Local Moral Worlds Research Articles

COVID-19, multiple emergencies, and moral entanglements: extraordinary and transcendental moral worlds as a new analytical framework

The COVID-19 pandemic resulted in a multitude of complex emergencies, extending beyond the realm of health and healthcare. The situation presented a significant challenge to human security. The content analysis and literature review provide evidence of varied choices and decision-making processes at individual, local, national, and global levels in response to the COVID-19 pandemic. These decisions were influenced by various factors such as time constraints, limited resources, unfamiliar situations, unpredictable outcomes, and the uncertainty surrounding the end of the pandemic. The necessity to make exceptional moral decisions posed a challenge to existing conceptual and analytical frameworks, including Arthur Kleinman’s concept of “local moral worlds.” An examination of emergency medicine, particularly in the context of a critical global event, revealed the presence of numerous ethical decisions that, I suggest, may better be termed extraordinary local moral worlds and transcendental moral worlds. Following the development of an effective vaccine and the official declaration of the end of the pandemic, a thorough assessment of these impacts has commenced at various levels. We have observed a growing sense of regret regarding numerous decisions made amidst this exceptional circumstance. Not only can individuals regret over their choices, but governments and stakeholders, including the World Health Organization (WHO), may also find themselves regretting decisions that were initially seen as pragmatic in containing the virus and flattening the curve. Individuals can also experience regret over their choices. To illustrate the exceptional impacts of the pandemic on “ordinary people”, I specifically draw upon the case of thalassemia patients from Pakistan as these patients required blood to survive, thus, they serve as a significant example of making certain choices. Lastly, I contend that it is crucial to reexamine these choices in order to gain valuable insights that can inform more moral and practical choices in the future.

Fighting the COVID-19 pandemic: A socio-cultural insight into Pakistan.

During the COVID-19 pandemic, healthcare professionals around the world were driven by universal values of solidarity and duty to provide care. However, local societal norms and existing healthcare systems influenced interactions among physicians, and with patients and their families. An exploratory qualitative study design using in-depth interviews was undertaken with physicians working at two public sector hospitals in Karachi, Pakistan. Using the constant comparison method of data analysis, several key themes were identified highlighting norms of kinship and interdependencies characteristic of collectivistic societies that influenced professional interactions. The role of seniors in the hierarchical society of Pakistan played a major role in provision of care. Physicians reported numerous challenges in dealing with patients and their families amidst public denial fueled due to ill-formed government policies. This included interruption of funeral rites which undermined public trust. The study provides insights into the local moral world of two healthcare institutions in Pakistan.

The ethnographer, the research participants, and the meaningful others: Gray zones of relationality and the ethics of dementia care research

The debate on the ethics of dementia research has tended to treat individuals with dementia, primary caregivers other family members and local communities as preestablished and distinct categories of research participants. What has been overlooked are the meaningful social relationships that run through these categories and how these relationships affect the ethnographer's positionality during and after fieldwork. In this paper, drawing on two cases of ethnographic research on family dementia care in North Italy, we propose two heuristic devices, “meaningful others” and “gray zones”, which highlight the ambiguous positionality of ethnographers in care relations and local moral worlds. We further show the benefit of incorporating these devices in discussions on the ethics of dementia care research: by rendering problematic any fixed and polarized positionality of the ethnographer, these two devices allow for a voice to be given to the individuals who represent the main research focus while addressing the interdependence and ethically nuanced dimension of caring relations.

The double-edged sword of ‘community’ in community-based psychosocial care: reflections on task-shifting in rural Nepal

