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A Reader’s Guide to the Anthropology of Ethics and Morality – Part III

Editor’s note: We asked several scholars which readings they would recommend to students or colleagues interested in familiarizing themselves with the anthropology of ethics and morality. This is the response we received from Jeannette Pols, Socrates professor ‘Social Theory, Humanism and Materialities’ at the Department of Anthropology, program ‘Health, Care and the Body’, at the University of Amsterdam. 

Empirical ethics and the study of care

Empirical ethics is the empirical study of what Laurent Thévenot (2001) calls forms of the good in practice. This ‘good’ is a heuristic or sensitizing term that awaits empirical concretization and helps to focus analytical work (Pols 2017), as well as co-laboring with health care professionals, patients and informal care givers (Ceci et al. 2017) with the aim of ‘improving care’ (Mol 2006; Moser 2010). My work on ‘good washing’ is an example of this; I did see very different ways in dealing with problems of hygiene in the care practices I studied, but I had to find out what particular goods these practices aimed to bring into being  (Pols 2006a,b). Alternatively, one may also follow a particular value or ideal, and see how it is made concrete in practice. For example, our study on dignity showed how the term is used in care practices as a principle related to an innate core of human worth, or as an aesthetic value that relates to what people find good or bad ways to live, often foregrounding concerns about hygiene and proper dress (Pols, Willems & Pasveer 2017).

Empirical ethics emerged out of the unease with critique as the main style of writing for the interpretive social sciences of anthropology and sociology. In the Netherlands, the country I am writing from, empirical ethics also emerged from an unease with the normative style of both ethics and the philosophy of knowledge. In this so-called empirical turn, philosophers approached the study of knowledge and science ethnographically. A classic work is Leviathan and the Air-Pump by Shapin and Schaffer (1985). They show how the scientific controversies surrounding Hobbes’ philosophical style of knowing and Boyle’s experimental style is about the material, social, and literary techniques of creating facts. But this controversy also interfered in discussions about the politics of their time. Civil war was raging, and Hobbes and Boyle suggested different ways to settle conflicts and promote ‘good governance’ of the nation. The intertwinement of knowledge and political or normative issues was on the agenda of science studies from the beginning, even if the creation of facts and the solving of controversies drew most attention.

The normative shift here was to no longer formulate criteria as to how one might discern true knowledge from error and belief. The question became: how do they do it? How do scientists in their laboratories, with their machines and colleagues, create facts that were not there before?  These scholars sought not to judge the scientists, but to learn about their practices before the outcome was clear and solidified (Latour 1987; Latour 1988). This line of research flourished under the name of science and technology studies (STS).

A comparable empirical turn emerged for ethics and the study of values, although normative issues proved less easy to tame. On the one hand, rather than formulating what one should do, the questions became: how do people try to achieve something good? And how do things and technologies as well as social norms bring values to practices? And what are the effects of this? This put everyday morality on the agenda, and challenged ethicists to leave their offices to look for the good outside. On the other hand, there were concerns about the (feminist) politics of articulating unheard voices and inventing new subject positions for women (after philosophers’ claimed the ‘Death of the Subject’, capital S, with pathos). The abolishment of prescriptive ethics sat uneasily with a feminist agenda. A good example of this ambivalence is Donna Haraway’s cyborg manifesto where both descriptive and political voices co-exist in the text: the cyborg is a concept for critique, as well as a political utopian ideal (Haraway 1991).

The ‘empircal turn’ was a call to bring together theoretical work and empirical research, while looking for ways to move ‘beyond critique’. Boltanksi & Thévenot famously complained that sociologists always somehow attempt to unmask their informants. Instead, they analysed the ways in which ‘ordinary people’ justify their actions. The aim was not to unmask them, but to learn about their justifications. The study of the good became a way to study health care practices, a branch that mixes STS and anthropology that became known as care studies.

Rather than approaching the field with a set political agenda or clearly developed criteria on how to judge what is good, the question became what inside these practices was the way professionals and patients shaped and framed ‘good care’ themselves –and how they were made to do that. One example is the book Care in Practice (Mol, Moser & Pols 2012). In this book, Dick Willems, for instance, shows how different breathing devices imply different directions for living a good life, with different advantages and drawbacks. Annemarie Mol shows how different values inform the organisation of meals in a nursing home, and how these values are always in tension, never to be resolved while still pertinent in care.

