In her article “The ‘We’ in the Me: Solidarity in the Era of Personalized Medicine,” Barbara Prainsack develops an earlier interest in the relationship between solidarity and autonomy and the way that these notions operate once passed through the lens of bioethical thought and practice. In his response to this article, Simpson introduces the perspective of two South Asian physicians on these issues. The piece highlights issues of personhood upon which the informed consent transaction is based and draws attention to (...) the culturally specific versions of how people conceive of relationality, duty, care, and the obligations they feel they owe to others. The piece highlights the pronomial shifts between the “we” and the “me” and the way that these dispositions emerge in sociopolitically configured spaces. By paying careful attention to the settings and situations in which the movements between different positions actually take place, the ways in which the fabric of ethical life is made rather than simply given is revealed. Ethnographic inquiry is seen as crucial in understanding this process because it points to disjunctions between the categories that we are provided to apprehend the world and what it is actually like to live in that world. (shrink)

Blood is now essential for a widening repertoire of therapies and with this comes new forms of regulation and governmentality focused on the collection, use and storage of blood. Here blood begins to lose its `natural' underpinnings as it is drawn into the realms of the synthetic and the scientific. However, this change in theoretical lens obscures the ways that, in practice, constructing a `modern' blood compatible with the demands of the global biopolis is elided with prosaic uses of blood (...) donation that convey powerful cultural and political messages at the local level. In a setting where, in recent decades, war, violence and the threat of social disintegration have been woven into the project of development and modernity, attempts at an alignment, or what might be characterized as the haemato-global assemblage, reveal significant tensions. The main one that I explore in this article is that between the aspiration to create an international blood donation service in which ideas of citizens and national solidarity are articulated through freely and altruistically gifted blood on the one hand and, on the other, the more potent and symbolically loaded ideas of blood, which come to the fore when connection and identity are threatened. (shrink)

In this article, the authors present an ethnography of biomedical knowledge production and science collaboration when they take place in developing country contexts. The authors focus on the arrival of international clinical trials to Sri Lanka and provide analysis of what was described as one of the first multisited trials in the country, a pharmaceutical company sponsored, phase 2, randomized, double-blind, placebo controlled trial carried out between 2009 and 2010. Using interviews with those who conducted the trial and six months (...) of participant observation at the trial hospital, the authors describe the work that goes on to perform trials according to international standards. The article describes what happens when a randomized controlled trial encounters existing epistemic virtues and documents the impacts on ideas of authority, expertise and doctor–patient relationships found in Sri Lankan medicine. (shrink)

This article is about the dream of a global bioethics. It touches upon some big issues concerning how progress in biomedicine and biotechnology might best be linked to justice and human flourishing in all parts of the world and not just in the global North. More specifically, however, it is about disappointment and regret when this dream is placed alongside the realities of living and working in a resource-poor setting in the global South. The essay focuses on a narrative account (...) of the work of an Indian medical educator and his efforts to embrace and promulgate the insights and benefits of bioethics in his own professional environment. It explores an individual biography in which intellectual frictions and... (shrink)

In Sri Lanka, termination of pregnancy, other than in extreme circumstances, is strictly illegal. Among the public and large sections of the medical community there is widespread support for some degree of liberalization of the law, particularly where this relates to serious genetic conditions which can be identified prenatally. Tension emerges out of a publicly maintained conservatism on issues of abortion on the one hand and a growing disconnection from unregulated practices of termination in the private sector on the other. (...) Social science approaches have much to contribute when understanding the ‘therapeutic gap’ that opens up and, in particular, the way that local ideas of fate, destiny and how suffering might be ameliorated become blended with the predictive power of genetic testing. (shrink)

This paper addresses the issue of how the scientific discourse of genetics is expressed in local idioms. The examples used are taken from fieldwork conducted in Sri Lanka and relate principally to Sinhala Buddhist attempts to socialise `big science.' The paper explores idioms of both nature and nurture in local imagery and narratives and draws attention to the rhetorical dimensions of genetic discourses when used in context. The article concludes with a preliminary attempt to identify the ways in which explanations (...) of genetic causality are aligned with notions of karma in the explanation of illness and misfortune. (shrink)