A Companion to Medical Anthropology. Группа авторов
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.
CONCLUSION
While the application of medical anthropology theory and methods continues to grow at a rapid pace, in many ways, the distinction between applied medical anthropology and any other form of medical anthropology is a false dichotomy, or an unnecessary distinction. All forms of medical anthropology are framed by the key cultural theoretical (or a-theoretical) paradigms and are exploring strong positions within key cultural contexts (Page and Trotter 1999). The methods that are used to create, assess, expand, challenge, or demolish existing theories are identical. Both approaches are susceptible to external debates and challenges of anthropology’s cross-cultural paradigms, and are susceptible to anthropology’s internal critiques, debates, and synthetic movements. Perhaps the single difference that is important to applied medical anthropologists, and to the communities they work with, and the sponsors for their projects is the fact that applied projects are deliberately targeted at solving problems, rather than simply producing cultural descriptions that may result in serendipitous or accidental or unintended consequences. This level of intentionality is important to many of the stakeholders that are engaged in improving the human health conditions on a local or global level.
NOTES
1 1 One of the key reasons that this section presents a general history of the development of ethnographic methods is because the current works do an excellent job of discussing theory and methods, but are missing most of the practical and pragmatic advice for rapport building, survival, and data management processes that are present in the earlier works. It is worth a little historical diving to find that advice. The earlier works are more student oriented, and the later works more professionally oriented.
2 2 This study, conducted by the World Health Organization, was designed to make the International Classification of Impairments, Disabilities and Handicaps cross-culturally applicable and to increase the utilization of the classification system for international health research.