physicians, patients and families come to understand the management and reduction of future cardiac risks to be germane for individuals even near the end of life. Driven by the logic and language of risk, decisions to intervene are experienced as incremental and largely unremarkable, and the pursuit of an open-ended future via biomedical means is perceived as an ethical imperative, trumping deliberation or discussion of the utility of intervention and the ultimate ends being pursued. For practitioners and patients alike, the engagement of risk, the preservation of hope it facilitates and the routinisation of intervention it produces all contribute to the emerging mandate to treat at ever-older ages. [ABSTRACT FROM AUTHOR]

The professional autonomy of physicians often requires they take responsibility for life and death decisions, but they must also find ways to avoid bearing the full weight of such decisions. We conducted in‐person, semi‐structured interviews with neonatologists (n = 20) in four waves between 1978 and 2017 in a single Midwestern U.S. city. Using open coding analysis, we found over time that neonatologists described changes in their sense of professional autonomy and responsibility for decisions with life and death consequences. Through the early 1990s, as neonatology consolidated as a profession, physicians simultaneously enjoyed high levels of professional discretion and responsibility and were often constrained by bioethics and the law. By 2010s, high involvement of parents and collaboration with multiple subspecialties diffused the burden felt by individual practitioners, but neonatology's professional autonomy was correlatively diminished. Decision‐making in the NICU over four decades reveal a complex relationship between the professional autonomy of neonatologist and the burden they bear, with some instances of ceding autonomy as a protective measure and other situations of unwelcomed erosion of professional autonomy that neonatologists see as complicating provision of care. [ABSTRACT FROM AUTHOR]

This article illustrates and discusses the idea of 'implicit normativity', and specifically its relevance to the management of ethical uncertainty. In particular I consider (i) the role implicit normativity plays in masking and containing potential ethical uncertainty and (ii) the contrast and boundary between implicit normativity and 'overt ethics' where ethical contestation – as well as particular processes and agents – are highlighted as salient. Using examples I show how the idea of implicit normativity can be applied not only to specific practices but also to whole fields of practice. The notion of 'moral settlements' – along with the explanatory role of the threat of 'chaos' – is introduced and elucidated to develop these points. I argue that attention to the management of ethical uncertainty shows the critically important contribution that an ambitious sociology of ethics can make to clinical ethics, including by helping to formulate and drive home questions about the 'ethics of ethics'. The account presented here has resonances with work that seeks to use sociological lenses to move beyond conventional bioethics, including Petersen's (2013) call for a 'normative sociology'. [ABSTRACT FROM AUTHOR]

Despite substantial efforts in the past 15 years to professionalise the field of clinical ethics consultation, sociologists have not re‐examined past hypotheses about the role of such services in medical decision‐making and their effect on physician authority. In relation to those hypotheses, we explore two questions: (i) What kinds of issues does ethics consultation resolve? and (ii) what is the nature of the resolution afforded by these consults? We examined ethics consultation records created between 2011 and mid‐2015 at a large tertiary care US hospital and found that in most cases, the problems addressed are not novel ethical dilemmas as classically conceived, but are instead disagreements between clinicians and patients or their surrogates about treatment. The resolution offered by a typical ethics consultation involves strategies to improve communication rather than the parsing of ethical obligations. In cases where disagreements persist, the proposed solution is most often based on technical clinical judgements, reinforcing the role of physician authority in patient care and the ethical decisions made about that care. [ABSTRACT FROM AUTHOR]

New biotechnologies such as assisted conception are socially embedded artefacts that raise context‐specific ethical, moral and social anxieties. In contexts where the regulations of these profitable developments are limited or ambiguous, and competition between private facilities is high, individual doctors become morally and socially responsible for determining the parameters of administering such therapies. Ethnographic research at two private fertility centres in Colombia reveals that doctors do not determine boundaries based on monetary gain but rather personal morals, social norms and professional obligations. Medical professionals hold diverse perceptions of assisted conception, and often struggle to make decisions regarding who should access such therapies, who are ideal gamete donors and the fate of extra embryos. The complexity of these perceptions applied in a context of limited regulation and the competition of private medicine impacts the praxis of assisted conception. As doctors determine the boundaries of their practice they not only create variation between clinical practices, but also make moral decisions regarding who should be parents, how families should be formed and the significance of embryos. Thus, in navigating their everyday practices, doctors also shape the social world. [ABSTRACT FROM AUTHOR]

Social scientists have recently diverged from mainstream bioethical discussion on the topic of the medical use of human biological materials for therapeutic, reproductive and research purposes. Rather than justifying the donation and provision of biological materials solely in terms of alleviating physical, psychological and social suffering, saving or enhancing life, and advancing biomedical knowledge, this work looks beyond humanist bioethics to take a social justice approach to questions of the life sciences. In this article, I draw insight from these accounts to propose an approach to the sociology of live kidney and breastmilk donation that is situated at the interface of the new sociology of morality and affect studies. To do so, I examine the moral economy of tissue provision with respect to its organisation around the discourse of altruism and the gift. I then turn to recent work on tissue economies, which are in the business of creating and producing biovalue, to discuss the manipulation of affect and the entanglement of new forms of bio‐intimacy in the production and reproduction of somatic life. The aim of the article was to contribute to the study of the sociology of donation as a substantive field of specialisation within sociology. [ABSTRACT FROM AUTHOR]

The first ‘modern’ presentation of medical ethics is generally acknowledged to be Percival's text of 1803. The main theme of this influential pamphlet was the way in which medical practitioners should relate to one another. Two centuries later, clinical practice has very different moral underpinnings: bioethics, which first emerged in the middle of the 20th century, is not concerned with how doctors should interact with each other but with the responsibilities of medical practitioners to their patients. The shift from an ethics based on the relationship between practitioners to one based on the relationship with their patients is viewed as a major advance brought about by a more enlightened society engaging with the consequences of new technologies. But rather than addressing the changing picture of medical ethics in its own terms (which over the last few decades has been from the perspective of bioethics) I examine the history of medical ethics in its close relationship to the form and nature of the medical profession. Further, in a parallel thread I describe contemporary developments in public health and explore the similarities and connections between the two. [ABSTRACT FROM AUTHOR]