Anthropology at Home in Australia

This introductory essay takes ‘anthropology at home’ to refer to the conduct of fieldwork and other kinds of anthropological research in or about communities which Australian anthropologists regard as culturally familiar. In that sense, anthropology at home raises two interrelated questions: 1) ‘What is an appropriate anthropological object?’ and 2) ‘What are the appropriate methods for studying that object?’ I argue that anthropology remains overdetermined by its colonial heritage and that it is still overly concerned with the study of ‘the other’ through long-term fieldwork. My feeling is that we should displace the idea of ‘the other’ in favour of an anthropological object construed in terms of self-other relationships. This not only implies that anthropology at home should cease to appear as an oxymoron, but also suggests that a more comprehensive employment of various study methods should displace long-term fieldwork as metonymic of the discipline.     

Issues and Challenges in Research on the Ethics of Medical Tourism: Reflections from a Conference

The authors co-organized (Snyder and Crooks) and gave a keynote presentation at (Turner) a conference on ethical issues in medical tourism. Medical tourism involves travel across international borders with the intention of receiving medical care. This care is typically paid for out-of-pocket and is motivated by an interest in cost savings and/or avoiding wait times for care in the patient’s home country. This practice raises numerous ethical concerns, including potentially exacerbating health inequities in destination and source countries and disrupting continuity of care for patients. In this report, we synthesize conference presentations and present three lessons from the conference: 1) Medical tourism research has the potential for cross- or inter-disciplinarity but must bridge the gap between researchers trained in ethical theory and scholars unfamiliar with normative frameworks; 2) Medical tourism research must engage with empirical research from a variety of disciplines; and 3) Ethical analyses of medical tourism must incorporate both individual and population-level perspectives. While these lessons are presented in the context of research on medical tourism, we argue that they are applicable in other areas of research where global practices, such as human subject research and health worker migration, are occurring in the face of limited regulatory oversight.     

FAIR TRADE INTERNATIONAL SURROGACY

Since the development of assisted reproductive technologies, infertile individuals have crossed borders to obtain treatments unavailable or unaffordable in their own country. Recent media coverage has focused on the outsourcing of surrogacy to developing countries, where the cost for surrogacy is significantly less than the equivalent cost in a more developed country. This paper discusses the ethical arguments against international surrogacy. The major opposition viewpoints can be broadly divided into arguments about welfare, commodification and exploitation.
It is argued that the only valid objection to international surrogacy is that surrogate mothers may be exploited by being given too little compensation. However, the possibility of exploitation is a weak argument for prohibition, as employment alternatives for potential surrogate mothers may be more exploitative or more harmful than surrogacy. It is concluded that international surrogacy must be regulated, and the proposed regulatory mechanism is termed Fair Trade Surrogacy. The guidelines of Fair Trade Surrogacy focus on minimizing potential harms to all parties and ensuring fair compensation for surrogate mothers.     

Stem cell tourism and future stem cell tourists: policy and ethical implications

Stem cell tourism is a small but growing part of the thriving global medical tourism marketplace. Much stem cell research remains at the experimental stage, with clinical trials still uncommon. However, there are over 700 clinics estimated to be operating in mostly developing countries--from Costa Rica and Argentina to China, India and Russia--that have lured many patients, mostly from industrialized countries, driven by desperation and hope, which in turn continue to fuel the growth of such tourism. While much research has focused on such dimensions as the promotions that allow such businesses to make their services known, media coverage, some patient research, and regulatory conditions for developing country clinics, little attention has been paid to the non-affected members of the general population, the future potential users of such services. This empirical study based on five focus group discussions with a diverse group of healthy adults in a Canadian city, explored participant views of patients who use stem cell tourism services, the likelihood they would avail themselves of such services if they were to suffer similar illnesses, and the conditions under which they might do so, and the impact that admonitions and advice from international expert bodies might have on their decisions. Our findings suggest that these healthy adults are sympathetic to the drivers of hope and desperation, and, despite cautions about research limitations, may seek such treatments themselves under similar conditions. These findings are discussed in the context of the policy and ethical issues raised by this form of medical tourism.     

Approche ph��nom��nologique du n��ant

In this article, we address the issue of nothingness on the basis of perceptive experience in its phenomenological dimension. Through an analysis of the visual perception and various types of memories related to it, we will try to answer three questions: what is phenomenological nothingness? What role does it play in the emergence of determinations within the consciousness? What are its relationships with disappearance and forgetting involved in all the stages of object donation in consciousness?     

