ethics

Conference: American Society for Bioethics and the Humanities, Oct 19-22, 2017

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This week we are highlighting four sessions from the upcoming American Society for Bioethics and the Humanities Annual Conference in Kansas City, MO from October 19-22, 2017. The sessions are categorized under Religion/Culture/Social Sciences, and include topics interesting to scholars in multiple disciplines. For the full conference schedule, visit the ASBH 2017 meeting website here.

Panel Session: China’s Forced Organ Harvesting: A Central Test of Our Time

Thursday, Oct 19 – 1:30-2:30pm

With David Li, Yiyang Xia, and Grace Yin

A decade of research by international investigators has concluded that the Chinese party-state is systematically killing prisoners of conscience on demand to supply its vast organ transplant industry. In June 2016, the U.S. House of Representatives unanimously passed H.Res. 343, condemning the harvesting of organs from Falun Gong adherents and other prisoners of conscience in China.

Researchers examined hundreds of transplant hospitals in China and analyzed data about their capabilities, capacity, personnel strength, and potential patient groups from medical journals, media reports, official statements, web archives, and government policies and funds.

The research estimates that China now performs between 60,000 and 100,000 transplants per year–more than any other country in the world. Even based on government-imposed minimum requirements, China could have performed more than one million total transplants since 2000.

The official organ sources–death row prisoners and voluntary donors–account for only a small fraction of the total volume. The victims are primarily Falun Gong meditators killed through organ extraction outside of judicial process as part of the Communist Party’s campaign to eradicate the group.

The issue of forced organ harvesting presents an opportunity and an obligation to bring medical and academic institutions to the center of bioethics. Presenters will articulate with the audience concrete actions to prevent the complicity of American institutions and individuals, including providing training, equipment, recognition, collaboration, and organ tourism to Chinese institutions that are participating in this crime. Comprehension of the issue helps institutions and individuals make informed choices and uphold social responsibility.

Panel Session: Pathways to Convergence: Sharing a Process that Aimed to Examine the Diverse Perspectives of Catholics on Advance Care Planning and Palliative Care in the United States

Thursday, Oct 19 – 2:45-3:45pm

With Robert Barnet MA MD, John Carney MEd, Matthew Pjecha MSPP, and Carol Taylor MSN PhD RN

Pew Charitable Trusts recently funded a project to examine views among Catholics in the U.S. regarding end-of-life, palliative care and advance care planning. Center for Practical Bioethics (CPB) served as coordinator for the project. A six-member steering group representing ecclesial, Catholic Health, and ethical interests, along with CPB (a secular organization) invited three groups of eight Catholics from different disciplines and perspectives to capture conservative and progressive themes within American society and among practice settings. Roles and responsibilities within those realms were prominently featured in deliberations with goal of clarifying areas of divergence, convergence and possible paths forward. The groups examined: – Social responsibility derived from tradition (how the Church presents itself and speaks in the public square and what informs this presence) – Covenant and contract (roles of free and informed consent in advance care planning and decision-making between patients and providers) – Shared decision making (Church teaching that informs specific decisions faced in goals of care conversations and interdisciplinary care planning for palliative care patients)Identified as Pathways to Convergence the groups aspired to identify common values and principles and report on the results following a convening. Presenters will explore how ethicists can use the processes, methods and findings of this group when workings with patients for whom faith tradition may play an important role and among providers, and others who share different perspectives on end of life to facilitate optimal advance care planning and palliative care.

Paper Session: Religion, Culture, and Social Sciences Paper Session 1

Thursday, Oct 19 – 4:00-5:00pm

Creating Compliance: Using Games to Engage Patients in Medical Management 

by Kristel Clayville

This presentation offers a method for increasing compliance among transplant patients. The recommendations presented are from non-medical clinical observation from a chaplain who deals with the day-to-day coping skills of transplant patients. The case studied focuses on the emotional aspects of compliance, and the attendant interpretation and recommendations focus on the social, emotional, and spiritual aspects of dealing with the existential difficulties of undergoing a solid organ transplant. Ultimately, the recommendations are for presenting medical compliance as a game that patients play rather than as a set of medical practices that sustain life. Thinking in terms of games not only helps the patient’s motivation, but it also offers the family and support network a language with which to engage the patient and help with the practices of compliance.

