EASA, 2006: EASA06: Europe and the world
Bristol, UK, 18/09/2006 – 21/09/2006
Anthropology of biopolitics and moral choices
Location Wills 3.23
Date and Start Time 19 Sep, 2006 at 11:30
Governments and social institutions take decisions about life and death at different levels. What kind of tools does anthropology have to describe the moral dimension of these biopolitical choices?
Governments and social institutions take decisions about life and death and implement public policies based on them. They focus on private life, procreation, consumption, environment, the use of the human body and body parts for research, etc. These policies take various shapes, from mere publicity campaigns organised to make people aware of a health risk to new legislation. They can also use the social security system in order to favour or reject some individual behaviours and choices. This workshop aims to describe these decisions on life and death considered as moral choices. It has a special interest in the various institutions and actors involved in the decision-making process: on the one hand, governmental and legislative bodies, safety agencies, ethical committees and hospitals, and on the other hand, civil servants, lawyers, consumers, patients and associations. It also deals with the way public powers handle these actors, their claims and the various manners in which they address them. In addition, this workshop intends to examine what kind of fieldwork can be done on such moral choices: does the anthropologist have to negotiate his/her presence and the results of his/her enquiry? How does he/she get accepted in the institutions mentioned above, some of them being partly determined by a culture of secrecy (medical or political)? What are his/her conceptual tools to describe the moral choices about life and death at stake in the various biopolitics? Finally, this workshop would like to raise the question of the relationship between anthropology and morals. It rejects the opposition between the claim for universal moral values and the relativist conception of moral choices, it wants to concentrate on the specific dimension of each situation and the various types of constraints inherent to them, and it develops an interest in the way moral values about life and death are expressed in ordinary actions about extraordinary issues.
How to implement a 'moral biopolitics': a French experience of clinical ethics practice ?
For four years, an experimental structure has been developing an activity of « clinical ethics » within one of the public hospitals of Paris, the hospital Cochin. This structure, the Center for clinical ethics, is implemented in order to answer queries for an ethical advice, whether coming from medical teams, patients or their proxies. These queries arise when a medical decision must be taken while raising a particular ethical problem that cannot be solved through a refinement of the medical analysis. The Center for clinical ethics only deals with the queries when each participant to the decision (physicians, patients, proxies) agree with the principles of explaining their moral point of view and hearing the various moral options at stake within the decision.
Created in the wake of the law on patients' rights (2002), the Center for clinical ethics is conceived as a way to contribute to the implementation of this law and more generally speaking to the development of the "démocratie sanitaire". The "démocratie sanitaire", though promoted first by leftwing political parties, has become today a consensual way to conceive the French health public policy and is very much supported by citizens themselves, whether individually or through various associations.
We are interested in the way the Center for clinical ethics has been conceived by its creator and present director as a tool of this French biopolitics. Two elements are decisive in this perspective. On the one hand, the "staffs" during which the queries are discussed, taking place every two weeks, are an essential place to observe how the Center for clinical ethics intend to achieve these goals. On the other hand, one is not to neglect the educational program created by the Center to give the adequate competences to the people participating in these "staffs" and develop a team spirit. One thing that is particularly interesting for our study is how these members have assimilated and accepted a methodology to deal with ethical problems first elaborated abroad, in the United States, and how this methodology has been converted to implement a biopolitics within the French health system and its social and cultural context.
In this paper, we intend to develop an ethnographic approach and we'll comment the specific position occupied for two hears and a half in order to get the necessary material to the description and analysis of this "moral biopolitics" (an "insider" position).
The (moral) sound of silence: acceptance of and resistance to genetics research in Southern Italy
My presentation focuses on the moral dimensions of a genetics research study now in its sixth year of development in Southern Italy. The area is called "Parco Nazionale del Cilento e del Vallo di Diano" and it is in the south of Naples (it is included in UNESCO "heritage of humanity" list and in UN "Man and Biosphere" programmes). It has given the name to the research project, "Parco Genetico del Cilento e del Vallo di Diano". The research project forms part of the worldwide genetics research on "isolated human populations" and started in 2000. It has involved fieldwork in 12 municipalities within the Park and aims at finding relations between some diseases and genes by crossreferencing genealogical, medical and genetic data. Besides this "global" setting, the project seeks to actively involve local populations and institutions.
My research on this project revolves mainly around one question: how and to what extent is moral discourse part of the transaction between researchers and locals? "Values" are by all means relevant in the negotiation of involvement and resistance. Yet the "global assemblage" seems different from what has emerged in previous researches of the same kind, namely in the Iceland case. Indeed, initial data do not show the wider national and local debates registered in Iceland, and in Cilento local subjects take for granted their role as objects of research.
Pálsson and Rabinow asked why biomedical issues become bioethical problems. Conversely, my question is: why don't biomedical issues become explicit and public bioethical problems? Although clearly focused on the Southern Italy case, my research thus implies a strong comparative approach.
The morality of family planning in Brazil: between biopolitics and social inequalities
In this presentation I will examine family planning politics in Brazil as bio-politics. Through the presentation of some ethnographic data from my fieldwork in Salvador de Bahia I will discuss the moral dimensions of these politics from the discourses of different actors, in particular doctors working in public family planning centres and their patients.
