Papers by Carolyn Smith-Morris
Cambridge Quarterly of Healthcare Ethics, Jan 13, 2023
Rigorous attention has been paid to moral distress among healthcare professionals, largely in hig... more Rigorous attention has been paid to moral distress among healthcare professionals, largely in high-income settings. More obscure is the presence and impact of moral distress in contexts of chronic poverty and structural violence. Intercultural ethics research and dialogue can help reveal how the long-term presence of morally distressing conditions might influence the moral experience and agency of healthcare providers. This article discusses mixed-methods research at one nongovernmental social support agency and clinic in Rio de Janeiro, Brazil. Chronic levels of moral distress and perceptions of moral harm among clinicians in this setting were both violent, following Nancy Scheper-Hughes' use of that term, and a source of exceptional and innovative care. Rather than glossing over the moral variables of work in such desperate extremes, ethnography in these settings reveals novel skills and strategies for managing moral distress.
Cambridge Quarterly of Healthcare Ethics
Rigorous attention has been paid to moral distress among healthcare professionals, largely in hig... more Rigorous attention has been paid to moral distress among healthcare professionals, largely in high-income settings. More obscure is the presence and impact of moral distress in contexts of chronic poverty and structural violence. Intercultural ethics research and dialogue can help reveal how the long-term presence of morally distressing conditions might influence the moral experience and agency of healthcare providers. This article discusses mixed-methods research at one nongovernmental social support agency and clinic in Rio de Janeiro, Brazil. Chronic levels of moral distress and perceptions of moral harm among clinicians in this setting were both violent, following Nancy Scheper-Hughes’ use of that term, and a source of exceptional and innovative care. Rather than glossing over the moral variables of work in such desperate extremes, ethnography in these settings reveals novel skills and strategies for managing moral distress.
Human Organization, Mar 1, 2004
The prevalence of diabetes among Pima (Akimel O'odham) Indians involves three important domains: ... more The prevalence of diabetes among Pima (Akimel O'odham) Indians involves three important domains: political-economic, eenetic. and cultural. Proerams in diabetes education have made noteworthv imnrovements in the last two decades in addressing-,. cultural information and attitudes. It is less common to see political-economic factors addressed, particularly the structural barriers to care that include poverty and unemployment. The genetic contributions to modem rates of diabetes have, perhaps, been overemphasized in the past, contributing to a sense that this disease is inevitable in American Indian populations. I review six lessons drawn from these domains and from diabetes prevention and treatment programs in Indian country: 1) the basic importance of cultural sensitivity; 2) the strengths of community participation; 3) the influential but not dominant significance of genetics; 4) some relevant structural changes in forms of health care; 5) fee need for political-economic change within tribes to sustain communitywide change; and 6) the significance of a stable financial foundation for diabetes programs.
Hispanic Journal of Behavioral Sciences, Sep 20, 2012
Research on core cultural values has been central to behavioral and clinical research in ethnic g... more Research on core cultural values has been central to behavioral and clinical research in ethnic groups. Familismo is one such construct, theorized as the strong identification and attachment of Hispanic persons with their nuclear and extended families. Our anthropological research on this concept among Mexicans and Mexican immigrants in the United States elaborates the concept, and promotes greater complementarity between quantitative and qualitative data on the topic. Ethnographic work spanning 3 sites over four years reveal that familismo as expressed in narratives is a more contested and evocative concept than most quantitative and behavioral literatures tend to suggest. By suggesting that when familismo is used in generalizing ways, it neglects the broader significance of nostalgia or of a larger social (extrafamilial) connectedness, we do not ignore the need for population-based research. Instead, we hope to forward and crystallize studies of culture
Philosophy, Psychiatry, & Psychology, 2009
Appetite, Oct 1, 2016
The term "traditional diet" is used variously in public health and nutrition literature to refer ... more The term "traditional diet" is used variously in public health and nutrition literature to refer to a substantial variety of foodways. Yet it is difficult to draw generalities about dietary tradition for specific ethnic groups. Given the strong association between migration and dietary change, it is particularly important that dietary advice for migrants be both accurate and specific. In this article, I examine the cultural construct of "traditional foods" through mixed method research on diet and foodways among rural farmers in Guanajuato, MX and migrants from this community to other Mexican and U.S. destinations. Findings reveal first, that quantitatively salient terms may contain important variation, and second, that some "traditional" dietary items elike "refresco," "carne," and "agua" e may be used in nutritionally contradictory ways between clinicians and Mexican immigrant patients. Specifically, the term "traditional food" in nutritional advice for Mexican migrants may be intended to promote consumption of fresh produce or less meat; but it may also invoke other foods (e.g., meats or corn), inspire more regular consumption of formerly rare foods (e.g., meats, flavored waters), or set up financially impossible goals (e.g., leaner meats than can be afforded). Salience studies with ethnographic follow up in target populations can promote the most useful and accurate terms for dietary advice.