The Ethics of Influence: Celebrity Physicians and Social Media 

by Patrick Herron

Growth of social media has not only changed how individuals interact socially, but in how we engage with professionals too. Recognition of a physician’s social media “influence” is based on her/his ability to affect other people’s thinking. The greater the influence, the more appeal that individual has to companies or other individuals who might want to promote an idea or sell a product. Celebrity actors/athletes are often seen as prime influencers with regards to advertising campaigns, (i.e. “Got milk?” and “Milk: it does a body good”) to increase sales.

Celebrity physicians such as Dr. Mehmet Oz have used influence to promote health products and interventions, which raised considerable debate as to whether there were lapses in ethical and professional judgment. Not all physicians will have the platform of a Dr. Oz, but social media has created ample opportunities for many lesser known physicians and trainees to leverage their own professional expertise and growing social media prominence to become influencers. Such financial partnerships raise questions about conflicts of interest, professionalism and potential violations of an ethical duty of care.

The impact of social media on consumer healthcare decision making along with the dependence by consumers on their friends and families for healthcare product reviews (often shared via social media) has dramatically changed marketing. Consumer confidence and increased reliance on the opinions of physicians they follow via social media accounts can have a detrimental affect on the patient-physician relationship that consumers have with their actual health care provider.

Make Aging Great Again: Imagining a YUGE Lifespan

by Leah Fowler

The new era of longevity research seeks extended healthy life, with hoped-for interventions that would slow the aging process so that one year of clock time is matched by less than one year of biological time. Infirmities of old age would compress into a short period at the end of life—thereby increasing the ‘health span’. The benefit: living long and living well. Embedded in longevity discourse is humanity’s oldest and most pervasive wish: defying death. Slowing the process of aging, it is hoped, will lead to treatments to reverse it.

Social arenas and actors at the center of longevity are grounded in big data, big investment, and a breathtaking sense that “the person who is born today will live to 200.” A prominent longevity researcher says, “It is ageist and morally repugnant to not treat aging as a disease that needs a cure.” These expectations, fueled by aging populations, are rooted in narratives that render the possible futures of long, healthy lives as inevitable and real today. Bringing the future into the present—conveying hope and fear as moral vectors— introduces an imperative to pursue the extension of the life- and health spans as a matter of course, and devalues alternatives as non-progressive or even immoral. This paper presents a qualitative analysis of longevity stakeholders discussing the moral imperative to extend human life and free of the ravages of aging. Their narratives illustrate future social imaginaries that are central to the movement and spur us to take action today.

Paper Session: Religion, Culture, and Social Sciences Paper Session 2

Sunday, Oct 22 – 9:15-10:45am

Religion Matters: A Critical Response to Daniel Weinstock’s Appraisal of Conscientious Refusal

by Nicholas Brown

Daniel Weinstock has recently argued that it is necessary to make a distinction between freedom of conscience and freedom of religion when evaluating questions of conscientious refusal. Weinstock holds a right to refusal to care on the grounds of conscience enjoys a more privileged status than refusals made on religious convictions inasmuch as he judges religious refusals to be non-essential to the flourishing of a robust democratic ethos, and because he finds religious objections to lack a sufficient epistemological and ethical rationality that is publicly “reasonable.” The purpose of this paper is to offer a response that is both critical and sympathetic. Toward that end my argument is as follows: First, I will critically evaluate the underlying epistemological assumptions undergirding Weinstock’s privileging of conscientious over religious refusals to care. More specifically I will draw upon the philosophical work of Nancey Murphy and Michael Polyani to show not only why Weinstock’s account of reasonability is inadequate, but also why a religious ratio is just as publicly accessible as a non-confessional one. Next, I will draw upon Romand Cole’s political theory to demonstrate why religious perspectives are not only vital to the flourishing of a democratic ethos, but are so precisely because they help inculcate the critical mode of conscience that Weinstock endorses. Finally, I conclude by suggesting that Lisa Sowle Cahill’s articulation of theology as a participatory mode of discourse offers a more compelling basis upon which to adjudicate the ethical tensions entailed in conscientious refusal that Weinstock rightly identifies.

