Discourse structure as the scaffolding of stance structure : developments of a central concept in a central site of discursive interaction in bioethics

Abstract

This study explored how a major concept and principle in the interdisciplinary area of bioethics, respect for autonomy, changed across the first and the seventh editions of the textbook Principles of Biomedical Ethics by Beauchamp and Childress, a period covering 33 formative years in the institutionalization and growth of bioethics. The question explored by the study was: what can the structure of the stance interactions between authors reveal about institutional changes and the relative position of different academic disciplines in bioethics over this period? A new, relational method of content analysis that draws on methods developed in applied linguistics, concerning evaluative or stance-taking language and on the discourse or rhetorical structure of expository texts, was used in pursuing an answer to the question. Between the first and seventh editions, the core of Beauchamp and Childress's concepts of respect for autonomy and informed consent did not change significantly, though additions and refinements were added in the seventh edition. Philosophy retained a prominent place in the discussion across editions, but medicine, combined with other biomedical sciences and professions, slightly overtook philosophy's place of prominence. The interactions between these disciplines were, on balance, cooperative, and some division of labor was evident in the seventh edition, with philosophers used mostly for conceptual analysis and biomedical disciplines used mostly for technical and empirical support of the concepts. The overall number of disciplines represented in the bioethics discourse on autonomy grew exponentially.