September 2009 • Anthropology News

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The Ethics of Engaged EthnographyApplying a Militant Anthropology in Organs-Trafficking Research

Nancy Scheper-Hughes UC Berkeley

Three years into the Organs Watch documentation and medical human rights project I realized that I had to change my modus operandi. I could never discover what was going on in the trans-plant trafficking underworld using conventional means. Both the AAA Code of Ethics and my university’s institutional review board required transparency, full disclosure of research goals, and signed informed consent from all research subjects, but how do you ask permission to study illegal and criminal behavior? With other forms of criminality and organized crime, anthropologists can rely on historical and criminal justice data, and can avoid confronting involved parties face-to-face (see Block’s The Mafia of a Sicilian Village and Peter and Jane Schneider’s Reversible Destiny). But I had chosen to study a field without data, without statistics, without a history, and without criminal pros-ecutions and records. Not even human rights organizations or the UN anti-trafficking office had data on organs trafficking. To the contrary, they looked to Organs Watch to provide them.

I had run into previous dilemmas with institutional ethical guidelines when conducting research for an NIMH-funded project on schizo-phrenia and family dynamics in Boston (1979–80). Most of the patients I spoke to were incapable of giving informed consent, under-standing my wish to compensate them for their time, or fully compre-hending that I was not a psychia-trist. My current project, however, was not concerned with protecting vulnerable mental patients, but learning about the preda-tors behind international human organs trafficking schemes. The UC Berkeley Faculty Committee on Human Subjects granted me an exemption to conduct the Organs Watch project, which required me to go “undercover” at times in order to document illegal traffic in human organs. Thus, on my next trip to Turkey, I went to a minibus station and flea market in

Askaray, a dilapidated immigrant section of Istanbul, accompanied by a Turkish journalist disguised as an organs broker wearing heavy gold jewelry, sunglasses and a tiny camera in the “diamond” stud of his tie.

We approached undocu-mented day laborers who had just arrived from rural Moldova and Romania and mingled among poor Turkish locals selling junk, cigarettes and counterfeit French perfume. Although local senti-ments ran strongly against traf-fickers and brokers, some near the station were looking for a windfall by whatever means necessary, even selling a kidney. Flanked by my faux broker, I sat primly at a small table in a café across from the flea market having a cup of tea with Saltimis K. After he lost his job at a commercial bakery in Istanbul, Saltimis’s wife left him and he

spent time living in the street. “I never thought it would come to this,” Saltimis said, referring to his current work as a junkman, wheeling his heavy wooden cart past cheap hotels and discount leather shops in Askaray, collecting scrap metal and empty soda cans. There among the open stalls of the flea market he heard about brokers in Armani suits who prowled the area looking for kidney sellers.

My counterfeit “broker” intro-duced me to Saltimis as an American lady looking to “arrange” a kidney transplant for her deathly

ill husband. Mr K nodded his head and quickly set an opening bid for one of his kidneys: “$30,000, left or right, your choice.” “That is impos-sible,” I replied, “I am not a rich woman and my husband’s medical bills have eaten away our savings.” Saltimis replied that he was a reasonable man and he reduced the price to $20,000. Did he know (I countered) that there were many Moldovan day workers across the street who were prepared to sell

a kidney for $3,000 or less? That may be, Saltimis said, “but Turkish citizens sell for more. This is our country and we set the price.” Saltimis was a cautious seller and he wanted to know who the surgeons would be and the name of the hospital where the opera-tions would take place. He wanted

assurances that he would be well cared for and fairly compensated. I said I would need time to think it over. “My final offer,” Saltimis said, as we rose to leave, “is $10,000.”

Just five minutes had passed when the time had come for full disclosure. “Mr K, don’t be angry with me,” I said, “I don’t want your kidney. I am a medical anthropolo-gist from the United States.” I gave him my Organs Watch calling card with the UC Berkeley logo and address. Saltimis was crestfallen, but not because of the “decep-tion.” He had hoped to make some

money. I offered to buy something else—perhaps he could sell me one of those soft black leather jackets that everyone seemed to be wearing. Quick as a flash he returned with a stylish jacket in my size, worn but service-able. We shook hands and Salimas confirmed that I could use his story and his photo in my research.

On the Adoption of Heretical MethodsHuman trafficking for organs and tissues is an extensive billion dollar industry that links elite surgeons to the activities of an organs mafia from the lowest reaches of the

criminal world. These transactions involve (and are often protected by) military police, immigration officers, state pathologists, tissue bank managers, lab technicians, airline companies, hospital admin-istrators, and transplant coordina-tors. What began as a conventional exploratory field research project led to the adoption of heterodox, even heretical, methods that trans-gress the discrete boundaries of anthropology, human rights activism, political journalism and detective work.