The Church Amendment Reconsidered: Lost Assumptions of the First Federal Healthcare Conscience Clause

by Ronit Stahl

In the wake of Roe v. Wade (1973), Congress passed the Church Amendment, which allows doctors, nurses, and hospitals to refuse to perform abortions or sterilizations on the basis of religious or moral convictions. As the foundation of subsequent federal and state conscience clauses, the Church Amendment operates as a powerful tool that enables healthcare providers and institutions to opt out of providing—and thereby restrict access to—contested medical interventions, typically in reproductive, end-of-life, and LGBT healthcare. Yet the legislative history of the Church Amendment offers a more complicated and nuanced set of assumptions about the intended effects and implementation of the nation’s first healthcare conscience clause. This talk will discuss the presumptions about access, disclosure, scope, and impact embedded in the Church Amendment and consider the value of a countervailing narrative about conscience clauses in an era of expanding conscience legislation.

Hinduism and Bioethics: Some Basics and Some Applications

by Deepak Sarma

With an increasing number of patients with Hindu heritage and background, it is imperative that the bioethics community begins better versed in germane issues pertinent to Hindus. What, for example, is the Hindu position on brain death and organ transplantation? What sorts of neurogenomic treatments and interventions are possible given the Hindu view of the self? How do these perspectives agree, or conflict with prevailing discourses in bioethics? Since Hindus makeup only a small population of patients they are further from the ‘center’ and from most patients. Healthcare providers, in this connection, will need to expand their knowledge of those whose beliefs are not at the center.

Article Highlight: Vol. 41, Issue 2, “The Moral Lives of Laboratory Monkeys: Television and the Ethics of Care”

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This week we explore Lesley Sharp’s The Moral Lives of Laboratory Monkeys: Television and the Ethics of Care. Sharp asks, “Why do lab monkeys watch TV?” This paper examines the prevalence of televisions in primate housing units based in academic research laboratories. Within such labs, television and related visual media are marked as part of welfare and species-specific enrichment practices intended for research monkeys. In many research centers, television figures prominently in the two inseparable domains of a lab monkey’s life: as a research tool employed during experiments, and in housing units where captive monkeys are said to enjoy watching TV during “down time.”

Sharp engages visual media as a means to uncover and decipher the moral logic of an ethics of care directed specifically at highly sentient creatures who serve as human proxies in a range of experimental contexts. Sharp suggests this specialized ethics of animal care materializes Cheryl Mattingly’s notion of “moral laboratories” (Moral Laboratories: Family Peril and the Struggle for a Good Life, University of California Press, Berkeley, 2014, available here), where television mediates the complicated boundary of species difference among the simian and human subjects who share laboratory worlds.

Sharp starts by discussing that scientific interest in primate theory of mind in a range of disciplines, especially within the fields of primate behavior, cognitive psychology, and experimental neuroscience. In the United States, chimpanzees are widely accepted as exemplifying “sentience” in non-human species. Television figures prominently within a larger arc of primate welfare in facilitating interspecies encounters within modern laboratory science.

In this paper, Sharp is most concerned with the moral sentiments of human workers who interact with lab-based primates, specifically research macaques. Because of their affective power, animals offer a powerful means by which to access “everyday” or “ordinary” ethics. Monkeys inspire specialized responses among lab personnel, including researchers, lab-based technicians, and animal technicians or “caretakers,” who together consistently underscore these creatures’ evolutionary proximity to us, alongside their being highly “sentient” beings. These understandings have a significant bearing on how personnel introduce, interpret, and modify notions of welfare and care in the laboratory.

