The application of human right frameworks is an increasingly important part of efforts to accelerate progress in global mental health. Much of this has been driven by several influential legal and policy instruments, most notably the United Nations’ Convention on the Rights of Persons with Disabilities, as well as the World Health Organization’s QualityRights Tool Kit and Mental Health Action Plan. Despite these significant developments, however, much more needs to be done to prevent human rights violations. This chapter focuses on (...) a critical component of this broader challenge, which is the question of how best to regulate and reduce the use of coercive measures. The recent literature on coercion in psychiatry – which addresses involuntary commitment, seclusion, restraint, and forced medication – represents a useful resource that can help guide tractable solutions in global mental health. These issues are evaluated from the perspective of global health governance, and several general recommendations are made in order to improve monitoring and enforcement, provide guidance for domestic legislative reform, and strengthen health systems. (shrink)

This edited volume provides a biosemiotic analysis of the ecological relationship between food and medicine. Drawing on the origins of semiotics in medicine, this collection proposes innovative ways of considering aliments and treatments. Considering the ever-evolving character of our understanding of meaning-making in biology, and considering the keen popular interest in issues relating to food and medicines - fueled by an increasing body of interdisciplinary knowledge - the contributions here provide diverse insights and arguments into the larger ecology of organisms’ (...) engagement with and transformation through taking in matter. Bodies interpret molecules, enzymes, and alkaloids they intentionally and unintentionally come in contact with according to their pre-existing receptors. But their receptors are also changed by the experience. Once the body has identified a particular substance, it responds by initiating semiotic sequences and negotiations that fulfill vital functions for the organism at macro-, meso-, and micro-scales. -/- Human abilities to distill and extract the living world into highly refined foods and medicines, however, have created substances far more potent than their counterparts in our historical evolution. Many of these substances also lack certain accompanying proteins, enzymes, and alkaloids that otherwise aid digestion or protect against side-effects in active extracted chemicals. Human biology has yet to catch up with human inventions such as supernormal foods and medicines that may flood receptors, overwhelming the body’s normal satiation mechanisms. This volume discusses how biosemioticians can come to terms with these networks of meaning, providing a valuable and provocative compendium for semioticians, medical researchers and practitioners, sociologists, cultural theorists, bioethicists and scholars investigating the interdisciplinary questions stemming from food and medicine. (shrink)

Este artículo presenta una reflexión política acerca del VIH-sida, estructurada en cuatro momentos: primero, una aproximación a las políticas de la vida donde se devela el actuar de la necropolítica, el biopoder, la biopolítica y biolegitimidad en relación con el VIH-sida; segundo, se aborda una antropología política del cuerpo, la cual advierte las distintas formas de poder, violencia y verdad que experimentan las personas que viven con VIH-sida; tercero, un acercamiento al modo en que se reproduce una economía moral del (...) castigo, donde se articulan elementos normativos, médico-sanitarios, de la vida, el cuerpo y la sociedad; cuarto, se propone repolitizar el VIH-sida, a fin de brindar insumos que permitan construir un orden social diferente para las personas que viven con dicha realidad. (shrink)

In this article, I report on a Bulgarian female migrant caregiver's “life-story,” especially focusing on her relationship with an old Italian woman, on the care practices performed in her favor in Italy, and on her daughter and parents still living in Bulgaria. I chose to do it by means of an anthropological approach based on experience as field of mediation between personal dimensions and historical and social processes and therefore centered on the body conceived as historical product, the influence of (...) political and social forces on shaping human lives, and finally interest in the specific link between bodies and work. From this analysis, based on language and narratives, I think useful cultural aspects may emerge about “gender” and care practices, regarding the two women linked by an assistance relationship, and the activities/strategies used by the Bulgarian caregiver to fulfill her family obligations. (shrink)