EvoS: A Prescription for What Ails Pre-Medical Education?

Pre-medical students are certainly a widely varied group, with different motivations and experiences, different skills sets and interests. However, they often tend to approach their undergraduate education as a necessary evil that they must endure in order to achieve their ultimate goals. This article summarizes recent literature addressing some of the questions that have been raised regarding pre-medical education programs. Are students prepared for the intellectual, emotional, and even physical challenges of medical training? What deficiencies are commonly seen in entering medical students? What are students’ perceptions of how well their pre-medical studies helped them? Many of these studies have resulted in a call for more science training, while some have advocated for less, but with an enhanced focus on humanistic studies. We supply a brief outline of our Evolutionary Studies (EvoS) program and reflect upon how participation in this program can enhance pre-medical students’ education. Importantly, we argue that EvoS can expand students’ depth of understanding of science, as well as nurture their ability to think about the needs of their patients and the context of their medical practice.     

Companion-Animal Caregiver Knowledge,Attitudes, and Beliefs Regarding End-of-Life Care

Although awareness of end-of-life care is growing within the veterinary field and there appears to be consumer demand for these services, it is unclear exactly what caregivers know about end-of-life options for their companion animals. Are companion-animal caregivers aware of the range of options for their nonhuman animals? What do they value most highly for their nonhuman animals at the end of life? Answers to these and other related questions about caregiver perceptions are important because what they know about end-of-life care and how they approach decision-making for their companion animals will shape the kind of care an animal receives. This article presents the results of a large survey exploring companion-animal caregivers’ knowledge, attitudes, and beliefs about end-of-life care, including in-home euthanasia, hospice and palliative care, financial commitment to end-of-life care, insurance usage, and level of comfort in providing care (e.g., subcutaneous fluids) in the home.     

Implementing environmental labelling of food products in France

Consumers increasingly demand information about the environmental impacts of their food. The French government is in the process of introducing environmental labelling for all food products. A scientific council was set up, and its main conclusions are presented in this article, through six questions: What environmental issues should be considered? What objective should be targeted? What data are needed, and for whom? What methods for assessing environmental impacts? Which environmental scores should be chosen? What label format should be proposed? By answering these questions and considering the context, the available data, the proposed methods and adjustments, and the knowledge of consumer perception of formats, the scientific council considers that a labelling scheme is feasible and relevant.

     

Transfer of medical technology from a developed to a developing country

Medical care is increasingly dependent on technology, but what are the problems involved in the transfer of technology from a developed to a developing country? What are the administrative, personnel and engineering problems? We address these questions in the context of our experience of transferring the medical technology and knowledge necessary for the development of nuclear medicine facilities in Kuwait.     

Legal aspects of genetic information

The federally funded Human Genome Initiative will lead to the development of new capabilities to learn about an individual''s genetic status. Legal issues are raised concerning patients'' and other parties'' access to that information. This article discusses the effect of existing statutes and case law on three pivotal questions: To what sort of information are people entitled? What control should people have over their genetic information? Do people have a right to refuse genetic information? The article emphasizes that the law protects a patient''s right to obtain or refuse genetic information about oneself, as well as the right to control the dissemination of that information to others.     

Endpiece: Three different talks

ObjectivesTo characterise the information needs of family doctors by collecting the questions they asked about patient care during consultations and to classify these in ways that would be useful to developers of knowledge bases.DesignObservational study in which investigators visited doctors for two half days and collected their questions. Taxonomies were developed to characterise the clinical topic and generic type of information sought for each question.SettingEastern Iowa.ParticipantsRandom sample of 103 family doctors.ResultsParticipants asked a total of 1101 questions. Questions about drug prescribing, obstetrics and gynaecology, and adult infectious disease were most common and comprised 36% of all questions. The taxonomy of generic questions included 69 categories; the three most common types, comprising 24% of all questions, were “What is the cause of symptom X?” “What is the dose of drug X?” and “How should I manage disease or finding X?” Answers to most questions (702, 64%) were not immediately pursued, but, of those pursued, most (318, 80%) were answered. Doctors spent an average of less than 2 minutes pursuing an answer, and they used readily available print and human resources. Only two questions led to a formal literature search.ConclusionsFamily doctors in this study did not pursue answers to most of their questions. Questions about patient care can be organised into a limited number of generic types, which could help guide the efforts of knowledge base developers.

