“Doctors With Borders” by Lesley Gotlib

Gotlib, Lesley. (2005). “Doctors with Borders”. In Anne Meneley and Donna J. Young (Eds.), Auto-Ethnographies: The Anthropology of Academic Practices (pp.39-50). Toronto, Ontario: Broadview Press.

In this chapter, Lesley Gotlib recalls her fieldwork experience early in her doctoral studies in two clinics for children born with a range of intersex conditions. Through “an articulate social worker named Tess” (p.39), she is introduced to Dr. Marvin, a child psychologist in charge of one of the clinics, and director of a collaborative research between the two clinics as well. Gotlib uses Dr. Marvin to introduce the question of who is considered, and who considers himself or herself a real scientist, and the question of the epistemological divide between “hard” and “soft” sciences. Per example, Dr. Marvin preps her before her first meeting with the doctors and suggests that she spits out her gum: “These guys are the real doctors” (p.40).

Gotlib’s first meeting with the doctors, where she is introduced by Dr. Marvin as a medical anthropologist, goes well. Although she feels “like a child amongst the grown-ups” (p.41), Gotlib manages to convince the doctors to agree to participate in her qualitative project. She prepares to leave the room, having not completed the ethics review yet, when Dr. Marvin stops her, tells her not to worry too much about ethics and to consider this her “pilot project” (p.41). However, Gotlib’s optimism at the idea of having found the perfect site for her research on medical management of gender non-conformity is quickly countered by the complicated process to obtain clearance from her university and the two different hospitals that house the gender clinic and the Intersex Clinic. The latter, housed in a prestigious hospital, refuses to proceed without assurance that the doctors will cooperate.

When Gotlib contacts the doctors to explain the situation and obtain the consent forms, she receives no reply. A few weeks later she sends a second message, and receives very different replies than at the initial meeting. Doctors decline to participate or literally state their opposition to her project. She is advised by Dr. Martin to carry on her “pilot study” while the ethics review can be sorted out. Had Gotlib not followed his advice, she would probably have had to give up on her project as it took nine months to receive the permission to carry out ethnographic research.

Gotlib then tells of her experience in the field and briefly describes the case of a young nine-year old-boy who the team agrees has gender disorder.  Gotlib writes that “In a nutshell, this particular case highlights some of the assumptions at work in the gender and intersex clinics”, where she argues that the “gendered paradigm was too limited” (p.46). However, a couple lines above, Gotlib describes how she was “struck by the fact that Mark resembles any nine-year-old boy” (p.46), which might have the reader wonder whether she too had assumptions about what children with gender disorders should look or act like.

The article’s main argument is that “the very nature of the relationship between [Gotlib] as an anthropologist and those [she] hoped to come to know through participant observation research was altered when a legal contract was introduced” (p.47). Consent forms “seemed unable to address the obvious power differentials at play; doctors themselves were granted much greater leeway in these regards” (p.48).  Gotlib further writes that the doctors “seemed more concerned with legal liabilities than with their patients’ rights” (p.48). More specifically, Gotlib felt uncomfortable with the casual manner in which the young boy and his mother were asked to give their consent.  She is even more surprised by the openness with which Dr. Marvin, not long after this episode, answers the questions of a journalist and shows him a video of the young boy in women’s clothing which the boy’s mother had not been allowed to watch.

Gotlib writes that “Dr. Marvin’s desire to promote the clinic publicly seemed to override the code of ethics by which his institution was governed” (p.47) and she clearly states her disappointment at Dr. Marvin’s disregard of institutional ethics during his interview with the journalist. Yet, were it not for Dr. Marvin’s wish and action towards getting publicity for his clinic, Gotlib would have had no doctoral thesis, and this chapter would not have been published either. Further, this leaves reason to think that Gotlib’s research was also a means for the clinic to obtain publicity to a certain extent since she received government funding. I can understand the author’s “ambivalence” (p.49) in a situation where she is confronted to how ethics are applied in daily life: often in opposition to the institutional, bureaucratic process she has been instructed to follow. But was this really a surprise?

The chapter is both a critic of the difficult process to obtain approval from institutional ethics review boards after the introduction of a new protocol in North America in the 1990s (the Tri-Council Policy Statement) and a critic of the doctors’ approach to forms of consent. The title, “Doctors With Borders”, specifically points to the reaction of the first groups of doctor who Gotlib initially met with when they were asked to give their consent so that she could obtain the hospitals’ ethics review boards approvals, and as a pun it is meant to contrast with the image of openness and selflessness of the organization Doctors Without Borders. As a result, the chapter appears to focus more on the “negative” attitude of the doctors rather than on a critic of the academic process of ethics review.

Gotlib nonetheless raises important questions. She argues that as for doctors, “ethics implies legal accountability” (p.48), same holds for universities and hospitals ethics review boards. Gotlib also writes that she became “a more ethical researcher in the eyes of the doctors” when she mentioned to them that she was guaranteed a large amount of government and private funding (p.48). The impact of money on credibility is an issue that will most likely never be resolved, but it nonetheless deserves further investigation with the goal of finding ways to neutralize bias. In my opinion, the most interesting question raised in this chapter is that of the difference between anthropologists, representatives of academia, and journalists, representatives of the media, when it comes to obtaining consent and information.

Journalists are also subjects to ethics guidelines such as that of the Society of Professional Journalists and of the Canadian Association of Journalists of which the first principles are respectively “to seek the truth and report it” and “accuracy”. I think the main difference between journalists and anthropologists lies in journalism’s claim to report the truth as opposed to anthropologists’ similar concern with accuracy but without specific claim to truth. The ethnographic account, especially in Gotlib’s case which is a qualitative research, is more complex, more open, avowedly subjective, and calls for a more reflexive approach, then the journalistic account.

My own hunch about why universities submit anthropologists to a more complicated ethics review than publishers do to journalists is that it has something to do with the desire of universities to preserve their prestige and situate themselves above journalists in the great chain of information. However, as more individuals become interdisciplinary, and more anthropologists publish as journalists and get involved in public anthropology (see the work of Thomas Hylland Eriksen for example), labeling will become more malleable.

Finally, Gotlib’s closes the chapter with a kind comment on her collaboration with Dr. Marvin. Her relationship with Dr. Marvin is an important topic of the chapter. Both an “important mentor and ally” (p.48), he also opens a window for Gotlib to observe how double standards are employed (p.49). However Gotlib rightly points to the importance of cross-disciplinary dialogue and of the right to openly disagree (p.49), two elements of research that are essential to an applied ethical approach and which she was able to share with Dr. Marvin.

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