Research in the field of Global Mental Health has stoked hopes that ‘task-shifting’ to community workers can help fill treatment gaps in low-resource settings. The fact that community workers inhabit the same local moral worlds as their clients is widely framed as a boon, with little consideration of the social and ethical dilemmas this might create in the care of chronic, stigmatized conditions. Drawing on 14 months of ethnographic research focused on psychosocial interventions in Nepal, this paper traces how the multiple roles community workers occupied with respect to their clients – clinician, neighbour, and at times kin – came to bear on the care they provided. In-depth case studies are used to explore two divergent logics of care informing Nepali community workers’ practice. While formal psychosocial care guidelines emphasized clients’ autonomy, calling for non-judgmental and non-directive forms of emotional support, everyday efforts to ‘convince’ neighbours and relatives in distress often involved directive guidance oriented toward the restoration of moral personhood and social relations. These approaches could be mutually supportive, but tensions arose when community workers invoked moral standards linked with mental health stigma. This analysis highlights the challenge of mobilizing communities’ strengths and resources without inadvertently reproducing their exclusions. It suggests the deployment of community workers to address psychosocial care gaps may entail not only leveraging existing relationships within communities, but also reconfiguring the very terms of relatedness.

Imaginaries of a laparoscope: power, convenience, and sterilization in rural India

Laparoscopic tubal ligation is the most prevalent method of contraception amongst India’s rural and urban poor. Drawing on 18 months of ethnographic fieldwork in rural Rajasthan in 2012–2013, this paper investigates how rural women’s perceptions of a biomedical instrument—the laparoscope—influence their perceptions of sterilization, a procedure often entrenched in coercive, target- and incentive-driven population control programme. By investigating how a laparoscope is entangled in global exchanges, national policies, institutional arrangements, and local moral worlds, this paper demonstrates that while wider biomedical discourses perpetuate the narrative of safety and convenience, people’s everyday lives inform their understandings of technology that is widely known but rarely seen.

Planning for the Family in Qatar: Religion, Ethics, and the Politics of Assisted Reproduction

ABSTRACT During research in Qatar with practitioners in assisted reproduction and infertility medicine, I found that across the broad range of views they expressed about their approaches to consulting with patients, there was something shared: that their work with assisted reproductive technologies (ARTs) entailed taking up moral and ethical positions. In this paper, I draw on interviews with medical professionals to analyse the local moral worlds which shape the practice of assisted reproduction. I provide an analysis of how professionals position themselves amid the complex ethical, moral, and cultural landscape in which ARTs in Qatar are situated. In developing my analysis of how these positionings involve a striving to be virtuous, I contribute to anthropological understandings of the complexities of everyday negotiations of moral practice. This is a process, I argue, that reveals both the interplay between self-construction and professional practice and the multidimensionality of the underexplored ART context in Qatar.

Negotiating SHI-FEI and shifei: Pursuing a Moralist Self in China's Community-Based Addiction Treatment Programs.

Based on 16months of fieldwork conducted at drug addiction treatment facilities in Yunnan, Southwest China, this article examines how Chinese drug users invent moralist selves during the frequent occurrences ofshifeiincidents. Shìfēi, meaning literally right/wrong, is a crucial concept in Chinese society with two contradictory meanings: (1) moral norms/judgment that ought to be discerned and followed (SHI-FEI); (2) "troubles" or "quarrels" that are often morally undesirable (shifei). By delving into a typical incident ofshifei, this article analyzes the logic, motivation, and interpretations of the drug users and addiction treatment facility staff who are involved in the local moral world. It argues that for drug users, the relationship between SHI-FEI and shifei is not oppositional, as often assumed. Instead, both are valuable moral experiences and useful cultural means in response to users' moral demands and tensions. Negotiating SHI-FEI and shifei enables an ambiguous space in which drug users seek, claim, and practice their moralist selves. This article also argues that under various sociopolitical and moral constraints, drug users' moral selves are characterized by an inward focus on claims of morality and legitimacy. This inward focus reflects a process of moral involution. This study contributes to understandings of moral self-making in stigmatized situations.

Vulnerabilities in 'local moral worlds': COVID-19 provincial social work interventions.

Intending to contextualize vulnerabilities at the local level during COVID-19, this article reports an investigation of the social workers’ interventions done in a Philippine province. Social workers as frontliners report on (i) the shift of interventions before and during COVID-19, (ii) the most vulnerable sector in their assigned areas, (iii) the problems in working out their field interventions, (iv) the emergence of creative programs and (v) key information to better improve or to have a more sustainable set of interventions in the long run.

