Medicine and Morality

As those of you following me on Twitter may have noticed, I spent much of the past month writing a draft of a scientific paper about some of my research. When there’s a finished, public version of it, I will definitely post a link! For now, though, I want to talk a little bit about one of the major themes that I developed there: morality and medical care.

First, it’s worthwhile to unpack the word “morality.” A quick Google search brings up the following definition for morality: “principles concerning the distinction between right and wrong or good and bad behavior; a particular system of values and principles of conduct, especially one held by a specified person or society; the extent to which an action is right or wrong.” Morality, according to Google, is mainly about determining what is right and wrong. It has a strong normative dimension. In other words, it’s not just that thinking about “morality” means thinking about right and wrong, good and bad; anyone with common sense knows right is better than wrong, good is better than bad. Talking about the morality of an action or person often means praising them for good values and actions or condemning them for causing harm or living in a way others disapprove of. It’s obvious to most people that there’s a “right” way to behave – a moral course of action – though the precise standards of right and wrong can vary from person to person.

Anthropologists who study morality mean something a little bit different when they use this word. For one, they try to avoid the normative dimension. Since anthropologists have historically studied cultures very different from their own with very different traditions and often different moral codes, they tend to shy away from making pronouncements of right and wrong. This is especially the case when they’re talking about small-scale communities with whom they have had extensive personal contact.

Second, they tend to be interested in how morality is embedded in cultural traditions and ways of living, in legal and bureaucratic procedures, and in small, ordinary interpersonal interactions. They tend to be wary of studying formal moral codes (like the Hippocratic Oath in medicine) on their own because their research methods prioritize experience living in a culture over taking someone’s word that they live in in a particular way. An anthropologist might also be interested in how and in what situations people in a society quote from a formal moral code like the Hippocratic Oath because it shows how such a document plays a role in real-life social interactions.

Instead, the study of morality for anthropologists is the study of how (typically human) life takes on value greater than the ability of an individual to do their job or fulfill their role in society. This is not a great definition, but it’s the best I can come up with. As far as I can tell, there IS no good definition of “morality” in the recent burst of anthropological research on the topic.

Maybe it helps to think with an example. One area of research where morality is important is research on end-of-life care. In many contexts, death marks the moment when an individual stops being a member of human society and moves into the realm of memory or spiritual afterlife. A doctor or an ethicist might pose the question, when is it alright to let someone with a terminal illness die? What signs and symptoms need to be present? What kind of consent (from the patient) or assent (from the family) should be sought if ending medical treatment will bring on the end of life? These are questions of right and wrong, both in the eyes of the family, patient, and doctor (no one wants to feel like a murderer), and in the eyes of the law (no one wants to get sued).

An anthropologist watching this situation would think about how a long-term illness might have reorganized family and social life to provide more resources and support for the dying person. What are the financial resources that have supported this person through their illness, and who in their family or social circle felt close enough to contribute in this way to their care? How have people rearranged their other commitments – job, community activities – to become caretakers, and how has this disrupted the social life of their communities? What values and ideas about health, sickness, and death do people use to make sense of what’s going on, and how does this episode challenge or confirm them?

In other words, the anthropologist is not just concerned about when to decide to end life; she is concerned with how the entire process of dying has changed everyday social, spiritual, and economic realities for the dying person’s entire social circle. By tracing one or more of these threads, the anthropologist can learn about how much money and time is thought to be appropriate to spend with end of life care, or how dying can strengthen and weaken different social bonds, or how death is the outer border of human society. These are moral questions because they are questions about an individual’s value in society, and how that value is made and realized through interactions with others.

Morality obviously has a role to play in medical care. Providing appropriate medical care can be the deciding factor between life and death – between active membership in society and existence in memory or an afterlife. Certain objects, like the ventilators sometimes used in critical care and at the end of life, force these questions into the foreground. In allergy, epinephrine auto-injectors play this role, too, since timely administration can buy precious minutes to get to the hospital for more extensive treatment.

Do you have questions, or tips to clarify the definition I’ve proposed for morality? Where are some places where morality (in the sense I’ve described) crops up in medical care in your experience? How can this expanded, non-normative way of thinking about morality help the delivery of medical care for allergy and asthma?

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