Tag: negotiating

Bioethics Blogs

‘A bit of a compromise’: Coming to terms with an emergency caesarean section by Terena Koster

During the midwife-hosted antenatal class Cath attended in a private hospital in Cape Town, South Africa, where she would eventually give birth, pregnant women were encouraged to name the kind of birth they wanted. They were presented with three options: “natural all the way with no medication”, “natural but open to medication”, or “elective caesarean”. The ‘choice’ women were expected to make featured as an important point of concern in their antenatal care and in their preparations for birth.

Hannah, a participant in the class, recalls a particularly striking moment when the midwife went around the room and pointed at each of the participants and asked, “Who is your gynae”. She went on to predict diverse birth outcomes, irrespective of participants’ stated intentions to birth vaginally. For Hannah this was an “eye opening” experience. A first time mother, she was now invited into a highly politicised birthing environment. Hannah had been uncertain about what kind of birth she wanted, but at 8 months pregnant she had decided on a ‘natural’ birth as opposed to a ‘caesarean’, with the caveat that in the event that an emergency caesarean section was a likely outcome, she would proactively opt for an elective caesarean.

At 39 weeks and near the end of her pregnancy, she found herself sitting opposite her obstetrician who told her there was “a real threat of the umbilical cord wrapping around [the baby’s] neck as she … drop[s] down,” adding that because the baby was “so big” there was “a high likelihood of [Hannah] tearing”. For the first time, the obstetrician instructed her to make a birthing decision: to continue trying for a vaginal birth or to opt for an elective caesarean section.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Research Ethics Roundup: Congress Reviews Regulatory Compliance Costs, Why the Fogarty International Center Matters, USDA Sued Over Animal Welfare Records, Negotiating Drug Prices with Human Subjects

This week’s Research Ethics Roundup reviews a Congressional hearing on reducing overhead payments for research oversight, highlights doctors’ arguments for saving the Fogarty International Center at the National Institute of Health (NIH), discusses legal challenges faced by the US Department of Agriculture (USDA) over their decision to delay reposting animal welfare records, and outlines a […]

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The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals: February 2017 by Christine Sargent

American Ethnologist

Good ramps, bad ramps: Centralized design standards and disability access in urban Russian infrastructure

Cassandra Hartblay

Accessible design seeks to reconfigure the social by restructuring the material. As the idea moves globally, it becomes entwined in local logics of moral obligations between citizens and the state. Wheelchair users in the city of Petrozavodsk, in northwestern Russia, talk about inaccessible infrastructure as being embedded in moral relationships. In their stories, hierarchies of expertise diffuse responsibility for outcomes and devalue user knowledge. When accessible design elements are installed to meet minimum standards, they are “just for the check mark” and often do not “work.” Wheelchair ramps produce value for businesses or governments by representing an idea of access that circulates as a commodity. Failed accessible design draws attention to a moral field governing the responsibilities of actors to produce a “good” built environment, imbricated in teleologies of progress. [disability, design, infrastructure, access, ramps, postsocialism, Russia]

Self-governance, psychotherapy, and the subject of managed care: Internal Family Systems therapy and the multiple self in a US eating-disorders treatment center

Rebecca J. Lester

“The self” has seen a surprising resurgence in recent anthropological theorizing, revitalizing interest in whether and how it can be studied ethnographically. These issues are brought to the fore by a newly popular psychotherapy technique, Internal Family Systems therapy (IFS), as practiced in a US eating-disorders clinic. There, clinicians and clients negotiate tensions between this model’s understanding of a multiple, refracted self and managed-care companies’ insistence on personal responsibility. In considering the moral and pragmatic work of IFS in the clinic, a new critical anthropology of selfhood illuminates the vectors through which economic and political commitments become imbricated in the self.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Aetna-Humana and the challenges of regulating while outsourcing

The health insurance industry has been in flux over the past few years, from the phasing in of major provisions of the Affordable Care Act (ACA) to a frenzy of consolidation. Of the country’s “big 5” health insurers (see table), UnitedHealth approached Aetna and Aetna approached Cigna about potential acquisitions. In July 2015, Aetna agreed to buy Humana for $37 billion and Anthem agreed to pay $54 billion for Cigna. Both deals were blocked by the Department of Justice (DOJ) and then litigated.