The challenges and dilemmas of local translators of human rights: The case of disability rights among Jewish ultra-Orthodox communities

Translators of global liberal human rights ideas into religious conservative communities are intermediaries who occupy a liminal position. They are located at a complex crossroad of incompatible values and norms. This article examines the translators’ challenges and dilemmas that stem from this position. The article focuses on translators of human rights of people with disabilities in Jewish ultra-Orthodox communities in Israel as a case study. The article analyzes the translators’ questions of identity and belonging, as well as their dilemmas and difficulties when there is a contradiction between the human rights discourse and the ultra-Orthodox discourse. It also illuminates the dilemmas that result from the tension between the state authorities’ perspective and the ultra-Orthodox perspective. These dilemmas differ from those discussed in the literature, which are usually related to choosing activist strategies. Furthermore, the findings suggest that, unlike previous studies that have portrayed human rights translators as actors with “double subjectivity” who can flexibly move between the global and the local moral worlds, the translators in this case are deeply entrenched in the local religious world. For them, localization is not merely an instrumental means to legitimize the global human rights principles but, rather, an essential way to settle their conflicting identities and beliefs.

Abrahamic traditions and egg freezing: Religious Women's experiences in local moral worlds.

In this article, we elucidate how elective egg freezing (EEF) has been received within the three Abrahamic traditions-Judaism, Christianity, and Islam-and how these religion-specific standpoints have affected the EEF experiences of women who self-identify as religiously observant. Through an analysis of religious women's narratives, the study explores the "local moral worlds" of religious women who chose to freeze their eggs for non-medical reasons. It draws on ethnographic interviews with 14 women in the United States and Israel who had completed at least one EEF cycle, and who were part of a large, binational study that interviewed, between 2014 and 2016, 150 women who pursued EEF. These religious women, who were all highly educated, faced a particular challenge in finding appropriate marriage partners. Feeling pressured but still hopeful to marry and create large families, the women used EEF to extend their reproductive timelines and reduce their anxieties. As the study showed, the women reinterpreted or reconciled religious restrictions on the use of EEF in various ways, believing that their ultimate pursuit of religiously sanctioned reproduction justified the means. This study, which is the first to compare Jewish, Christian, and Muslim women's experiences of EEF, illustrates how this novel technology is now shaping the local moral worlds of religious women.

Assisted Reproduction: Politics, Ethics and Anthropological Futures

ABSTRACT Anthropological literature on Assisted Reproductive Technology (ART) has burgeoned in the forty years since IVF emerged as a potential solution to childlessness. A lexicon has consolidated, and key sets of debates have been identified. Chief among these are questions of kinship, the intersection of technologies and local moral worlds, and the circulation of gametes and technological know-how. The recent publication of five books in the Berghahn series on Fertility, Reproduction and Sexuality offers an opportunity to think about new affordances and futures for research. We review the texts and suggest several strands for research, concluding that anthropological objects do not become saturated by our knowledge of them and that ARTs will remain fertile ground for thought.

Professional development lost in translation? ‘Organising themes’ in Danish teacher education and how it influences student-teachers’ stories in professional learning communities

Retaining the quality of teachers and improving teacher education and professional development through professional learning communities (PLCs) has long been on the policy agenda of, among others, the United Nations Educational, Scientific and Cultural Organization (UNESCO), Organisation for Economic Co-operation and Development (OECD), and the Framework for 21st Century Skills. This study explores and compares student-teachers’ use of PLCs in Danish teacher education institutions and how PLCs are shaped by institutional, organising themes. An ‘organising theme’ is conceptualised as a fundamental ‘idea’ of how – for instance institutional – everyday practices become organised; exploring how institutional organising themes are translated into educational practice in students’ PLCs makes it possible to understand how local moral worlds in teacher education institutions shape students’ communal work and professional development. Drawing on situated learning, social anthropology of institutions and the literature about PLCs, the professional narratives of three Danish student-teachers are compared. The findings suggest that professional development in PLCs takes place in the intersection between personal stories, situated learning in PLCs and institutional themes.

