In This Article Expand or collapse the "in this article" section Bioethics

  • Introduction
  • The Anthropological Critique of Bioethics: Foundational Texts
  • Bioethics in Global Perspective
  • Journals
  • Organ Transplantation
  • Prognosis, Secrecy, and Disclosure
  • Genetics and Genomics
  • Bioethics beyond the Clinic

Anthropology Bioethics
by
Mara Buchbinder
  • LAST MODIFIED: 25 September 2019
  • DOI: 10.1093/obo/9780199766567-0221

Introduction

The discipline of bioethics emerged in the United States in the 1960s as a response to several prominent controversies in medical research and practice, including the aftermath of the Tuskegee syphilis experiments and the development of kidney dialysis and associated concerns about resource allocation. Anthropology and bioethics have had a contentious relationship since the field’s inception. Anthropologists have viewed bioethics as ethnocentric, universalizing, and inattentive to the social, cultural, and political contexts of bioethical dilemmas. Anthropologists have challenged foundational bioethical concepts such as autonomy, showing that decision making, in many cases, unfolds in a relational context that is poorly matched to individualized models of informed consent, which lodge decisional authority within a single autonomous patient or research subject. At the same time, anthropology has much to offer the discipline of bioethics. Empirical data can help to address or resolve normative questions, bring unrecognized factors to light, and open up new avenues for further exploration. Anthropology’s characteristic use of cases grounds bioethical debates in contextual details that may change the stakes of discussion. And anthropology can enrich bioethics scholarship with its use of ethnography and social theory to illuminate power structures and relations of inequality, its characteristic dual focus on the micro and the macro, and its capacity for reflexivity. In exchange, bioethics may beckon anthropologists to go outside their comfort zone and develop prescriptive solutions to ethical challenges. On the other hand, debate is ongoing about whether anthropologists should revitalize bioethics and infuse it with more attention to cultural and historical contexts, or, instead, leave bioethics behind entirely and develop their own ethical projects. Moving forward, it may be useful to distinguish between anthropology in bioethics and anthropology of bioethics. The former category of research and scholarship encompasses anthropological studies of bioethically relevant topics, such as end-of-life decision making, organ transplantation, genetic screening, stem cell research, and the globalization of clinical trials. Anthropology of bioethics performs a critical analysis of bioethics as a sphere of knowledge production and professional expertise. This approach acknowledges that bioethics, as an ideology and a practice, may best serve certain kinds of social actors and obscure its limits for other actors and conditions. While these two approaches are by no means mutually exclusive, they can help to structure an understanding of anthropology’s potential contributions to the field.

The Anthropological Critique of Bioethics: Foundational Texts

The anthropological critique of bioethics suggests that bioethics relies too heavily on universal principles and fails to account for the ways in which moral reasoning is shaped by cultural values and locally situated practices. Anthropologists have challenged Tom Beauchamp and James Childress’s influential framework, which holds that four principles—autonomy, beneficence, non-maleficence, and justice—provide a foundation for bioethical reasoning. From Beauchamp and Childress’s perspective, applying these principles to particular circumstances will result in ethical decisions. For anthropologists and likeminded social scientists, however, this approach is ethnocentric, reductionist, and decontextualized. In arguing for attention to the contingent and locally situated nature of moral decision making, many anthropologists rely on a distinction first posed in Kleinman 1995 between ethics, as a codified body of norms and principles, and morals, contextual understandings of what is at stake in everyday experience. Fox and Swazey 1984 draws on research in China to highlight the value of a comparative ethnographic perspective for illuminating the ethnocentric assumptions that shape bioethical decision making. The authors suggest that professional bioethics in the United States overemphasizes individualism and reflects a shallow view of American values. Sargent and Smith-Morris 2006 challenges Beauchamp and Childress’s presumption of a common morality shared by “all serious people.” Myser 2003 argues that the field of US bioethics has failed to recognize its own dominant whiteness as an analytic weakness. Das 1999 draws attention to the inadequacies of dominant bioethics frameworks in non-Western, low-income countries. Muller 1994 suggests that bioethics, as a sphere of professional knowledge, ought to be treated as an object of cultural investigation in its own right. A tension between critiquing the field of bioethics and highlighting the potential for generative anthropological contributions runs throughout these accounts. Even at the time of its publication, Marshall 1992 acknowledged “winds of change” emerging in mainstream bioethics with respect to the central role of individualism and noted promising directions for future contributions, many of which have been borne out in the intervening years. Brodwin 2008 later picked up on this theme in encouraging anthropologists to adopt a more constructive stance toward engaging with bioethics. Fassin 2008 offers one model for such an approach with its clinical ethnography of a South African hospital, which identified “elementary forms of care” grounded in everyday care practices.

  • Brodwin, Paul. 2008. The coproduction of moral discourse in US community psychiatry. Medical Anthropology Quarterly 22.2: 127–147.

