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Resisting commensurability : against informed consent as an anthropological virtue Bell, Kirsten 2014

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AMERICAN ANTHROPOLOGISTResearch ArticleResisting Commensurability: Against Informed Consent asan Anthropological VirtueKirsten BellABSTRACT In this article, I examine anthropology’s embrace of the informed consent doctrine at the end of the1990s. Although acknowledging its utility in resolving the tensions between disciplinary ideals of openness in fieldresearch and the diverse array of contexts in which anthropologists now work, I argue that it has not been in our bestinterest to co-opt the concept. Bringing together the prior critiques of the informed consent doctrine’s application toethnography, I criticize the tendency of some ethnographers to characterize ethnographic practice as “insuperablyflawed,” pointing instead to the problems with the doctrine itself. I tease out underlying assumptions about thenature of research (and researchers and research subjects) that it presumes, and I conclude by suggesting the needfor anthropology take a principled stance against the informed consent doctrine. [ethnography, informed consent,research ethics, institutional review boards, anthropology of ethics]RESUMEN En este artı´culo, examino la aceptacio´n de la doctrina del consentimiento informado por la antropologı´aa finales de los 1990s. Aunque reconociendo su utilidad para resolver tensiones entre los ideales disciplinarios deapertura en el campo de la investigacio´n y el diverso arreglo de contextos en los cuales los antropo´logos ahoratrabajan, argumento que no ha sido en nuestro mejor intere´s el cooptar el concepto. Juntando las crı´ticas anterioressobre la aplicacio´n de la doctrina del consentimiento informado a la etnografı´a, critico la tendencia de algunosetno´grafos a caracterizar la pra´ctica etnogra´fica como "insuperablemente problema´tica," en vez de sen˜alar losproblemas con la doctrina en sı´ misma. Extraigo los supuestos subyacentes sobre la naturaleza de la investigacio´n(y los investigadores y los sujetos de investigacio´n) que e´sta presume, y concluyo sugiriendo la necesidad de laantropologı´a de tomar una posicio´n de principios en contra de la doctrina del consentimiento informado. [etnografı´a,consentimiento informado, e´tica de la investigacio´n, juntas de revisio´n institucional, antropologı´a de la e´tica]As most readers will be aware, the recently revisedAmerican Anthropological Association Statement onEthics (AAA 2012) emphasizes the importance of informedconsent.1 To quote from the code, “Anthropological re-searchers working with living human communities must ob-tain the voluntary and informed consent of research partici-pants” (AAA 2012). During the consultations regarding theproposed revisions to the code, I watched the discussions un-fold on the AAA blog with much interest. However, whileseveral concepts engendered lively debate, the discussionAMERICAN ANTHROPOLOGIST, Vol. 116, No. 3, pp. 1–12, ISSN 0002-7294, online ISSN 1548-1433. C© 2014 by the American Anthropological Association.All rights reserved. DOI: 10.1111/aman.12122thread on the principle of informed consent was noticeablylackluster.The most contested principle was the admonishment to“do no harm,” which generated 50 responses, ranging fromexpressions of unqualified support to an emphatic dismissalof its relevance to anthropology. For example, according toMurray Leaf, “Do no harm is fine as a principle of medicalpractice, where you are working with a single individual.It is nearly meaningless when you (we) work with humancommunities, in which what is good and what is harm is2 American Anthropologist • Vol. 116, No. 3 • september 2014usually in contention” (AAA 2010a).2 In the view of GeraldSider,Do no harm, which sounds good and clean and noble, is just aboutthe most self-serving, juvenile crap I have heard in a very longtime, and morally vacuous to boot . . . There is no way we can dono harm, unless we are postmodernists who write drivel, becauseto live morally in an unequal world we have to hurt someone. Theonly question that matters is who and why . . . Go and tell meyou do not want to do any harm to anyone, when the violence ofinequality and domination within native communities is probablythe most salient feature of the last 3 or 4 decades of indigenouspeoples’ histories. Unlike what the U.S. does, we do not have to kill ortorture anyone, just move them very firmly aside. [AAA 2010a]In contrast, only nine comments were posted on theinformed consent principle, and most took the form of sug-gested tweaks to the wording, with several explicitly affirm-ing the importance of the concept to the discipline. Accord-ing to Shalini Shankar, “Informed consent, as this principleemphasizes, is indeed an essential part of anthropologicalresearch” (AAA 2010b). The bulk of feedback centered onthe need to encourage ethics boards tomove beyond the ideaof consent forms; the following comment by Linda Giles isrepresentative of the responses posted:I like the addition that informed consent does not need to [beobtained] via awritten form. I find such a formvery off-putting andworrying for many local peoples outside of the European culturalmilieu—they worry about what they are signing and moreoverthey often worry about remaining anonymous. Hopefully addingthis part will help influence IRBs [institutional review boards] torealize that written consent forms are often not the best way toobtain consent in many fieldwork contexts. [AAA 2010b]The applicability and validity of the concept of “informedconsent” itself was not challenged to any substantive de-gree in the feedback. In this respect, the comments largelyechoed the results of Lisa Wynn’s (2011) international sur-vey of ethnographers’ experiences with institutional ethicsoversight, wherein many respondents criticized their ethicscommittee’s preoccupation with written consent and theidea of consent as a one-off process, but none challengedthe doctrine itself. However, while currently treated as aclosed debate within anthropology (in official discourse, atleast), as the historian Zachary Schrag (2010) documents,it was only in the late 1990s that the doctrine of informedconsent was formally embraced in the discipline, in the con-text of ongoing debate about its validity for anthropologicalresearch.How did the informed consent doctrine come to be im-ported into formal articulations of anthropological researchethics? Pointing to the debates about the concept of informedconsent in medicine and bioethics, the sociologist OonaghCorrigan has observed that her field has “by and large, posedvery few questions and has not contributed much in the wayof theoretical or empirical insight to this issue” (2003:769).This observation also holds equally true for anthropology.For various reasons, we haven’t subjected the concept to thedisorienting, critical-comparative perspective that is a char-acteristic feature of our discipline (cf. Lederman 2007:323).Such restraint is a little surprising, given that we’ve beensome of the loudest and most vehement critics of the ex-pansion of human subjects