Читать книгу A Companion to Medical Anthropology - Группа авторов - Страница 56

Applied medical anthropology has (and needs) a strong ethics core that anchors medical anthropological praxis to appropriate standards of conduct. The complexities of ethnic and cultural nationalism, combined with the excesses and outright abuses of power during both colonial and post-colonial globalization periods have had a powerful impact on anthropologists’ ability to do applied medical anthropology.

Applied medical anthropologists face two complex, interwoven, yet frequently dichotomized ethical challenges that must be negotiated, addressed, and jointly accommodated. These two challenges are the ethics of professional praxis and the ethics of conducting cross-cultural research on health, healing, and medicine within a global multicultural context. The first challenge is to construct and conduct research in an ethical manner by successfully anticipating, addressing, and appropriately applying the numerous, often vague (sometimes culture bound), contradictory, and challenging disciplinary, national, and international ethical rules, guidelines, and treaty obligations surrounding the conduct of science and research. The history of human research is unfortunately littered with the cultural debris of harmful actions on the part of the researchers and their sponsors. Following the principles, guidelines, and laws that protect people from unethical research is a critical requirement for protecting humans from harm at the hands of researchers. An equally important complementary ethical challenge for anthropologists is to conduct their professional activities (teaching, applied practice, and knowledge dissemination) ethically within and across competing social and cultural boundaries. Anthropologists must be particularly ethically vigilant when they are using anthropological theory, knowledge, or praxis that might be a direct (and sometimes even indirect) cause of harm for vulnerable people. People’s lives can be impacted by what anthropologists say and what anthropologists do in their personal and professional capacity.

Anthropologists have been intimately involved in the public debates and explorations of the ethics of research ever since the emergence of the disciple in the late 1800s, when much of the ethical elements of the debate revolved around the meaning of evolution, the relationship of science to theology, and the nature of “civilization” to other forms of social complexity, as opposed to other cultural conditions. Since that time, the discussion of ethics in anthropology has consistently paralleled the concerns, explorations, and debates focused on science in general, on the impact of changing technology and globalization for all cultures around the world, on war and conflict, and on the emerging ethical concerns in the other social sciences (such as deception or sociobiology). One of the first public explorations of ethics in anthropological research is the American Anthropological Association’s participation in the drafting of the Universal Declaration of Human Rights (United Nations 1948).

The Board collaborated in preparing the Declaration on Human Rights, which appeared in the October 1947 American Anthropologist, Vol. 49, No. 4. The original draft was written by Melville J. Herskovits. Contacts concerning this statement have been made, either in person or by mail, with various State Department and United Nations commissions. (Barnett 1948: 380)

One of the key anthropological contributions to the Declaration was the establishment of the principle of cultural relativism (Herskovits 1958). The first formal code of ethics for anthropologists was published by the Society for Applied Anthropology, in 1949, which indicates the ongoing concern among applied anthropologists for the ethical conduct of their research and praxis, since it preceded the development of a code of ethics for the general discipline by several years, even though it was essentially the same individuals who were involved in all of the primary anthropological associations of that time (i.e., it was a very small world). Those professional guidelines for ethical research have been subsequently reviewed and revised to take into account more recent changes in the standards and practices that are the core of anthropological research (American Anthropological Association 2005). The 2005 statements on ethics focused on the primary areas of stakeholder responsibility for anthropologists conducting research. These areas of responsibility include: (1) Relations with those studied, with a primary emphasis on resolving conflicts of interest in favor of those studied, over the other stakeholders; (2) Responsibility to the public, including ethical dissemination of works; (3) Responsibility to the discipline for ethical conduct of research and reputation of the discipline; (4) Responsibility to students, stating that anthropologists should be “candid, fair, nonexploitative, and committed to the student’s welfare and progress;” (5) Responsibility to sponsors, promulgating the rather vague statement that “in relations with sponsors of research, anthropologists should be honest about their qualifications, capabilities, and aims. Anthropologists should be especially careful not to promise or imply acceptance of conditions contrary to their professional ethics or competing commitments. Anthropologists must retain the right to make all ethical decisions in their research.” (6) Responsibilities to one’s own government and to host governments, based on the principles that “in relation with their own government and with host governments, research anthropologists should … demand assurance that they will not be required to compromise their professional responsibilities and ethics as a condition of their permission to pursue research.” This latter responsibility is focused on application of the recently revised federal guidelines and regulations on the protection of human subjects in research [CFR 45, Part 46 [https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46 Mar 10, 2021 · 45 CFR 46. The HHS regulations for the protection of human subjects in research at 45CFR 46 include five subparts. Subpart A, also known as the Common Rule, provides a robust set of protections for research subjects; subparts B, C, and D provide additional protections for certain populations in research; and subpart E provides requirements for IRB registration.] The primary application of those rules is conducted through Institutional Review Boards (IRB’s) and other ethical review institutions. The current statement of ethical principles for the American Anthropological Association include x obligations: The Association’s Principles of Professional Responsibility include: 1) Do No Harm, 2) Be Open and Honest Regarding Your Work, 3) Obtain Informed Consent and Necessary Permissions, 4) Weigh Competing Ethical Obligations Due Collaborators and Affected Parties, 5) Make Your Results Accessible, 6) Protect and Preserve Your Records, 7) Maintain Respectful and Ethical Professional Relationships. https://www.americananthro.org/ethics-and-methods. These principles are generally accepted by anthropologists, but not without debate, discussion, challenges, and recommendations for revision to make these guidelines more (or less) compatible with both national and international formal ethical principles and guidelines. One of the critical trends in the debate is the ongoing tension in applied medical anthropology between science and humanism, between positivism and other more interpretive paradigms, and between modernism (especially the concept of progress and the concept of universalism) and post-modernism (especially the concepts of cultural particularism, cultural relativism, and constant cultural constructions).

A large number of the current ethical problems medical anthropologists face result from the unanticipated consequences of multidisciplinary research designs where there are competing ethical frameworks from disparate disciplines. Others result from the unfortunate clash of two positive ethical principles. These are labeled as ethical dilemmas; a situation where two or more of the basic ethical principles are in conflict, and where adherence to one of the principles may violate another (see Singer et al. 1999; Whiteford and Trotter 2008). For example, medical anthropology researchers promise confidentiality to each and every person they interview, and promise to protect any information they provide (such as their health status). But they also promise to limit any harm that might result from participation in the research, to every participant. As a consequence, they are faced with the dilemma of what to do if a married couple is enrolled an AIDS prevention project, and they find out one partner is HIV positive and is having unprotected sex with their uninfected partner but is not telling the other that they are living with an infected person. There is a clear conflict between the two principles of confidentiality and do no harm for the project. In this kind of situation, the researcher may have to decide if they have a greater obligation to protect confidentiality, or to prevent harm to the uninfected person. Preventing harm may help the one individual, but breaking confidentiality may harm the entire project, since anyone who heard about the breach would either quit the project or would not participate. There are times when the researcher is forced to decide which of two ethical principles takes precedence in a particular research situation, and the choice of one principle causes the other principle to be violated in some minor or major way. A practical guide for practicing anthropologist who inevitably encounter these types of ethical dilemmas before, during, and after field research and data collection use the Whiteford and Trotter (2008) ethical workup guide/procedure to reduce unintended ethical consequences.