Shyrock (2008) points out ‘[h]ospitality is always partially unseen. As a social performance, many of its most important elements are time delayed or acted out elsewhere’ (2008:59). His comment builds upon Pitt Rivers’ study, which observes that
While a host has rights and obligations in regard to his guest, the guest [...] incurs [...] the right and obligation to return hospitality on a future occasion on territory where he can claim authority. The reciprocity between host and guest is thus transposed to a temporal sequence and a spatial alteration in which the roles are reversed (2012[1963]: 514-515, emphasis added)
The Survey is not only a form of standardisation that links locations across space: in time, as with Pitt Rivers’ observation, the roles are reversed. Surveyors — who themselves come from ethics committees — will be surveyed. Those being surveyed have the chance to learn to be surveyors.
‘They’re surveyor in one place, surveyee in another. You’ll be surveyed yourself. The surveyor will come from somewhere, some other country,’ explained Juntra. Unlike the reversal in Pitt Rivers’
study above however, hospitality on one’s own territory does not come with a claim to authority.
Pitt Rivers observes that ‘[h]ost and guest can at no point within the context of a single occasion be allowed to be equal, since equality invites rivalry. Therefore their reciprocity resides, not in an identity, but in an alteration of roles. (1963: 21). This forms a mutual interdependence, described as a ‘self-sustaining model’ because the groups relied upon one another to ‘keep the standard’ of the recognition program. The annual Conference was ‘like a reunion of family’ because, over the year, delegates have been working together, ‘visiting one country, visiting another.’ To Juntra, since all the surveyors had been ‘talking about the same goal that each one contributes to’, ‘instead of competing or being jealous, because of exchanging, people are accountable to one another.’ This
‘accountability’ led to a common interest in the quality of the recognition program, so that the standards would not fall, and the value of the recognition would be maintained:
The recognised people say we need to keep up with quality - if one of us jeopardizes it....so they’re looking after themselves. They talk to each other and suggest ways to improve. This model is very good.
Juntra’s description of her intended outcome — that it creates a self sustaining system made up of equally invested partners in a dance of reversing places. In this, the survey program itself is at stake. If mutual investment in the quality of the recognition program leads to a mutual monitoring, there is also the question of what and whose standards are to have the final say. In the making-equal of surveyors and surveyees through the language of friendship, the edge of
authority of Surveyors diminishes. The threat of non-accreditation remains, of course, but the atmosphere meant that the surveyees were very willing to question and engage the surveyors in discussion about their ‘findings.’ Nonetheless the influence of American priorities is clearly felt:
It’s about power, influence. The NIH you see is funding research. WHO, maybe their presence is not as much. [We] see lots of US projects. WHO is seen as more humanitarian, not affiliated to one country. This one [US] there’s pressure for you to comply because you’re receiving money. The Americans also feel that their standards are the best.
Interest in becoming hosts to American research means there is also interest in being recognised by American standards. What FERCAP’s approach to standard making through mutuality shows up is the difference they perceive between their hospitality based survey and the attempts of other recognition programs to break into the Asian market. As Selwyn writes, ‘the rules and principles of hospitality stand at one remove from the principles and procedures of the market place,’
reminding us that both Mauss and Malinowski warned against interpreting the meaning of gift exchange in terms of trade (Selwyn 2000:35). I have shown how FERCAP differentiates itself, places itself ‘at one remove’ from audit models based solely on evaluation and the marketplaces of both committee accreditation and trial attraction. I suggest that the framing their program of mutuality through hospitality helps illustrate this difference more clearly.
Foregrounding the hospitality of the Survey has also allowed me to demonstrate what Candea and da Col (2012: S14) refer to as a scale-shift through reference to Herzfeld’s observation of an:
essential homology between several levels of collective identity - village, ethnic group, district, nation. What goes for the family home also goes, at least by metaphorical extension, for the national territory (Herzfeld 1987:76).
