These principles are generally accepted by anthropologists, but not without debate, discussion, challenges, and recommendations for revision to make these guidelines more (or less) compatible with both national and international formal ethical principles and guidelines. One of the critical trends in the debate is the ongoing tension in applied medical anthropology between science and humanism, between positivism and other more interpretive paradigms, and between modernism (especially the concept of progress and the concept of universalism) and post-modernism (especially the concepts of cultural particularism, cultural relativism, and constant cultural constructions).
A large number of the current ethical problems medical anthropologists face result from the unanticipated consequences of multidisciplinary research designs where there are competing ethical frameworks from disparate disciplines. Others result from the unfortunate clash of two positive ethical principles. These are labeled as ethical dilemmas; a situation where two or more of the basic ethical principles are in conflict, and where adherence to one of the principles may violate another (see Singer et al. 1999; Whiteford and Trotter 2008). For example, medical anthropology researchers promise confidentiality to each and every person they interview, and promise to protect any information they provide (such as their health status). But they also promise to limit any harm that might result from participation in the research, to every participant. As a consequence, they are faced with the dilemma of what to do if a married couple is enrolled an AIDS prevention project, and they find out one partner is HIV positive and is having unprotected sex with their uninfected partner but is not telling the other that they are living with an infected person. There is a clear conflict between the two principles of confidentiality and do no harm for the project. In this kind of situation, the researcher may have to decide if they have a greater obligation to protect confidentiality, or to prevent harm to the uninfected person. Preventing harm may help the one individual, but breaking confidentiality may harm the entire project, since anyone who heard about the breach would either quit the project or would not participate. There are times when the researcher is forced to decide which of two ethical principles takes precedence in a particular research situation, and the choice of one principle causes the other principle to be violated in some minor or major way. A practical guide for practicing anthropologist who inevitably encounter these types of ethical dilemmas before, during, and after field research and data collection use the Whiteford and Trotter (2008) ethical workup guide/procedure to reduce unintended ethical consequences.
CONCLUSION
While the application of medical anthropology theory and methods continues to grow at a rapid pace, in many ways, the distinction between applied medical anthropology and any other form of medical anthropology is a false dichotomy, or an unnecessary distinction. All forms of medical anthropology are framed by the key cultural theoretical (or a-theoretical) paradigms and are exploring strong positions within key cultural contexts (Page and Trotter 1999). The methods that are used to create, assess, expand, challenge, or demolish existing theories are identical. Both approaches are susceptible to external debates and challenges of anthropology’s cross-cultural paradigms, and are susceptible to anthropology’s internal critiques, debates, and synthetic movements. Perhaps the single difference that is important to applied medical anthropologists, and to the communities they work with, and the sponsors for their projects is the fact that applied projects are deliberately targeted at solving problems, rather than simply producing cultural descriptions that may result in serendipitous or accidental or unintended consequences. This level of intentionality is important to many of the stakeholders that are engaged in improving the human health conditions on a local or global level.
NOTES
1 1 One of the key reasons that this section presents a general history of the development of ethnographic methods is because the current works do an excellent job of discussing theory and methods, but are missing most of the practical and pragmatic advice for rapport building, survival, and data management processes that are present in the earlier works. It is worth a little historical diving to find that advice. The earlier works are more student oriented, and the later works more professionally oriented.
2 2 This study, conducted by the World Health Organization, was designed to make the International Classification of Impairments, Disabilities and Handicaps cross-culturally applicable and to increase the utilization of the classification system for international health research.
3 3 Excerpts in this section and expansion of the ideas presented can be found in Linda Whiteford and Robert T. Trotter, II (2008) Ethics in Anthropological Research and Practice. Boston, MA. Wadsworth.
REFERENCES
1 Agar, M. (1980). Professional Strangers: An Informational Introduction to Ethnography. New York: Academic Press.
2 Anker, M. (1991). Epidemiological and statistical methods for rapid health assessment. World Health Statistics Annual (WHO) 44 (3): 94–101.
3 Aral, S.0. and Fransen, L. (1995). STD/HIV prevention in Turkey: Planning a sequence of interventions. AIDS Education and Prevention 7 (6): 544–553.
4 Askew, I., Tapsoba, P., Ouedraogo, Y., Viadro, C., Bakouan, D., and Sebgo, P. (1993). Quality of care in family planning programmes: A rapid assessment in Burkina Faso. Health Policy and Planning 8 (I): 19–32.
5 Assembly, UN General. (1948). Universal declaration of human rights. UN General Assembly 302(2):14–25.
6 Barnett, H.G. (1948). On science and human rights. American Anthropologist 50(2): 352–355.
7 Bentley, M., Pelto, G., Straus, W., Schumann, D., Adegboda, C., and de la Pena, E. (1988). Rapid ethnographic assessment: Applications in a diarrhea management program. Social Science and Medicine 27 (1): 107–116.
8 Bernard, H.R. (2011). Research Methods in Anthropology: Qualitative and Quantitative Approaches, 6th Edition Altamira Press.
9 Beteille, A. and Maden, T.N. (eds.) (1975). Encounter and Experience, Personal Accounts of Fieldwork. Honolulu: University of Hawaii Press.
10 Clatts, M., et al. (1996). Risk Behaviors among Injection Drug Users in New York City: Critical Gaps in Prevention Policy. Global AIDS Policy. Douglas A. Feldman, ed. Westport CT: Bergen and Garvey. Applied Medical Anthropology. 65.
11 Clatts, M., Davis, W.R., Deren, S., Goldsmith, D., and Tortu, S. (1996). Risk behaviors among injection drug users in New York City: Critical gaps in prevention policy. In: Global AIDS Policy. (ed. D. Feldman).
12 Corbin, J.M., and Strauss, A. (1990). Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative sociology 13(1): 3–21.
13 Dale, J., Shipman, C., Lacock, L., and Davies, M. (1996). Creating a shared vision of out of hours care: Using rapid appraisal methods to create an interagency, community oriented, approach to service development. British Medical Journal 312: 1206.
14 Eaves, E.R., Trotter, R.T. and Baldwin, J.A. (2020). Another silver lining?: Anthropological perspectives on the promise and practice of relaxed restrictions for telemedicine and medication-assisted treatment in the context of COVID-19. Human organization 79(4): 292–303.
15 Ensign, B.J. and Gittelsohn, J. (1998). Health and access to care: Perspectives of homeless youth in Baltimore City. U.S.A. Social Science and Medicine 47 (12): 2087–2099.
16 Epstein, A.L. (ed.) (1967). The Craft of Social Anthropology. London: Tavistock.