Recent decades have seen a significant increase in physicians participating in international short-term missions to regions with limited or no access to health care by virtue of natural disaster or lack of resources. Recent publications in the ethics literature have explored the potential of these missions for unintentional harm to the intended beneficiaries. Less has been discussed about how to respond when harm actually occurs. The authors review the ethical issues raised by short-term medical and humanitarian missions and the literature (...) on responding to unintended error to provide guidelines for avoiding harm to the intended beneficiaries of missions and an appropriate response when harm occurs. Two cases demonstrating an analysis and response to unintended harm are presented. (shrink)

This theoretical paper argues for prioritarianism as an ethical underpinning for digital health in contexts of extreme disadvantage. In support of this claim, the paper develops three prioritarian principles for making ethical decisions for digital health programme design, grounded in the normative position that the greater the need, the stronger the moral claim. The principles are positioned as an alternative view to the prevailing utilitarian approach to digital health, which the paper argues is not sufficient to address the needs of (...) the worst off. As researchers of digital health, we must ensure that the most globally marginalised are not overlooked by overtly technocentric implementation practices. Consequently, the paper concludes by advocating for use of the three principles to support stronger critical reflection on the ethics involved in the design and implementation of digital health programmes. (shrink)

Several important ethical dilemmas emerge when nurses join a public-sector strike. Such industrial action is commonplace in South Africa and was most notably illustrated by a national wage negotiation in 2010. Media coverage of the proceedings suggested unethical behaviour on the part of nurses, and further exploration is merited. Laws, policies and provisional codes are meant to guide nurses’ behaviour during industrial action, while ethical theories can be used to further illuminate the role of nurses in industrial action. There are, (...) however, important aspects to consider before judging whether nurses act unethically when striking. Following Loewy’s suggestion that the nature of the work, the proceeding commitment of the nurse to the patient, the prevailing situation when the strike is planned and the person(s) who stand(s) to benefit from the strike be considered, coupled with a consideration of the South African historical socio-political context, important aspects of the ethics of nurses’ behaviour in industrial action transpire. (shrink)

The goal of this paper is to articulate and advocate for an enhanced role for philosophers of science in the domain of science policy as well as within the science curriculum. I argue that philosophy of science as a field can learn from the successes as well as the mistakes of bioethics and begin to develop a new model that includes robust contributions to the science classroom, research collaborations with scientists, and a role for public philosophy through involvement in science (...) policy development. Through an analysis of two case studies, I illustrate how philosophers of science can make effective and productive contributions to science education as well as to interdisciplinary scientific research, and argue for the essential role of philosophers of science in the realm of science policy. (shrink)

One-third of all human lives end in early death from poverty-related causes. Most of these premature deaths are avoidable through global institutional reforms that would eradicate extreme poverty. Many are also avoidable through global health-system reform that would make medical knowledge freely available as a global public good. The rules should be redesigned so that the development of any new drug is rewarded in proportion to its impact on the global disease burden (not through monopoly rents). This reform would bring (...) drug prices down worldwide close to their marginal cost of production and would powerfully stimulate pharmaceutical research into currently neglected diseases concentrated among the poor. Its feasibility shows that the existing medical-patent regime (trade-related aspects of intellectual property rights—TRIPS—as supplemented by bilateral agreements) is severely unjust—and its imposition a human-rights violation on account of the avoidable mortality and morbidity it foreseeably produces. (shrink)

