Medical Anthropology Quarterly最新文献

Choice is a central concept in reproductive rights. However, a discourse of choice in reproductive health can also mask precisely the act it aims to protect against: coercion. Whilst choice has been explored extensively in studies of reproductive rights and justice, understandings of coercion are fragmented and under-theorized. This article explores the relationship between coercion and choice, not as a binary but as a coexistence in which they overlay and conceal one another. Drawing on ethnographic research amongst health professionals during family planning training in Timor-Leste, this article shows how a discourse of choice obscures coercive structures and practices, whilst coercive approaches can paradoxically reveal hidden choices. I argue that this coexistence, characterized by concealment, leads to iatrogenesis-medical harm with immediate and lingering effects. By recognizing the coexistence of choice and coercion, and revealing their concealment of one another, we might limit iatrogenesis and enable greater reproductive freedom.

Based on mixed-methods, ethnographic research in a geographically isolated rural medical center in the upper midwestern United States, this paper explores the social implications of healthcare quality assurance policies highly reliant on managerial logics, including measurement and monitoring programs. Initially observed as expressions of apathy, throughout 21 months of observation in the medical center I increasingly witnessed tensions erupt due to divergent views of quality care. While explicitly intended to improve biomedical care, clinicians were quick to describe how quality assurance policies impeded their ability to provide high-quality primary care in this rural setting. This article theorizes ongoing tensions between patient care and institutional care as a key aspect of the observed organizational discord. The article concludes with recommendations for how to operationalize institutional care in this setting to respond to clinician and staff concerns about the unique challenges of this biomedical practice environment.

In this article, we conceptualize how Davis' two concepts of uneven reproduction and obstetric racism-both rooted in the US context-are effectuated in the Netherlands. We consider uneven reproduction to consist of bio- and necropolitics, namely the management and regulation of a population's bodies, life and death. Through bio- and necropolitics, certain life is optimized by investments, and other life is negated by disinvestments in reproductive care in daily care work through obstetric racism. We develop an understanding of obstetric racism in the Netherlands by analyzing how it operates as a form of uneven reproduction, by providing theoretical depth to the concept of obstetric racism in the context of Europe. Based on data analysis from interviews and focus group conversations on obstetric violence with midwives, doulas, midwives-in-training, and mothers who gave birth within the last 10 years, we link the concept of uneven reproduction to daily practices of obstetric racism in the Netherlands. We find that obstetrics operates on the basis of linguistic racism and othering through exoticization, specifically for women racialized as Black through the racial stereotype of being "natural birthers," while other marginalized racialized women are seen as "bad birthers."

How do public health metrics of "good death" shape care and everyday life? Concerns over dying alone has become prevalent worldwide. In Japan, social anxieties over solitary deaths (kodokushi) have intensified in a rapidly aging society. In response, care practices have emerged to keep people social in life and death. Through ethnographic fieldwork in a tsunami-affected town in Miyagi, I examine how post-disaster care has been reorganized in response to fears of kodokushi. Care workers improvised their activities to reconcile bureaucratic demands for "statistics of sociality" with survivors' shifting needs and desires. These activities demonstrate the impact of standardized scripts of "good death" on the quality of life and care of those they aim to protect. At the same time, they reveal the potential for care that embraces the indeterminacy and situatedness of what constitutes a good death, allowing for diverse ways of living and dying well.

Harm reduction professionals strive to reduce the health, social, and legal consequences associated with drug use in contexts permeated by violence. Building on fieldwork in Paris and Barcelona, we examine how they make sense of this violence. In Paris, the discussion of violence primarily hinges on the narratives of suffering from people who use drugs and the obstacles posed by the political context. In Barcelona, the narrative emphasizes precariousness and deficiencies in organizational violence management, which intensifies perceptions of violence. Moving beyond polarized understandings of violence, we argue that violence is socially constructed as an inherent aspect of the culture of harm reduction work. This process involves mechanisms of naturalization, delegitimization, and normalization, shaping work experiences and the construction of the professional self. Although violence manifests in similar forms and manifestations across settings, experiences of that violence differ based on how it perpetuates power dynamics and inequalities within the workplace.

In this article, I explore the connections between the medicalization of childbirth and environmental devastation through Guarani-Mbyá understandings of life and the living. I argue that the cuts made to Guarani-Mbyá women's vaginas (episiotomies) in Brazilian hospitals are experienced and situated on the same cosmopolitical level as the cuts made in their ancestral territories by fences that demarcate soybean plantations and cattle ranches. What I call an extractivism of vitalities occurs precisely through both bodies and territories. In exploring this issue, I highlight connections obvious to Indigenous women: Their bodies and territories are inherently linked by vital forces that are shared and modulated through different qualities of relations involving humans and other-than-human beings.

For over four decades we have collaborated as a team of anthropologists and Indigenous Elders of the Yanyuwa language group. The Yanyuwa are the Indigenous owners of lands and waters in Australia's Gulf of Carpentaria. While medicalized healthcare has not been our specific research focus, wellness and ill health have been recurring themes. Death has been tragically prevalent. So too has been a sense of liveliness among households in the remote township of Borroloola. This paper explores ethnographic moments that speak to how Yanyuwa experience illness, as a bodily, relational, and communal possibility. Building out from these, we reflect on how people in this community seek to survive, in part, through kincentric relationality: the art of keeping company. Reflecting on culturally nuanced responses to illness supports anthropological engagements with connections that heal and those that pose a threat, offering some insights to progress efforts in medical pluralism and kincentric care.

In the United States, emergency departments aren't supposed to turn anyone away. They are the safety-net of the safety-net providing life-saving care. Yet, what happens to healthcare when conditions are so strained that patients and staff lash out at each other? What happens when the safety net becomes a carceral net? I argue that social and economic pressures placed on emergency medicine generate conflict between patients and nurses who increasingly rely on the restriction of resources, use of restraints, and police in healthcare.

While US cancer survival rates have improved in recent years, the rising incidence of early-onset cancers means cancer is shifting younger, imposing new generational challenges for survivors and their families. This article explores the experience of a cancer diagnosis during one's re/productive years by analyzing how parents with dependent children maintain a future amid heightened economic precarity (e.g., loss of stable employment, downward mobility, and a degraded public sphere). By linking physical survival with the social conditions necessary for post-treatment quality of life, we develop a more collectivistic notion of survivorship, where parent-survivors' efforts to stay employed during treatment serve as an extension of family caregiving in austere times. Reflecting on how the lead authors' own experience of work and cancer emerged in interviews with 12 parent-survivors, we intervene on traditional team science methods, making space for the autoethnographic voices that underlie interpretations of illness.

How do palliative care professionals negotiate end-of-life care with family members when prognosis and dying are not openly discussed? Based on ethnographic fieldwork in an Indonesian palliative care unit, I argue that palliative care professionals employ implicit, ambiguous and culturally sensitive communication to carefully negotiate hospital discharge and discuss end-of-life care. I focus on listening to what is said and what remains unspoken in the embodied communicative practices about end-of-life care in family meetings to discuss hospital discharge. I show how palliative care professionals carefully navigate tensions between the hospital's need to discharge patients, family expectations of a cure, and the palliative care value of supporting patients and families. They do so by keeping the possibility of receiving treatment open while simultaneously using implicit language to suggest that end of life may be near.