Bioethics

In recent years a growing number of anthropologists have turned their attention to the discipline of biomedical ethics. Bioethics traces its origins as a distinct field to the styles of reasoning and reflection found within analytic philosophy and legal scholarship. In its early decades, work in bioethics relied heavily on principle-based analysis, an approach that often led to critiques of the moral dimensions of healthcare practice divorced from underlying social, cultural and political context. Often called the "empirical turn" in bioethics, social scientists utilizing diverse theoretical and methodological programs have questioned approaches to healthcare ethics that fail to account for context (Weisz; Hoffmaster, 2001; DeVries and Subedi; Brodwin, 2000).

Researchers in medical anthropology represent one arm of a strong, and growing, internal critique of bioethics. In addition to social science voices, this critique includes diverse perspectives within philosophy, such as feminist readings of core bioethics dilemmas and a resurgence of interest in the traditions of American pragmatism and casuistry. Even philosophers working within the Kantian tradition have called attention to bioethics' need to balance attention to "institutional and professional realities and diversities" with philosophical rigor (O'Neill, p. x). O'Neill questions the primacy of autonomy, to the exclusion of a focus on relationships of trust and trustworthiness, in contemporary bioethics discourse.

This entry explores how anthropologists working in the field of bioethics bridge the gap between conceptions of medical morality grounded in local worlds and the universal understandings espoused within the western philosophical tradition. Ongoing debates about relativism from the perspectives of anthropology and philosophy also are addressed with special attention paid to the implications of a "culturally informed" practice of bioethics. Culturally diverse understandings of the meaning and expression of personhood are highlighted in order to illustrate difficulties that emerge when one tries to judge certain practices as good or bad, appropriate or inappropriate. An anthropologically informed bioethics produces a fuller account of healthcare practices, an account that grounds ethical universals such as respect for persons in local moral worlds.

The body of empirical work reviewed below reveals the thinness of bioethics accounts that disregard social context and that celebrate a particular (often American) version of individual autonomy. Ethical analyses centered exclusively on individual actors create strong barriers to understanding the troubling conflicts that emerge in multicultural worlds, especially in the arena of social justice and human rights. A simplistic application of ethical universals to particular cases discounts the complexity of lived experience and real world dilemmas. In the same way, a naive and unqualified acceptance of ethical relativism diminishes the potential of negotiating moral consensus across cultural boundaries. An anthropologically grounded framework for bioethics requires a solid recognition of the cultural assumptions that underlie our definition of the "good" in biomedicine. An anthropologically informed bioethics calls attention to the social, political and structural factors that affect the production of scientific and clinical knowledge and its application in the practice of global biomedicine.

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