In the process of professionalization, the American Society for Bioethics and Humanities (ASBH) has emphasized process and knowledge as core competencies for clinical ethics consultants; however, the credentialing program launched in 2018 fails to address both pillars. The inadequacy of this program recalls earlier critiques of the professionalization effort made by Giles R. Scofield and H. Tristram Engelhardt, Jr.. Both argue that ethics consultation is not a profession and the effort to professionalize is motivated by self-interest. One argument they offer (...) against professionalization is that ethics consultants lack normative expertise. Although the question of expertise cannot be resolved completely, the accusation of self-interest can be addressed. Underlying these critiques is a concern for hubris, which can be addressed in certification and the vetting of candidates. Drawing on the virtue ethics literature of Alasdair MacIntyre and Edmund D. Pellegrino, I argue that medicine is a moral community in which ethics consultants are moral agents with a duty to foster the virtue of humility (or what Pellegrino and Thomasma call self-effacement). The implications of this argument include a requirement for self-reflection in one’s role as a moral agent and reflection on one’s progress toward developing or deepening virtuous engagement with the moral community of medicine. I recommend that professionalization of clinical ethics consultants include a self-reflective narrative component in the initial certification and ongoing renewal of certification where clinical ethics consultants address the emotional dimensions of their work as well as their own moral development. Adopting a teleological view of ethics consultation and incorporating narratives that work toward that purpose will mitigate the self-interest and hubris of the professionalization project. (shrink)

The lack of medical availability of effective pain medication is an enduring and expanding global health calamity. Despite important medical advances, pain remains severely under-treated worldwide, particularly in developing countries. This article contributes to the discussion of this global health crisis by considering international legal and institutional mechanisms to promote wider accessibility to critical narcotic drugs for pain relief.

Important medical advances over the last several decades have vastly improved the technical capacity to control human pain. Millions of patients suffering from cancer, HIV/AIDS, and other conditions have been able to find relief from incapacitating chronic and acute pain. However, despite these developments, pain remains severely under treated worldwide, particularly in developing countries. The tragic consequence is that for millions of people around the globe, excruciating pain is an inescapable reality of life.

The predominant influences on health are social or upstream factors. Poverty, inadequate education, insecure and toxic environments, and inferior opportunities for jobs and positions are inequitable disadvantages that adversely affect health across the globe. Many causal pathways are yet to be understood. However, elimination of these social inequalities is a moral imperative of the first order. Some physicians by word and deed argue that medical doctors should oppose the “structural violence” of social inequalities that greatly shorten lives and wreak so (...) much suffering. (shrink)

This paper examines the particular relevance of feminist critiques of epistemic authority in contexts of institutionalized violence. Reading feminist criticism of “experts” together with theorists of institutionalized violence, Stone-Mediatore argues that typical expert modes of thinking are incapable of rigorous knowledge of institutionalized violence because such knowledge requires a distinctive kind of thinking-within-discomfort for which conventionally trained experts are ill-suited. The author demonstrates the limitations of “expert” modes of thinking with reference to writings on the Iraq war by Michael Ignatieff (...) and Fouad Ajami. Finally, the author turns to a newly active group of epistemic agents—anti-war relatives of soldiers--to examine the role that undervalued epistemic traits can play in knowledge of war and other forms of structural violence. (shrink)

Recent decades of women's rights advocacy have produced numerous regional and international agreements for protecting women's security, including a UN convention that affirms the state's responsibility to protect key gender-specific rights, with no exceptions on the basis of culture or religion. At the same time, however, the focus on universal women's rights has enabled influential feminists in the United States to view women's rights in opposition to culture, and most often in opposition to other people's cultures. Not surprisingly, then, feminists (...) across the global South have criticized the universal-women's-rights agenda. This article reviews representative critical responses to universal-women's-rights advocacy. The author argues that, taken collectively, these critical responses do not reject the possibility of cross-cultural feminist advocacy but they do suggest the need for feminists in the United States and Europe to focus less on transferring rights across the obstacles of culture and more on how they can revise and expand their own understanding of women's rights in response to the struggles of other women, many of whom view women's rights as organic to their own cultures and as connected to broader social struggles. (shrink)

