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ERIC SMITH
ETHICAL RAMIFICATIONS
Measuring efficacy by way of ethnographic productivity creates a heuristic
for empirically tracking a paradigm that is inherently difficult to track.
Healthcare systems are then led to erroneously correlate an enumeration of
ethnographic knowledge with a degree of understanding. Supposedly, the
more knowledge on Indigenous people a healthcare system has, the greater
capacity the system has to integrate this knowledge, creating “understanding”.
However, while knowledge is certainly required for understanding, knowledge
and understanding are not the same thing. I can know the first 100 digits
of the number pi and recite them to anyone who asks, but this does not
mean that I actually understand the important function of this number in
something like calculating the area of a circle. Indeed, my “understanding”
of pi would be very limited, considering my removed perspective from what
the number actually represents in practice. Likewise, utilizing cultural safety
in this way has led to healthcare developing a removed concept of Indigenous
understanding that only serves to perpetuate epistemic oppression and
problematic ideals of race-based medicine.
The means by which Canada and the U.S. are applying cultural safety are
not entirely problematic. There are a limited number of good reasons for
using race-based medicine, most of which have to do with the etiology of
illness.* Certain illnesses disproportionately or differently impact different
groups (e.g., sex-linked chromosomal illnesses). In these cases, there is
good reason to purposefully seek out knowledge that separates those who
are susceptible and those who are not. There is also reason to think that the
ethnographic primacy of cultural safety is an expeditious route to achieving
an understanding of Indigenous persons. After all, ethnographic study
does not (usually) require time or resources dedicated to building mutually
beneficial relationships with target community members. Observation creates
data; data create knowledge bases; knowledge bases create foundations for
understanding and mutual benefit. However, these benefits could result from
the application of any knowledge-promoting paradigm. It is also dangerously
optimistic to think that unidirectional and externally directed ethnography
(i.e., healthcare observing the community, but not themselves) is able to
“render simply transparent representations of what is culturally ‘out there”.
The ethical risks of this sort of racially fuelled ethnography only stand to
instantiate the erroneous divides between groups of people.?
Jonathan M. Kaplan, When Socially Determined Categories Make Biological Realities:
Understanding Black/White Health Disparities in the U.S., The Monist, Vol. 93, No. 2 (2010),
282.
52 Tallbear, Native American DNA, 14-15.
Kaplan, Socially Determined Categories, 282-283.