Lecture on anthropology bringing insight into bioethics

Melissa Hope Johnson

Medical anthropologist Dr. Carolyn Smith-Morris delivered the latest in a series of lectures on bioethics on Nov. 11. The lecture, entitled “Ethics of Research in Indian Country,” was given in the Wriston Auditorium. Smith-Morris, whose current research involves the study of diabetes among Pima Indians, offered a critical perspective challenging the validity of standard biomedical ethics.
Smith-Morris’s work with the Pima entails a “political economy” approach, which understands health problems as resulting from a combination of political and economic factors in addition to the biological aspects of disease. Such an approach also looks at the process of globalization and the transition of indigenous groups from subsistence economies to wage labor and cash economies as producing a series of health problems which need to be understood in their full historical context. Research among the Pima, who live in Arizona in the Sonoran Desert, indicates that the prevalence of diabetes in this population includes a combination of political, genetic and cultural factors. It is largely these cultural issues upon which this lecture focused.
Research among indigenous groups, Smith-Morris suggested, includes two different types of ethics: there are ethics of working with tribes, and there are ethics of biomedical research. The problem is that these two sets of ethics are not always compatible with one another. In particular, Smith-Morris focused on the biomedical concept of individual autonomy as a European-based idea that does not apply to all populations.
As Smith-Morris explained, the concept of autonomy, which understands each individual as capable of making self-decisions, is not shared by all cultures. This concept reinforces specific Western cultural notions about the target of care, the definition of the patient and the responsibilities of the parties involved. Overall, Smith-Morris suggested that this notion is completely out of touch with multicultural settings, and thereby is unsuitable for working in health care, which has become increasingly involved with patients from foreign cultures.
Failure on the part of researchers and physicians to understand the cultural issues involved in specific settings may be detrimental to providing health care. Among the Pima, for instance, growing suspicions toward researchers and treatment/prevention programs have incited the Pima to begin kicking researchers off their reservations. Inadequacy on the part of researchers and health care workers to help this population results from a combination of failures into which ethnography offers important insights: the lack of cultural training among clinic personnel; a failure to understand the full etiology of disease among this population, including the socio-political and economic factors; and unequal power relations between the Pima, the researchers and the personnel all contribute to this problem.
What Smith-Morris suggests is that anthropology can provide alternatives for biomedical research in response to these cultural issues. She proposes that biomedical researchers need to step beyond the bounds of hegemonic assumptions and elicit cultural understandings of disease and illness. Attending to issues of power and authority are also necessary to ensure that both patient and clinician expectations are met. Researchers must share power with tribal leaders and other community members, empowering them to make the changes they want. Smith-Morris advocates that these are the ways that anthropology can contribute to biomedical research for the benefit of all parties involved.
Smith-Morris, who holds a doctorate in medical anthropology from the University of Arizona, currently teaches at Southern Methodist University in Dallas.