Table Of ContentSOCIAL SCIENCE PERSPECTIVES ON MEDICAL ETHICS
Culture, Illness, and Healing
VOLUME 16
Editors:
MARGARET LOCK
Department ofH umanities and Social Studies in Medicine,
McGill University, Montreal, Canada
ALLAN YOUNG
Department ofH umanities and Social Studies in Medicine,
McGill University, Montreal, Canada
Editorial Board:
LIZA BERKMAN
Department of Epidemiology, Yale University,
New Haven, Connecticut, U.sA.
RONALD FRANKENBERG
Centre for Medical and Social Anthropology, University of Keele,
England
ATWOOD D. GAINES
Departments ofA nthropology and Psychiatry, Case Western Reserve
University and Medical School, Cleveland, Ohio, U.S.A.
GILBERT LEWIS
Department ofA nthropology, University of Cam bridge,
England
GANANATH OBEYESEKERE
Department ofA nthropology, Princeton University,
Princeton, New Jersey, U.SA.
ANDREAS ZEMPLENI
Laboratoire d' Ethnologie et de Sociologie Comparative,
Universite de Paris X, Nanterre, France
SOCIAL SCIENCE
PERSPECTIVES
ON MEDICAL ETHICS
Edited by
GEORGE WEISZ
Department of Humanities and Social Studies in Medicine,
McGill University, Montreal, Canada
KLUWER ACADEMIC PUBLISHERS
DORDRECHT / BOSTON / LONDON
Library of Congress Cataloging in Publication Data
Soclal Science perspectives on medical ethics I edited by George
Weisz.
p. cm. -- (Culture, illness, and healing; v. 16)
Based on a conference held at McGill University in 1988.
Includes bibl iographical references.
1. Medical ethics--Congresses. 2. Medical ethics--Social aspects-
-Congresses. I. Weisz, George. II. Series.
R724.S596 1990
174' .2--dc20 89-24626
ISBN-13: 978-94-010-7361-5 e-ISBN-13: 978-94-009-1930-3
DOT: 10.1007/978-94-009-1930-3
Published by Kluwer Academic Publishers,
P.O. Box 17,3300 AA Dordrecht, The Netherlands.
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TABLE OF CONTENTS
CONTRIBUTORS
VII
ACKNOWLEDGEMENTS xi
GEORGE WEISZ / Introduction 3
PART I: CLINICAL ENCOUNTERS OF THE ETHICAL KIND
IAN ROBINSON / Clinical Trials and the Collective Ethic: The Case of
Hyperbaric Oxygen Therapy and the Treatment of Multiple Sclerosis 19
JOSEPH M. KAUFERT AND JOHN D. O'NEIL / Biomedical Rituals and Informed
Consent: Native Canadians and the Negotiation of Clinical Trust 41
ALLAN YOUNG / Moral Conflicts in a Psychiatric Hospital Treating
Combat-related Posttraumatic Stress Disorder (PTSD) 65
CHARLES W. LIDZ AND EDWARD P. MULVEY / Institutional Factors Affecting
Psychiatric Admission and Commitment Decisions 83
PART II: ETHICS IN THE PUBLIC ARENA
MARGARET LOCK AND CHRISTINA HONDE / Reaching Consensus About
Death: Heart Transplants and Cultural Identity in Japan 99
PATRICIA A. KAUFERT / Ethics, Politics and Contraception: Canada and the
Licensing of Depo-Provera 121
PART III: THE INSTITUTIONS AND IDEOLOGY OF MEDICAL ETHICS
GEORGE WEISZ / The Origins of Medical Ethics in France: The International
Congress of Morale Medicale of 1955 145
MARGARET STACEY / The British General Medical Council and
Medical Ethics 163
VI TABLE OF CONTENTS
DAVID J. ROTHMAN / Human Experimentation and the Origins of
Bioethics in the United States 185
RENEE C. FOX / The Evolution of American Bioethics: A Sociological
Perspective 201
PART IV: MEDICAL ETHICS AND SOCIAL SCIENCE
RICHARD W. LIEBAN / Medical Anthropology and the Comparative Study
of Medical Ethics 221
BARRY HOFFMASTER / Morality and the Social Sciences 241
BRUCE JENNINGS / Ethics and Ethnography in Neonatal Intensive Care 261
BIBLIOGRAPHY I / Book-length Works Reflecting or Relevant to Social
Science Perspectives on Medical Ethics 273
BIBLIOGRAPHY II / Selected List of Book-length Works on or Basic to
Medical Ethics 281
AUTHOR/NAME INDEX 285
SUBJECT INDEX 291
NOTES ON CONTRIB UTORS
Renee C. Fox is Annenberg Professor of the Social Sciences at the University of
Pennsylvania. Among her books are (with Judith Swazey) The Courage to Fail: A
Social View of Organ Transplant and Dialysis (1974), Essays in Medical
Sociology: Journeys into the Field (1979), and The Sociology of Medicine: A
Participant Observer's View (1989). She is currently completing a book based on
many years of first-hand research in Belgium and Zaire. Mailing Address:
Sociology Department, 3718 Locust Walk, Philadelphia, PA, 19104-6299.