regulation to anthropological re-search. It suggests that informed consent has reached thestatus of an unassailable value—after all, how can one beagainst informed consent?Inspired in part by Michael Lynch’s (2000) effort toquestion the meaning and epistemic virtues ascribed to “re-flexivity,” I want to challenge the embrace of informed con-sent as an academic—and anthropological—virtue. In aid ofthis agenda, I focus on three distinct topics: (1) the context ofanthropology’s embrace of the concept, (2) the fundamentalincompatibility between ethnography and the informed con-sent doctrine, and (3) the underlying assumptions embeddedin the concept itself. I should note up front that much of thisarticle covers well-trodden ground and accompanies, ratherthan necessarily extending, the cogent critiques of humansubjects regulation leveled by others. However, by focusingspecifically on informed consent, I hope to challenge readersto consider whether it is in our discipline’s best interests toco-opt the doctrine as a meaningful way of conceptualizingand addressing the ethical issues involved in ethnographicresearch.INFORMED CONSENT: THE RISE OF A DOCTRINEThe doctrine of informed consent is generally deemed tohave made its first appearance in the originary sacred text ofbioethics: the 1947 Nuremberg Code. This code, developedin the wake of the Nazi war crimes trials, forms part of theobligatory history section of research ethics textbooks andis seen to represent the beginning of a more enlightened ap-proach to research ethics in the middle of the 20th century(Fitzgerald 2004; Petersen 2010). Although such Whiggishaccounts have been challenged (e.g., Vollman and Winau1996), it was indisputably the Nuremberg Code that en-trenched informed consent as a core ethical value. Althoughthe code pertained specifically to medical experiments, itbecame the foundation for subsequent efforts to articulateresearch ethics principles writ broad, including the BelmontReport, the first major effort to expand the scope of researchethics guidelines to social science and behavioral research(see Schrag 2010).The Belmont Report equally stressed the primacy ofinformed consent, stating:Respect for persons requires that subjects, to the degree that theyare capable, be given the opportunity to choose what shall or shallnot happen to them. This opportunity is provided when adequatestandards for informed consent are satisfied.While the importanceof informed consent is unquestioned, controversy prevails overthe nature and possibility of an informed consent. [HHS 1979]3Despite the overt centrality of biomedical rationales to theBelmont Report, this frame of reference is generally un-derstood as a neutral medium for expressing universallyapplicable principles (Lederman 2012). In this framework,informed consent to research participation is conceptualizedas a basic human right, one underpinned by the assumptionBell • Resisting Commensurability 3that enabling individuals to make free and informed choicesprotects their rights and welfare.Although energetic critiques have been mounted ofthe autonomous, rational individual evoked by the conceptand the fetishization of informed consent at the expense ofbroader moral issues (e.g., Corrigan 2003; Corrigan et al.2009; Harper and Jime´nez 2005; van den Hoonaard 2011),it remains at the heart of contemporary formulations of re-search ethics. Indeed, research ethics and informed consenthave come to be seen as virtually interchangeable synonyms;ergo to obtain informed consent is to be ethical, and beingethical is about obtaining informed consent.Despite its centrality to research ethics frameworks,as previously noted, it was only in the late 1990s that theAAA formally embraced the concept, which had both vocalsupporters and vehement detractors in the discipline. In anarticle published in Human Organization in 1994, CarolynFluehr-Lobban—one of the more influential supporters—opened the conversational gambit by unfavorably compar-ing anthropology with psychology, which embraced the in-formed consent doctrine in the 1960s. “Why,” she asked,“has such a potent doctrine not been explicitly incorporatedwithin the social sciences and their standards of professionalconduct?” (1994:2).Arguing against a position of disciplinaryexceptionalism, Fluehr-Lobban concluded that implement-ing the spirit of the doctrine of informed consent wouldresult in “better researchers and better research” (1994:8).Murray Wax (1995), perhaps the most longstandingcritic of efforts to extend human subjects regulation to an-thropology (e.g., Wax 1977), responded by articulating avariety of concerns about its application to the discipline.Arguing that it would foreclose valuable anthropological re-search, he pointed to the problems with determining whoshould provide consent in contexts of differing social andpolitical interests, as well as the general difficulty of com-municating study goals to people who often confuse anthro-pologists with welfare workers, missionaries, and so on. ForWax, “unhappily, we have usually been the target of regu-lators who operate in ignorance of our research situation”(1995:330).The debate continued in the journal over the followingyear, with Chris Herrera taking Wax to task for assertingthat anthropology should not be held to what now amountedto a universal standard. Herrera argued that “within the nar-row band of scientific inquiry that would be affected bya more stringent informed-consent doctrine, it is difficultto explain what kind of ‘damage’ greater attention to ethicswould cause” (1996:236). Clearly evident in Herrera’s com-mentary is a tendency to conflate informed consent with re-search ethics more broadly, perhaps unsurprising given theformer’s stranglehold on the latter, as well as Herrera’s owndisciplinary background in ethics rather than anthropology.Patently unimpressed with the likes of an ethicist enter-ing the fray, Wax decried such “tedious moralizing” from acommentator whose arguments drew exclusively from thepsychological and philosophical literature and who “uncon-sciously assumes the arrogance of the proselytizer, preachingto the heathen, and so uncomprehending of their resistanceto his misguided message” (1996:238). Attempting to dis-entangle informed consent from questions of morality andethics, Wax argued that the informed consent dogma waslargely irrelevant to the moral problems of cultural anthro-pology, becoming meaningless ideology that overlooked theresponsibilities of prolonged fieldwork.The final word went to Fluehr-Lobban (1996), whoreiterated her initial points using the language that has nowbecome standard in principled approaches to research ethics,arguing that a wide degree of pandisciplinary consensus hadbeen achieved regarding consent as an ethical and legal con-cept that recognized a basic set of rights all human “subjects”have. She warned, “The spirit of informed consent is notdivisible by discipline or subdiscipline, by research up anddown the social pyramid, or by the ‘good’ or ‘bad’ intentionsof the researcher” (1996:240). In the end, Fluehr-Lobbanprevailed, and in 1998 the AAA adopted informed consentlanguage for the first time (Schrag 2010:144).ANTHROPOLOGY’S