Managing ethical uncertainty: implicit normativity and the sociology of ethics

Abstract

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’.

Understanding and managing uncertainty in health care: revisiting and advancing sociological contributions

“…As Cribb notes, clinical uncertainty as an epistemic concept relates to the incomplete knowledge of healthcare professionals (including within biomedical sciences more generally) (Cribb 2019). The value and epistemic authority of medicine is open to challenge as medicine has no epistemological essence ‐ there is no single medical model (Rose 2007).…”

“…In addition to epistemic and ontological uncertainty, Cribb also brings into focus the existential element of uncertainty; ‘the phenomenological or affective concept relating to the experience of the patient’ (Cribb 2019). He calls for normative rather than just descriptive or explanatory thinking to surface underpinning value judgements that intersect with uncertainty work.…”

“…He calls for normative rather than just descriptive or explanatory thinking to surface underpinning value judgements that intersect with uncertainty work. Cribb’s focus on the role of implicit normativity in the management of ethical uncertainty foregrounds ethical uncertainty as a pervasive risk which tends to evade resolution (Cribb 2019). Only some of this uncertainty is surfaced through professional ethics, or other ethics discourses, but ‘much is implicitly managed through forms of social organisation and routine practice’ (Cribb 2019, p. 2).…”

“…Cribb’s focus on the role of implicit normativity in the management of ethical uncertainty foregrounds ethical uncertainty as a pervasive risk which tends to evade resolution (Cribb 2019). Only some of this uncertainty is surfaced through professional ethics, or other ethics discourses, but ‘much is implicitly managed through forms of social organisation and routine practice’ (Cribb 2019, p. 2). Ethical uncertainty is argued to be managed through the construction of ‘moral settlements’, a matrix of norms, social practices, cultures and technologies, and ‘the socially embedded dispositions of human and non‐human actors’ (Cribb 2019).…”

“…Categorising patients and medical work is intrinsic to the bureaucracy of healthcare organisations; classification of medical work knits together ‘to form the texture of a social space’ (Bowker and Star 1999, p. 286). All of the papers in this collection highlight, in different ways, processes to tame uncertainty by filtering, ordering, structuring and imposing limits (Cribb 2019). Incentives, social sanctions, performance measures, directives and guidelines all work to shape the environment, construct what good looks like, and set boundaries around what can be tolerated and normalised (Amalberti et al .…”