Caring as sharing. Negotiating the moral boundaries of receiving care

ABSTRACT Informal caregiving is increasingly considered a health care delivery-resource within the North European welfare states. While ‘informal’ often refers to non-professional, ‘caregiving’ connotes both affective concern (caring about) and practical action (caring for). This duality of meanings, however, often refers to the one direction in which care is given. Care, we suggest, is relational and also requires that people receiving care are able to or wanting to share their needs. Informal caregiving thus requires sharing. Based on 155 semi-structured, narrative interviews with people with lung or bowel cancer, living in Denmark, Sweden or England, this paper explores how and with whom people ‘share’ when they fall ill. We approach sharing as a heuristic for reflecting on informal-caregiving, and illustrate how being cared for or asking for care are entangled with the management of social risks and notions of selfhood. We conclude that informal caregiving should explicitly be recognised as morally and sympathetically committed practices, which attend to the diversity of local moral worlds of patients, their needs and experiences.

Beyond Ethics: Professionalism and Social Belonging in Social Workers’ Moral Deliberations

ABSTRACTIn professional therapeutic settings, care-providers are required to work through dilemmas in light of a professional ethics that demands the suppression of other aspects that may inform their moral experiences. Drawing upon in-depth conversations with Jewish-Israeli female social workers who talked about dilemmas at work, we analyse how they carry out such deliberations. When recounting their dilemmas, social workers relied on shared professional principles for justifying their decisions, but upon closer examination, differences were apparent in their decisions. Whereas religious (observant) social workers tended to follow professional regulations, seculars (non-observant) favoured clients’ interests and took some liberty in bending rules. Accordingly, we argue that while care-providers follow shared professional ethics, they still implicitly adhere to the local moral worlds that inform their moral experiences. We analyse this discrepancy in relation to the interface between a modernist professional ethos and acknowledged and unacknowledged motives that pragmatically participate in professionals’ deliberations.

Clean Blood, Religion, and Moral Triage in Tuberculosis Vaccine Trials

ABSTRACT During ethnographic research at a tuberculosis vaccine trial site in South Africa, trial participants often evoked the idiom of “clean blood.” In this article, we illustrate how the trials enacted a form of moral triage in which “objective” bioscientific knowledge and moral subjectivity were coproduced. Participation created possibilities to demonstrate healthiness, respectability, and godliness in a context where positive self-imaginings were hard won, but could also lead to dejection and shame. We suggest that struggles to be recognized as virtuous are often overlooked in anthropological critiques of clinical trials and bioethics, but are important for understanding how trials meld with local moral worlds.

The Knowledge of People Disappeared During Argentina’s Military Rule

Antonio Ruiz (a pseudonym) is an officer who took part in the Argentine 1976–1983 military rule and disappeared the body of a tortured woman. My aim is to offer an ethnographic account of the embodiment of the knowledge of bodies—the local moral worlds in which the officer Antonio and his wife lived and legitimated state violence by imagining themselves as victims, and Antonio subsequently followed his commander’s order and buried the body of a tortured woman. The armed forces provided soldiers of the armed formal manuals in which political violence was described as an ever-present threat. At home Antonio and his wife exchanged accounts detailing the risk of armed struggle to their fledgling family, with Antonio carrying out commissions of repression as father and husband and not only soldier. The narratives officers constructed and acted upon about themselves as imagined victims linger to this day in contemporary Argentina in the form of the disappeared—the missing thousands who remain unaccounted for, buried in unknown, clandestine graves or drowned alive at sea, with thousands of family members suspended in doubt, unsure where the disappeared might truly be, and whether they live or died.

