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)

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)

Cuba currently has more than 38,000 health workers providing emergency relief, long-term community-based care and medical education to some of the most vulnerable communities in the world. This current outreach to 76 countries positions Cuba as a leader in global health outreach. This has been well documented and praised by many scholars and policy makers alike. While many acknowledge the importance and impact of the Cuba’s global effort, there is very little understanding as to why Cuba makes such a large (...) global health commitment in the first place. I argue that solidarity is in fact a mixture of national pride, self-interest and humanistic outreach. Ultimately, it is a calculated effort to overcome current structures of inequity and exploitation on a global scale by expanding new opportunities for health professionals dedicated to providing care in marginalized communities. (shrink)

Abstract:This article examines the relationship between philosophy and culture in global bioethics. First, it studies what is meant by the term “global” in global bioethics. Second, the author introduces four different types, or recognizable trends, in philosophical inquiry in bioethics today. The main argument is that, in order to make better sense of the complexity of the ethical questions and challenges we face today across the globe, we need to embrace the universal nature of self-critical and analytical philosophical analysis and (...) argumentation, rather than using seemingly philosophical approaches to give unjustified normative emphasis on different cultural approaches to bioethics. (shrink)

This essay describes and critically evaluates a co-operative educational program to train Ugandan health care workers in bioethics. It describes one bottom-up effort, a week-long intensive workshop in bioethics provided by the authors to health care professionals in a developing country—Uganda. We will describe the background and circumstances that led to the organization of the workshop, and review its planning, design, curriculum, and outcome. We will focus especially on measures taken to make the workshop relevant for the audience of Ugandan (...) professionals, and describe lessons learned after two presentations of the workshop. Finally, we will discuss the strengths and weaknesses of such a format, and its potential value in raising bioethical expertise in developing countries. (shrink)

Corresponding Author, Health Policy & Ethics Fellow, Chronic Disease Prevention & Control Research Center, Department of Medicine, Baylor College of Medicine, 1709 Dryden, Suite 1025, Houston, TX 77030, USA. Tel.: 713.798.5482; Fax: 713 798 3990; Email: danielg{at}bcm.edu ' + u + '@' + d + ' '//--> . Abstract This article defends a broad model of public health, one that specifically addresses the social epidemiologic research suggesting that social conditions are primary determinants of health. The article proceeds by critiquing one (...) of the strongest arguments in favor of a narrow model, advanced by Mark Rothstein. The critique sets up the argument that a model of public health that does not address what actually causes health and disease is unlikely to improve public health. Assessing the substantial evidence regarding the social determinants of health, the article engages the policy paradox that precludes utopian prescriptions but demands more than mere expedience. CiteULike Connotea Del.icio.us What's this? (shrink)

Randomized experiments, as developed by Esther Duflo and Abhijit Banerjee at the Abdul Latif Jameel Poverty Action Lab, offer a novel, evidence-based approach to fighting poverty. This approach is original, in that it imports the methodology of clinical trials for application in development economics. This paper examines the analogy between J-PAL’s field experiments in development economics and randomized controlled trials in medicine. RCTs and randomized field experiments are commonly treated as identical, but such treatment neglects some of the major distinguishing (...) features that make each experiment specifically apt for use in its respective field. The central claim of this paper is that the analogy between medicine and development economics is incomplete because the central dimensions of RCTs are not simply different but altogether lacking in J-PAL’s approach. This weakens both the political and the theoretical power of such experiments in development economics. (shrink)

Thomas Alured Faunce, College of Law, Fellows Road, Acton, Canberra ACT 0200, Australian National University, Fax: 61 2 61253971, Email: Thomas.Faunce{at}anu.edu.au ' + u + '@' + d + ' '//-->This paper sets out to analyse three different academic proposals for addressing the needs of the poor in relation to new, rather than ‘essential’ medicines. It focuses particularly on research and development prize funds, a health impact fund system and a multilateral treaty on health technology cost-effectiveness evaluation and competitive tender. (...) It compares the extent to which each responds to the ‘market fundamentalist’ philosophy and begins to analyse their respective strengths and weaknesses. CiteULike Connotea Del.icio.us What's this? (shrink)

This chapter concerns the normativity of the concepts of paternalism and libertarian paternalism. The first concept is central in evaluating public health policy, but its meaning is controversial. The second concept is equally controversial and has received much attention recently. It may or may not shape the future evaluation of public health policy. In order to facilitate honest and fruitful debate, I consider three approaches to these concepts, in terms of their normativity. Concepts, I claim, may be considered nonnormative, normatively (...) charged, or normative in that they involve more complex relationships between values or duties. While the last approach is often best, other approaches may be appropriate depending on the context and purpose of discussion. The chapter’s conceptual investigation is illustrated by application to two public health policies: a tax on the consumption of fat and the encouragement of health-promoting food displays in restaurants and supermarkets. (shrink)