Nursing has a unique opportunity to address issues of structural violence that contribute to poor health outcomes. Models for designing nursing care relative to the social determinants of health can be adapted from the discipline of peace studies and the phenomenon of peacebuilding. The aim of this qualitative study was to describe the lived experience of peacebuilding from the perspective of community or public health nurses. Interviews were conducted with eight participants. Attributes of the peacebuilder included fostering human relationships that (...) value the inherent worth and dignity of others, nurturing a character of humility and moral courage, and contemplating the personal cost of engaging in prolonged processes of peacebuilding. Practices of peacebuilding included mediating conflict through multilayered processes, accompanying others to places of empowerment, and utilizing interdisciplinary teaching and learning to build capacity for change. Increasing an understanding of the lived experience of peacebuilding by nurses is relevant to nursing research, theory, and practice, and adds to a broader understanding of peacebuilding. (shrink)

The past two decades have seen the extensive privatisation and marketisation of health care in an ever reaching number of developing countries. Within this milieu, medical tourism is being promoted as a rational economic development strategy for some developing nations, and a makeshift solution to the escalating waiting lists and exorbitant costs of health care in developed nations. This paper explores the need to problematize medical tourism in order to move beyond one dimensional neoliberal discourses that have, to date, dominated (...) the arena. In this problematization, the paper discusses a range of understandings and uses of the term ‘medical tourism’ and situates it within the context of the neoliberal economic development of health care internationally. Drawing on theory from critical medical anthropology and health and human rights perspectives, the paper critically analyzes the assumed independence between the medical tourism industry and local populations facing critical health issues, where social, cultural and economic inequities are widening in terms of access, cost and quality of health care. Finally, medical tourism is examined in the local context of India, critiquing the increasingly indistinct roles played by government and private sectors, whilst linking these shifts to global market forces. (shrink)

CAPPE LPO Box 8260 ANU Canberra ACT 2601 Australia Tel: +61 (0)2 6125 4355, Fax: +61 (0)2 6125 6579; Email: michael.selgelid{at}anu.edu.au ' + u + '@' + d + ' '//--> Abstract This article reviews ethically relevant history of tuberculosis and recent developments regarding extensively drug resistant tuberculosis (XDR-TB). It argues that tuberculosis is one of the most important neglected topics in bioethics. With an emphasis on XDR-TB, it examines a range of the more challenging ethical issues associated with tuberculosis: (...) individual obligations to avoid infecting others, coercive social distancing measures, third-party notification, health workers' duty to treat contagious patients, and international justice. In each of these cases, key philosophical questions are highlighted and the need for empirical research/information is demonstrated. CiteULike Connotea Del.icio.us What's this? (shrink)

This seminal collection on the ethical issues associated with infectious disease is the first book to correct bioethics’ glaring neglect of this subject. Timely in view of public concern about SARS, AIDS, avian flu, bioterrorism and antibiotic resistance. Brings together new and classic papers by prominent figures. Tackles the ethical issues associated with issues such as quarantine, vaccination policy, pandemic planning, biodefense, wildlife disease and health care in developing countries.

The capacity-building strategy used by a US-based research organisation, the Pacific Institute for Research and Evaluation , to strengthen the system for the protection of human research subjects and the infrastructure of its international collaborating partner, the University of Liberia, are discussed. To conduct the much-needed biomedical and social science-based research-related activities in the future, this partnership is expected by PIRE to gradually evolve over time to strengthen the capacity of the local investigators and administrators of the University of Liberia. (...) Accordingly, a unique opportunity to share technology and resources with a post-conflict, resource-constrained country is created by this partnership. This capacity-building model to strengthen the protection of human subjects in research can also be replicated in similar resource-constrained international settings and, accordingly, our experiences and limitations are shared in this paper. (shrink)

Jeffrey Bishop’s The Anticipatory Corpse exposes a functional metaphysics at the root of contemporary medical practice that gives rise to inhumane medicine, especially at the end of life. His critique of medicine argues for alternative spaces and practices in which the communal significance of the body, its telos, can be restored and the meaning of a “good death” enriched. This essay develops an alternative epistemology of the body, drawing from Christian theological accounts of the communal or Eucharistic body and linking (...) liturgical practices to the cultivation of solidarity. It argues for an epistemology of the body that makes visible the invisible bodies at medicine’s margins and illumines the disparate worlds of health care globally. (shrink)

Lisa A. Eckenwiler, Long-term care, globalization, and justice, Baltimore: The Johns Hopkins University Press, 2012, reviewed by Lynette Reid.

