Ethics in Ethnography: Lessons of Amana and Ghayb in the Middle East for Medical Anthropology.

Abstract

Much has been written about the ethics of doing and writing ethnography, the imbalance of power between anthropologists and the communities they study, the extraction of information from interlocutors – who are often themselves on the margins of their communities – and the ethical dilemmas that arise in ethnographic fieldwork. For medical anthropologists working with vulnerable populations – patients, refugees, migrants – on the relationship between medicine and politics, these ethical concerns are only intensified. I write this not to take us down the path of recounting the ills and evils of ethnography, nor to explain many anthropologists’ turn to activism and performative solidarity. I also do not aim to return us to the critique of writing culture (Clifford and Marcus 1986), or the idea that confessing our ills and various privileges will save us from our position within a stratified world. Rather, I ask how ethnography can explore truth and justice while allowing space for others’ desires to be heard ethically, without slipping into a politics of compassion and empathy (Dubal 2018; Iqbal 2019; Liu and Shange 2018; Mittermaier 2019; Pandolfo 2018). How could such an approach be the means by which space is produced for waves to be generated for our interlocutors, for ourselves, and for scientific inquiry (Pandolfo 2018:339)? In this essay, I present reflections from my own fieldwork experiences that detail the knot of positionality and methods of research and inquiry that I encounter as a medical anthropologist specializing in the Middle East. As I moved through my field sites of Yemen, Jordan, and Saudi Arabia during the summers of 2009 and 2013 and for 24 months between 2016 and 2018, working with physicians, bioethicists, patients, migrants, and refugees, I found my interlocutors and medical staff evaluating me by the same criteria that are used to evaluate physicians: i.e., do they bear the divine trust (amana) and practice their craft with an openness to the unseen realm (al-ghayb)? This assessment of a good physician included evaluation of their modes of knowing and expertise. These in turn depended on their capacity to hone their internal and external senses, which was affected by the cultivation of their soul, piety, and akhlaq (character). In my field sites, the physician was understood as a malakat al-rahma (angel of mercy). That they were seen as instruments or tools of the divine, in working for individual and communal wellbeing (‘afiya), did not enhance their authority so much as underscore their fallibility and limitations (Hauter 2020a). As I found myself being assessed by the same criteria, I came to understand that, for an ethnographer, bearing the amana and admitting the ghayb involved listening ethically, transmitting knowledge as intended, not stealing or misrepresenting ideas, and not Orientalizing or essentializing interlocutors. These latter commitments are particularly relevant given the prevailing geopolitics of medicine, science, and politics in the Middle East North Africa region. The rest of this editorial explores the implications of being held to this standard. Following the prompt of my interlocutors, how might anthropologists see themselves as tools and instruments, rather than as messengers, scribes, or excavators whose primary commitments lie outside the ethnographic exchange? What criteria of evaluation and consideration are appropriate? How might becoming an instrument let ethnographers learn without knowing: to hold our capacity to learn within our hands and our potential to not know within our hearts? This is to learn without transforming that learning into positive, historical knowledge and allow our tools, orientations, and methods to transform when we are not entirely possessed by them. Such an ethics begins with exchange, channels through analytic processes, and maintains a (non-sovereign) gap within one’s writing. Within hospitals, I witnessed physicians exercise and buttress their expertise in the eyes of patients not by demonstrating biomedical mastery but through amana and reintroducing al-ghayb into the clinic. Physicians acknowledged their temporal limitations when making diagnoses, contrasting their MEDICAL ANTHROPOLOGY 2023, VOL. 42, NO. 7, 697–705 https://doi.org/10.1080/01459740.2023.2257017