EMBRACE OF THE CONCEPTSo what prompted the change—and why at this particu-lar juncture? As Peter Pels observes, “the present interestin ethical codes is only one way of institutionalizing moralstandards and ethical guidelines in anthropology and a veryrecent and fairly unusual one at that” (1999:101). Notably,the introduction of the informed consent wording in 1998coincided with the reconfiguration of the AAA’s “Princi-ples of Professional Responsibility” as a “code of ethics.”Prefiguring ethics in this way located the document withina broader pandisciplinary conversation; after all, ethics, asFluehr-Lobban made clear, are not local and particular butuniversal. And as we have seen, despite Wax’s attemptsto challenge the conflation, to talk of “ethics” makes talkof informed consent virtually unavoidable. In fact, what issurprising is that anthropology resisted the siren call of anethical code for so long.For Pels (1999), the field’s initial discomfort with rati-fying core principles is largely due to anthropology’s “ethicalduplexity.” In his view, anthropology’s epistemological com-mitment to cultural difference since the late 19th century hasmade its morals essentially duplex: “without duplicitous in-tent or moral corruption, anthropologists cannot but adopt‘double standards’” (1999:102). It was such duplexity—andthe ethical and epistemological doubling it entailed—thatenabled anthropologists to simultaneously service and dis-tance themselves from the colonial administrations that bothfacilitated and were the primary consumers of anthropolog-ical research.Pels argues that a major turning point occurred withthe outrage over Project Camelot: the social science re-search project in support of the U.S. Defense Department’scounterinsurgency program in Latin America. The AAA’s1967 Statement on Problems of Anthropological Researchand Ethics roundly condemned clandestine research and4 American Anthropologist • Vol. 116, No. 3 • september 2014activities in which restrictions were placed upon the free dis-semination of study results. This statementwas succeeded bythe Principles of Professional Responsibility in 1971, whichwas formulated in the wake of concerns about anthropolog-ical involvement in counterinsurgency research in Thailand(see Jorgensen and Wolf 1970). This statement introducedwording about anthropologists’ paramount responsibilitiesto the people they studied and condemned the secret dissem-ination of findings to some groups while withholding themfrom others (AAA 1971).According to Pels, these developments signaled a majorshift in anthropology toward the values of the people rep-resented. In other words, those studied could now be con-ceptualized as the field’s intended clients, and third-partyinvolvement in the dyadic relationship between anthropol-ogist and informant was explicitly acknowledged and prob-lematized. However, as Pels notes, these principles assumedthe academic context of anthropological employment—anassumption that became increasingly difficult to sustain inthe 1970s and 1980s as opportunities for academic em-ployment dwindled. By the mid-1980s, more professionallytrained anthropologists were employed outside the academythan within its halls; the proposed revision of the AAAPrinciples of Professional Responsibility in 1984 was devel-oped in response to these changed circumstances, recogniz-ing that anthropologists’ professional situations are variedand complex (Fluehr-Lobban 2003). However, the pro-posed changes were controversial—especially the removalof the clause about anthropologists’ obligations to the peoplethey study. Gerald Berreman (2003) later attributed thesechanges to the broader cultural climate in the United Statesin the 1970s and 1980s. To Berreman, “it seems that the eraof Reaganomics spawned the nightmare of Reaganethics”(2003:75). He argued that with its emphasis on free en-terprise research, the proposed statement reflected a shifttoward a preoccupation with personal well-being at the ex-pense of the broader principles of social justice.The controversy that the proposed revision to the Prin-ciples of Professional Responsibility generated led to itsabandonment. The document ratified in 1989 retained state-ments about anthropologists’ primary obligations to thosethey studied, although it failed to condemn clandestine andsecret research in the same clear-cut fashion as the 1971 ver-sion (Berreman 2003). The next iteration of the documentin 1998 marked its reframing as a “code of ethics” repletewith informed consent wording, stating:Anthropological researchers should obtain in advance the in-formed consent of persons being studied, providing information,owning or controlling access to material being studied, or other-wise identified as having interests which might be impacted by theresearch. [AAA 1998]There is little doubt that the intensification of regimesof research ethics oversight throughout the 1990s influencedthe growing importance placed on the doctrine of informedconsent in anthropology (see Schrag 2010). For example,this context was explicitly referenced in Fluehr-Lobban’s(1994:4) original call for anthropologists to embrace theinformed consent doctrine, wherein she argued that theconcept applied not only on moral and humanistic groundsbut also because “anthropological and social science researchis increasingly subject to the same regulation” as other typesof research. It is also indirectly referenced in the 1998 codeitself in statements such as this one: “Researchers are re-sponsible for identifying and complying with the variousinformed consent codes, laws and regulations affecting theirprojects” (AAA 1998).Although these external factors were clearly influen-tial in the embrace of the concept in anthropology, I don’twant to imply that the discipline merely acceded to externalpressures. In my view, the doctrine was also useful in me-diating between the academic and applied contexts in whichanthropologists were increasingly working—contexts thathad been the source of such friction in earlier discussionsof ethics. For example, while the 1998 code remained coyon the topic of secret research, it’s clear that the informedconsent provision became seen as a way of indirectly ensur-ing that secret and clandestine research was disavowed. Theutility of the informed consent doctrine in resolving thesetensions between the proprietary contexts inwhich some an-thropologists nowworked and disciplinary goals of opennessin field research is evident in Fluehr-Lobban’s later statementthat she was “unsuccessful in trying to get language aboutsecret research back into the code, but . . . more success-ful in introducing informed consent language” (Berreman2003:77). What I am suggesting here is that embracing theinformed consent doctrine meant that the differing environsin which anthropologists were working could now be con-sidered largely irrelevant as long as people provided their“informed consent” to being studied.ETHNOGRAPHY AND THE IMPOSSIBILITY OFINFORMED CONSENTAlthough the concept of informed consent has now been en-shrined in the AAA Code of Ethics for more than 15 years,the reality is that it is not an appropriate standard withwhich to judge ethnographic fieldwork. Beyond