It’s nice when things come together, even if it’s just in a small way. Life carries on while I’m working things out (I’ve had an email from MSD confirming they got my letter) and I’ve been spending this morning preparing for one of my final essays, for my medical anthropology paper. The topic is on medical ethics, and the first half of the question goes something like:
Joralemon believes the anthropologist has a special vantage point on bioethical issues that justifies the move from analysis to advocacy. An anthropologist may have an understanding of different cultural attitudes to the integrity of the body, ritual practices that attend birth and death, or the acceptability of the application of techniques that may cause harm or pain to the patient. However, it is important to remember that “moral decision making is contextual…” (Jessica Muller in Joralemon 2010 p.107).
Can there be an ethical code that includes the cultural values and norms that guide healing-related behaviour in any given society? Under what conditions should an anthropologist intervene in a medical context?
For a while I didn’t entirely know exactly what the question actually meant, let alone how to answer it, but when I turned my computer off to let it cool down and lay down with my Kobo and a pad of paper in case of ideas and just read for a while, it solidified. The book I was finishing is called Sniper by Jon Wells, and it’s about an anti-choice terrorist who shot several doctors in Canada and the USA, the last one of which died. The legal case hinged on whether he was intending to injure or to kill but in defence speeches there was a lot of moralising over whether force (deadly or not) was justified to prevent harm in the form of terminations. So I was reading the final few chapters of this book and coming across passages where it’s quite clear that no one can ever agree because the pro-choice and anti-choice positions start at inherently different philosophical positions. It also reminded me of an image someone posted on twitter that I’d glanced at about subsidies for the movie industry, where pro-subsidy people say “If we don’t give perpetually increasing subsidies the jobs will go elsewhere!” and anti-subsidy people say “We’ll have to give perpetually increasing subsidies or the jobs will go elsewhere!” It’s hard to find a universally acceptable answer there because both positions completely agree on the fact, but disagree on which value is the most important.
So, when I put down my Kobo and glanced at my pad of paper, everything just sort of crystallised. There cannot be a universal rule of ethics in medicine because different cultures view things so differently. Under one system you might view the individual patient as central and focus on their physical symptoms to find an evidence-based solution to prevent them from occuring, while under another you might have a holistic collective view where it’s just as or even more important to deal with the entire family, to tend to any tension or social discord that is causing or exacerbating symptoms. Or have different ideas on who should be responsible for decision making – like, what if what the patient wants goes against the interests of the family or contradict medical best practice? What’s the difference morally between a DNR order and euthanasia? What level of mental disability is enough to override the wishes of the patient and cause them to be considered incapable? How is the conception of a person linked to their physical body, and when does that start and end? How do you weigh post-mortem organ donation against beliefs surrounding the treatment of the deceased?
It will be interesting to write because the second half is to be about a current medical ethical debate in New Zealand. I’m doing the treatment (especially with regards to income support) of people with disabilities, particularly mental illness, which will touch on those things like who gets to make decisions and what best care entails. The guy who is like the head advisor to MSD about medical issues has this position where he believes that putting someone on a disability benefit and letting them not work is, like, literally as unhealthy for them as smoking some ridiculous number of cigarettes a day, and WINZ has switched to this position of focusing on what people CAN do rather than what they CAN’T, but they use unqualified people to make these decisions. So all that sort of thing is basically what I’m going to cover, the questions about what is the best outcome for the government or society or the patient and which outcome should be the highest priority and our cultural assumptions about self-reliance, the history of the welfare system, whose interests are supposed to be protected. It’s not as great a topic as I did for my last anthropology final essay, but now that I’ve figured out what I’m going to say it is definitely going to be something that I’ll enjoy writing, not some tedious shit like my first NZ Land Wars essay.