In order to enhance the “structural competency” of medicine—the capability of clinicians to address social and institutional determinants of their patients’ health—physicians need a theoretical lens to see how social conditions influence health and how they might address them. We consider one such theoretical lens, fundamental cause theory, and propose how it might contribute to a more structurally competent medical profession. We first describe fundamental cause theory and how it makes the social causes of disease and health visible. We then (...) outline the sorts of “fundamental interventions” that physicians might make in order to address the fundamental causes. (shrink)

In the last few years, justice has emerged as a matter of concern for the contemporary constitution of technoscience. Increasingly, both practicing scientists and engineers and scholars of science and technology cite justice as an organizing theme of their work. In this essay, I consider why “science and justice” might be arising now. I then ask after the opportunities, but also the dangers, of this formation. By way of example, I explore the openings and exclusions created by the recent conjugation (...) of science and justice in the field of personal genomics. Finally, I conclude with reflections on what other forms “science and justice” might take, and what might be gained or lost in fostering them. (shrink)

This essay offers a Jewish approach to ethnography in religious ethics. Following the work of other ethnographers working in religious ethics, I explore how an ethnographic account of reproductive ethics among Haredi Jewish women in Jerusalem enhances and improves Jewish ethical discourse. I argue that ethnography should become an integral part of Jewish ethics for three reasons. First, with a contextual approach to guidance and application of law and norms, an ethnographic approach to Jewish ethics parallels the way ethical decisions (...) are made on a daily basis in Jewish communities. Second, ethnography bolsters the voices of those involved in ethical discourse. Third, ethnography facilitates the bridge between local ethical questions and global ethical discourse. (shrink)

In December 2010, the governor of Mississippi suspended the dual life sentences of two African American sisters who had been imprisoned for sixteen years on an extraordinary condition: that Gladys Scott donate a kidney to her ailing sister Jamie Scott. The Scott Sisters’ case is a highly unusual one, yet it is a revealing site for inquiry into US biopolitics more broadly. Close attention to the conditional release and its context demands a broader frame than traditional bioethics and helps to (...) push science and technology studies analysis of race past its conventional focus on genetics. This article draws on the Scott Sisters’ case as a site for interrogating the US context of racialized mass incarceration and kin-oriented and consumerist valorization of organ donation. Tensions between racialized exclusions, the promise of consumerist freedom, and the lack of expectations of the state are foundational to a distinctly American biological citizenship. By putting the Scott Sisters’ case into conversation with broader arguments about incarceration as a site of racialization and STS literatures of organ transplantation and of biological citizenship in diverse geographical sites, this article seeks to articulate some of the racialized contours of biopolitics in the United States. (shrink)

Many legal scholars well recognize that, in some instances, support for a law or policy may be primarily because of its expressive function, i.e. the statements it makes about underlying values. In these cases, the expressive content of a law or policy may actually overshadow its central purpose. Examples of this phenomenon, according to Cass Sunstein, include, for example, regulations against hate speech in the USA. He suggests that achieving the consequence (prohibiting hateful speech against certain groups) may not be (...) the real focus (central purpose) of the law. Rather, the real focus is on the social meaning of these regulations—that bigotry is unacceptable in a liberal society. In this way, a particular law or policy can operate on many levels—while aiming to achieve a particular objective or behavior, it can also be a valuable tool for achieving other important social goals through its expressive function. This article applies this insight to the realm of public health policy, with particular attention to the case of pandemic planning, and suggests that public health policy and its overall goals may be well-served by deliberate regard for, and appropriate utilization of, the expressive function. (shrink)

