“Normalized Deviance” in Bioethics: It’s Normal to Pretend to be a Bioethicist

What is the sociologic definition of the expression “normalization of deviance” which is applied to human behavior? The expression was invented by a sociologist Diane Vaughan and represents when individuals in a system, over time, change the rules of what has been found an appropriate and safe behavior to one which is less appropriate and less safe because each individual finds that other individuals are changing the rules in the same way. So that behavior which is deviating from the established rules is now being made normal and common by this phenomenon.

Normalized deviance can be found in a number of systems including government, business, technology and medicine. Marshall Allen writing in the Las Vegas Sun for August 14 2008 gives examples of such behavior affecting medical care in Las Vegas. He starts out with a technological example of normalized deviance which was identified by Vaughan in the Challenger disaster. The cause of the incident was due to O-ring failure and where O-rings were known to be brittle in the cold environment to which they were exposed. Yet, according to Allen “Politics and a culture of compliance led decision-makers to determine it was an acceptable risk. ‘They redefined evidence that deviated from an acceptable standard so that it became the standard,’ Vaughn wrote.”

I think that in the bioethics discipline we also have an example which could be termed “normalized deviance”. Medical (or so-called "clinical") bioethics is a consultative activity which in the case of medical bioethics deals with the ethics of medical research and the ethics of medical care and treatment as applied to individual patients and to society. Individuals calling themselves “bioethicists” are examining patient’s charts, talking with patients, family, physicians and other healthcare providers and then discussing with all an ethical viewpoint in the form of a professional consultation. There is nothing wrong with that as it stands in the form of a professional consultation except for the fact normalized deviance is present and therefore it is not clear that medical bioethicsts are practitioners of a formal profession.

We know that in other consultative professions, medicine, law, engineering and more, there are formalized methods of accreditation of institutions teaching the knowledge and skills of the profession, there is a formalized certification of the student on completion of the course of study and finally there is a code of ethics for the profession. Why is this necessary? Because the professions need practitioners who have demonstrated knowledge and skills to handle complex problems and where effective consultation is a goal and where client safety (physical, financial or other) is at risk. It is also important that rules are followed so that the consultations are ethically handled fairly and without, for example, personal conflicts of interest. What have we got for medical bioethics? None of the above. Why? This deviance from what is considered acceptable for all such professions has for most been itself considered with the view "bioethics has been doing business for more than 25 years and it has all worked out well so that status quo is acceptable"--thus, normalized deviance from the established requirements of a consultative profession.

There are now stirrings to the creation and development of a true profession of medical bioethics which will lead the former activity away deviance and toward an accepted normalization of what it takes to be a professional. ..Maurice.