Wax’s in-terventions, periodically the difficulty of obtaining informedconsent in the context of ethnographic research has beenraised in discussions of the relationship between ethnog-raphy and human subjects regulation. For example, BarrieThorne (1980:291) has pointed out that most ethnographersrely on “partial truths” to gain access to the field and thatthe method of participant-observation doesn’t lend itself tomoments of announcement and choice. She also observedthat fieldworkers often find the “forgetting of the researchpurpose” that happens in the context of long-term ethno-graphic research quite helpful (1980:291).4 In a similar vein,Elizabeth Murphy and Robert Dingwall (2007) have notedthat the accounts that ethnographers give to participants arenecessarily partial and that the identity blurring that is anintrinsic feature of ethnography means that the researcher’sBell • Resisting Commensurability 5identity qua research begins to fade into the background overtime, muddying the lines between “data” and other types ofsharing.Others have focused on the impossibility of pre-emptingthe course that ethnographic fieldwork might take. Forexample, Rena Lederman (2006:485) has highlighted the“systematic openness to contingency” and “disciplined re-linquishment of control” that characterizes ethnographic re-search, wherein ethnographers are neither in a position todemarcate their research spaces nor their social identities. Inan intriguing analogy (one I will return to), Daniel Bradburdhas observed thatat the very least, the open-ended nature of the ethnographic en-counter radically changes the conditions under which one gathersproof of informed consent, moving it from a portion of a struc-tured exercise to, potentially, a break in a spontaneous encounter,raising problems perhaps more often associated with safe sex thanwith ethnography. [2006:493]Others, still, have evinced a specific interest in informedconsent documents themselves. For example, JenniferShannon (2007) has explored the ways in which the consentform becomes an “actant” that sets into motion a cascadeof actions, alliances, and commitments. In particular, shedemonstrates that it puts into effect a certain kind of re-lationality in fieldwork—one rendered in legal terms thatinserts the institution into the relationship between anthro-pologists and their interlocutors. On a related note, Marie-Andre´e Jacob (2007) highlights the ways in which consentforms contribute to the making of persons—epitomized inthe growing use of “consent” as a verb as well as a noun. Inher words,the noun consent and verb to consent have, it seems, metamor-phosed from being what patients and research subjects do to whatresearchers and health care providers do to subjects and patients.In other words, subjects become the objects of the verb. Someindividuals . . . literally and grammatically become objects ratherthan subjects. This reveals how little depth there is to the idea of“subject” in the context of consent. [Jacob 2007:256]Yet, all these complexities are elided in the current AAAStatement on Ethics. Although it speaks of consent as an “on-going dialogue” and “negotiation” rather than a form, it setsup a series of oppositions—between openness and decep-tion, between transparency and secrecy, between honestyand dishonesty, and so on. The document thus echoes theprevailing dichotomy in which participants are either “fullyinformed” about the research and consent to participationor they are not—and the research, by definition, becomes“covert” or “deceptive.” More surprising still, a similar af-firmation of the doctrine occurs in various commentarieschallenging its application to ethnography (e.g., Murphyand Dingwall 2007; Shannon 2007; Thorne 1980). In otherwords, while such commentators they reject the ways thatregulatory ethics regimes have applied the concept, theyaffirm its general importance. The views of Murphy andDingwall (2007) are typical in this respect. They state:Our argument is not that informed consent is trivial or irrele-vant. It is, rather, that informed consent in ethnography is neitherachievable nor demonstrable in the terms set by anticipatory reg-ulatory regimes that take clinical research or biomedical experi-mentation as their paradigm cases. [2007:2225]In this framing, the concept itself is not intrinsically prob-lematic. Instead, the issue relates to the rise of “audit culture”(Strathern 2000) and the enmeshment of research ethics ina bureaucratic machinery whose surface taxonomic schemesserve to subdue and subsume difference.Where the impossibility of informed consent has beentaken seriously, it’s generally used as a means of critiquingethnographic research rather than the informed consentdoctrine itself, which emerges largely unscathed. Notably,ethnographic sociologists have been themore vociferous crit-ics here. For example, Charles Bosk (2001), reflecting onhis own experience of conducting ethnographic fieldworkin hospital settings, has argued that structure and natureof this approach precludes the possibility of informed con-sent. While recognizing that an overly zealous approach toinformed consent would be intrusive, disruptive, and “sosocially bizarre that it would make fieldwork impossible tocomplete” (Bosk 2001:211), he nevertheless concludes:There is a deeper level at which we breach the spirit of informedconsent.Wemislead subjects about our intentions and keep themin the dark about reasonable and easily recognized risks, evenwhen our subjects understand (and misunderstand) our role . . .We describe our intent, but we omit a detail. We disclose butonly incompletely. [Bosk 2001:212]Bosk argues that ethnographers rarely inform participantsthat the world from their point of view is only the startingpoint for the analytic work of ethnography. Yet, in his view,it’s precisely these interpretations that engender a sense ofbetrayal among participants when they view the productsof such research. For Bosk (2001:218), the “manipulations,deceptions, evasions, and silences” required in ethnographicfieldwork make it difficult for any ethnographer to be abovereproach. He argues that ethnographers have largely ignoredthese ethical difficulties by either pretending they don’t existor treating efforts to more fully explain the nature of ethno-graphic portraits as simply too difficult to attempt. Thus,in Bosk’s (2001) account, it is not so much informed con-sent that is the issue; instead, ethnographic research, withits “insuperable ethical problems” (2001:200), becomes theculprit.Arguing in a somewhat different vein, Julia O’ConnellDavidson (2008) has also raised questions about the problemsthat ethnographic research poses in relation to informed con-sent. Based on her fieldwork at a privately run UK brotheland the close relationship she subsequently developed with“Desiree,” the brothel’s owner, O’Connell Davidson arguesthat it is impossible for participants in ethnographic researchto truly consent to what amounts to their own objectifica-tion. As she puts it,6 American Anthropologist • Vol. 116, No. 3 • september 2014No matter how reflexive, non-hierarchical and ethically sensitivethe researcher, ultimately her or his task is to transform