Barry Hoffmaster is an Associate Professor in the Department of Philosophy and
the Department of Family Medicine at the University of Western Ontario,
London, Ontario, N6A 3K7. His main areas of interest are medical ethics, moral
philosophy, and philosophy of law. With Ronald Christie he is the author of
Ethical Issues in Family Medicine (1986). He currently is completing an
international study of the ethical decision-making of family doctors in Canada,
the United States and Britain.
Christina Honde received her B.A. from the University of California, Berkeley.
During twenty years' residence in Japan, Ms. Honde worked as an interpreter,
translator, and language teacher, and assisted with research in medical anthropol
ogy. She is presently employed as an interpreter, and is working with a Japanese
psychiatrist on a translation of his work into English.
Bruce Jennings is Associate for Policy Studies at the Hastings Center, 255 Elm
Road, Briarcliff Manor, New York, N.Y., 10510. He has published extensively on
topics involving the role of ethics in public policy. Among his recent books are
The Ethics of Legislative Life (1985) and the anthology (with Daniel Callahan)
Ethics, the Social Sciences, and Policy Analysis (1983).
Joseph M. Kaufert is a Professor in the Department of Community Health
Sciences at the University of Manitoba, 750 Bannantyne Ave., Winnipeg,
Manitoba, R3E OW3. He is a Medical Anthropologist who has published widely,
most recently in Sociology of Health and Illness and Social Science and
Medicine. He is currently engaged in ethnomedical research on medical interpre
ting and renal disease among Native Canadians and sociological research on
aging with a disability and impact of life support technology.
Patricia A. Kaufert is Associate Professor in the Department of Community
Health Sciences University of Manitoba, 750 Bannantyne Ave., Winnipeg,
Manitoba, R3E OW3. She has published numerous articles about women's health
vii
VllI NOTES ON CONTRIBUTORS
issues, most recently in Social Science and Medicine, Maturitas and Culture,
Medicine and Psychiatry. She is currently investigating childbirth and mid-life
among Inuit women.
Richard W. Lieban is Professor Emeritus of Anthropology at the University of
Hawaii at Manoa, 2424 Maile Way, Porteus Hall 346, Honolulu, HI, 96822. He is
the author of Cebuano Sorcery (1967, paperback reprint 1977) and of many
articles, most recently in Culture, Medicine and Psychiatry.
Charles W. Lidz is Professor of Psychiatry and Sociology and Associate Director
for Research Administration of the Center for Medical Ethics at the University of
Pittsburgh. His research includes descriptive studies of: informed consent proce
dures in medical care, how psychiatrists assess risk to others, and the effect of
nursing home organization on patient autonomy. His most recent book is
Informed Consent, Legal Theory and Medical Practice (1987). Mailing Address:
Department of Psychiatry, 3811 O'Hara Street, Pittsburg, PA, 15213-2593.
Margaret Lock is Professor of Medical Anthropology at McGill University. She
is the author of East Asian Medicine in Urban Japan (1980), and editor (with
Edward Norbeck) of Health, Illness and Medical Care in Japan (1987) and (with
Deborah Gordon) of Biomedicine Examined (1988). Her research interests are in
the anthropology of the body, the cultural construction of life-cycle transitions,
and comparative medical systems. Mailing Address: Department of Humanities
and Social Studies in Medicine, 3655 Drummond Street, Room 416, Montreal,
P.Q., H3G 1Y 6.
Edward P. Mulvey is Associate of Child Psychiatry at the University of
Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburg, PA, 15213-2593.
His research interests are primarily focused on the use of clinical discretion in
social control agencies such as the juvenile court and mental hospitals.
John D. O'Neil is an Assistant Professor of Medical Anthropology in the
Department of Community Health Sciences, University of Manitoba, 750 Ban
nantyne Ave., Winnipeg, Manitoba, R3E OW3. He has published numerous
articles, most recently in Human Organization and Medical Anthropology Quar
terly.
