Sociological Perspectives on Medical Ethics and Decision-Making

Sociologists have not addressed directly the normative issues that constitute the core of medical ethics as an intellectual discipline. They have, however, contributed to a “realist” critique of medical ethics in practice. In regard to the institutionalization of “autonomy” around the principle of informed consent, they have noted widespread indifference on the part of patients, considerable variation among settings, and a persistent ability of physicians to deflect challenges to their authority. In regard to failed efforts to institutionalize “justice,” sociologists have noted both the difficulty physicians experience moving from individual clinical decisions to a recognition of the collective consequences of those decisions and the social structures that shape allocation decisions along dimensions orthogonal to ethical concerns. Most importantly, however, medical ethics is an arena in which sociologists can revisit, in new form, old issues about the doctor-patient relationship, the relationship between medicine and gender, the meaning of death and dying, and the character of medical professionalism.