With STS as a background, there was great interest in how science and technology impacted on care practices. An early paper from Mol (2000) describes how measurement devices do not simply register what is out there, but intervene in the lives of people with diabetes. Ingunn Moser’s (2018) analysis of the different ways in which Alzheimer’s is shaped is another example, as is her chapter in the Care in Practice book that addresses how quantitative scientists wrestle with the study of care practices. A practical development of methods to interfere in care practices is Jessica Mesman’s use of video methods to help participants to learn from their own practices (see also her 2011 book). Myriam Winance famously wrote about the normativity of wheelchairs (2006) and about how to think about what norms are and how they are made (2007), while Tamar Sharon unravelled how the goods of autonomy, solidarity, and authenticity take shape in discourses of the quantified self (Sharon 2017). Hoogsteyns & Van der Horst (2013) compared the values that influenced the design of artificial arms with the values of the potential users; rather than care about accurate movement, the latter used an artificial arm for occasions in which they did not want others to see they had one arm. Its functionality was of minor importance, as they were much more skilled without an artificial arm. Marianne Boenink and colleagues (2018) edited a book on what responsible innovation could be in the case of research into the early diagnosis of Alzheimer’s disease.

Dementia care, as care for subjects that are hard to represent with social scientific methods, proved a fruitful area for ethnographic research to study the good. Kamphof (2015; 2018) and Thygesen (2009; 2010) and Driessen (2018) wrote on technology in dementia care, Janelle Taylor wrote about dementia and friendship. Mette Nordahl Svendsen and her team (2018) studied what made a life worth living in the neonatal clinic, in dementia care, and in research on piglets.  A European team studied developments in telecare (López 2015; López & Domenech 2008; Pols 2012; Mort & Roberts & Milligan 2011; Mort et al. 2015; Thygesen & Pols 2017). This work was continued by Van Hout and colleagues (2015) for nursing care and by Ahlin (2018) for the use of everyday technologies in transnational care. A fine study of care for obesity and the values and subject positions therein is Vogel (2018). There are many more examples!

These studies showed that the values embedded in the practices of good care were very different and that they also had different effects. A question which came up was how empirical ethicists or anthropologists studying the good would handle normative concerns in their own work. They could articulate the different goods that came with devices and ways of organising care, as well as their effects. But to what end would they do this, if judgement and critique had run out of fashion?

This question is still hotly debated today. My take on this is that a different way of looking at normativity might help us out of the impasse between description and prescription. Researchers use methods, concepts, and devices to help shape their object of research. We might ask what research tools can make what objects visible or invisible, and what are the effects of this? The aim here would be to learn how to ask questions that make research objects interesting. Vincianne Despret (2006) shows how in animal research chimps always appear as the most interesting species, because no biologist attempts to ask proper questions about sheep. Questions about shaping one’s object can be asked for any research project, be it medical, ethnographic, or mathematical. Researchers re-scribe their objects of study (Harbers 2005). This places creativity (rather than either discovery or intervention, or prescription and ethical demands) at the centre of scientific work, exemplifying a ‘politics of what’ (Mol 2002). This is a politics without a pre-determined substance, but engages with different ways of making objects.

But there is another normative concern with re-scriptive practices. What can students of the good add to the practices they study? Are there good or better ways to care, or better devices or ideals? Effects can be compared, and values can be linked to other values: what were the hopes of policy makers/ caregivers /patient organisations? How did it turn out? Situated suggestions would be the term here, because it would recognize that recommendations, new concepts, or the possible workings of devices in one place, need to travel to another. They need to be translated to make them useful in new socio-material situations. Specificity is not averaged out, as in the quantitative sciences, but is central to this ‘improvement work’.

 

Works Cited

Ahlin, T. (2018)  Only Near Is Dear? Doing Elderly Care with Everyday ICTs in Indian Transnational FamiliesMedical Anthropology Quarterly 32(1): 85-102,

Boltanski, L., & Thévenot, L. (2006). On justification: Economies of worth. Princeton: Princeton University Press.

