Medical Volunteering Abroad

* Note: This is the first of a new type of ethics blog post—a short description of an ethics issue related to anthropology that is appearing in the news and other online media, accompanied by links to original source material. Students and scholars interested in submitting a piece should send their work to the Chair of the Committee on Ethics, Steven Black ([email protected])

Medical Volunteering Abroad
Gabriela Alvarado, MD, MPH
Georgia State University

Many people assume that poor countries with little access to health care and lack of health care providers benefit from international volunteers. However, this may not be the case. In the United States you cannot perform any type of health care related act if you are not a licensed professional. It is deemed unethical. So why is it appropriate for unlicensed people to provide these services in other countries? In addition to untrained people administrating medications, providing sutures, and even performing pelvic examinations there are another set of ethical issues that should also be examined. Developing countries have limited staff as it is, and sending in armies of unqualified volunteers means that the staff has to divert time away from actually caring for patients and tend to the international volunteers. Furthermore, medical student volunteers often want to learn procedures they might not be able to do in the United States, may will focus on experiences for personal benefit instead of what is actually needed in the community.

As a medical doctor, I volunteered in my home country (Costa Rica), in an area of the country called Talamanca. Talamanca is the region of the country where most of the indigenous communities are located; these communities tend to have very poor infrastructure and limited access to healthcare. As a medical intern I spent two weeks volunteering in Talamanca, and quite honestly, I never stopped to consider the ethical implications of me being there. The local doctor had to make time to accommodate three interns, show us around, and figure out things to keep us ‘entertained.’ Now, as a graduate student with an interest in medical anthropology, I wonder: was it really necessary for us to be there? Who gained the most from the whole exchange?

While these issues have been overlooked in the past in public discourses, they are now starting to be considered and there is a call to reexamine the role of volunteers abroad and how to really benefit local communities:

http://www.orlandosentinel.com/opinion/os-ed-health-care-third-world-022616-20160225-story.html
http://www.npr.org/sections/goatsandsoda/2016/02/11/465428990/the-risks-and-unexpected-benefits-of-sending-health-students-abroad
https://www.cfhi.org/sites/files/files/pages/beyond_medical_missions_to_impact_driven.98631.pdf

Ethics, Anthropology, and Adjudication

Steven P. Black
Georgia State University

 

In my work as the chair of the Committee on Ethics (CoE) of the American Anthropological Association (AAA), I’ve noticed that a number of the “ethical queries” that the CoE receives are not about what researchers should do during fieldwork, but rather about what other colleagues and professionals have already done that is perceived to be a violation of anthropological ethics. This is a valid and important topic for an ethical query, and the CoE endeavors to provide helpful advice in response to such questions, in addition to all others on the topic of anthropological ethics. However, it seems that many people want something more than advice from the committee—they want adjudication. There may be legal reasons why the AAA does not provide adjudication—certainly, the AAA does not have the legal authority to engage in many forms of punishment. Furthermore, senior colleagues have explained to me how adjudication backfired in earlier iterations of the CoE. However, there is also a philosophical reason for the current lack of adjudication: to encourage a stance on anthropological ethics that emphasizes nuance and reflection.

 

Moralities and Anthropological Ethics

Much of anthropology is rooted in a broad commitment to moral relativity in one form or another. Moral relativity is not an excuse for abandoning anthropological ethics but rather is an invitation to anthropological ethics. From this standpoint, morality becomes pluralized (moralities). Each cultural context is saturated in its own moral specificities, including multiple ideological and moral stances. This becomes a point of entry into discussion of anthropological ethics. As many anthropologists use the terms, “ethics” refers to understandings of cause and effect that are the result of conscious reflection and attention, whereas “morality” refers to default, taken-for-granted discourses and dispositions (this general distinction is taken from the work of Michel Foucault, among others). Here, ethics involves reexamination of one’s own taken for granted moral stances, respect and consideration for other cultural traditions of morality, and reflection on how to resolve the juxtaposition of sometimes disparate moral discourses.

 

Reflection and Adjudication

The AAA statement on ethics is a long-term result of these sorts of intellectual processes surrounding questions of moral relativity alongside consideration of the impact of anthropological research on research participants and others. In its current form online it is meant to be a living, breathing document. Indeed, this Ethics Blog is also part of the broader context of the statement. Anthropologists recognize the conflicting concerns and moral ambiguities that are inherent in our lives, both personal and professional. Do no harm—yes, but what happens when avoiding harm to one group involves the potential for harm with another? Be open and honest regarding your work—surely, but what about those cases in which honesty in one context will lead to harm in another?

 

Each conflict is an opportunity to consider the competing obligations and overlapping moral frameworks that make anthropological scholarship so interesting. By its very nature, adjudication involves a flattening of this ethical landscape, collapsing multiple moral universes into a one-dimensional artifact in the service of judgment. Adjudication is sometimes necessary and important. However, in its current configuration, adjudication is not within the scope of the CoE’s activities. Rather, the committee, the code, and the blog represent a forum for members of the AAA to unpack and examine competing moral claims, discourses, and ideologies, where our reflection is not shaped by the imperative to assign blame or administer punishment.

 

For more information on the development of the Principles of Professional Responsibility, Code of Ethics, and Ethics Blog in their current form, please see Anthropological Ethics in Context: An Ongoing Dialogue, edited by Dena Plemmons and Alex Barker.

 

Thank you to former chairs of the CoE Lise Dobrin and Dena Plemmons for suggestions and comments on an earlier draft of this piece. Any mistakes or omissions are my own.

 

Further Reading

For recent scholarly discussions of anthropological ethics, see:

 

Fassin, Didier

2008  Beyond Good and Evil?: Questioning the Anthropological Discomfort with Morals. Anthropological Theory 8(4):333-344.

2012  A Companion to Moral Anthropology. Malden, MA: Wiley-Blackwell.

Robbins, Joel

2007  “Causality, Ethics, and the Near Future.” American Ethnologist 34(3):433-436.

Stoczkowski, Wiktor

2008  The ‘Fourth Aim’ of Anthropology: Between Knowledge and Ethics. Anthropological Theory 8(4):345-356.

Throop, C. Jason, and Jarrett Zigon, eds.

2014  Moral Experience. A Special Issue of Ethos 42(1).

Zigon, Jarrett

2008  Morality: An Anthropological Perspective. New York: Berg.