Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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442 Surgery and Healing in the Developing World
other people, students or other graduate health care givers, who join me in treating
people across very large gulfs in economics, technology, religious, language, education,
social and political boundaries. I have both practiced treatment, and sometimes
reported the results of my observations in so doing on how treatment modified
both the treater and treated.
At least one of these reports recently published has drawn a considerable storm
of protest as to the methods and permission of treatment of a group I had represented
as my intended beneficiaries in a medical aid project in Central Africa. After
an initial acceptance with some enthusiasm for the intent and effect of the proposed
health care intervention, a minority opinion was raised, not once, but on three
consecutive peer reviews. The opinions of the demurring reviewers can be taken
from the titles “Moral Maladaptation” and “Medical Imperialism” of editorial opinions,
claiming higher authority, quoting Nuremberg Trial principles and international
political processes in organizations with or without the imprimatur of the
United Nations. These ethicists made the claim that another universally accepted
form of “due process” was not followed or was unacceptably modified in the constraints
of the conditions under which the treatments were conducted. It is true that
the majority of the reviewers found the reports acceptable and some even thought
the process described might explain elements of human species development and
differentiation. The misunderstanding or misrepresentation of the “undertaking to
treat” had given me pause, however, to reconsider by what right we might ever
undertake to intervene in the circumstances of another, and endeavor to take it
upon ourselves “to treat” when nearly all such treatment would involve quite different
“others,” and a nearly inevitably wide gulf across which advocacy must function
with imperfect information and limited understanding.
How might the Human Sciences help to illumine this controversy and prevent
the theoretic paralysis that might otherwise lead to practice solipsism?
Theory Constraining Practice
Practice patterns have evolved over time to describe, and then prescribe ethical
behavior of those who treat others. These principles have been encoded in such
supra-statal professional creeds as the Hippocratic oath, or a methodology known in
anthropology as participant observation, or in Kantian ethics as treating all subjects
as entities who are not means toward some end but an end in themselves with applications
of any actions based in generalizable principles one might wish to have acted
upon in one’s own treatment. This may be simplified in the Golden Rule. As generalizable
as such a first principle might be, it might be caricatured in some extraordinary
real-world circumstances: “I want to treat as I might wish to be treated, if only
I were not sick and starving just now as you seem to be.”
The fundamental modification of the observed means that even the allegedly
noninterventive practice of participant observation can come under considerable
critical pressure for interference in the lives of those observed. The somewhat contrived
controversy over the genetic research among the Yanomami Indians that has
recently embroiled many institutions has resulted in the reexamination of similar
questions of the ethics of anthropologists’ behavior in ethnography alone, if not in
directly invasive actions into the lives of the communities under observation.
The paternalistic assumption that we, older, perhaps, at least more knowledgeable
if not wiser heads know what is best for not just individuals, but whole populations,
underlies quite a number of actions taken in public health, with even some
recent authors alleging that there has been a failure of trust in not taking the impera-