researchsubjects into objects . . . that will be exposed to the gaze of,and consumed by, other people. This remains the case even forthose researchers who state that their aim is merely to ‘give voice’to their research subjects by collecting and presenting narratives.Is it possible for a person to genuinely consent to this type ofobjectification? [O’Connell Davidson 2008:57–58]Both Bosk and O’Connell Davidson share a tendencyto speak in totalizing terms about ethnography, withoutany recognition of the differences between “participant-observation” as practiced in the varied disciplines that havecome to claim a stake it. As Bruce Kapferer (2007) andLederman (2007) observe, anthropological ethnography isquite distinctive from the uses of ethnography as a tech-nique for gathering data—the dominant way the term isemployed in sociology. Lederman (2007, 2013) points outthat participant-observation in sociology is a minority ap-proach, one often considered ethically suspect precisely be-cause it upsets sociological norms regarding the clear linesof demarcation between researchers and participants. Foranthropologists, on the other hand, their “social proxim-ity to their sources, their method of opening themselves tobeing socially defined by the folks they aim to understand,appears to them as self-evidently edifying despite its ethicalrisks” (Lederman 2013:598). What Bosk’s and O’ConnellDavidson’s accounts also have in common is a tendency tocollapse questions of informed consent with issues of textualrepresentation in ethnography.DIFFERENTIATING BETWEEN ETHNOGRAPHY ASFIELDWORK AND AS TEXTQuetzil Castan˜eda (2006) has emphasized the need to dif-ferentiate the ethical and moral issues that arise in ethno-graphic fieldwork from those that inhabit ethnography as atextual product. For Castan˜eda, these are different concep-tual and analytic registers, although he recognizes that thereare “significant overlappings, complicated intersections, andparallels between them” (2006:122). The former relies on asituational ethics that is both context driven and context spe-cific; the latter relies on a normative moral position regard-ing the consequences of representation. His work thereforeprovides a useful frame through which to examine Bosk andO’Connell Davidson’s efforts to connect issues of informedconsent and ethnographic representation.Informed consent, as originally conceptualized, is aboutagreeing to be “done to” in the context of data collectionitself. The key issue is that in ethnographic research—inany of its disciplinary formulations—for the most part, the“doing to” doesn’t happen in the fieldwork situation but,rather, in the act of writing about it. This is why Boskand O’Connell Davidson can claim that ethnographers havenot adequately considered the ethical problems that ethnog-raphy poses in relation to informed consent, despite thelongstanding debates in anthropology around the “moral vi-olence” (Castan˜eda 2006:128) of knowledge, writing, andrepresentation.It’s not that the problems Bosk andO’Connell Davidsonraise haven’t been discussed. They have—somewhat end-lessly, in point of fact—but the focus is generally on thewritten representations that derive from ethnography “here”rather than the politics of fieldwork engagements “there.” AsCastan˜eda illustrates, these two contexts are not commen-surate; they entail different ethical and moral issues. Indeed,prevailing research ethics frameworks remain largely silenton the ethics of representation, an absence that speaks totheir underlying positivism, whereby the act of writing isgenerally understood to present a transparent “writing up”of study results and ethical concerns tend to array aroundissues like data fabrication. In fact, the context perhaps mostequivalent to ethnographic research is that of clinical casereports of patients receiving the usual standard of care, andsuch reports aren’t generally subject to institutional ethicalreview or informed consent requirements because there isno “doing to” the subject that happens beyond the course ofa regular day-to-day interaction.5Let us not forget that all “subjects” lose control overthe ways they are represented in the products of our re-search, whether the context is an ethnography, an inter-view, a clinical case study, or a drug trial. While fieldworkintimacies give us access to informants’ lives beyond theways in which they might formally present themselves ifour interactions were limited to a discretely bounded space,the moral issues surrounding representation don’t dissipatein other contexts, although they may be less acute (or, atthe very least, experienced as such). For Bosk, however,the ethnographer’s inability to disclose “completely” makesthe practice uniquely morally suspect. He writes,these are not arguments that are given much credence whenphysicians use them as an excuse for failing to provide patientsthe data necessary for informed consent. They possess no morecredence when given by social scientists as a justification for lessthan full disclosure. The simple fact is that we do not try to explainthis aspect of our work to our subjects, and we feel no obligationto try for this level of consent. [Bosk 2001:214; see also Bosk2007:205]The most striking aspect of this passage is the act of trans-lation Bosk undertakes, wherein the ethnographer becomesdirectly equivalent to the physician and is found wanting asa result. Of course, the comparison can be used to entirelythe opposite effect, as Dingwall and Murphy illustrate:The relationship between the ethnographer and their [sic] hostsis more akin to that of a patient with a general practitioner thanwith a surgeon. The patient gives tentative and limited consentbefore contact with a general practitioner . . . Mostly, consentis implied rather than stated and operates within a context wherethe patient may withdraw cooperation at any time. [2007:226].However, regardless of the uses to which the compari-son is put, is an ethnographic encounter commensurate witha series of interactions between a patient and general practi-tioner? As Lederman observes, “one of the strongest barriersBell • Resisting Commensurability 7to genuine ethical and disciplinary pluralism is a pervasiveinsistence on construing the standards by which we assessone another’s work as neutral when they’re more often pro-jections of this or that disciplinary perspective” (2012). Suchprincipled ethical approaches function—asBosk (1999) him-self has elsewhere noted—in much the same vein as double-entry bookkeeping in accounting: making commensurablewhat was formerly incommensurable. While such acts oftranslation are tempting, perhaps it’s better to resist themaltogether.6As Lederman (2006:485) has argued, ethnographicfieldwork’s lack of fit with the prevailing biomedical andbehavioral-science models of research makes it appear“downright deviant on practically every count” when judgedthrough the lens of such models. The acts of translation re-quired to fit ethnography into the informed consent moldmean that it is held to a standard that far exceeds that re-quired of any other type of research and then is condemnedfor failing to meet it. When judged through this frame,“ethnographic research ethics” appears to be nothing morethan an oxymoron. Isn’t this essentially the conclusion thatboth Bosk and O’Connell Davidson fall just shy of drawing?7This, I think, is precisely what Wax was on about in hiscontention that the concept of informed consent is largelyirrelevant to the moral problems of cultural anthropology.Once we take this possibility seriously, it enables us to seethat if anything has “insuperable problems” (Bosk 2001:200),it may very well be the concept of informed consent itself.