In our study of U.S. counterterrorism programs, we found that anthropology needs a mode of analysis that considers security as a form distinct from insecurity, in order to capture the very heterogeneity of security objects, logics and forms of action. This article first presents a genealogy for the anthropology of security, and identifies four main approaches: violence and State terror; military, militarization, and militarism; para-state securitization; and what we submit as “security analytics.” Security analytics moves away from studying security formations, (...) and how much violence or insecurity they yield, to identifying security forms of action, whether or not they are part of the nation-state. As a framework for anthropological inquiry, it is oriented toward capturing how these forms of action work and what types of security they produce. We then illustrate this approach through our fieldwork on counterterrorism in the domains of law enforcement, biomedical research and federal-state counter extremism. In each of our cases, we use security analytics to arrive at a diagnosis of the form of action. The set of conceptual distinctions that we propose as an aid to approaching empirical situations and the study of security is, on another level, a proposal for an approach to anthropology today. We do not expect that the distinctions that aid us will suffice for every situation. Rather, we submit that this work presents a set of specific insights about contemporary U.S. security, and an example of a new approach to anthropological problems. (shrink)

some 20 years. Yet the ethical issues surrounding the disclosure of positive HIV status have not been examined comprehensively. This report examines the ethics behind the disclosure of HIV-positive status primarily or individuals to their sex partners, and for health care practitioners to a patient’s sex partner when the patient is unwilling to disclose. Relevant rights and ethical principles are analysed, including the rights to: self-preservation; privacy and confidentiality; and the bioethical principles of respect for autonomy, beneficence, non-maleficence, and justice. (...) Historic and contemporary individual rights that people living with HIV have regarding disclosure are emphasised, especially in adverse circumstances, where ethics can support non-disclosure based on the right to self-preservation. Rights declarations and current disclosure guidelines for health care practitioners from several international and South African medical organisations also are reviewed. Of key importance to disclosure decisions are the specific situations of individuals in climates rife with stigma toward, and discrimination against, PLHIV, existing more or less worldwide. The potential negative impacts of disclosure are the basis for disclosure decisions of PLHIV. Research study results show that the negative impacts of disclosure can be severe for individuals, ranging from divorce or abandonment to community ostracism and even to murder. Relevant current theories of social justice related to HIV disclosure also are discussed. A conclusion is reached that, by decreasing stigma and discrimination against PLHIV and protecting individual rights related to HIV disclosure, prevention behaviours will be practised more widely, including ‘positive prevention’ by PLHIV and higher rates of disclosure. The eventual result will be the long-term public health goal of decreased spread of HIV. (shrink)

Food Sovereignty is a vibrant discourse in academic and activist circles, yet despite the many shared characteristics between issues surrounding food and public health, the two are often analysed in separate frameworks and the insights from Food Sovereignty are not sufficiently brought to bear on the problems in the public health discourse. In this paper, I will introduce the concept of 'self-organised community viability' as a way to link food and health, and to argue that what I call the 'Health (...) Security' paradigm requires a 'Health Sovereignty' response modelled on Food Sovereignty. (shrink)

W pracy przedstawiono główne założenia polityki zagranicznej George’a W. Busha zaprezentowane w dwóch kampaniach prezydenckich, z 2000 i 2004 roku, opierając się na informacjach pochodzących z transkrypcji debat telewizyjnych. Na podstawie zgromadzonych materiałów autor zaprezentował również ewolucję znacze - nia polityki zagranicznej jako czynnika wpływającego na wynik wyborów, a także zmiany preferencji Amerykanów, które przekładały się na ich poparcie dla poszczególnych kandy - datów na prezydenta. Najpierw wymieniono czynniki, które sprawiają, że polityka zagraniczna staje się wio - dącą kwestią w (...) trakcie kampanii prezydenckich. Opisano także jej specyfikę jako jednego z czynników, na podstawie którego dokonuje się ewaluacji kandydatów. Następnie przy - bliżono zjawisko polegające na tym, że kandydaci często składają obietnice, których nie są w stanie zrealizować i wytłumaczono, dlaczego tak się dzieje. Można zwrócić uwagę na wyraźną ciągłość polityki zagranicznej Stanach Zjednoczonych. Choć kandydaci w trakcie wyborów często proponują zmiany, to jednak tuż po nich jej trzon pozostaje niezmieniony. Autor zaprezentował ewolucję głównych założeń polityki zagranicznej Busha. Podstawę analizy stanowiły wypowiedzi prezydenta zaczerpnięte z debat zarówno z okresu pierw - szej, jak i drugiej kampanii. Pozwoliło to na uchwycenie różnic pomiędzy centralnymi punktami planowanej przez niego aktywności na arenie międzynarodowej, a także zobra - zowanie wyraźnego wzrostu znaczenia wątków związanych z polityką zagraniczną. Autor prześledził przebieg tej zmiany i odszukał jej determinanty. Oprócz odwołań do książek i artykułów naukowych, w publikacji nie zabrakło również wyników sondaży, które zda - niem autora, najlepiej oddawały charakter dokonujących się przemian. (shrink)