Saturday, March 30, 2013

Glass ceiling for developing world bioethicists?

The Journal of Bioethical Inquiry has recently published a Letter to the Editor entitled: Bioethics and Its Gatekeepers: Does Institutional Racism Exist in Leading Bioethics Journals? The authors have done an analysis of 14 leading bioethics journals in regard to the composition of their editorial and advisory boards. Their question was: how many editorial and advisory board members are located in countries ranked very high, high, medium or low in the Human Development Index? The answer is chilling: approximately 95 percent of editorial board members are based in (very) high-Human Development Index (HDI) countries, less than 4 percent are from medium-HDI countries, and fewer than 1.5 percent are from low-HDI countries. Eight out of 14 leading bioethics journal have no medium- or low-HDI country editorial board membership. Eleven bioethics journals in their sample of 14 have no board members from any low-HDI country.

How is this to be understood? The authors claim that the underrepresentation of developing countries on bioethics editorial and advisory boards suggests 'institutional racism' on the part of bioethics journals. This broadside misses the mark, for reasons other than the obvious, i.e. that membership in a developing country does not constitute membership in a 'race.' The barriers to professional advancement in bioethics are not (just) racial, and run deeper. The dominant educational centers for bioethics (as well as the journals) are in North America, Western Europe and Australia; many educational institutions in developing countries do not include (or barely cover) medical ethics, research ethics or public health ethics in their curriculum. The dominant language of bioethics is English, which poses linguistic problems for many.  In the current situation, those in the developing world who devote a substantive amount of their professional life in bioethics do so at their economic peril, unless they manage to combine it with a lucrative occupation. So the near absence of the developing world at the tables of bioethics editorial and advisory boards is not simply institutional racism on the part of those journals, but that for the most part (despite a number of educational initiatives) bioethics as a professional interest remains largely a mainstay of rich and powerful countries, despite their being no shortage of pressing and fascinating bioethical problems in low-resource settings.  

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Saturday, March 02, 2013

Judicial amputations in Sudan

According to news and NGO reports, a judicial cross amputation recently took place in Sudan. The cross amputation, in this case, was the amputation of a man's right hand and left foot. The man was charged with armed robbery, and this was part of his punishment. But amputation is usually a medical procedure, so it is suspected that health professionals and institutions were involved, more specifically doctors at Khartoum's Al-Ribat University Hospital.

Human rights groups and representative of medical associations are protesting this form of punishment as barbaric, and the involvement of medical practitioners in judicial amputation as reprehensible. Amnesty International calls the practice a clear violation of prohibitions against cruel and inhumane punishment. A spokesman for the World Medical Association said judicial amputation is contrary to their guidelines regarding physician participation in torture and ill-treatment of persons. Similarly, the British Medical Association issued a statement about the impermissibility of using clinical skills for non-clinical, judicial purposes.

The involvement of medical professionals in anti-Hippocratic activities -- in order to promote the morally questionable purposes of a state -- is fairly widespread. Judicial amputation is just a particularly vivid form. Less vivid, but no less questionable, is the involvement of physicians in capital punishment or 'harsh interrogations.' Anti-Hippocratic activities elsewhere may be regarded as a form of justice or justified by national interests closer to home.

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