As early as the 1930s, animal behaviorists and psychologists showed silent clips from films and cartoons to a variety of primate species to measure their perceptions of and “responsiveness” to “moving pictures.” Yet the choices appear to have been based on various assumptions: that a non-human species might find moving pictures interesting; that at least some primate species were capable of reading these images for what they were; and that visual media might evoke strong emotional responses in a viewer. Conducting various experiments with both still and moving color images that were in or out of focus, researchers showed to a dozen restrained juvenile and adult rhesus macaques 16mm films, such as a caged, female and male pair of rhesus macaques eating, climbing, and threatening a photographer, and a clip from a Woody Woodpecker “Indian Whoopee” cartoon episode.

By the 1950s, these experiments were decisively entrenched in a scientific logic that presumed film might evoke emotional responses in primates, and that they might also offer clues for deciphering human psychology. As such, apes and monkeys could stand in as proxies for human subjects, where visual technologies employed as compelling research tools could effectively reconcile species difference. Over the course of less than a century, television’s value as a research tool in laboratory settings became related to ideas about how best to distract or amuse lab-based primates in nonexperimental contexts, referred to as “down time.”

Sharp states that during laboratory experiments, visual technologies are used as interactive devices where, for example, a monkey works alone at a monitor and solves a sequence of problems where responses are digitally recorded by a researcher and transformed into data. In contrast, within a housing room, visual technology is marked by comparatively passive engagement, where a monitor is mounted nearby to allow monkeys to see and watch TV. Sharp explains that television is a literal manifestation of the moral laboratory when lab personnel must work to establish best practices, set against the unavoidable paradox that they are working with lab-based macaques who are viewed as “neither pets nor wild animals.”

In Moral Laboratories, Cheryl Mattingly argues for the addition of a “first person virtue ethics” in her analyses of the everyday struggles of disempowered people in contexts of unending suffering. As Mattingly explains, even seemingly dull decisions regarding the “care of the intimate other” may bring about ethical dilemmas and an associated complex reasoning. Mattingly uses the concept of “moral laboratory” metaphorically for defining an “imaginative space” of ethical experimentation, impacting possibilities for transforming the self.

Sharp proposes a slight variation, involving the literal understanding of the “moral laboratory” as a way to describe primate research labs in academic neuroscience programs. The presence of lab animals is effective in uncovering the logics of scientific morality. The widespread use of primates in neuroscience comes largely from the deep-seated understanding that they are humans’ closest evolutionary “cousins” and, therefore ideal proxies for humans.

Television’s presence figures importantly in a “first person ethics” among lab personnel, standing out as a specialized welfare practice that demonstrates what Mattingly describes as the “care of the intimate other,” in this instance, across the species divide. With these statements in mind, Sharp probes this moral logic of care, where television demonstrates efforts to provide “a good [laboratory] life” to captive, highly sentient creatures. Television is generally understood as a suitable enrichment strategy for highly sentient creatures who can easily suffer from boredom and succumb to pathological, repetitive behaviors known as stereotypy, withdrawal, forms of self harm, or failure to thrive.

As intelligent creatures, macaques are understood as being “interested” in TV, and staff may spend significant consideration and imagination in trying to determine what makes for effective “monkey TV.” Yet the influence of visual technology in aiding animals to “flourish and thrive” may extend beyond the restrictions of a housing room and include experimental contexts, where television-as-research tool may similarly be described as a form of healthy “engagement” for animals, despite such engagement is also regarded as “work.” As one lab director explained, “lab work [itself is] a form of enrichment” because his macaques so clearly “enjoy” computers, regardless of context.

For Sharp, attention may truly signal interest or curiosity, but it may not necessarily specify pleasure or enjoyment. Furthermore, labs where staff regards television as “enrichment” have monitors engaged with a nonspecific monkey in mind, with the same video loop playing repeatedly throughout the day, week, month, or year. In response, Sharp does not ask what television viewing tells us about monkeys’ preferences, but instead questions what pervasive beliefs and assumptions about television say about lab-based humans’ understandings of subjectivity. Or, what might the supposed primate desire for television say about the morality of interspecies encounters in lab areas?