Working at the bedside and within communities as patient advocates, nurses frequently intervene to advance individuals’ health and well-being. However, the International Council of Nurses’ Code of Ethics asserts that nurses should expand beyond the individual model and also promote a rights-enabling environment where respect for human dignity is paramount. This article applies the results of an ethnographic human rights study with displaced populations in Rwanda to argue for a rights-based social advocacy role for nurses. Human rights advocacy strategies include (...) sensitization, participation, protection, good governance, and accountability. By adopting a rights-based approach to advocacy, nurses contribute to health agendas that include more just social relationships, equitable access to opportunities, and health-positive living situations for all persons. (shrink)

This article reflects on the value of training of health care professionals that find themselves in variously changing and complex settings, and who find themselves interacting with themes, problems and practices related to mental health. Starting from some reflections that emerged with operators involved in a professional training course within a specific research-intervention project, the contribution questions how a renewed “pedagogy of care” can help these professionals to better understand the nature and the constitutive factors of the process of signification (...) and re-signification of the experience of psychiatric illness, especially when one comes into contact with subjects involved in forced migratory experiences. (shrink)

The concept of social structure is ill defined in the literature despite the perennial problem and ongoing discussion about the relationship between agency and structure. In this paper I will provide an outline of what the term social structure means, but my main focus will be on emphasizing the value of the concept for nursing research and demonstrate how its erasure in some research negatively effects on our understanding of the nurses' role in clinical practice. For example, qualitative research in (...) nursing has largely focused on agency through such theories as phenomenology, hermeneutics, and symbolic interactionism. The result is that social structure may be erased or seen as epiphenomena of agency. My purpose is to provide a theoretical discussion of social structure and how such a discussion can help us to understand how nurses live and experience clinical practice. While not denying the importance of agency, I will argue that the thinned out approach to social structure places limits on our understanding of the constraints nurses experience in their working lives. The result is that nurses' attitudes and clinical failings are individualized, resulting in ever more calls for improved education, when a more thorough examination of structural issues may elucidate more fundamental problems. (shrink)

A friend once told me I was wasting my time writing about cross-cultural perspectives on the beginnings of life. “Your work is interesting for its curiosity value,” he said, “but fundamentally worthless. What happens in other cultures is totally irrelevant to what is happening here.” Those were discouraging words, but as I followed the American debates about the beginnings and ends of life, it seemed he was right. Anthropologists have written a great deal about birth and death rites in other (...) societies and about non-western notions of personhood, but to date our findings have had little impact on American policy, ethics, or law. The recognized experts on contentious topics such as abortion and euthanasia tend to come from the fields of philosophy, bioethics, theology, law, and biology, but rarely from the social sciences. I was a bit surprised, therefore, to be invited to address the Thomas A. Pitts Memorial Lectureship on “Defining the Beginning and the End of Human Life.”. (shrink)

Ethical perspectives on regional, rural, and remote healthcare often, understandably and importantly, focus on inequities in access to services. In this commentary, we take the opportunity to examine the implications of normalizing metrocentric views, values, knowledge, and orientations, evidenced by the recent (2022) New South Wales inquiry into health outcomes and access to hospital and health services in regional, rural and remote New South Wales, for contemporary rural governance and justice debates. To do this, we draw on the feminist inspired (...) approach to rural health ethics involving analysis of power relationships developed by Simpson and McDonald and related ideas from critical health sociology. In presenting this analysis, we extend contemporary thought about spatial health inequities and structural violence. (shrink)