Key messages

• Questions that doctors have about the care of their patients could help guide the content of medical information sources and medical training
• In this study of US family doctors, participants frequently had questions about patient care but did not pursue answers to most questions (64%)
• On average, participants spent less than 2 minutes seeking an answer to a question
• The most common resources used to answer questions included textbooks and colleagues; formal literature searches were rarely performed
• The most common generic questions were “What is the cause of symptom X?” “What is the dose of drug X?” and “How should I manage disease or finding X?”

     

FAIRNESS AND EQUITY IN THE PROVISION OF ANTI‐RETROVIRAL THERAPY: SOME REFLECTIONS FROM LESOTHO

The number of people in immediate need of anti‐retroviral treatment (ART) in the southern African region continues to significantly exceed the capacity of health systems there to provide it. Approaches to this complex rationing dilemma have evolved in different directions. The ethical concepts of fairness and equity have been suggested as a basis to guide the development of approaches to select patients for ART. This article reports the results of a case study on patient selection at a rural ART clinic in Lesotho. The purpose of the study was to examine whether or not such concepts had relevance or operative value for a treatment team providing ART in rural Lesotho. The study found that while concepts of fairness and equity were relevant to the work of the treatment team, patient selection practices did not necessarily reflect what these concepts entail. The idea of fairness as a structured, formalized selection process did not figure in the approach to ART provision at the site. A less formal, ‘first‐come‐first‐served’ approach was adopted. While there was knowledge among some team members that social, economic or geographic conditions inhibit individuals and groups from gaining access to ART and that this was inequitable, it was felt that there was little they could do to try to mediate the impact of these conditions. The study's findings pose importance questions about the approach to ART programming in resource constrained settings. The findings also question the relevance of trying to achieve fairness and equity when the gap between need for care and capacity to provide it remains so large.     

Valéry et l’automatisme psychologique

While the name of Paul Valery is usually associated with that of Leonardo da Vinci or the character, Monsieur Teste, most people are unaware of Valery’s posthumous work, which he considered the most significant of his writings: Cahiers/Notebooks, a voluminous and dense work, in its dimensions (around 30,000 pages) as well as in what it discloses about the daily ponderings of a man who considered himself — in spite of himself — a philosopher. It is a multifaceted work, touching on all fields of thought: history, politics, and the sciences, in all their diversity, from mathematics to physics, and biology to the theory of evolution. Neither philosophy, nor theology, nor linguistics is left in the dark. But he clearly expressed a preference for psychology and, more specifically, the question of mental function: What is it to think? How does the mind link ideas? What is abstraction? What role do feelings play? What is the relationship between the mind and the machine? Must we concede the existence of the unconscious mind. These are some of the questions we address in elucidating the concept of automatism through what makes it work as well as its failings.     

HOW TO CONNECT BIOETHICS AND ENVIRONMENTAL ETHICS: HEALTH, SUSTAINABILITY, AND JUSTICE

In this paper, I explore one way to bring bioethics and environmental ethics closer together. I focus on a question at the interface of health, sustainability, and justice: How well does a society promote health with the use of no more than a just share of environmental capacity? To address this question, I propose and discuss a mode of assessment that combines a measurement of population health, an estimate of environmental sustainability, and an assumption about what constitutes a fair or just share. This mode of assessment provides an estimate of the just and sustainable life expectancy of a population. It could be used to monitor how well a particular society promotes health within just environmental limits. It could also serve as a source of information that stakeholders use when they deliberate about programs, policies, and technologies. The purpose of this work is to focus attention on an ethical task: the need to fashion institutions and forms of life that promote health in ways that recognize the claims of sustainability and justice.     

Cost-Benefit Analysis in a Regulatory Setting

The purpose of requiring cost-benefit analysis is to produce better out-comes from regulatory processes. If implemented well, cost-benefit analysis and risk assessment can produce improvements at several levels, by encouraging regulators to consider unintended effects of regulations and thereby avoid making things worse, to find the least burdensome approach to a goal, and to balance the pluses and minuses involved in choosing a goal. Whether these improvements will occur depends in large part on how cost-benefit analysis is implemented. Guidelines for conducting cost-benefit analysis and procedures for considering evidence on costs and benefits play an important role. This article describes how guidelines and rules of process can affect outcomes, and the issues that cost-benefit guidelines need to cover. Guidelines can affect the bias of a regulatory process toward one set of stakeholders or another, make outcomes more predictable, define the information needed for decisions, and provide a basis for legal challenges. The questions that guidelines should address include: what are costs and benefits, what constitutes good economics, what are standards of proof, how should unquantified costs and benefits be treated, how should uncertainties of cost-benefit estimates be dealt with, and how should alternatives be generated? The article concludes with recommen dations about how the adoption of cost-benefit analysis can be made most effective and beneficial in regulatory processes.     

