Medical Anthropology – GMP 2020. 09. 23.

3rd year
Introductory Lectures

Bodnár János Kristóf

(PhD, MS Bioethics)

Alcím mintájának szerkesztése

Introduction into Medical Anthropology –

Culture and Values in Medicine
Medical Anthropology
 Etymology of the expression: Anthropos („human”)  Logos
(„talk”, „inquiry”, „science”, „truth”)
 Natural sciences aim to describe their subject matter in an
objective manner, as universal, value-free / culture-
independent things
 Is this approach applicable to the subject matter of medicine –
human beings and diseases?
 Objects here are subjects as well – interaction between investigation and
its „object”
 Universality vs. An anthropological / historical-hermeneutic
understanding of humans and societies
 Value-free vs. Trying to see how incorporating such values might yield a
better understanding of health and provide better healthcare
Medical Anthropology

Medical Anthropology is about:

1. How medicine as a ‚logos’ (a science, a narrative, a viewpoint

etc.) shapes/constructs human beings self-understanding and
identity

2. How it is shaped and constructed by the many other ‚logos’

(cultures as a whole, religion, values) it is embedded in.
Facts and Values – an Ethical Outline
The Values – are they True or simply Right?
Factual statements (empirical propositions) vs. Value Judgments (normative propositions) (Objectivists vs.
Pragmatists, Rorty)
Do they have truth-value (moral realism vs. noncognitivism)
How to ground, justify them? (Wittgenstein, Nietzsche)

The Is – Ought problem (Hume)

The Naturalistic Fallacy (Moore)
Hedonism, Religious Fundamentalism (Pro Life movements)

Can Science give Ethics to itself?

Healthism (Harris)
The problem of the Free Will
Determination of the End of Life
What is the ‚essence’ of human beings?
 1. Decomposition  „Bare life” (unintegrated) Artificial maintenance
of vital functions (artificial integration)Personhood
2. Criteria of death – Is it a medical (scientific) or mixed (philosophical,
anthropological and scientific question)?
3. Scientific inquiry (‚how?’) and philosophical examination (‚why?’,is
science capable to decide it?’)

Historical development of death-criteria:

• Somatic ones (breathing, heart-beat)  bypassing
• Neurological ones: ”bypassing brains?” (Transhumanism)
• 1968: Harward Brain Death Criteria, 1981: UDDA:
• „Irreversible cessation of either the cardiopulmonary functions or the
functioning of the whole brain (stem included)”
Determination of the End of Life
 1. Biological – philosophical idea behind it: „The time of the death is the
irreversible loss to carry out integrative functioning” – i.e. wholism
(Beecher)

 2. Problems: A: CNS is not the only integrator-organ! (see e.g. brain

dead bodies digest, maintain homeostasis, carry out a fetus, heal wounds
– Shewmon: Longest „survivals”)
Definition of the commission  Biological reality of death
B: Not appropriate clinical tests UDDA criteria

 2008 - 2009: President’s Council on Biethics: This ‚essence’ is the „vital

function of fundamental openness to respond to and affect the
environment”
 BUT! (Troug, Miller) „vital function” taken seriously higher-brain
standard (PVS patients) should be used – „Legal Fiction”
Determination of the End of Life
Philosophical debates (underdetermination): Equating life with
consciousness is a decision (1. Value - disagreement)
Neocortex-reductionism vs. Brain stem activity (2. Conceptual –
disagreement AND Scientific disagreement)
Irreversibility, recoveries, minimal consciousness: Grammatical vs.
empirical use of scientific claims (3. Scientific disagreement)

Ethical implications:

 It is rather a decision than a discovery, rather a process than an event

 Transplantation of vital organs (dead-donor rule vs. Heart transplant) and
choosing between cortical criterion vs. whole-brain New Jersey, Romania,
Japan – autonomy in and policies re. The acceptance of criterion of death
* It demonstrates the interrelatedness of science, law, religion and
philosophy!
Determination of the Beginning of Life
What is the essential part (e.g. an embryo lacks but a newborn possesses) of human
beings that deserves legal protection?

The liberal, conservative and middle-ground approach

1. Is it a medical (scientific) or mixed (philosophical, anthropological and scientific
question)?
2. How could it be proven? (E.g. this essential part could be reduced to the
development of certain vital organs/functions)

• E.g. even accepting consciousness-reductionism: How could such a subjective

phenomenon be determined by medicine alone?

• Symmetrization of brain-death

• Fuzzyness vs. Laws: After which point during the in utero development should a
fetus be conceived as having a moral / legal stance
Determination of the Beginning of Life
Abortion, Prenatal Genetic Diagnosis

Uncertainty about the social/cultural/religious acceptance :

• Liberalism and the Neutrality of the State ?

• It is not necessarily stemming from a medical approach
whether it should be accepted(feminism,population control)

PNGD, „backdoor to eugenics”, reproductive ethics

1. Should disease avoidance type of abortion after PGD be
comprehended as a form of ‚soft eugenics’? (aims vs.
methods)
2. Is disease so a value-free concept? (Disability rights
approach, social constructivism)
Religion and Medicine:
1. The cases of ‚wonderful recoveries’
 Could science / medicine prove/disprove the existence of
miracles? (Wittgenstein)
2. The cases of ‚prophets’:
 Would we /should we (retrospectively) label them as suffering
from mental disorders (schizophrenic)?
 Could / Should it be decided by means of medicine?
 Freud’s Reductionism