Disclaimer: I just submitted this as my weekly post to the discussion board a global health ethics class that I’m taking at Duke University…so forgive me if you’ve already seen it there. This post is a follow-up to the previous (and much more coherent) piece about reading Partner to the Poor: A Paul Farmer Reader, which I do highly recommend. I’d love to hear your thoughts about these issues, or any others (including whether you liked the book!!).
Paul Farmer is very clear about where he stands: health is a human right, and both physicians and states are morally obligated to do all within their power to combat illness and disease, even if it will bankrupt them in the process (although he argues that it will not). However, some would argue that Farmer is overstepping the boundaries of what constitutes ethical behavior by pushing us from “treating others as we would want to be treated” to “treating others as they want to be treated”—that is, a shift from merely leaving others to their own affairs to actively getting involved to do something for/with others. Part of the danger then with Farmer’s argument is how far do we take this—was the 2003 invasion of Iraq ethical because we were ostensibly “protecting the rights of citizens”? Is there an ethical obligation to get involved militarily in North Korea? Does this include ignoring national sovereignty in the interest of best serving the people of a country (who constitutes “the people”?)? Is there a point where this type of interventionism becomes paternalistic and just a 21st century version of “the White Man’s Burden”?
Furthermore, Farmer is highly critical of medical ethics boards, which he argues overlook basic moral tenets. The examples he cites certainly make this seem the case. But if so, how did/do we allow researchers to become so removed from the humanity of their “guinea pigs” that these types of things happen? I would argue that the proverbial “Ivory Tower” is not filled with sociopaths, so then how do we explain the disconnect? Is it the structure of grant proposals and journal articles—e.g. the conventional formality of such writings force a dehumanization of the subject in order to facilitate a sufficiently scholarly write-up and discussion? But more importantly, once we identify the problematic structures that convert academia into a “human rights violator” (defining “human rights” broadly, as Farmer does) how do we address them in a way that keeps academia effective (I struggle to say impartial here because I personally have yet to see a truly impartial piece of scholarship)?