8/8/2019 AJOB - Consent While Hanging From a Cliff - 2010

1/3

PLEASE SCROLL DOWN FOR ARTICLE

This article was downloaded by: [Justo, Luis]

On: 3 February 2010

Access details: Access Details: [subscription number 919064697]

Publisher Routledge

Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-

41 Mortimer Street, London W1T 3JH, UK

The American Journal of BioethicsPublication details, including instructions for authors and subscription information:http://www.informaworld.com/smpp/title~content=t713606739

Consent While Hanging From a Cliff?Luis Justo aa Universidad Nacional del Comahue,

First published on: 03 February 2010

To cite this Article Justo, Luis(2010) 'Consent While Hanging From a Cliff?', The American Journal of Bioethics, 10: 2, 61 62, First published on: 03 February 2010 (iFirst)

To link to this Article: DOI: 10.1080/15265160903531283URL: http://dx.doi.org/10.1080/15265160903531283

Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf

This article may be used for research, teaching and private study purposes. Any substantial orsystematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply ordistribution in any form to anyone is expressly forbidden.

The publisher does not give any warranty express or implied or make any representation that the contentswill be complete or accurate or up to date. The accuracy of any instructions, formulae and drug dosesshould be independently verified with primary sources. The publisher shall not be liable for any loss,actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directlyor indirectly in connection with or arising out of the use of this material.

http://www.informaworld.com/smpp/title~content=t713606739http://dx.doi.org/10.1080/15265160903531283http://www.informaworld.com/terms-and-conditions-of-access.pdfhttp://www.informaworld.com/terms-and-conditions-of-access.pdfhttp://dx.doi.org/10.1080/15265160903531283http://www.informaworld.com/smpp/title~content=t713606739

8/8/2019 AJOB - Consent While Hanging From a Cliff - 2010

2/3

Ethics of Researching Asylum Seeker Health

Consent While Hanging From a Cliff?Luis Justo, Universidad Nacional del Comahue

If a person is falling from a cliff and I throw a rope to res-cue her, is there any moral sense in explaining to her the

ropes diameter, its weight-sustaining capacity in differentconditions, the possibility of being scratched while beingpulled up from the cliff, the reproaches that she may getfor being an imprudent person, the legal consequences offalling down, and so on? Is she in an adequate situation tomake a meditated rational evaluation of risks and benefits?Or should I just throw her the rope and shout to her to holdtight?

In many a dire situation, there are standards that cannot be considered as paternalistic, since they reflect interna-tional rights consensus in emergencies, and in those situa-tions the prerequisite of informed consent loses its originalsense, and its meaningseems overextended. While we agreewith Rousseau and Kirmayer (2010) in worrying about the

possible misuse of power by deciding for others that theylack the capacity (whether due to their circumstances or totheir personal condition) to have a voice, surely there aretimely opportunities to actively work for this voice to beheard. In the meantime, silence is not an option.

Thereport by Zion and colleagues (2010)shows howhu-man rights of imprisoned refugees in Australia are grosslyviolated, and, as a consequence, their health status dete-riorates and mental health troubles are frequent. The Aus-traliangovernments denial of such human rights violationsapproaches the behavior of authoritarian governments.1

Even if research is needed to gather evidence and to doc-ument those violations, such research is difficult and mayharm those it is trying to help. But in situations of gross

human rights violations the first duty of scientists is to de-nounce them and develop advocacy and activism to stopthe infringements.2 That is the main requirement of a rig-orous ethical science, and people of science should not bediverted from it by methodological requirements that maybe established by governments as distractive maneuvers. Toengage in debate about the rigorousness of research and theethics of informed consent in such a situation could amountto involuntarily falling prey to oppressor power rules, sincethere is no intrinsic reason to consider that narrative-basedresearch is not appropriate as evidence, as there is not ascientifically established way to study human suffering.