Medical Anthropology, Apr 1, 2005
Gestational diabetes is the one form of this well known, chronic disease of development that disa... more Gestational diabetes is the one form of this well known, chronic disease of development that disappears. After the birth of the child, the mother's glucose levels typically return to normal. As a harbinger of things to come, gestational diabetes conveys greater risk for later type 2 (previously ''non-insulin dependent'') diabetes in both the mother and child. Thus, pregnant women have become a central target for prevention of this disease in the entire Pima population. Based on ethnographic interviews conducted between 1999 and 2000, I discuss the negotiated meanings of risk, ''borderline'' diabetes, and women's personal knowledge and experiences of diabetes, particularly during the highly surveilled period of pregnancy. I also highlight the heterogeneity of professional discourse pertaining to gestational diabetes, most notably the debate surrounding its diagnosis. Significantly, women's narratives reveal the same set of questions as is raised in the professional debate. Implications for diabetes prevention and for balancing the increased surveillance of pregnant women with clinical strategies that privilege their experience and perspectives are also discussed.
Cambridge Quarterly of Healthcare Ethics, Mar 1, 2023
In the article by Sale and Smith-Morris, 1 Ana Carolina Gahyva Sale was incorrectly listed as bei... more In the article by Sale and Smith-Morris, 1 Ana Carolina Gahyva Sale was incorrectly listed as being affiliated with both Southern Methodist University and the University of Texas Southwestern Medical Center. She is only affiliated with Southern Methodist University. This has been corrected in the article and above. We regret the error. Note 1. Sale ACG, Smith-Morris C. Moral distress under structural violence: Clinician experience in Brazil caring for low-income families of children with severe disabilities. Cambridge Quarterly of Healthcare Ethics 2023;32(2).
Medical Anthropology, Nov 17, 2019
Cambridge Quarterly of Healthcare Ethics, Feb 14, 2006
This paper presents an analysis of the applicability of a principalist approach for a global, or ... more This paper presents an analysis of the applicability of a principalist approach for a global, or cross-cultural, bioethics. We focus especially on the principle of individual autonomy, a core value in ethical discourse. We echo some long standing criticisms of other anthropologists, sociologists, and many medical ethicists that the individualistic approach to autonomy is a Euro-American value and cannot be ethically applied in all settings. As a remedy, we suggest an adaptation of Kleinman's Explanatory Model approach to questions of decisionmaking. 1 We argue that the analysis and resolution of ethical dilemmas might also benefit from forms of pedagogy that integrate anthropological and other social science perspectives, and the incorporation of ethnographic tech niques in ethical practice. We begin our discussion with a case. Case 1 Mr. R is an Asian man with seriously compromised lung function, hospitalized for several months, currently on a ventilator. The lCU medical team wants to remove him from life support, but the family, consisting of his wife and two daughters, have so far declined. An ethics consult is arranged to mediate between the lCU personnel and the family. The family has been in the United States for about six years and the wife does not speak English. An interpreter is present. A physician begins by asking the wife, through the interpreter, "00 you think your husband would want to be like this? Do you think he is happy?" He then shows an X ray of the patient's lungs to demonstrate the gravity of his condition. A bilingual friend arrives. The physicians present options: Place the patient on a ward with a DNR order and the understanding that he will not be moved back to the lCU or send him home with a ventilator (although the family has already said that everyone works extensive hours and no one will be available to stay with him). Because he is not a citizen, there are no nursing homes available (in this state) for transferring a ventilator-dependent patient. The family friend translates for his wife: "She is his wife, she cannot say whether he is happy. As his wife, she does not know what he would want. It is not possible for her to decide. Also, she believes that as a Catholic, she cannot choose to We appreciate the extensive efforts of Michelle Amoruso, doctoral candidate in anthropology, who assisted with the preparation of the manuscript.