“NO MEANS NO”: PARALLELS BETWEENCONCEPTIONS OF CONSENT TO RESEARCH ANDSEXUAL INTERCOURSEThe informed consent doctrine presumes a great deal—notonly about the nature of ethical research but also aboutthe nature of research itself. As Lederman argues, “to reg-ulate research ethics is, in effect, to regulate our modesof knowledge-making themselves” (2012:6). In assuminginvestigator control over the research process, it elides theenormous variability in what counts as “research” from disci-pline to discipline and the differing sets of relations betweenresearchers and their “subjects”; the effect is to constituteresearchers and subjects as having radically different kindsof agency (Lederman 2006).This point was brought home to me at a conference Iattended in 2010 aimed atmembers of the academic commu-nity involved in human research ethics. Such conferences,of course, are not actually about research ethics per se but,rather, research ethics administration, and their audienceconsists primarily of academic board members and admin-istrators. During the conference, I attended a workshop atwhich a variety of case studies were presented for the audi-ence to dissect. One of the examples we were given was ofa researcher who wanted to study the relationship betweendiabetes and schizophrenia in a group of homeless people.The researcher planned to recruit participants being treatedat a local psychiatric facility but had decided not to disclosethe fact that one of the main inclusion criteria for studyparticipation was schizophrenia; her stated concern was thatsome of the participants were likely in denial about theircondition. The audience members immediately decried thestudy as unethical. Conversation swiftly turned to the factthat the researcher seemed to be using this justification as acover to “get away with” not obtaining informed consent. Asconversation progressed, people got increasingly worked upabout the unethical behavior of the researcher. “No meansno!” cried a female audience member as the discussion waswrapping up, with many of the assembled participants nod-ding in agreement.I was particularly intrigued by the woman’s use of acatchphrase institutionalized in the anti-rape movement—“nomeans no”—to describe her sense ofmoral outrage at thestudy. Although I found the pairing of research-ethics speakand anti-rape rhetoric incongruous at the time, the sexualanalogy is one I have seen repeated on several occasions. It’sworth noting that the title of O’Connell Davidson’s (2008)aforementioned critique of ethnography’s capacity for in-formed consent is “If No Means No, Does Yes Mean Yes?”and she uses the sexual metaphor at various points in theessay, likening ethnographers to the clients of sex workers.Bradburd (2006), in contrast, evokes the analogy to showthe problems with the concept in informal research settings.I want to suggest here that such metaphors are revealing;they say something important about how research—as wellas both researchers and research subjects—are being con-structed in the dominant framework.In contemporary research ethics guidelines, research isframed as an intrinsically risky enterprise (Bell in press;Lederman 2007). For example, the Institutional Review BoardGuidebook, aimed at members of institutional review boardsin the United States, asserts the following: “Risks to researchsubjects posed by participation in research should be justi-fied by the anticipated benefits to the subjects or society”(OHRP 1993). More to the point, research is often quiteexplicitly configured as a violation or invasion: biomedicalresearch violates the physical integrity of the body, and socialscience research violates the individual’s privacy. Thus, onetextbook on ethical issues in behavioral researchwarns: “Thecentral ethical issues in field research are likely to revolvearound potential invasions of privacy” (Kimmel 2007:117).This constitution of research as a “violation” or “invasion”helps to explain why informed consent is deemed so centralto contemporary conceptions of research ethics. After all,to consent is quite literally to acquiesce to being “done to.”In this framing, research is a violation to which, like sex, onemust willingly consent (but presumably not actively partic-ipate in, like the Victorian bride counseled to “lie back andthink of England”). Informed consent to research partici-pation, like conceptions of consent to sexual intercourse,is thus based on certain underlying assumptions about thenature of the protagonists in this encounter.In her analysis of theways inwhich rape prevention cam-paigns construct sex,MoiraCarmody (2005) argues that they8 American Anthropologist • Vol. 116, No. 3 • september 2014affirm totalizing versions of masculinity and femininity, withmen depicted as violent patriarchal creatures and women aspassive, agentless objects who are “done to” in the contextof a sexual encounter. As she notes: “This approach reflects afixed subjectivity in which power relations between womenand men are deterministically constructed as oppressive andexploitative to women and in which men are all powerful”(2005:468). Similarly totalizing views of the researcher andsubject are enacted in the context of contemporary researchethics guidelines. Subjects appear in this framework as thepassive objects of research; they are fragile, possess con-ditional reason, and require protection (Dehli and Taylor2006; Jacob 2007; Jacob and Riles 2007). But in this fram-ing, researchers, too, possess conditional reason. Driven byour own lust for knowledge, career advancement, and so on,we are supposedly incapable of recognizing the ethical issuesthat our own research poses to participants (Bell in press). Ifnot held in check through formalized research ethics reviewprocesses, some of us would inevitably devolve to our basestinstincts to exploit and violate our research participants. AsJacob and Riles observe, “in this system, the one who isimagined as giving of one’s self to a researcher is a researchsubject in need of protection, and the one who is imagined asreceiving this gift is a researcher-perpetrator” (2007:182).Interestingly, despite the assumption of equivalence inthe different types of research to which “subjects” might beexposed, here researchers and subjects are “construed notsimply as unequal but as incommensurable: always poten-tially opposed” (Lederman 2006:488). Informed consent,with its presumption of voluntary submission to the inter-ests and desires of others, is the only way this fundamentalinequality can be mediated in either a sexual or researchencounter.8 However, this very same dynamic always callsthe potential voluntariness of consent into question. Herewe see evidence of the epistemological