In conclusion, Sharp states that through an under-theorized theory of mind, television provides a powerful medium for fostering human-monkey relatedness. Television draws monkeys in close with humans while simultaneously ratifying the morality of lab animal “care” and “welfare.” Essentially, television brings them closer to us. Just as television transforms the macaque as “intimate other” into a humanized creature, animal caretakers through a specialized “first person ethics,” are transformed into moral beings as well.

SPA 2017 Biennial Meeting: Breakfast Lecture with Richard Shweder and Byron Good

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This week we’re featuring a summary of The 2017 Biennial Meeting of The Society for Psychological Anthropology Breakfast Lecture. This year, the Breakfast Lecture presented a conversation with the 2016 Lifetime Achievement Awardee, Richard Shweder, and the 2017 Lifetime Achievement Awardee, Byron Good. In this event, Dr. Shweder and Dr. Good reflect on morality and “the mental” in both Cultural Psychology and Psychological Anthropology, discussing how profoundly different worlds still share some moralities and orientations. They also discuss some critical challenges and opportunities for psychological anthropology. By interviewing each other, a foundational technique in anthropology itself, Dr. Shweder and Dr. Good explore their past works, theoretical orientations, and their anticipation of where anthropological explorations of psychological processes are heading.

2016 SPA Lifetime Achievement Awardee Richard Shweder

The conversation begins with Dr. Good asking Dr. Shweder to “tell us about your history.” Dr. Shweder delves into his upbringing in Great Neck on the north shore of Long Island, at the time an emerging suburb with a very progressive, left-wing population. He discusses the first time he heard the word anthropology in his 11th grade English class when “Mr. Beal” said, “for any of you who don’t know what to do in life, there’s this thing called anthropology.” After graduation Dr. Shweder went to the University of Pittsburgh where Dr. Arthur Tuden, an Africanist and Cultural Anthropologist, taught his Introduction to Anthropology class, bringing in the study of culture with current events and ultimately solidifying Dr. Shweder’s path in Anthropology. From Pittsburgh, Dr. Shweder progressed to Harvard, where he states several figures had an impact on his intellectual growth, including Cora DuBois and John Whiting. After finishing his Ph.D. at Harvard, Dr. Shweder taught at the University of Nairobi in Kenya before finally landing at the University of Chicago.

Dr. Shweder then, discussing approaches and schools of thought in Cultural Psychology, defines Cultural Psychology as “the study of differences in mentalities across human populations.” Psychological Anthropology, for Dr. Shweder, has been more interested in taking universal psychological schemes and applying them to particular cultures to see whether or not different practices or beliefs were essentially manifestations of a broader psychological concept, such as a variation on an Oedipus complex. There is not a denial of universals in Cultural Psychology, however, since, to Dr. Shweder, there is not a way of studying differences without also studying universals. Dr. Shweder describes his way of defining the Cultural Psychology of Morality as “investigating the fates of moral absolutes in history and to show the way they get transformed, take on different content, and lead to different judgments.” To Dr. Shweder, behind a culture or individual is a set of moral absolutes, or rules of moral reason. Yet these moral absolutes and rules are abstract concepts which do not present determinations of actual cases, histories, or cultural contexts. Cultural Psychology is not about looking for likenesses, but looking for the differentiations and local adaptations that have taken place. For Dr. Shweder, the psychological means looking at differences in “the mental.” “The mental” refers to what people know, think, feel, want, and value as good and bad. Dr. Shweder states, “Anywhere you look in the world you’re going to find that people know, think, feel, want, and value things as good and bad. In some sense, that’s what it means to be a person.”