Address correspondence to Luis Justo, Universidad Nacional del Comahue, Catamarca 140, 8324, Argentina. E-mail: ljusto@gmail.com

1. Current government efforts to alleviate the refugees situation by closing Nauru and changing regulations governing permission towork for asylum seekers, as mentioned by Amnesty International Australia, should be recognized.2. The scientific establishment in severalLatin American countries wassilentaboutphysicians involvement in human rights violations.As a sad example, Argentinas Academia Nacional de Medicina (National Medicine Academy) didnt raise its voice when Argentinedoctors participated in torture during the last military dictatorship.3. Ill treatment during captivity, such as psychological manipulations, humiliating treatment, and forced stress positions, does not seemto be substantially different from physical torture in terms of the severity of mental suffering they cause, the underlying mechanism oftraumatic stress, and their long-term psychological outcome. Thus, these procedures do amount to torture, thereby lending support totheir prohibition by international law.

As Robertson, Bedell, Lavery, and Upshur (2002) observe,even if such acts of bearing witness cannot, in themselves,

be reduced to a measurable outcome, . . . they do constitutea form of evidence. Zion and colleagues (2010) sensiblycomment that all these methods of data collection, includ-ing subversive methods, narratives, and stories, build up ahealth map that may be integrated with more conventionalresearch and professional theoretical lenses to provide alegitimate account of the implications of public policy thatmocks human rightsprinciples andengendersill-health andprofound suffering (Zion et al. 2010).

Few would dispute that the treatment asylum seekersreceived in Australian detention camps was cruel, inhu-man, and degrading. That kind of treatment amounts totorture in conception and also in consequences, as shown byBasoglu and colleagues3 (2007). Participation of doctors or

other healthworkers in it should be vigorously opposed andsanctioned (Justo 2003; 2006), as normative codes and in-ternational sanctions are importantalthough the effectivedissuasive power in the field cannot be known in advancesince authoritarian governments strive to disclaim such de-nunciations and sometimes loosen the harshness of deten-tion conditions.

A TRIUMPH OF COLONIALITY

Many of the former European colonial powers are cur-rently confronting immigration through porous boundaries(ONeill 2000) and refugee problems arising from their pastcolonialrule, butAustralian disrespect for the human rightsof refugees could be seen as a triumph of coloniality, as

colonial behaviors formerly applied to this country by theBritish Empire are subsequently internalized and adoptedby it. This adoption and institutionalization of colonial rules by the colonized (currently and historically observed inLatin America) is called by Quijano coloniality of powerandaccounts for the persistenceof a colonialframe of worldperspective, in which the cognitive, juridical, and powerstructures of new states are similar to those of the formercolonial master (Quijano 2000).

Of course, bearing witness and making public state-ments risks retaliation fromthe authoritiesand punishment,including work loss for state employees, and hardening of

February, Volume 10, Number 2, 2010 ajob 61

8/8/2019 AJOB - Consent While Hanging From a Cliff - 2010

3/3

The American Journal of Bioethics

detention conditions for refugees. Although this fact callsfor extreme caution and deliberation about the measuresto be taken, as humanitarian lawyer Francoise Bouchet-Saulnier (2000) states, Contrary to the general view, pub-lic statements by humanitarian organizations constitute, inextreme circumstances, a guarantee of the quality of theiraction and an act of protection for endangered popula-tions. They shatter the relationship of passive complicitythat is created between the executioner and relief person-nel. However, this marks a very thin line for the limit be-tween helping people and being an involuntary accompliceof abuses; the rebellious humanitarianism" of experiencedMedecins Sans Frontieres could be of help when trying toformulate such new operating frames.

ONeill,a strong critic of abstract utilitarian cosmopoli-tanism, questions the role of states in seeking and accom-plishing international justice, and criticizes the cosmopoli-tan rhetoric while engaging in anti-cosmopolitan action. Inher view, this is favored by declarations of rights, sincethey have no practical meaning as they dont determinewho ought to do or provide what for whom. But then shecontinues by saying that institutions cannot have obliga-tions to perform tasks for which they lack capabilities andthat weak states cannot coherently be required to carrytasks for which they are not competent. Nor can weak in-ternational institutions.1 This is a dangerous approach, asthe actions of states and international institutions are of-ten framed within normative codes that establish obliga-tions that are not currently in their scope of possibility. Theidea of progressivity in the rights fulfillment duty bringsthis very point to reality. In the absence of the progres-sivity criterion the instantaneous fulfillment of every rightcould and should be demanded of every state, which consti-tutes clearly an impossible task, therefore lackingany moralmerit.