doubling of whichPels speaks, with modern ethics “built around the discur-sive oscillation between the absolute denial of politics that isimplied by ethical standards and the absolute affirmation ofpolitics that the necessarily partial use of these ethical stan-dards brings with it” (Pels 1999:103). The preoccupationof bioethicists with “therapeutic misconception”—wherebyparticipants inmedical research have been consistently foundto “misunderstand” the experimental rather than therapeuticnature of the research—is a good example of the contor-tions produced by this epistemological doubling, revealingthe informed and consented subject for precisely what it is:a simulacrum.The great irony, of course, is that in presuming this re-lationship of inequality, the doctrine actively reinscribes it.As several commentators have observed, the concept actu-ally serves to minimize researchers’ responsibilities to theirparticipants (e.g., Bradburd 2006; O’Connell Davidson2008; Wax 1995). Moreover, as Jacob’s (2007) workdemonstrates, whether the context is a biomedical or so-cial science setting, it also undermines the very thing it aimsto ensure: choice. In her words, “perhaps it is time to decen-ter consent from the bulk of discussions on decision makingand rule making in the contexts of health care and research.It might be time for scholars to stop fantasizing about choiceas the lived experience of the consent process” (Jacob 2007:264).THE WAY FORWARDIn the spirit of Lynch’s (2000) critique of reflexivity as an aca-demic virtue, Iwant to stress that being against informedcon-sent doesn’t mean being for deception or covert research. Italso doesn’tmean being against ethics (a` la Herrera’s critiqueof Wax). Instead, it is to recognize that these oppositionsare a fundamentally inappropriate way of conceptualizingthe ethics of ethnographic research. Although it seems hardto believe now, we can actually talk about research ethicswithout recourse to the concept of informed consent—orthe preposterous “fully informed consent.”9 Consider theinjunction in the 1971 Principles of Professional Responsi-bility to communicate ‘“the aims of the investigation . . . aswell as possible to the informant” (AAA 1971). Contrast thiswith the 2012 code’s assertion:Minimally, informed consent includes sharing with potential par-ticipants the research goals,methods, funding sources or sponsors,expected outcomes, anticipated impacts of the research, and therights and responsibilities of research participants . . . Anthro-pologists have an obligation to ensure that research participantshave freely granted consent, and must avoid conducting researchin circumstances in which consent may not be truly voluntary orinformed.Beyond the absence of references to the notion of “con-sent” itself, entirely missing from the 1971 document isan appeal to universal standards regarding communicationand the outcomes it should produce. In the 2012 code,community permissions to conduct fieldwork, interactionswith interlocutors on the ground, and the politics of writ-ing and representation are all subsumed under the categoryof informed consent, and “sharing” about such is treated asa self-evident, straightforward, primarily technical transac-tion. The 1971 document, however, implicitly recognizesthe complexities of such communication and the impossibil-ity of any sort of unitary view of the research (as evidencedby the “as well as possible” clause). It therefore implies thatethnographic research can proceed ethically in the absenceof a mutually agreed-upon understanding of its aims and thatthis absence is to a certain extent unavoidable.In his initial critique of Fluehr-Lobban’s proposal to im-port the informed consent doctrine into anthropology,Waxobserved, “Given that our hosts and we usually inhabit twodifferent conceptual universes, it has been notoriously dif-ficult to communicate who we are and what are our goals”(1996:330). Bosk makes much the same point in his criti-cism that “ethnographers trade quite freely on an almost uni-versal misunderstanding between our research subjects andourselves” (2001:206). Yet, it’s worth considering whethersuch “misunderstandings” are a distinctive feature of ethnog-raphy.Here, thework ofMaryDixon-Woods and colleaguesBell • Resisting Commensurability 9(2007) is instructive. Based on interviews with participantsin a genetic epidemiology study, the authors found that sub-jects’ perspectives on the research were often directly atodds with the information they had been given. They arguethat this “misunderstanding . . . may be a persistent andincorrigible feature of people’s participation in research”(2007:2212), drawing on sociological literature on the dif-ferences between lay and expert perspectives to make thispoint. They conclude that while researchers must aspire to-ward clarity and honesty, it is simultaneously possible forlegitimate decisions to be made that don’t “require a fullunderstanding and acceptance of the scientific account of aresearch study” (2007:2220). Thus, while the informed con-sent doctrine is an extraordinarily poor fit with ethnography,indications suggest it is not an appropriate standard for anyresearch. Given that even the Belmont Report was hedgingits bets on the possibility of “an informed consent,” thereis a clear argument to be made for jettisoning the conceptentirely.Although this may have the ring of a utopian dream, theproposed revisions to the Federal Policy for the Protectionof Human Subjects suggest some openness to the sustainedquestioning of the current regulatory regime in the UnitedStates.Nevertheless, in the immediate term, anthropologistsmust still submit their ethics applications to boards whosemandate revolves primarily around evaluating the adequacyof the informed consent process. While many anthropol-ogists have perfected the art of “simulated consilience,” itdoesn’t help review boards understand what ethnographersactually do, and it actively contributes to misinformationabout ethnographic fieldwork (Lederman 2007:33). Thetrickier path is to openly challenge the paradigm and its ap-plication to our research. However, as Gustavo Lins Ribeiropoints out, “if researchers want to do research and guaran-tee ‘academic freedom,’ they need to do politics within andoutside their own institutions” (2006:530–531).Working to retain our owndisciplinary idioms and stylesmeans that ethicists and review boards will invariably con-strue us as “unprofessional, inappropriate, or incomprehen-sible” (Lederman 2012), although there are heartening ex-amples of anthropologists who have succeeded in educatingtheir boards about the distinctive attributes of anthropologi-cal fieldwork (e.g., Lederman 2006). Given the critical rolethat disciplinary associations play in enabling researchers tosuccessfully challenge IRB regulations, it would thereforebe beneficial if we had some backing from our professionalassociations (rather than their apparent wholesale capitula-tion) in making a case for what Lederman (2012) refers toas “ethico-epistemological pluralism.”10How might discussions of the ethics of ethnographicresearch differ if we did away with the concept of informedconsent? First, it would allow us to talk