Dr. Shweder follows up with a discussion that anthropologists are supposed to fairly represent the groups they study; to try to portray their way of life in a way that the people the anthropologist is writing for might see them not as “exotic aliens,” but as morally sensitive persons who do things for recognizable reasons. Dr. Shweder proposes the conspicuous use of the notion of “oppression,” or seeing the social order as oppressive, combined with the now popular term “agency,” suggests that to have agency was to be opposed to culture. Thus, for Dr. Shweder, the concept that there might be people whose agency was used to carry forward a cultural tradition which was in a framework where they felt they could be fulfilled, was gone. “When I went to India I was in a world where if I approached it as ‘a good liberal,’ assuming everything is free choice and the world is there to satisfy my preferences, I would have seen it as an oppressive order. Yet the people who live there, for the most part, feel quite at home with rich, meaningful lives,” Dr. Shweder states.

Building off the discussion of morality, Dr. Good then engages with concepts of morality and oppression. Dr. Good states that for him, the experience of morality is often an experience of oppression. He expresses that many people spend at least parts of their lives resisting or fighting against morality, feeling that the moral system around them is actually an oppressive system causing them to live their lives “wrongly” within it. It seems to Dr. Good that reading ethics with a grand “they” or a grand “we” misses, ethnographically, another side of the story. Dr. Shweder responds that there is a multiplicity of the moral world. The moral world has many goods and desires that are in conflict with each other, and one cannot have them all. This sets up the dynamic of resistance since the system of conflict and prioritization pushes alternatives to the side. Dr. Shweder states that within any society there is the orthodox and the heterodox, that which is center stage and that which is done covertly. The mistake is to privilege one ethic over another, to act as if that privileging itself is not a choice or commitment, or to label the ethic of autonomy as the “natural way” in which anyone who is fully enlightened will ultimately go. Dr. Shweder cautions against the view of “liberalism as destiny,” where there are stages of moral development, the height of moral development being an autonomous, individualized person or society.

2017 SPA Lifetime Achievement Awardee Byron Good

Dr. Good then discusses his personal and academic history. He starts by commenting that his childhood and upbringing couldn’t have been more different than Dr. Shweder’s, growing up on a Mennonite farm in the Republican mid-west. Dr. Good spent much of his life feeling that religion and divinity grounded and oriented aspects of his academic life. “I don’t romanticize ethical norms if they, over time, have become more and more interested in controlling our lives in ways that we have very little direct knowledge of,” Dr. Good states. “I don’t romanticize suffering.” While at Goshen College in Goshen, Indiana, Dr. Good started studying mathematics before spending a year at the University of Nigeria. Dr. Good expressed this time as having a powerful impact which changed his life. “My worldview became profoundly different,” he states. Coming back from Africa convinced that there had to be something more than mathematics, Dr. Good decided to go to Harvard Divinity School. It was there that he began taking courses in anthropology and religion. Attending the University of Chicago for his Ph.D., Dr. Good states his first year at Chicago was Clifford Geertz’s last year. Yet even after Geertz left, Dr. Good still considered him a mentor and inspiration. This was also a very political moment for universities and the country in general. Dr. Good describes how he came of age in anthropology in a time of the Vietnam War, in a time of activism, and in the time of the Civil Rights Movement. These were all very powerful influences on how Dr. Good conceptualized the importance of anthropology.

Discussing his research, Dr. Good describes the time he spent in a genuinely post-colonial conflict setting of Aceh, Indonesia.  He became very aware of colonialism and its colonial history and how it had impacted political life along with a diverse set of religious and cultural influences. It was a setting that had a history of tremendous violence. “It was my first experience of working in areas of really intensive conflict,” Dr. Good states, “and I have to say that I went home from that experience very affected by listening to stories of violence.” Terms like “post-colonialism” and “post-colonial subjectivity,” and even terms like “haunting” and “hauntology” became central to his vision of what Psychological Anthropology can be today. Dr. Good poses the question of how one does Psychological Anthropology in settings of violence. “My thinking about hauntology started off with being in Aceh, and thinking about what Aceh was like post-tsunami and post-conflict,” Dr. Good remarks. Aceh was a place where ghosts and spirits of the dead were everywhere, alongside the ghosts of the recent violence and the emergence of political gorillas who had been previously hidden away. “Suddenly Aceh was no longer in the midst of a war and people who had been fighting were coming back and appearing in everyday life,” Dr. Good explains, “and I began thinking about post-authoritarian Indonesia and why it is that there are certain moments in a society that ghosts begin to appear in a very powerful way, and ghosts that are related to historical violence.” Dr. Good became fascinated with the relationship between historical memory, histories of violence, how they make themselves present, and how they reintroduce themselves in psychological experience.