“Big 5” health insurersMarket Value
UnitedHealth Group$155.7 billion
Aetna$41.3 billion
Anthem$41.1 billion
Cigna$38.2 billion
Humana$30.1 billion

Judge John Bates of the United States District Court for the District of Columbia recently enjoined the merger between Aetna and Humana. Judge Bates sided with the DOJ, concluding that the merger would likely substantially lessen competition in violation of antitrust law. He was not convinced that efficiencies resulting from the merger and then passed on to consumers—cost savings that come from a stronger negotiating position with respect to other healthcare players, for instance—would counteract the anticompetitive effects that would operate to consumers’ detriment.

While the opinion focused on the impact of the putative merger on consumers, it also raises concerns about the power dynamic between health insurance companies and the government. The case considered whether competition would be diminished in two product lines, one being individual plans offered on state public exchanges created by the ACA. The DOJ identified 17 counties across three states where market concentration in public exchanges would reach unlawful levels post-merger.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Special Issues! The Publics of Public Health in Africa | Anthropological Interrogations of Evidence-Based Global Health by Anna Zogas

I’d like to highlight a pair of Special Sections in the early 2017 issues of Critical Public Health. The first is “The Publics of Public Health in Africa,” guest edited by Ann H. Kelly, Hayley MacGregor, and Catherine M. Montgomery. The second is “Anthropological Interrogations of Evidence-Based Global Health,” guest edited by Elsa L. Fan and Elanah Uretsky. Here are the abstracts for the articles in both sections!

 

The Publics of Public Health in Africa 

The publics of public health in Africa (open access)
Ann H. Kelly, Hayley MacGregor & Catherine M. Montgomery

Excerpt: How do we understand the public character of public health in contemporary Africa? What are the parameters of community engagement in health care delivery, medical research and disease control programmes? To what extent is public health in Africa a project led by African Governments? Through what political processes and deliberative practices can African publics influence the priorities of research in health sciences and interventions which aim in broad terms to improve the health of such publics? Drawing insight from empirical research conducted with African scientists, nurses, community members, clinical trialists and policy-makers, this special section examines the multiple ways in which the publiccomes into being around public health provisioning and investigation in sub-Saharan Africa, its role and political reach. Collectively, these papers show how contestation and negotiation around different ideas about who the public is and what being public means can lead to the emergence of conflicting understandings, with implications for who and what is seen to represent the public interest, and for the acceptance of research and other interventions.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Brain Death Deserves a Fuller and More Public Debate

Margaret Hayden won the 2016 Henry K. Beecher Prize in Medical Ethics.  Her essay, “Negotiating Ambiguities in Life and Death,” has some constructive insights for the growing brain death debate.  

Hayden notes that “in many ways, the ambigui…

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

A New Edition of Interacting With Computers Is Now Available

January 3, 2017

Interacting With Computers (vol. 29, no. 1, 2017) is available online by subscription only.

Articles include:

  • “Disruptions, Dilemmas and Paradoxes: Ethical Matter(s) in Design Research” by Lisa P. Nathan, Anja Thieme, Deborah Tatar, and Stacy Branham
  • “A Framework for Negotiating Ethics in Sensitive Settings: Hospice as a Case Study” by Robert Ferguson, Emily Crist, and Karyn Moffatt
  • “From Empathy to Care: A Feminist Care Ethics Perspective on Long-Term Researcher–Participant Relations” by Austin Toombs, Shad Gross, Shaowen Bardzell, and Jeffrey Bardzell

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Beyond Miracles: How Traditional Chinese Medicine Establishes Professional Legitimacy in Post-colonial Macau by Loretta I.T. Lou

[Editor’s Note: An earlier version of this article appeared in Imponderabilia: The International Student Anthropology Journal (2014). This piece is updated with new data and photos collected between 2015 and 2016.]

