Bioethics, Raw and Cooked

Extraordinary Conflict and Everyday Practice

The language of principlism ensures that time-pressured, life-and-death decisions made by health care workers, are ethically sound.

In this article, the author examines bioethics as a language for framing ethical questions in public forums and a set of organizational policies, formal procedures and work routines. The author fuses two theoretical terms in coining the phrase “essentially-contested total social conflict” (ECTSC). An ECTSC is a public event that originates as a private bioethical dispute. Examples are the cases of Nancy Cruzan and Terry Schiavo.

This article also explores how the bioethical language of principlism transforms social spectacle into organizational routine. For the author, ethical procedures originate in ECTSCs. The resolution of ECTSCs has given rise to principlism, the everyday language that health workers use to make ethical decisions. This article focuses on the development of bioethics in two areas: end-of-life decision-making and the protection of human research subjects.

Key Findings:

  • Principlism, the language that formed to resolve ECTSCs, has been adopted as a decision-making tool in clinical practice.
  • The Tuskegee syphilis experiment raised awareness of unethical practices in medical research.
  • The development of procedures to enforce ethical standards in research turned bioethics into a growth industry; bioethics led to the expansion of human subjects research into many academic fields.

Ethics in health care has become a public issue: hospitals have their own ethics commissions, research involving human subjects must submit to an institutional review board (IRB), and ethics committees advise U.S. presidents in the formation of policy. In this essay, Charles L. Bosk describes how public events become ethical policy and procedures.