Pogge (2002), in his defense of an intermediate cos-mopolitanism, states: We have a negative duty not toimpose an unjust institutional order upon any humanbeingcompatriots or foreigners. Framingthe issue in thisconception, we could say that the respect for human rightsis a minimum standard owed both to compatriots andforeigners, and this constitutes a sound basis to considerrefugees mistreatment. Starting from this point, a mixtureof advocacy and activism, illustrated by narrative research,shows the way to advance asylum seekers cause, withinthe path of rebellious humanitarianism of Medecins SansFrontieres.

Should, then, research be done in detention camps withrefugees? I think yes, indeed, if it is useful to end the in-human and cruel detention conditions. As to how shouldit be done, researchers will have to thread a narrow strait

between the Scylla of silence and the Charybdis of endan-gering refugees conditions. Usual rules of research ethicssuch as informed consent should be applied, taking the ut-most care for the asylum seekers welfare. A certain doseof paternalism could perhaps be discerned in this proposal,but, if present, it seems to be adequately justified by theharsh reality so well described by Zion, Briskman, and Loff.

REFERENCES

Basoglu, M., M. Livanou, and C. Crnobaric. 2007. Torture vs. other

cruel, inhuman, and degrading treatment. Is the distinction real or

apparent? Archives of General Psychiatry 64: 277285.

Bouchet-Saulnier, F. 2000. The theory and practice of rebellious

humanitarianism. Humanitarian Exchange Magazine, drawn from

the MSF International Activity Report (2000). The report is

available on the MSF website, Available at http://www.msf.

org/msfinternational/invoke.cfm?component=article&objectid=

6589C8A5-DC2C-11D4-B2010060084A6370&method=full html

Justo, L. 2003. Argentina: Torture, silence and medical teaching.

British Medical Journal 326: 14051406.

Justo, L. 2006. Editorial: Doctors, interrogation, and torture. British

Medical Journal 332: 14621463.ONeill, O. 2000. Distant strangers,

moral standing and porous boundaries. In Bounds of justice, 186.

Edinburgh, UK: Cambridge University Press.

ONeill, O. 2002. Global justice: Whose obligations? Talk given at the

launch of the Centre for the Study of Global Ethics, University

of Birmingham. Available at http://www.globalethics.bham.ac.uk

(accessed August 23, 2004).

Pogge, T. 2002. Cosmopolitanism: A defence. CRISPP 5(3): 8691.

London.

Quijano, A. 2000. Colonialidad del Poder y Clasificacion Social.

Journal of World-Systems Research Special Issue: Festschrift for Im-

manuel Wallerstein, I(vi, 2): 342386.

Quijano, A. 2000.Colonialidad delpoder, eurocentrismoy America

Latina. In La colonialidad del saber: Eurocentrismo y ciencias socials,

comp. E. Lander, 246, 55. Perspectivas latinoamericanas. CLACSO,

Consejo Latinoamericano de Ciencias Sociales, Ciudad Autonoma

de Buenos Aires, Argentina.

Robertson,D., Bedell,R., Lavery, J.,and Upshur, R. 2002.What kind

of evidence do we need to justify humanitarian medical aid? Lancet

360: 330333.

Rousseau, C., and Kirmayer, L. 2010. From complicity to advocacy:

The necessity of refugee research.American Journal of Bioethics 10(2):

6567.

Zion, D., Briskman, L., and Loff, B. 2010. Returning to history: The

ethics of researching asylum seeker health in Australia. American

Journal of Bioethics 10(2): 4856.

62 ajob February, Volume 10, Number 2, 2010