Bentuhua: Culturing Psychotherapy in Postsocialist China

The breathless pace of market reform in China has brought about profound ruptures in socioeconomic structures and increased mental distress in the population. In this context, more middle-class urbanites are turning to nascent psychological counseling to grapple with their problems. This article examines how Chinese psychotherapists attempt to “culture” or indigenize (bentuhua) three imported psychotherapy models in order to fit their clients’ expectations, desires, and sensibilities: the Satir family therapy, cognitive behavioral therapy, and sandplay therapy. It addresses three interrelated questions: What is the role of culture in adopting, translating, and recasting psychotherapy in contemporary China? How is cultural difference understood and mobilized by therapists in the therapeutic encounter? What kind of distinct therapeutic relationship is emerging in postsocialist China? Data presented here are drawn from my semistructured interviews and extensive participant observation at various counseling offices and psychotherapy workshops in the city of Kunming. My ethnographic account suggests that it is through constant dialog, translation, and re-articulation between multiple regimes of knowledge, cultural values, and social practices that a new form of talk therapy with “Chinese characteristics” is emerging. Finally, I reflect upon what this dialogic process of transformation means for psychotherapy as a form of globally circulating knowledge/practice.     

Darwin's principles of divergence and natural selection: Why Fodor was almost right

Darwin maintained that the principles of natural selection and divergence were the “keystones” of his theory. He introduced the principle of divergence to explain a fundamental feature of living nature: that organisms cluster into hierarchical groups, so as to be classifiable in the Linnaean taxonomic categories of variety, species, genus, and so on. Darwin’s formulation of the principle of divergence, however, induces many perplexities. In his Autobiography, he claimed that he had neglected the problem of divergence in his Essay of 1844 and only solved it in a flash during a carriage ride in the 1850s; yet he does seem to have stated the problem in the Essay and provided the solution. This initial conundrum sets three questions I wish to pursue in this essay: (1) What is the relationship of the principle of divergence to that of natural selection? Is it independent of selection, derivative of selection, or a type of selection, perhaps comparable to sexual selection? (2) What is the advantage of divergence that the principle implies—that is, why is increased divergence beneficial in the struggle for life? And (3) What led Darwin to believe he had discovered the principle only in the 1850s? The resolution of these questions has implications for Darwin’s other principle, natural selection, and permits us to readjust the common judgment made about Jerry Fodor’s screed against that latter principle.     

“What Do Animals Mean to You?”: Naming and Relating to Nonhuman Animals

ABSTRACT

This article presents an analysis of data from over 200 accounts of, and responses to questions about, how animals feature in people's lives. The accounts were generated by a Mass Observation Project (MOP) directive on “Animals and Humans.” The MOP, based at a UK university, sends out two or three directives a year, asking correspondents to write in response to a series of questions and prompts. The “Animals and humans” directive began with the question, “What do animals mean to you?” followed by a range of prompts about respondents' experiences of animals. The paper is specifically concerned with issues of how language both reflects and contributes to typologies of living creatures. It presents a qualitative analysis of some of the themes that emerged from responses to the directive, as well as a more quantitative analysis of the words chosen by respondents to denote different kinds of animals. Using these different methodological approaches, it focuses on how moral ambiguity is expressed and the ways in which categories and meanings shift depending on linguistic context. These methods complement each other, with the computer-assisted linguistic analysis providing a different and more quantitative method of revealing aspects of people's values, attitudes, and assumptions as they report on the role of animals in their lives. Overall, the paper shows how a corpus linguistic analysis can demonstrate the permeability of categories and boundaries, and the moral ambiguity toward animals that is revealed in the way language is used.     

GLOBAL BIOETHICS: UTOPIA OR REALITY?

This article discusses what 'global bioethics' means today and what features make bioethical research 'global'. The article provides a historical view of the development of the field of 'bioethics', from medical ethics to the wider study of bioethics in a global context. It critically examines the particular problems that 'global bioethics' research faces across cultural and political borders and suggests some solutions on how to move towards a more balanced and culturally less biased dialogue in the issues of bioethics. The main thesis is that we need to bring global and local aspects closer together, when looking for international guidelines, by paying more attention to particular cultures and local economic and social circumstances in reaching a shared understanding of the main values and principles of bioethics, and in building 'biodemocracy'.