Ceci, C., Pols, J. & Purkis, M.E. (2017). Privileging practices: Manifesto for “new nursing studies”. In Foth Thomas, Holmes Dave, Remmers Hartmut, Kreutzer Susanne & Hülsken-Giessler Manfred (Eds.) Critical Approaches in Nursing Theory and Nursing Research: Implications for Nursing Practice. Vandenhoek & Ruprecht V&R unipress, University of Osnabrück, 51-68

Despret, V. (2016)  Sheep do have opinions. In Latour, B & Weibel P. Making Things Public. Atmospheres of Democracy. Cambridge: MIT Press, 360-370

Haraway, D. (1991). A Cyborg Manifesto: Science, Technology, and Socialist-Feminism in the Late Twentieth Century. In Simians, Cyborgs and Women: The Reinvention of Nature. London: Routledge.

Harbers, H. (Ed.) (2005) Inside the Politics of Technology. Agency and Normativity in the Co-Production of Technology and Society, Amsterdam: University of Amsterdam.

Hout, A. Pols, J. & Willems, D. (2015) Shining trinkets and unkempt gardens: on the materiality of care, Sociology of Health & Illness, 37, 8: 1206-1217

Driessen, A. (2017) Sociomaterial Will-Work: Aligning Daily Wanting in Dutch Dementia Care In Krause, F., & Boldt, J. (Eds.). Care in Healthcare: Reflections on Theory and Practice. Springer. p.111-133.

Hoogsteyns, M., & van der Horst, H. (2013). Wearing the arm (or not). Reconceptualising notions of in-and exclusion in Disability Studies. Scandinavian Journal of Disability Research15(1), 58-69.

Kamphof, I., Hendriks, R., & Swierstra, T. (2018). Eindverslag. ZonMW project. Make-believe Matters. The Moral Role Things Play in Dementia Care. https://www.zonmw.nl/nl/onderzoek-resultaten/kwaliteit-van-zorg/programmas/project-detail/ethiek-en-gezondheid-2012-2015/make-believe-matters-the-moral-role-things-play-in-dementia-care/verslagen/

Kamphof, D. J. (2015). A Modest Art. Securing Privacy in Technologically Mediated Homecare. Foundations of Science, 1-9. DOI: 10.1007/s10699-015-9448-5

Latour, B. (1988) The pasteurization of France. Harvard University Press.

Latour, B. (1987) Science in Action: How to Follow Scientists and Engineers Through Society, Harvard University Press.

López, D. (2015). Little arrangements that matter. Rethinking autonomy-enabling  innovations for later life. Technological Forecasting and Social Change, 93, 91–101

López, D., & Domènech, M. (2008). Embodying autonomy in a home telecare service. The Sociological Review, 56(s2), 181–195.

Mesman, J. (2011) Resources of Strength: an exnovation of hidden competences to preserve patient safety. In: E.Rowley, J.Waring (eds) A Socio-Cultural Perspective on Patient Safety, Ashgate.

Mesman, J. (2008) Uncertainty in Medical Innovation. Experienced Pioneers in Neonatal Care. Palgrave MacMillan.

Milligan, C., Roberts, C., & Mort, M. (2011). Telecare and older people: Who cares where? Social Science and Medicine, 72(3), 347–354.

Mol, A. (2010). Care and its values. Good food in the nursing home. In Mol, A., Moser, I., & Pols, J. (Eds.).Care in practice: On tinkering in clinics, homes and farms, Bielefeld: Transcript Verlag. pp. 215–234.

Mol, A. (2006) Proving or improving: on health care research as a form of self-reflection. Qualitative Health Research. 16(3):405-14.

Mol, A. (2000). What diagnostic devices do: the case of blood sugar measurement. Theoretical medicine and bioethics21(1), 9-22.

Mort, M., Roberts C, Pols J, Domenech M, Moser I on behalf of EFORTT investigators (2015) Ethical implications of home telecare for older people: a framework derived from a multisited participative study. Health Expect. 18(3):438-49.

Moser, I. (2018) Making Alzheimer’s Disease Matter: The Politics and Interferences of Different Practices Concerning AD. In: Boenink, M., Van Lente, H. & Moors, E. (eds) Emerging Technologies for Diagnosing Alzheimer’s Disease. Palgrave.

Moser, I. (2010) Perhaps tears should not be counted but wiped away. On quality and improvement in dementia care. In: Mol, A.Moser, I. & Pols, J. (eds) Care in practice. On tinkering in clinics, homes and farms. Bielefeld: Transcript verlag,277-300.

Pols, J., Pasveer, B., & Willems, D. (2018). The particularity of dignity: relational engagement in care at the end of life. Medicine, Health Care and Philosophy21(1), 89-100.

