ASA Decennial Conference - Anthropology and Science

Between micro realities and macro ethics: what might an anthropology of contemporary biomedical ethics look like?

Contact Convenor: Bob Simpson

Department of Anthropology, University of Durham
43 Old Elvet
Durham, DH1 3HN

Tel. 0191 374 7659

Robert.simpson@durham.ac.uk 

Co-Convenor: Martin Sexton

m.sexton@wellcome.ac.uk 

Panel abstract

The field of biomedical ethics is now more or less firmly established as an adjunct to the practice of medicine and health care in western societies. As such, it operates as a meta-discipline which not only guides individual decision-making but also provides checks and balances on the conduct of medicine and medical research. Dominated by the pursuit of beneficience, non-maleficience, justice and autonomy, contemporary biomedical ethics is firmly rooted in western religious and philosophical traditions. As such the discourses which surround the ethical constitution and regulation of medical practice and research are mostly informed by medical practitioners, philosophers and theologians. The social sciences in general and anthropology in particular have had a relatively limited in-put to these debates. In as much as anthropology has informed the relationship between biomedical ethics and practice, it has usually been in the form of a relativist critique; a plea for cultural sensitivity in the face of the totalising and universalising claims of western-oriented ethical systems.

However, the rise of the biotechnology industries coupled with the globalisation of communication, markets, science and research begins to shift these debates, and the place of anthropology within them, onto an altogether different plane. Simple dichotomies between global systems and local beliefs are inadequate to capture the complexity or significance of what is currently taking place. Moving novel health technologies and research into settings which might variously be described as non-western, post-colonial and developing raises important questions of ethical and political representation. For example, in the increasingly rapid transfers of health research and technology where do distinctively local perspectives on health, body, personhood, ethnicity, kinship and morality feature? How do local practitioners and their publics respond in their interaction with western biomedical technologies and research or, more precisely, with the systems of biomedical ethics that come attached to them? Will the outcome of this interaction be new forms of domination, a layering of immiscible systems or novel patterns of ethical hybridity?

The contributors to this panel will each take up themes arising from these general questions. Particular attention will be paid to:

  • the over-arching and perennial question of whether there can be universal ethical principals which adequately accommodate the fact of cultural diversity
  • the ethics of conducting of health-related research in developing countries
  • cases studies of projects in which ethical/ cultural conflicts have arisen
  • illustrations of how the practice of gathering research participants, obtaining informed consent, ensuring autonomy etc are perceived by those involved in research or novel treatments.

Between micro realities and macro ethics: what might an anthropology of contemporary biomedical ethics look like?

Bob Simpson, University of Durham

The gulf between abstract discourses of western biomedical ethics and the health concerns of the majority of the world’s population would appear to be a large one.  Yet, an increasingly important point of intersection occurs where medical innovation is concerned. The globalisation of communication, markets, science and research opens up new opportunities for developing countries to be drawn into the global project of medical advancement.  Integral to this development is an engagement with the rapidly proliferating field of biomedical ethics. However, the extent to which a western tradition of biomedical ethics can encompass the range and complexity of issues raised by health care delivery in the developing world is open to question.  A growing critique from the developing world asks whether the preoccupations of western biomedical ethics are appropriate when dealing with global health problems of such enormous magnitude.

To date, the contribution of anthropology to these debates has been mostly confined to describing beliefs and practices as they relate to health and illness in particular contexts.  Such accounts have provided an important counter to the tendency to assume that the principles of bio-medical ethics are straightforwardly universalisable.  However, in addition to providing particularistic, grounded accounts of human experience, I argue in this paper that there are important and largely uncharted territories in the realm of public culture to which anthropologists ought to pay attention.  Consideration of the institutional and cultural spaces that connect the abstract injunctions of bioethics on the one hand to the particularities of local people’s beliefs on the other provide important insight into the processes whereby local responses are shaped and given context.  Using illustrations drawn from recent fieldwork in Sri Lanka into the reception of new reproductive and genetic technologies I discuss the role of ethics committees, research institutes and the local science media in creating a distinctive framework of biomedical ethics in contemporary Sri Lanka.

Research in HIV: a new tyranny?

E Preston-Whyte,

The paper takes as its starting point the recently published article in the Lancet by Beyrer and Kass (2002) which focuses on ethics and human rights and warns, yet again, that research which ‘at first seems to be low risk may become high risk’ if implemented in contexts where breaches of confidentiality are likely, and where results might be used to the detriment research participants. Anthropologists have long been acutely aware of the ethical dilemmas and imperatives that these possibilities awake. However, new research situations inevitably invoke new ethical challenges. The  locale of this discussion is South Africa and the contemporary context is that of health research and specifically research in HIV/AIDS. Telling comparative reflections are, however, offered on two time periods of anthropological research in the country: that of the 1970s and 1980s during the height of Apartheid (when the first ethical guidelines of the Association for Anthropology in Southern Africa were drawn up (AASA approved 1987; Preston-Whyte 1990), and the current dispensation in which HIV enters and dominates virtually all social science research. It is argued that despite the establishment of democracy and the establishment of a charter for Human Rights enshrined in the New Constitution, both individuals and particular South African communities are potentially as threatened and vulnerable to exploitation and abuse as they were at the height of Apartheid. The specific context and the nature of the threats may be different, but the end result is the same. The tenets of the earlier AASA Ethical Guidelines are as pertinent now as they were 25 years ago – indeed, they may require bolstering in the face of the involvement of anthropologists in multidisciplinary projects, and increasingly, in research with a variety of medical colleagues who are now engaging not only individually focussed research in clinical settings, but in intervention programmes which have repercussions well beyond individual treatment. The implication of the examples given suggest (as, possibly, do Beyrer and Kass ) that even the revisions of internationally recognized research ethics review procedures may not protect all, and particularly people from poor and powerless communities, from intrusion and harm at the hands of unthinking or determined researchers.

References

Association for Anthropology in Southern Africa: Constitution and by-laws, and Ethical Guidelines for South African Anthropologists (approved 1987)

Beyrer, C. and Kass, E. N.  Human Rights, Politics, and Reviews of Research Ethics, Lancet 2002; 360: 246-51

Preston-Whyte, E.M. 1990 Research Ethics in the Social Sciences, in Morton, J. and Joubert, D. (eds), Knowledge and method in the human sciences, 239-259,HSRC, Pretoria.

Bioethical practices in developing countries

Kaja Finkler, University of North Carolina at Chapel Hill

The aim of this presentation is first, to explore whether the ethical principles of beneficence, nonmaleficence, autonomy and justice, regarded universally applicable to biomedical practice and research, are applicable to  medical practice and research in developing nations such as Mexico, where familism, paternalism and trust are deeply rooted themes in the culture at large and where the political regime is authoritarian, which casts back on biomedical ethics. Second, and related to the first, to consider the personal ethical conundrums that I experienced as a researcher in a hospital in Mexico, which led me to question anthropologists’ responsibilities to the subjects one studied and to one’s own cultural sensibilities, as well as the degree to which one person’s experience is generalizable to social science research in the medical field.

The presentation will include an overview of the development of bioethics in the U.S. and its cultural, religious and political underpinnings; the cultural nature of biomedical practice in Mexico, which conflicts with two of the bioethical principals- autonomy and justice- that also bear on questions of informed consent. It will conclude with a consideration of the personal ethical dilemmas of doing research in a developing country and how it reverberates on research.