With attention to the experiences, agency, and rights of tuberculosis patients, this symposium on TB and ethics brings together a range of different voices from the social sciences and humanities. To develop fresh insights and new approaches to TB care and prevention, it is important to incorporate diverse perspectives from outside the strictly biomedical model. In the articles presented in this issue of the Journal of Bioethical Inquiry, clinical experience is married with historical and cultural context, ethical concerns are brought (...) to bear on global health, and structural analyses shed light upon the lived experience of people living with TB. The relational and reciprocal dimensions of care feature strongly in these discussions, which serve as a poignant reminder that behind each of the yearly deaths from TB is a deeply personal story. No single discipline holds a monopoly on how to care for each of these people, but strong cases are made for support from mental health and social workers in addressing the kaleidoscope of needs in TB prevention. As the World Health Organization moves towards the goal of eliminating TB globally by 2050, attending to the needs of TB patients serves global interests to lower disease burden and to develop better integrated communities worldwide. (shrink)

In Vermont, approximately 1000–1200 migrant workers from Latin America are helping to sustain the state’s dairy industry. These dairy workers, the majority of whom are from Mexico and Guatemala, experience significant mental health impacts stemming from a combination of stressors due to leaving their home of origin and challenges related to working in rural Vermont. This article employs a framework of structural violence and structural vulnerability to situate the lived experiences and health concerns of migrant farmworkers in Vermont’s dairy industry. (...) It presents two case studies of applied projects that have been utilized to address these health concerns, a gardening project called Huertas that addresses issues of food insecurity and barriers in access to fresh and culturally familiar produce, and a participatory comics project called El Viaje Más Caro that aims to address mental health concerns through engaged storytelling and comics production. The authors of this article have designed and carried out these projects with the goal of interrupting the forms of structural violence and structural vulnerability that negatively impact the wellbeing of farmworkers in the state’s dairy industry. This article describes the successes and limitations of these projects with the hope they can be adapted and replicated for other farmworker communities facing similar health barriers. (shrink)

This paper argues that Amartya Sen’s comparative approach to justice requires a politics that is attentive to the agency of the other. Rethinking representation as a relational, rather than a sovereign, concept captures the relationship between agency and justice that is emerging in global politics today. It is increasingly common that non-governmental actors engage with communities through practices of trust and responsibility without appeal to political authority. Relational representation helps clarify the dynamics of these relationships and provides a way to (...) think about their purpose. That purpose is to effect changes that ameliorate suffering and injustice, working to re-present the represented persons as more capable persons, more free to use their agency. (shrink)

This paper examines two reasons anthropological expertise has recently come to be considered relevant to American debates about the beginnings and ends of life. First, bioethicists and clinicians working to accommodate diverse perspectives into clinical decision-making have come to appreciate the importance of culture. Second, anthropologists are the recognized authorities on the cultural logic and behaviors of the “Other.” Yet the definitions of culture with which bioethicists and clinicians operate may differ from those used by contemporary anthropologists, who view culture (...) as a contingent, contested set of social practices that are continually formulated and re-negotiated in daily interactions. Using ethnographic examples, the author argues that the qualities that constitute “personhood” should be sought in social practices rather than in cognitive capacities or moral attributes. (shrink)

This article explores the work of the contemporary sociologist and urban photographer, Camilo Vergara. The piece draws on early work in critical theory to characterize Vergara's work as `rescuing critique'. Specifically, the article maintains that it is only in the theoretical vocabulary of Walter Benjamin that the methodological uniqueness, historical sensitivity and critical thrust of Vergara's project can be adequately understood. Indeed, it is argued that what is truly distinct about Vergara's work is the decidedly Benjaminian way in which, in (...) the ruinous present of neoliberal `progress', it fuses the aesthetic power of images with an anamnestic obligation to the urban past. In such a fusion, Vergara's photo-ethnographies of America's new ghettos raise critical questions about what has – and might yet – become of such places, and those who inhabit them. (shrink)

This essay recognizes that the interactions that define medical care are problematic and that narrative is invoked to overcome these strains. Being grounded in science, medicine, too, might be influenced by a particular world-view that arose in the natural philosophy of the Scientific Revolution. If narrative responds to this sort of medicine, it may retain traces of this mindset. A feminist approach responds to this viewpoint and may used beneficially to analyze both the story of medicine and the stories within (...) medicine. Tensions discussed from this perspective are those between sickness and health and those between patient and provider; also questioned are suitable form(s) of narrative and whose narratives are valued. Suggestions for broadening narrative to address these issues include letting the body speak for itself, overcoming the power differential in the patient/provider interaction and using standpoints to foster a more equal and just medical system. (shrink)