In Brazil the first family planning programs have been carried out by International Agencies and national private Institutions since the second half of the Sixties, during the Dictatorship (1964-1984), through the diffusion of two main contraceptives: the pill and women's sterilization. In 1991 the rate of women who had been sterilized was so high that a Parliamentary Commission was formed and a federal law finally established some limits of age and the impossibility of practicing sterilization and the Caesarian at the same time. The family planning programs developed before the law were defined as neo-malthusian birth-control programs and new public programs were carried out, including programs for the prevention of HIV and STD. However even now sterilization is the contraceptive most used in the country. At the same time abortion, which is illegal, is still one of the main causes of motherly death, especially in poor regions like Bahia. What kind of moral values concerning sexuality, parenthood and gender are at stake here? Do we have to consider other issues, as class and race, to understand the contemporary debate about family planning in Brazil? Can we talk about bio-politics in this context?
Medical paternalism and the limits of biopolitics: how childhood confronts AIDS in Uruguay
The notion of biopolitics, in its original sense, as the investment into life through and through, creating human matter and thereby subjectivities that correspond to new modes of self-government, does not apply to every public health setting. Although HIV/AIDS prevention, based on transnational institutions and development organizations, can be understood as a global biopolitics, national variants do not necessarily comply. Public health in Uruguay, which is almost entirely populated by European immigrants, does not follow this enlightenment project. Autonomy and individual behavior change among families living with HIV/AIDS is not promoted by an "empowerment" approach that either boosts individual responsibility or claims social and economic rights. In the face of medical institutions all people living with HIV/AIDS turn into children tutored by an omnipotent physician-father. New subjectivities based on self-government are not induced by a state organized biopolitics but rather through resistance against medical paternalism. Taken the severity of the disease, this resistance is maladaptive and frequently results in the death of the protagonists. Biopolitics starts with the management of potential orphans that become the object of state intervention. Looking at the international Convention on the Rights of the Child a fundamental contradiction of the enlightenment project becomes salient: How to mediate autonomy and dependency? Who is responsible for children's rights in the face of death?
Implemented biopolitical choices and moral dilemmas: the case of Thalassaemia
This presentation aims to discuss the issues raised within the interests of this workshop by drawing from research carried out in Greece focusing on the genetic (chronic) condition of Thalassaemia, a hereditary condition with high prevalence of heterozygotic carriers in various areas around the Mediterranean. This case study is believed to be an exemplary of policies being implemented, policies based on decisions about life and death carried out by various governmental and social institutions. In the case of Thalassaemia, thalassaemic patients, medicalised from the very onset of their lives, deal with such decisions in multiple ways, when dealing with therapies, current and future ones, blood transfusions or the welfare system. On top of all such decisions, acting also as a kind of framing device, stands the National Prevention Program for Thalassaemia, active since the '80s (involving testing and counseling of carriers-couples usually prior reproduction choices), a paradigmatic realization of the decision that no more people with Thalassaemia should be born, (since the choice has been made regarding the "abnormality" of Thalassaemia, no more births would contribute to the "genetic normalcy" of the population). This decision, whether presented as a moral choice or not has been normalized-routinized and currently doesn't embody any kind of a moral dilemma at least on the level of the official decision-making involving key-actors and institutions. By focusing on the actual patients -Thalassaemic sufferers-, representing also the "last generation of Thalassaemic sufferers" this research highlights the way such decisions/moral choices are appropriated by those that embody in all respects exactly that which was decided/ chosen to be avoided or in other words, not to exist. In what occasions and serving what purposes is the moral dimension of such decisions "remembered" or brought to the surface? In what occasions the bringing forward of the moral character of such decisions allows and enables the transformation of such moral choices once again to moral dilemmas?
Food security as a moral dilemma: interest of the public vs. interest of the market
This paper starts from an ethnographic enquiry on the French Food Safety Agency (AFSSA), and raises issues of moral choices in the domain of the gestion of risks, generally conceived as biopolitical. Experts gathered by the AFSSA have to produce an independant and transparent collective expertise on alimentary risks, while working privately for food companies as scientific advisors. How do they cope with this double position, and how do they follow the constraints of the two situations ? The AFSSA has codified this dilemma through the declaration of conflict of interest ; but what does it mean to serve both the interest of the public and the interest of the market, and to what extent can it be declared ? To understand the moral dilemmas that experts have to face, it is necessary to go back to the creation of the AFSSA at the time of mad cow disease : under the head of the principle of precaution, decisions were taken by politicians relying on experts to avoid the contamination of consumers by prions, that went against the interests of the market (the most strinking being the destruction of cattle suspected). How far is it possible to describe the daily moral constraints of experts by reference to a state of exception in which moral choices became particularly stiff ?
Besides this general question, that concerns the link between science, economics and morals, two methodological questions will be adressed. First, how is the ethnographer to engage his participant observer situation, that is, to what kind of interest is he suspected to be linked ? Second, can concepts of Durkheimian sociology, such as sacred, contagion and participation, be used to describe the mental and moral constraints of the codification of food, in a biopolitical situation that recasts and transforms the anthropological problems raised by religion in other societies ?