LOCAL MORAL WORLDS”: CBEC TEACHING VIDEOS WITH A DESI SPIN

Arthur Kleinman, the renowned US-based psychiatrist and medical anthropologist coined the phrase “local moral worlds” to highlight how individuals experience the everyday, emphasizing the importance of context and relationships in understanding health and illness. We chose to use his term as the title of CBEC’s ongoing series of teaching videos to provide audiences an insight into how illness situations unfold in the Pakistani context.

Few videos exist that capture the ethical reality of clinical situations as they unfold in collectivistic cultures such as Pakistan. This deficiency led us to initiate producing teaching videos in 2010 embedded within the socioeconomic, cultural and religious realities of South Asia. Since then, CBEC has produced 12 videos that span from 10 minutes to 20 minutes for effective use in classrooms and during workshops. Our amateur productions offer a desi perspective, in a mix of Urdu and English, ensuring that the video clips resonate with local audiences. Many of these are based on case scenarios from real clinical encounters.

Consider the example of informed consent in clinical practice. While a universal standard, physicians in Pakistan may struggle with obtaining consent from a married woman who states that her husband takes all decisions on her behalf including the medical. How should physicians handle such situations where ethical principles of contemporary bioethics clash with the value systems of exisitng cultures?

A recent video focuses on aspects of decision-making in the case of an incapacitated patient who is a member of a large extended family. An upcoming one will cover issues related to obtaining assent in children for treatment within strong hierarchical family structures in which parents make decisions for their children, sometimes even beyond adolescence.

Our previous videos have highlighted local tensions that arise due to public health measures such as quarantine, and the influence of public mistrust of foreign researchers. While these aspects would be present in other contexts, the mores and responses to B such measures often play out differently in the local morals worlds of South Asia.

Our videos do not aim to provide answers to students. Rather they seek to reflect the ethical tensions in play from the Pakistani perspective, which may also be applicable to other South Asian countries. These then offer a microcosm of the sociocultural landscape so that students can reflect on the ethical conflicts between theory and practice.

This couplet from the contemporary Urdu poet, Faryad Aazar, summarizes the essence of our videos:

‘Tis possible, at times, to shrink an entire river to a mere vessel,

At others, for a single drop to contain an entire ocean within.