To wrap up the Breakfast Lecture, Dr. Shweder discusses how the issue of nationalism is front and center in a very powerful way at the moment. He suggests that anthropologists should be qualified to talk about the ethno-national impulses people are facing and examine why it is that some people feel like their way of life, or their control over their life, is being threatened by globalization, for example. He calls on anthropologists to give a native point of view instead of simply reacting with fear and mainstream ideology. “This is anthropology. There are in-groups and there are out-groups. People have ways of life and traditions; they want to exercise control over their way of life. This has to be examined,” Dr. Shweder states. He further discusses that one of the things that’s exceptional to the United States is that we are a nation in which constitutional patriotism is the binding feature. In principle, that means there is space for cultural diversity. “The ways in which tyranny can be built up and balanced through distribution of power are all rich topics right now. Immigration. Making sure we represent minority views in a way that majority groups understand them and why the way they live is both meaningful and justifiable.” Dr. Shweder finishes by stating that there are also threats to anthropology from within. He warns against a “liberal tyranny” which can be compared to a “white-man’s-burden-style” of thinking with regard to cultural differences. Dr. Shweder sees this as using the notion of oppression or exploitation as an excuse for interventions into other people’s ways of life rather than starting by seeing whether or not one can understand other practices and social organizations in a morally-motivated way. Dr. Good closes the conversation session by encouraging anthropologists to be engaged in both theoretical debates within the discipline as well as policy and implementation projects and practices which can benefit the people in the communities we study.

Richard Shweder is the Harold H. Swift Distinguished Service Professor of Human Development in the Department of Comparative Human Development at the University of Chicago. He is the author of Thinking Through Cultures: Expeditions in Cultural Psychology (1991) and Why Do Men Barbecue? Recipes for Cultural Psychology (2003), both published by Harvard University Press. Dr. Shweder is also an editor or co-editor of many books in the areas of cultural psychology, psychological anthropology, and comparative human development. For more information on Dr. Shweder, visit his page at the University of Chicago here, as well as the Society for Psychological Anthropology 2017 Biennial Conference Breakfast Lecture website, available here.

Byron Good is a Professor of Medical Anthropology at, and former Chair (2000-2006) of, the Department of Social Medicine, Harvard Medical School, and Professor in the Department of Anthropology, Harvard University. Dr. Good is director of the International Mental Health Training Program, funded by the Fogarty International Center to train psychiatrists from China in mental health services research. Dr. Good’s broader interests focus on the theorization of subjectivity in contemporary societies, focusing on the relation of political, cultural, and psychological renderings of the subject and experience, with a special interest in Indonesia. He is the editor or co-editor of many significant volumes, books, and is a former editor-in-chief of our Culture, Medicine, and Psychiatry journal (1986-2004). For more information on Dr. Good, visit the Harvard Medical School Department of Global Health and Social Medicine website here, as well as the Society for Psychological Anthropology 2017 Biennial Conference Breakfast Lecture website, available here.

Issue Highlight: Vol 39 Issue 4, Incarceration & Medical Anthropology

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This blog post is the second installment of our three-part issue highlight on the new December 2015 issue of Culture, Medicine & Psychiatry (the full issue is accessible here.) In this week’s blog, we examine Carolyn Sufrin’s article on the shared roles of clinicians and anthropologists working with incarcerated women in the United States.