In Search of Reclusive Doctors (xunzhao yin shi yishu) was the first Chinese TV documentary about medical miracles “made” by doctors of traditional Chinese medicine (TCM). When it was first broadcasted in 2001, it evoked great public interest in the Pearl River Delta region. In exalting the Chinese doctors’ miraculous power to save people on their deathbeds, the documentary paradoxically placed great emphasis on the scientific validity of TCM and folk medicine. In line with this, Mei Zhan’s ethnographic study of TCM doctors in Shanghai and San Francisco also found that the legitimacy of traditional Chinese medicine is built upon its ability to treat difficult cases (Zhan 2001:454). She argues that TCM doctors have used “miracle-making” to “craft a niche for traditional Chinese medicine within a biomedicine-centered health care system. The everyday practice and discourse of traditional Chinese medicine has come to be a site for the ‘production of the extraordinary’” (Ibid).

In an environment where TCM is in fierce competition with biomedicine, it is understandable that some TCM practitioners feel they have to establish their legitimacy through miracle-making. However, my research in Macau suggests a different story. A former colony of Portugal (1557-1999), Macau was returned to the People’s Republic of China in 1999 and is now a Special Administrative Region (SAR) of the PRC. Although Macau had the first Western-style hospital in Asia, it was not until 1984 when the Macau-Portuguese government finally reformed its health care system and established a public health network composed of a government hospital and a dozens of community health centers.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In The Journals – November by Christine Sargent

Hello trusty readers. Check out November’s haul for “In The Journals,” and be sure to check out the special issue of Science, Technology, and Human Values: Feminist Postcolonial Technosciences.

 

American Ethnologist:

Memory, body, and the online researcher: Following Russian street demonstrations via social media (open access)

Patty A. Gray

The Moscow street demonstrations of 2011–12 were the largest public gatherings in Russia since the collapse of the Soviet Union. They were also the largest-ever gathering of Russians on social media. While using the Internet to follow such large-scale social movements remotely, researchers experience social media as a context in which anthropology happens. They may think about “being there” in new ways that shift their focus to their own processes of memory making and sense of bodily presence. Experiencing and remembering social media in the body challenges the distinctions we might otherwise make between virtual and physical encounters.

Royal pharmaceuticals: Bioprospecting, rights, and traditional authority in South Africa

Christopher Morris

The translation of international biogenetic resource rights to a former apartheid homeland is fostering business partnerships between South African traditional leaders and multinational pharmaceutical companies. In the case of one contentious resource, these partnerships are entrenching, and in some instances expanding, apartheid-associated boundaries and configurations of power. The state and corporate task of producing communities amenable to biodiversity commercialization and conservation is entangled with segregationist laws and spatial planning. Rather than exclusion and the closure of ethnic boundaries, resource rights in this context foreground forced enrollment and the expansion of indigenous group-membership as modes of capitalist accumulation in an extractive economy.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Conflictor-In-Chief: President Trump’s Many Conflicts of Interest

by Craig Klugman, Ph.D.

Every year, my university requires me to file a conflict-of-interest (COI) statement. I had to ask the COI committee for permission in order to use the ethics textbook that I edited for my classes (since I do not receive any residuals on it, there’s no conflict, but had I received money for each sale, I would have). When I give a talk to a national professional group I have to list honorariums for talks and consulting. I even have to report if my spouse has any positions, grants, or funding from a company that could potentially compromise my objectivity. If I had children, the rule would also apply to their investments and connections. The goal is transparency—in the absence of avoidance, that such conflicts are acknowledged and broadcast. Such rules also apply to most elected officials at all levels. However, the election of Trump has raised the question of avoiding and acknowledging conflicts of interest to a new height.

Consider that in a 60 Minute interview on Sunday, Ivanka Trump wore a bracelet. After the broadcast, her marketing group sent out a message that the bracelet was part of her personal jewelry line and could be purchased for $10,800. If you liked the dress she wore at the RNC convention this summer, then you are out of luck. The dress was part of her line of clothing and is sold out at Macys and Nordstroms. Her national stage has turned into free advertising.

Donald Trump has said that he will turn over his business interests to his children.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.