Medical Anthropology, Mar 22, 2018
If, in the past decade, you have not dusted off your philosophy readers or revisited Carol Gillig... more If, in the past decade, you have not dusted off your philosophy readers or revisited Carol Gilligan's In A Different Voice, then you might have missed medical anthropology's decade on "care." This surging area of study showcases the relationships, roles, and meanings of care, and is the ethnographic version of an ethics of care initiated by feminist scholars like Gilligan and others in the 1970s. For ethicists, the major concern is interdependence of persons and the vulnerability of the sick to the moral actions of others. Anthropologists take up these ethical questions with less universalist perspectives, emphasizing local practices and the "tinkering" that can only be described as relationship-specific (Mol et al. 2015; see also Huang 2015). For an introduction to this perspective, one might read any of a few published reviews (Alber and Drotbohm 2015; Martin, 2013) or several early works including an essay by Janelle Taylor (2008 and response by Lawrence Cohen) and the books of Annemarie Mol (2008; Mol et al. 2010) or Miriam Ticktin (2011). But if the roots of care in ethical theory are to be remembered, and I
Rutgers University Press eBooks, Dec 13, 2019
Medicine anthropology theory, Jun 16, 2020
Before professional diagnosis, the determination of whether one is 'ill' or 'well' rests within t... more Before professional diagnosis, the determination of whether one is 'ill' or 'well' rests within the patient. These moments, when sufferers (re)cognize their own bodily and phenomenological experience as abnormal or different, are critical to the positioning of healer and patient. So too are moments when diagnosed patients, struggling with a treatment regime, compromise and adjust to embrace, if only partially, disparate ideas of health. In this article, I apply Homi Bhabha's framework of hybridity and difference to think about the perception of illness, self-diagnosis, and power in healing relationships. I consider how sufferers enact hybrid positions between their bodily perceptions and their professional diagnoses. To illustrate the utility of Bhabha's colonial critique for health care, I examine narratives by patients with diabetes-related vision loss about: (1) first realizations that something was wrong, what Bhabha might call the 'intervention of difference'; (2) expressed differences between self-knowledge and biomedical knowledge, corresponding to Bhabha's 'partial embrace' of the colonial ideal; and (3) the self-colonizing epistemological work that compliant patients do as they reorient their pre-diagnostic self to a post-diagnostic habitus of self-monitoring, timed medications, and other treatments. I conclude with a discussion of how Bhabha's colonial hybridity supports a more productively contentious medical anthropology that envisions and pursues decolonized health care.
Human Organization, Sep 1, 2007
Ethnographic and biological research among tribal communities demands that a researcher successfu... more Ethnographic and biological research among tribal communities demands that a researcher successfully navigate not only the social environment but also the political, legal, and biomedical perspectives that compete in today's ethics battleground. Health researchers are, therefore, increasingly drawn into the complex arenas of tribal identity, self-determination, and governance. This brief discussion reflects upon almost a decade of research among indigenous groups in the American Southwest, spanning some of the region's most hostile and unwelcoming years toward outsiders since the Pueblo Revolt. I focus upon the concept in biomedical ethics of individual autonomy, a powerful but inadequate concept for treatment of tribal decision-making and community self-determination. Incompatible with culture mores of strong family, community, and group decision-making, the principle of autonomy serves as an acculturative agent within medical research and treatment. Alternative approaches to consent, and to ethics more broadly, are called for.
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Papers by Carolyn Smith-Morris