MEDIDAS EN FASE DE FUNCIONAMIENTO

Evidence-based medicine (EBM) is “the conscientious, explicit and judicious use of current best evidence in mak- ing decisions about the care of individual patients” (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Within Western countries, EBM has grown in importance in the clinical arena as a mechanism to elimi- nate the over- or under-use of medical services and thus to maximize efficient care (Sackett et al., 2000). Few anthro- pologists have begun to explore the cultural values under- pinning both the reliance on randomized clinical trials to inform health policy, and health professionals’ resistance to implementing such guidelines into clinical practice (Bogdan-Lovis, 2001; Gordon, 2003b). Ethically, EBM raises questions about macro-allocation in the provision of quality care because health insurance plans increasingly depend on EBM guidelines to determine which problems receive coverage (Hope, 1995). Since EBM has become integrated into medical education, future research could investigate shifts in medical knowledge (epistemology) and concomitant changes in clinical practice by, for instance, investigating how physicians negotiate between drawing on population-based data (consistent with the goals of public health) and drawing on the knowledge and preferences of individual patients (consistent with the traditional goals of medicine and ethics) (Tonelli, 1998). Thus, research in EBM is a fertile area that entails the intersection of cultural studies of science, decision- making, and health policy.

C

ONCLUSION

Anthropological research in bioethics has flourished in its first decade. We can see that the relationship between anthropology and bioethics is twofold: some do research “of” bioethics as a cultural domain while others do research “in” bioethics, often collaborating with others outside the field to better address more applied concerns. The field of bioethics as well as its methods, theories, and practices are all rich areas for anthropological inquiry given the diverse range of topics and issues that call for a contextualized exploration of what it means to be a moral human being. The continued development of biotechno- logical advances, health care challenges, and greater con- cern for the moral life or suffering experienced by patients, families, and clinicians in a global world context generates new questions about the definition of life and death, self, other, personhood, power dynamics, and right and wrong in the context of illness, health, and healing. To answer these questions and to better inform health policies, anthropologists are increasingly participating in interdisciplinary collaborative bioethics research. Such participation enables anthropological concerns to be given greater voice in ensuring that taken-for-granted cul- tural assumptions are not accepted prima facie but are instead contextually considered when analyzing theory and practice within the bioethics enterprise.

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