Homology here is more than metaphorical extension: surveyors applying the principle of gender balance as ‘ethics’, for example, want to see equal numbers of men and women both as Surveyors and as committee members. In the material above, like hospitality, objectivity appears to shift scale, applied to the committee meeting and to the Survey. The Survey, aware of its politics, borrows from the familiar scientific language of its participants the tool of objectivity. Through combining the views of each of the Surveyors into the corporate person of Dr Sam, and by amassing the ‘evidence’ that will be used to support the recommendations, objectivity emerges as a social strategy, to neutralize the dangerous tensions of critique. As Candea points out, ‘points of tension in practice coalesce around scale-shifts: when an individual’s action is taken to be representative of an entire group, or, conversely, when an entire group is seen to act against a single individual’ (2012: S46). Here I have shown how the emphasis on evidence deflects from the
possible insult of judgement. But in its familiar of evidence and through its mimicry of science, perceived as ‘good’ it leads to surveyors focusing on that which can be evidenced. This in turn encourages committees to regard evidence for decisions as essential. What is interesting about this instance of hospitality is that it is employed in a form of governance. How people handle the potential for critique causing insult is central to the next two chapters.
Shapin and Schaffer claim that in the English 1600s the question,’Where can I find a natural philosopher at work?’ would have had no single reply (1985:333). The creation of a ‘special professional space’, at least to one of their book’s protagonists, Hobbes, was a ‘threa[t to] the public status of philosophy’ (1985: 333). In this chapter, I show how a room assigned to an ethics committee is not just an anonymous office but is given meaning by the staff who work there, the committees who convene there and the Surveyors who visit.24 For the ethics work of FERCAP, however, the creation of a ‘special professional space’ is a criterion upon which the enterprise of a systematised ethics rests. To draw out the importance of a room let me first recount an encounter with a committee without a room.
The first ethics committee meeting I saw when I arrived in Sri Lanka in early 2009 was being held in the Medical Faculty in Colombo and I saw it entirely by chance. Thirsty, and hoping to fill my water bottle before leaving the faculty, my colleague and I had stepped into the Senior Common Room in search of a water cooler. It was mid-afternoon, and the water of the monsoon rainstorm was pouring down the windows. ‘Looks like an ethics committee,’ I joked to her quietly, as we crossed the room across from a table piled high with paperwork, around which a dozen or so people were sitting. It was a joke, because less than two weeks into fieldwork, I was still very much focused on finding and getting access to these committees. I had no reason to imagine I might literally walk in on a meeting. Yet as I stood, filling the bottle facing away from the table, murmurs of the ‘benefits to Sri Lanka’, and talk of ‘risk’ drifted across the room. ‘You know, I think it actually is!’ whispered my colleague, having turned to face the deliberators at the table: ‘Here they all are.’ She had started research in the country over a year beforehand, and recognised faces I too would soon come to know. I filled the bottle slowly, wishing I could stay, but unnerved enough to leave, knowing that my own ethics application for research had been reviewed by that same committee in same manner it was now reviewing another just a few meters away.
24 Sometimes, as in the example above, offices are connected to the boardrooms where deliberations happen. More often, the office designated for ethics committee work is separate from an institution’s boardroom which is used for the committee meeting. I pay attention to both spaces - as the survey does in its observation of both the office, and the ethics committee meeting.
That the committee were meeting in a common room which, while partially restricted by being
‘senior’ was still open, had little meaning for me at the time. In an interview a few weeks later, during a discussion about capacity building, the first hints of a link between the ‘where’ of ethics
— its physical institutionalisation — and its social robustness began to emerge. The term
‘grounding’ might be useful in two senses here: both as a physical grounding in a room, and the grounding that an individual conversant in a field of knowledge. My interviewee, Dr Suraj, was the chair of a department at the same medical faculty. He been involved in establishing ‘ethics’ in the University, and was adamant that unless ‘local people have capacity to train others, institutions will not develop.’ We were talking about research ethics, and its presence in Sri Lanka. He drew his examples from histories of his own department:
Psychiatry was not a department in the 1970s. It was one person. Now, there are six. It is a separate subject in the undergraduate curriculum, people can get interested in it. It is like this local knowledge can develop. For example, there were all these dams built. One by the British, the French, the Dutch, all of them said, ‘We’ll come in and do capacity building, we’ll teach you how to do it yourselves, so Sri Lankans can do it.’ That never happened.
His examples were a way of talking about how research ethics as a set of knowledges was being introduced:
Something happens in the UK or the US, someone gives a lecture, comes, goes away. That is useless. It is not of help to Sri Lanka. We need a group of people here, developing knowledge, discussion. Without indigenous institutions as the knowledge base, no subject will live.