Pols, J. (2017). Good relations with technology: Empirical ethics and aesthetics in care. Nursing Philosophy, 18(1), [e12154]. DOI: 10.1111/nup.12154 

Pols, J. (2015) Towards an empirical ethics in care: relations with technologies in health care Medicine Health Care and Philosophy, 18:81-90.

Pols, J. (2012). Care at a distance: On the closeness of technology. Amsterdam:  Amsterdam University Press.

Pols, J.  (2006a) Washing the citizen: washing, cleanliness and citizenship in mental health care, Culture, Medicine & Psychiatry 30, 1, 77-104.

Pols, J. (2006b) Accounting and washing:  good care in long-term psychiatry, Science, Technology & Human Values, 31, 4, 409-30.

Shapin, S & Schaffer, S (1985) Leviathan and the Air-Pump: Hobbes, Boyle, and the Experimental Life. Princeton University Press.

Sharon, T (2017) Self-Tracking for Health and the Quantified Self: Re-Articulating Autonomy, Solidarity, and Authenticity in an Age of Personalized Healthcare, Philosophy & Technology 30, 1, 93–121.

Svendsen, Mette Nordahl; Navne, Laura Emdal; Gjødsbøl, Iben Mundbjerg; Dam, Mie Seest. (2018) A life worth living: Temporality, care, and personhood in the Danish welfare state. American Ethnologist, Vol. 45, No. 1.

Thévenot, L. (2001). Pragmatic Regimes Governing the Engagement with the World. In T. R. Schatzki, K. Knorr-Cetina & E. von Savigny (Eds.), The practice turn in contemporary theory, (pp. 56–73). London:Routledge.

Janelle S. Taylor. 2017. Engaging with Dementia: Experiments in Art and Friendship. Culture Medicine and Psychiatry 41(2):284-303.

Janelle S. Taylor. 2017. Should Old Acquaintance Be Forgot? Friendship in the Face of Dementia, In Sarah Lamb, ed., Successful Aging as a Contemporary Obsession: Global Perspectives. New Brunswick, NJ: Rutgers University Press, pp. 126-138.

Thygesen, H. (2009). Technology and good dementia care. A study of technology and ethics in everyday care practice. PhD thesis available from the Centre for Technology, Innovation and Culture (TIK) University of Oslo, Norway.

Thygesen, H., & Moser, I. (2010). Technology and good dementia care: An argument for an ethics-in-practice approach. In Domenèch, M. & Schillmeier, M. New Technologies and Emerging Spaces of Care (pp. 129–147). Farnham: Ashgate.

Thygesen H. & Pols, J. (2017) Care, self management and the webcam. In: Manderson, L., Cartwright, E. & Hardon, A., The Routledge Handbook of Medical Anthropology.

Vogel, E. (2018) Operating (on) the self: transforming agency through obesity surgery and treatment, Sociology of Health and Illness, 40,3: 508-522

Willems, D. (2010). Varieties of goodness in high-tech home care. Care in practice: On tinkering in clinics, homes and farms, 257–276. Bielefeld: Transcript Verlag.

Willems, D., & Pols, J. (2010). Goodness! The empirical turn in health care ethics. Medische Antropologie/ Medical anthropology, 1, 1.

Winance, M. (2006) Trying Out the Wheelchair.The Mutual Shaping of People and Devices through Adjustment, Science, Technology & Human Values, 31 issue: 1,: 52-72

Winance, M. (2007) Being normally different? Changes to normalization processes: From alignment to work on the norm, Disability & Society 22(6):625-638


Jeannette Pols is appointed as Socrates professor ‘Social Theory, Humanism and Materialities’ at the Department of Anthropology, program ‘Health, Care and the Body’, at the University of Amsterdam. She is Associate Professor and Principal investigator at the section of Medical Ethics of the Academic Medical Centre in Amsterdam. In 2017 Pols was appointed as a member of the Advisory Board for the Government on health care: RVS (Raad voor Volksgezondheid & Samenleving). The core of Pols’ research is empirical ethics, which studies ‘normativity in practice’. She formulated three research lines for the Socrates chair, to which she was appointed in 2012: 1) the analysis of ethical and aesthetic values in sociomaterial care practices; 2) the articulation of actual and preferable subject positions of people with chronic disease and other technology users; and 3) conceptualizing practical knowledge of patients and their caregivers.


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