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Clinician-anthropologists are in a unique position to lend voice to their participants and to care for their medical needs. For Carolyn Sufrin, who served both as a physician and an ethnographic researcher for incarcerated women in the United States, the clinical and anthropological roles intersected in deeply meaningful ways. Sufrin notes that in these dual roles, she observed with female prisoners and analyzed their experiences, and provided reproductive health care and delivering the same women’s babies in a county hospital, where imprisoned women gave birth. The women were alternately enrolled in Sufrin’s study upon ceasing to officially be her patients, or were individuals that Sufrin cared for during her tenure as their OB/GYN.

Sufrin uses her case as an example of how to interpret the ethical consequences of working as a clinician-anthropologist. Part of the challenge she faced as both a physician and anthropologist to the women was that IRB and HIPAA regulations divided the types of data she could use in her anthropological research. Though some details of her participants’ lives, such as past trauma or childhood abuse, were essential to their experiences as mothers and as incarcerated women, she could not use this data inasmuch as it had been shared with her in the context of a patient-practitioner interaction: in other words, it was considered classified personal health information that could not be subsequently utilized in her ethnographic research. These methodological hurdles, Sufrin explains, shed light on the complexities of what constitutes “sacrosanct” data. It also suggests how the safeguarding of medical data does not necessarily translate to the “protective” collection of ethnographic data which is not isolated to the case of individual patients, and which relies on knowledge of participants and their connections to other people (in this instance, to individuals in the participant’s life who had caused past psychological harm.)

Likewise, as stated earlier, relationships between the participant/patient and the clinician/anthropologist are another form of interpersonal connection which must be reconfigured depending on the nature of the exchange taking place. In Sufrin’s case, this meant being clear with her participants that– upon entry into her anthropological study– she was no longer their physician, and that the nature of their exchanges and their professional relationship would take a new form. She could share their information (albeit de-identified), unlike information drawn solely from their medical records or from an examination.

Yet here, Sufrin notes that the anthropologist– like the clinician– is still engaged in an ethic of care. For example, one of Sufrin’s former patients in the prison was charged with child endangerment after giving birth in an alley and handing her child to a stranger, unable to afford treatment at a hospital following her release from prison. The story made news headlines, and as public knowledge, was within the realm of information that Sufrin employed in her ethnographic analysis of reproductive health in the American prison system. However, Sufrin knew an added piece of information that was not already publicized from her interaction with the woman in prison: a clinical detail that she understood as a physician, but was shared during her time as an ethnographic researcher. This detail would have enhanced her analysis of the situation, but she chose to omit it out of concern that to publicize the detail would be to betray the woman’s trust in her as a researcher and as someone who served in the prison as a physician.

In other instances that Sufrin discusses, her role as both an anthropologist and clinician led the women she worked with in each capacity to feel as if she was especially attentive and caring. Rather than always relying on her medical authority, Sufrin underscores her decision to remain non-judgmental and supportive even when the women in her study had made potentially harmful choices; for example, she chose not to openly admonish a woman who was continuing to use crack upon release from jail, despite being thirty-two weeks pregnant. Sufrin notes that her silence hid her own frustration with this choice, but it strengthened the woman’s trust in her as an anthropologist and “as a doctor.”

In sum, these dual roles ultimately bolstered her relationships to the incarcerated and formerly incarcerated women that she served. Thus, the author argues that both anthropologists and clinicians share an “ethic of care” in their relationships with research subjects or patients. This ethic involves a careful fostering of the professional, interpersonal connections that ethnographers make with research participants, or that physicians make with their patients. This care entails the protection of private information and the researcher/clinician’s conscious attendance to interpersonal exchanges that bolster the patient/participant’s trust in the clinician/anthropologist. Likewise, an analysis of the clinician role alongside the anthropological one demonstrates both the delineations between multiple forms of care and social connection, as well as the shared commitment in medicine and anthropology to the sensitive attendance to patient and participant experiences.