Call Boys

Marginalized young men are a familiar presence in the areas surrounding Philippine ports, selling food and refreshments to the thousands of passengers who come through daily. A closer look, however, reveals that they engage in many other activities as they participate in an informal economy where income opportunities skirt the boundaries between licit and illicit. One job many of them engage in is sex work: as “call boys,” they offer their sexual services to male clients. Many of them also use drugs, particularly shabu (methamphetamine). This article examines the relationship between sex work and drug use and situates it in the everyday lives of young men. The researcher conducted in-depth interviews and focus group discussions among 20 males aged 18–25 years old, and over a period of 12 months, “hung out” with them, observing their activities, and listening to their conversations. This ethnographic study, conducted 3 years before a violent “war on drugs” began to waged in the country, argues that the young men view drug use and sex work as pragmatic choices in their everyday economic lives. Drug use and sex work are also linked to their notions of masculinity and are fraught with risks and unintended consequences that they often overlook—even as they have their own notions of safety and risk. Understanding the intersections between sex work and drug use in relation to young people’s “local moral worlds” and gender ideologies can help craft more effective drug policies in the Philippines.

Crossing boundaries of state and religious power: Reproductive mobilities in Singapore

AbstractSingapore has one of the tightest regulations over assisted reproductive technologies (ARTs) in Asia, a consequence of Singapore's strong state, the priority it gives to reproduction, and the numerous religious groups in the country and their direct and indirect influence on the Bioethics Advisory Committee, which recommends ART regulations for the country. Together, these key actors give shape to the ‘local moral worlds’, which undergird ART governance in the country. Drawing on in‐depth interviews and data from online forums, we illustrate Singaporean fertility seekers' attempts to juggle myriad and sometimes confusing obligations to the state, society and religion in making reproductive choices. We then explore the limits and possibilities for fertility seekers to circumvent the restrictive rules and ‘moral safety valves’ set in place in their home country simply by stepping out to another jurisdiction across national borders. The paper goes on to show how the Internet communities serve as a bridgespace, propelling fertility mobilities by enabling Singaporeans to see creative possibilities in patchwork regulations. At the edges of state and religious power, fertility‐seeking subjects take advantage of liminal spaces, grey areas, or permissive regimes to gain several degrees of freedom to practise adaptive fertility strategies that may be ‘unofficial’ but ‘licit’ or ‘socially acceptable’.

Supporting the role of community members employed as research staff: Perspectives of community researchers working in addiction research

Community researchers are laypersons who conduct research activities in their own communities. In addiction and HIV research, community researchers are valued for their insider status and knowledge. At the same time, their presence on the research team raises concerns about coercion and confidentiality when community researchers and participants know each other personally, and the work of navigating between the worlds of research and community leads to moral distress and burnout for some community researchers. In this paper, we draw upon the concept of ‘moral experience’ to explore the local moral worlds of community researchers in the context of addiction research. In February and March 2010, we conducted focus groups with 36 community researchers employed on community-based addiction studies in the United States to elicit perspectives on ethical and moral challenges they face in their work and insights on best practices to support their role in research. Community researchers described how their values were realized or thwarted in the context of research, and their strategies for coping with shifting identities and competing priorities. They delineated how their knowledge could be used to inform development of research protocols and help principal investigators build and maintain trust with the community researchers on their teams. Our findings contribute to current understandings of the moral experiences of community members employed in research, and inform policies and practices for the growing field of community-engaged research. Funders, research organizations, and research ethics boards should develop guidelines and standards to ensure studies have key resources in place to support community researchers and ensure quality and integrity of community-engaged work. Investigators who work with community researchers should ensure channels for frontline staff to provide input on research protocols and to create an atmosphere where challenges and concerns can be openly and safely discussed.

Cancer

Previous work in the anthropology of cancer often examined causes, risks, and medical, familial, and embodied relationships created by the disease. Recent writing has expanded that focus, attending to cancer as a “total social fact” ( Jain 2013 ) and dissecting the landscape of “carcinogenic relationships” ( Livingston 2012 ). Cancer-driven relationships become subjectively real through individual suffering, stigma, and inequality. This article traces concepts developed from a primarily US-centered discourse to a global cancer discourse, including cancer-related issues continuing to raise concern such as stigma, narrative moments of critical reflection on the dominance of biomedicine, and processes by which individuals and communities manage inadequate access to biomedical technologies. Beyond the medical relations and politics of cancer, this article considers the ways in which ethnography addresses local moral worlds and differences that come to matter in attending to the disease, the person, and consequent social and material relations.