The analysis of the impact of economic globalisation on health depends on how it is defined and should consider how it shapes both health and health policies. I first discuss the ways in which economic globalisation can and has been defined and then why it is important to analyse its impact both in terms of health and health policies. I then explore the ways in which economic globalisation influences health and health policies and how this relates to equity, social justice, (...) and the role of values and social rights in societies. Finally, I argue that the process of economic globalisation provides a common challenge for all health systems across the globe and requires a broader debate on values, accountability, and policy approaches. (shrink)

In this paper I utilize anthropological insights to illuminate how health professionals and patients navigate and negotiate what for them is social about tuberculosis in order to improve treatment outcomes and support patients as human beings. I draw on ethnographic research about the implementation of the DOTS approach in Georgia’s National Tuberculosis Program in the wake of the Soviet healthcare system. Georgia is a particularly unique context for exploring these issues given the country’s rich history of medical professionalism and the (...) insistence that the practice of medicine is a moral commitment to society. I argue for critical attention to the ways in which treatment recipients and providers navigate what, for them, is “social” about therapeutic practices and their significance for avoiding biological and social reductionism. (shrink)

This article argues that to advance the struggle for access to essential medicines, it is necessary to identify the global and local regimes that shape the rules that give impetus to particular policy options, while undermining others. In exploring the role of law and politics in this process, the author first outlines the globalization of a standardized, corporate-inspired, intellectual property regime. Second, the author uses the example of the HIV/aids pandemic to demonstrate how the stability of this new regime came (...) under pressure, both locally and globally. Finally, it is argued that while the global HIV/aids pandemic and the social movements that emerged in response to government inaction have effectively challenged the TRIPS regime, this complex contestation has reached an unsustainable stalemate in which development aid, corporate, and non-governmental philanthropy is simultaneously providing increased availability to drugs while precluding a more lasting solution to the crisis of access to essential medicines in developing countries. (shrink)

Peace and conflict studies education has grown significantly in the last 30 years, mainly in Higher Education. This article critically analyzes the ways in which this field might be subject to poststructural critique, and posits Bourdieusian second-order reflexivity as a means of responding to these critiques. We propose here that theory-building within PACS education is often limited by the dominance of Galtung and Freire, and that, while the foundational ideas of positive and negative peace, structural and cultural violence, conscientization, reflexivity (...) and critical pedagogy are still relevant today, they nevertheless need to be combined in new ways with each other, and with Bourdieu’s notions of habitus and field, to adequately respond to poststructural critique. Thus, we call here for greater field-based reflexivity in twenty-first century PACS. (shrink)

Amartya Sen’s comparative approach to justice makes clear that notions of justice are shaped by human agency and experience, and both his focus on the ‘internal view’ of well-being that emphasizes suffering as a central feature of illness and his recognition that social and cultural factors shape perceived injustice are critical to this approach. However, Sen questionably depicts the contributions of anthropological research to this project as limited to ‘the sensory dimension of ill-health.’ Focusing on mental health in the context (...) of global justice, I argue that Sen’s treatise on justice can be refined through an ethnographic method that synchronizes attention to (1) cultural knowledge and social relations in ecological settings; (2) fundamental human needs; and (3) levels of analytic specificity involving situations, categories, and events. This method integrates analysis of internal phenomenology and external constraints of political economy and ideology. To demonstrate I discuss three cases involving students and violence in Rio de Janeiro, women and witchcraft in Ghana, and historical migration and war trauma among Vietnamese immigrants in which external conditions of insecurity and inequality contributed to deteriorating mental health conditions including depression, trauma, and debilitating anxiety. (shrink)