Ian Robinson is Director of the Centre for Research in the Sociology and
Anthropology of Medicine and Health at BruneI, The University of West London,
Oxbridge, Middlesex, U.K., UB8 3PH. After obtaining degrees in sociology at
Nottingham University, England, he has pursued research on a range of issues in
medical sociology, focusing particularly on chronic illness. His most recent book
is Multiple Sclerosis (1988).
NOTES ON CONTRIBUTORS ix
David Rothman is Bernard Schoenberg Professor of Social Medicine and
Director of the Center for the Study of Society and Medicine at Columbia
University, College of Physicians and Surgeons, 630 West 168th Street, New
York, N.Y. 10032. Among his books are The Discovery of the Asylum (1971),
Conscience and Convenience: The Asylum and its Alternatives in Progressive
America (1980) and (with Sheila Rothman) The Willowbrook Wars (1984). He is
completing an analysis of the origin and implications of the new regulation of
medical decision-making.
Margaret Stacey is Emeritus Professor of Sociology at the University of
Warwick, Coventry, U.K., CV4 7AL. She graduated from the London School of
Economics in 1943. Among her publications are Tradition and Change: A Study
ofB anbury (1960), Women, Power, and Politics (1981) (with Marion Price) which
gained the 1982 Fawcett Prize, and The Sociology of Health and Healing (1988).
She is currently writing up her research on the General Medical Council (to be
published by Wiley Medical).
George Weisz is Professor of the History of Medicine at McGill University. He is
the author of The Emergence of Modern Universities in France 1863-1914
(1983), and editor (with Robert Fox) of The Organization of Science and
Technology in France 1808-1914 (1980). He is currently completing a book about
the Academy of Medicine and the medical elite in 19th-century France. Mailing
Address: Department of Humanities and Social Studies in Medicine, 3655
Drummond Street, Room 416, Montreal, P.Q., H3G lY6.
Allan Young wrote this essay while Professor of Anthropology at Case Western
Reserve University. He now holds the same position at McGill University. He has
conducted ethnomedical research in Ethiopia, Nepal, Israel and the United States.
His recent work has been published in Medical Anthropology Quarterly, Culture,
Medicine and Psychiatry, and the Annual Review of Anthropology. He is now
working on a book on the cultural construction of Posttraumatic Stress Disorder.
Mailing Address: Department of Humanities and Social Studies in Medicine,
3655 Drummond Street, Room 416, Montreal, P.Q., H3G lY6.
ACKNOWLEDGEMENTS
The editor of any collective volume accumulates a great many intellectual debts.
The chief ones, undoubtedly, are to the contributors. Let me here express my
gratitude to my fifteen co-authors for producing the contents of this book and,
more personally, for the ideas and stimulation which they have provided. I also
owe very special thanks to my colleagues in the Department of Humanities and
Social Studies in Medicine, Don Bates, Margaret Lock, and Ted Keyserlingk,
who were a constant source of ideas and advice and who allowed me to
monopolize a disproportionate share of departmental resources while I prepared
this volume. Our shared experience of interdisciplinarity has shaped the intellec
tual vision which gave rise to this book.
I would not have survived the arduous experience of editing an interdiscipli
nary (and intercontinental) volume without the cheerful and very capable
assistance of Elsbeth Heaman. I would like to express my thanks to her and to
John Roston and Alexandra Doroschin of McGill's Instructional Communications
Centre for producing the printed text with amazing speed. I would also like to
thank Miriam Zehavi for typing endless streams of editorial revisions and Harvey
Blackman for preparing the index.
This book grew out of a conference held at McGill University in 1988. I would
like to take this opportunity to thank all those who participated, particularly my
colleagues in the McGill Centre for Medicine, Ethics and Law, for teaching me
much of what I know about the subject of this volume.
In preparing that meeting, I received organizational assistance of a very high
calibre from Pam Dunk. That this conference took place at all is due in large
measure to Dean Richard Cruess of McGill's Faculty of Medicine who intervened
at a crucial moment to ensure funding. Even more important, Dean Cruess has
over the years, and in spite of an environment of economic austerity, made the
McGill Medical Faculty a place where both the social sciences and medical ethics
could flourish.
I also gratefully acknowledge the generous financial support for the confer
ence provided by the J.W. McConnell Family Foundation, the Social Sciences and
Humanities Research Council of Canada, McGill's Faculty of Graduate Studies
and the British Council.
Finally, I would like to express my very special thanks and my love to Zeeva,
Talia and Jonathan who put up with my absences and, worse, my frequently
preoccupied presence, while helping me get through the more difficult moments
in the production of this book.
George Weisz
xi