Dr Suraj then proceeded to ‘ground’ a knowledge of ethics, and the potential for ethical thought, in all people. At the same time, he traced the ‘grounding,’ or institutionalisation of ethics within the physical buildings of the university:
Suraj: People feel ethics is exotic, it has experts. I don’t believe in that. If you really look at ethics in the world, it’s in every field. In medical schools, it is the case that in almost all of the classes the teacher knows more than the students. But that is not true in ethics - in ethics, both are equal. It is just that the student is not sensitized, they haven’t developed an analytical rational expertise.
RDJ: How might they do that?
Suraj: It is a value system. You must value ethics as important. And then you are interested in it and learn. So it was a ‘sensitisation process’, people realising that ethics is related to clinical work and to policy. We started talking about equity systems, and public health, organised in different ways. This lasted five or six years. Lots of people were exposed. Ethics became something not alien, exotic, something to do with day to day work. At that time they had no guidelines, institution, workshop. So I got the WHO funding, books computers, training programs. I got that room.
RDJ: Can I ask you why that is important?
Suraj: Otherwise it is person, there is not a system. The ERC, I recruited them, but unless we have commitment to the development of ethics....[shrugs]
Leaving the offices where we had talked, I stopped by the room he had mentioned. The tall wooden door bore a small printed sheet reading ‘Ethics Committee Room,’ and though the glass was dusty, through it I could see a pair of interconnected rooms. Paint peeled from the walls and wooden furniture was piled up against one of the windows. It was a site of disarray. When I asked around about the room, I was told that progress on its restoration was slow going, funds were difficult to find. The suggestion was that some of the barriers to financing the room were also barriers to the formalisation of ethics, but that with dedication it ‘would happen’, indeed, had to happen, in order for the committee to be surveyed by FERCAP.
This all happened during my first stay in Sri Lanka. By the time I returned, just over six months later, the room had transformed. The space had been cleared, freshly painted and a new floor laid. It was filled with new furniture and equipment, chosen with the recent Survey in mind. On arrival, I went to find Madhubashini, one of the secretaries I knew, only to discover her in her new office, overhead fans whirring, brand new filing cabinets lined up behind the desks. Another secretary had been recruited to join her, and we talked about their experiences of the FERCAP survey. As I went to peer into the adjoining room, to which Madhubashini had just delivered some ‘short eats’ from the canteen, she blocked me with her body. ‘Confidential meeting,’ she said.
For Suraj, the room was a change in the status and permanence of ethics in the institution.
Unlike the people who carried the knowledge of ethics, who could leave, the room could be a container for that knowledge; it would remain. Anthropologists have long paid attention to the relationship between the arrangement of persons in space and the conceptual work that those spaces are made to do. We can recall Wagner’s diagram of the inversions in a Usen Barok Kaba mortuary feast (2001: 34-47), Mitchell’s Foucaldian treatment of the disciplined and disciplining spaces of colonial Egyptian schools (1988: 78-79) or Humphrey’s analysis of a Mongolian hut with its male and female domains (1974:26). In this chapter, I attempt a related approach to committee rooms, the physical arrangement of space and the conceptual and social relationships therein. In opening with Shapin and Schaffer’s work, a study that tracks the ‘nascent laboratory’ of Boyle (1985: 334), I am making a case that there is something akin to the ‘laboratization’ of ethical review processes. The room is at once a template and a unique space in an institution or hospital, and the Survey assesses both. In the language of capacity building, the space of the room is both a
marker of capacity and a capacity in itself, indicative of a change in the relationship between those who championed it and their institution. But I would like to suggest that there is more to be gained from the analysis of a physical room. As the chapter proceeds, I embark on an analysis of what happens inside the confines of the room, taking first the discussion of its physical boundaries during a Survey. Through this, we become aware of the room’s edges — how the discussions of people within it reference the world outside of it — and how what happens within it is translated for that outside. This translation I consider through the art of minute taking, the innovation of ‘realtime minutes’ and the visibility they offer both during the meeting and for future audits. Visibility is, however, of concern to some committees when it comes to making a decision. I detail decision-making devices, real and ideal, as committee members struggle with voting and consensus. Issues of visibility and concealment which link these three vignettes are brought to the fore in my closing discussion of Conflict of Interest, in which the invisibility of the relations that committee members may have (relations configured as interests) leaves the FERCAP trainers and committee members anxious.