    DOI: 10.1111/j.1548-1387.2008.00011.xE-mail Citation »

    After summarizing the social scientific critique of bioethics, Brodwin suggests that this critique threatens to impede anthropological contributions to bioethical inquiry because it challenges bioethicists’ authority. He urges anthropologists to move beyond a critical stance and explore, instead, the coproduction of moral discourse by formal bioethics and everyday clinical practice. This argument is illustrated with examples from his ethnography of frontline psychiatric case management on the negotiation of confidentiality.

  • Das, Veena. 1999. Public good, ethics, and everyday life: Beyond the boundaries of bioethics. Daedalus 128.4: 99–134.

    E-mail Citation »

    This article suggests that work in bioethics in low-income countries has primarily focused on translating key concepts, such as autonomy, for use in these underresourced settings. Using the case of smallpox eradication in India, Das proposes instead an exploration of the concept of health as a public good, which draws attention to issues of equity and justice.

  • Fassin, Didier. 2008. The elementary forms of care: An empirical approach to ethics in a South African hospital. Social Science & Medicine 67.2: 262–270.

    DOI: 10.1016/j.socscimed.2008.03.044E-mail Citation »

    While bioethics tends to apply universal principles to empirical cases, this article proposes to reverse the analytic process and extrapolate ethical precepts from grounded observations of everyday practice. Using ethnographic observations of nursing practices in a South African hospital, Fassin identifies a set of “elementary forms of care” that form the basis for a practice-based nursing ethics.

  • Fox, Renee C., and Judith P. Swazey. 1984. Medical morality is not bioethics—medical ethics in China and the United States. Perspectives in Biology and Medicine 27.3: 336–360.

    DOI: 10.1353/pbm.1984.0060E-mail Citation »

    The authors suggest that an examination of Chinese medical morality can challenge the ethnocentric and universalizing assumptions of American bioethics. They draw on ethnographic research in China to show that medical ethics is tied to social and cultural values. While the authors are sociologists, the article serves as a key touchstone for anthropology and bioethics because it was the first to propose a culturally relative view of professional bioethics.

  • Kleinman, Arthur. 1995. Anthropology of bioethics. In Writing at the margins: Discourse between anthropology and medicine. Edited by Arthur Kleinman, 41–67. Berkeley: Univ. of California Press.

    E-mail Citation »

    Kleinman argues that bioethics, like biomedicine, is ethnocentric in its privileging of individual rights and its presumption of an isolated, autonomous self. He also critiques the focus in bioethics on high-stakes encounters in hospital settings, arguing instead that most moral dilemmas emerge in more ordinary settings of family-based care. Kleinman proposes that an anthropological turn can ground bioethical inquiry in interpersonal experience and local moral worlds.

  • Marshall, Patricia. 1992. Anthropology and bioethics. Medical Anthropology Quarterly 6.1: 49–73.

    DOI: 10.1525/maq.1992.6.1.02a00040E-mail Citation »

    Marshall reviews the history of the field of bioethics in the United States, considers why anthropologists have not historically been involved in the field, describes current contributions to bioethics, and offers promising directions for future research. In closing, she suggests that anthropologists can extend the scope of bioethical inquiry by drawing attention to cross-cultural variation in bioethical practice, and to the cultural underpinnings of ethical concepts.

  • Muller, Jessica. 1994. Anthropology, bioethics, medicine: A provocative trilogy. Medical Anthropology Quarterly 8.4: 448–467.

    DOI: 10.1525/maq.1994.8.4.02a00070E-mail Citation »

    After a review of the history of bioethics and dominant theoretical frameworks, Muller examines four dimensions of an anthropological approach to bioethics: (1) the contextual nature of bioethical dilemmas, (2) the cultural embeddedness of moral systems, (3) the multicultural character of bioethical problems, and (4) an examination of bioethics as a cultural phenomenon. She suggests that anthropologists can contribute to ongoing theoretical debates in bioethics, such as the role of relativism in moral reasoning.

  • Myser, Catherine. 2003. Differences from somewhere: The normativity of whiteness in bioethics in the United States. American Journal of Bioethics 3.2: 1–11.

    DOI: 10.1162/152651603766436072E-mail Citation »

    Myser argues that mainstream bioethics in the United States has failed to acknowledge the normativity of whiteness, as a form of social positioning, in its approach and foundational assumptions. This oversight risks reinscribing white privilege into the field’s theories and methods. She argues for more reflexive attention to race and the invisibility of white dominance within the field.

  • Sargent, Carolyn, and Carolyn Smith-Morris. 2006. Questioning our principles: Anthropological contributions to ethical dilemmas in clinical practice. Cambridge Quarterly of Healthcare Ethics 15.2: 123–134.

    DOI: 10.1017/S0963180106060154E-mail Citation »

    The authors use clinical cases as a foundation to critique two dominant assumptions: the presumption of an autonomous individual as the unit and focus of care and the notion of a common morality. They outline factors relevant to an anthropological approach to bioethics and recommend the exploration of moral issues at the initial presentation for care, using Kleinman’s explanatory-models approach. (See the Oxford Bibliographies in Anthropology article “Medical Anthropology.”)

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