in a farmore nuancedway about the verydifferent issues currently subsumedunderthe concept. Second, it would entail a recognition that anevaluation of anthropologists’ communication about theirresearch is intrinsically subjective—a matter of individualjudgment, always open to debate, and only really apparentafter the fact. Third, it would enable us to grapple moreclearly with the different ethical dilemmas anthropologistsconfront depending on where they do their fieldwork andwith whom they work. As Laura Nader commented morethan 40 years ago, “We should not necessarily apply thesame ethics developed for studying the private, and evenethics developed for studying in foreign cultures (wherewe are guests), to the study of institutions, organizations,bureaucracies that have a broad public impact” (1972:304–305).CONCLUSIONThe rise of the informed consent doctrine in the latter halfof the 20th century is evidence of the oft-observed biomed-ical underpinnings of contemporary research ethics frame-works. However, while the doctrine may have been usefulat a particular historical juncture when anthropology wasgrappling with the changed professional circumstances ofthose trained in the discipline, in my view the embrace ofthe concept at the end of the 1990s has not served us well.Simply put, it is not an appropriate frame through which theethics of our research can—or should—be judged. While“informed consent” might mean different things in differentfields (Lederman 2009), I’ve tried to show that the assump-tions embedded in the concept are so odds with the realityof ethnographic research that there is no way of reconcilingthe two without harming the latter.Inmyview, all the talk in theworldof “ongoingdialogue”and “negotiation” will not resolve this fundamental issue be-cause the concept so utterly “mutes” (Lederman 2012) thecentral assumptions informing ethnographic practice. It setsthe wrong sort of standard (by implying that there is one); itforces researchers, research participants, and research ethicsboards to focus on the wrong sorts of questions; and it enactsa certain type of “subject”—one that seems designed to pro-mote even less ethical research. While we make and remakesubjects constantly in our research—in our fieldwork andfield notes, in our anecdotes and our published accounts—the particular subject “materialized” (cf. Jacob 2007) in thedoctrine of informed consent is one we should emphaticallyreject. Doing so will enable us to grapple more fully with thecomplex ethical dilemmaswe tackle in our fieldwork and ourwriting—dilemmas that defy prescription or easy resolutionand that reflect the extraordinarily varied circumstances inwhich fieldwork is conducted today.Kirsten Bell Department of Anthropology, University of BritishColumbia, Vancouver, British Columbia V6T 1Z1, Canada; kibell@mail.ubc.caNOTESAcknowledgments. A debt of gratitude is owed to Rena Leder-man and Simone Dennis, both of whom provided invaluable feedback10 American Anthropologist • Vol. 116, No. 3 • september 2014on this article and were instrumental in the development of certainlines of argument. I am also very grateful to Michael Chibnik andthe four American Anthropologist reviewers for their thoughtful andhelpful comments and Mayumi Shimose for her copyediting skills. Inthinking through this topic, I have also benefited from conversationswithDarleneMcNaughton, Rohan Bastin, JudithGreen,Will van denHoonaard, and participants at the 2012 Ethics Rupture conference,especially Zach Schrag and Lise Dobrin. I also want to particularlyacknowledge Laura-Lee Balkwill, a policy analyst from Canada’s Sec-retariat on Responsible Conduct of Research, who braved the denof frustrated social scientists at the conference in an effort to try tounderstand our concerns. After my talk, she took me aside to ask(in genuine bewilderment) why I had such a problem with informedconsent. Unable to articulate my concerns clearly at the time, thisarticle represents my attempt to formulate a coherent response tothe question.1. See also theAustralianAnthropological Society’s andAssociationof Social Anthropologists’ Code of Ethics (AAS 2012; ASA1999).2. Although the comments are publicly available on the AAA web-site, I received permission from all of those quoted to reproducetheir names here. Some requested that I make minor modifica-tions to their excerpted quotes to clarify their meaning; thesemodifications are indicated via the use of italics.3. Although informed consent is presented as an “unquestionedvalue” in one breath, the report acknowledges in the next breaththat it may not, in fact, be possible. This seems to be a rhetoricalstrategy designed to preemptively avoid critique by acknowl-edging it up front.4. Although not focusing specifically on informed consent, GaryAlan Fine (1993) makes a number of related points about the“lies” ethnographers tell themselves—and others—about thenature of ethnographic fieldwork. See particularly his overviewof “the kindly ethnographer” and “the honest ethnographer.”5. This speaks to an issue that Katz (2006) and Lederman (2006,2007), among others, raise regarding the ways that a majorexpansion of IRB jurisdiction is being institutionalized througha vague, unnecessary, and impractical reading of “research.”One of the resulting ironies is that biomedical exemptions frominstitutional review requirements are far more clear cut thanthose for the social sciences, wherein the overarching vaguenessmeans that nothing is outside the scope of institutional review.6. The temptation to translate is so powerful that I earlier suc-cumbed to it myself by comparing ethnographic fieldwork toclinical case reports of patients receiving the usual standard ofcare.7. Despite their critiques, neither Bosk nor O’Connell Davidsoncondemn ethnography outright. Although each makes a case forits immorality, they ultimately invoke a consequentialist logicto justify its usage.8. Although theneed for consent to be “informed” ismore explicitlyhighlighted in the context of research, it is also important todeterminations of the voluntariness of sexual intercourse—asthe concept of statutory rape suggests.9. To my mind, this concept is about as meaningful as the notionof “strenuously objecting” as a legal strategy (as illustrated in thefilm A Few Good Men [1992]).10. For example, at a national level, the joint efforts of the Amer-ican History Association and Oral History Association led theOffice of Human Research Protection to exempt oral historyinterviews from IRB oversight in 2003. At an institutional level,the codes of ethics of the American Sociological Association andthe American Political Science Associationwere used to success-fully challenge Simon FraserUniversity’s introduction of limitedconfidentiality clauses on consent forms following the RusselOgden incident, wherein the field notes of a criminology mas-ter’s student writing about assisted suicide were subpoenaed bya coroner during an investigation of a death about which he wassuspected to have some knowledge (see Palys and Lowman inpress).REFERENCES CITEDAmerican Anthropological Association1971 Principles of Professional Responsibility. 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