Thus, as I discuss in “Illegal Organ Trade” (Living Organ Transplantation 2007), I have had to rethink the “ethics of the craft” as opposed to the bureau-cratic ethics of the IRB and human subjects panels. How does one investigate covert and criminal behavior as an anthropologist? To whom does one owe one’s divided loyalties? Under normal conditions anthropologists proceed with a kind of “hermeneutic generosity” toward the people they study. By training we tend to accept at face value—and not to second guess—what we are told. We think of our anthropological subjects as friends and research collabora-tors rather than as “informants.” Our method requires building trust that will allow access to “back stage” scenes. Whether we work in villages, street corners, slums or hospitals, we expect to win our research subjects over to what is often a mutually rewarding expe-rience. But in studying human trafficking for transplant organs

Nancy Scheper-Hughes “On Duty” for Organs Watch, Transplant Unit, Cape Town, South Africa. Photo courtesy Viviane Moos

See Organs on page 14

C O M M E N T A R Y

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all the rules of fieldwork prac-tice and ethics seemed inadequate. These engagements required me to enter spaces and into conversa-tions where nothing could be taken for granted or on face value and where a “hermeneutics of suspi-cion” replaced earlier fieldwork modes of bracketing, cultural and moral relativism, and suspension of disbelief. The research required a healthy dose of skepticism.

In other essays I’ve argued for a militant anthropology, for an antropologia-pé-no-chão, a bare-foot anthropology, an anthro-pology-with-one’s-feet-on-the-ground, and an emancipatory anthropology, modeled on the work of base communities and theologies of liberation in Brazil and South Africa (“The Primacy of the Ethical,” Current Anthropology 36[3]). But in posing as a kidney buyer in order to understand the misery that prompts a person to bargain over the value of his kidney, as if it were a thing apart from himself—a rug or a used car—I was complicit in the behavior I was studying. Similarly, each time a kidney seller offered to strip and show me his large scar, sometimes requesting a fee to do so, I became another sort of kidney hunter. In his book about the kidney sellers of Recife (Rim Por Rim 2008) Julio Ludimir embarrassed me with a chapter about my detec-tive work uncovering the kidney trade triangle among Israel, Brazil

and South Africa entitled the “Caçadora” (the Huntress). Indeed, as my Brazilian friends like to say, “No one is innocent,” least of all, the anthropologist herself.

These new engagements require not only militancy, but also a relentless self-reflexive and self-critical rethinking of anthro-pological ethics, the production of truth, and the protection of research subjects. Goffman once posed as a mental patient at St Elizabeth’s Psychiatric Hospital in Washington, DC, but such covert practices are no longer permissible for researchers operating under today’s human subjects guidelines. However, when one researches organized, structured and largely invisible violence, there are times one must ask if is more impor-tant to strictly follow a professional code or to intervene. What if the best method to learn of the hidden suffering of an invisible population of medically abused and mortally neglected people involves entering a facility in disguise?

By far my most difficult deci-sion concerned sharing informa-tion on organized crime networks with authorities, including US Congress, Ministries of Health, parliamentary investigations, Moldovan and South African police and even, when all else failed, the FBI. Anthropologists are not detectives, and we are trained to hold anthropologist–informant relations as a sacred trust. But surely this does not mean that one has to be a bystander to interna-tional crimes against vulnerable populations. Thus, at the request of public heath officials in New

York, I met with an FBI agent charged with investigating corrup-tion and extortion. The case I presented—kidney extortion and transplant fraud—was something new; the agent was disbelieving and the information about the Brooklyn-based organs traffickers and their victims sat untouched for almost seven years. I’ve also been in the ambiguous position of inter-viewing international kidney traf-fickers in a Brazilian prison who knew that my research and formal testimony at a state investigation had contributed to their undoing. Despite this, I developed a colle-

gial and respectful relationship with the convicted leader of the Recife scheme, Gadalya Tauber, who I now dare to call a friend and confidant (see my three-part series in Anthropology News 2007). The work of the dogged ethnog-rapher, unlike that of the jour-nalist or police, has no convenient ending. Our training in empathic listening and our habit of moral and ethical relativism mean that our lives become entangled with our informants, even when they might be criminals or sociopaths.

That my transgressive uses of anthropology in the Organs Watch project have made my anthro-pological colleagues uneasy goes without saying. Neither am I entirely comfortable with what I have taken on. Given these quanda-ries, I do not expect Organs Watch to become a model for engaged or public anthropology, but I do hope that it can be used in rethinking the ethnographer’s craft. Despite some of the unsolvable ethical challenges this research has posed, I wonder if any other discipline is better suited than anthropology to interrogate human behavior on the margins of the global (medical) economy. Anthropological research can offer alternatives to the utilitarianism and focus on individual “choice” that underlie so much stunted bioethical thinking that contrib-utes to the relentless growth of markets in humans, dead and alive, for their organs.

Nancy Scheper-Hughes is Chan-cellor’s Professor of Medical Anthropology at UC Berkeley and director of Organs Watch.

Taking the Next StepWhy We Should Continue Strengthening the AAA Ethics Code

Roberto J González San Jose State U

Hugh Gusterson George Mason U

A recent article in the New York Times profiled the work of Kelly Peña, a market researcher employed by the Walt Disney Company. According to the author, Brooks Barnes, “Peña and her team of anthropologists have spent 18 months peering inside the heads

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of incommunicative boys,” aged 6 to 14 years old. In her efforts to understand the typical American child, Peña is engaged in what the Times calls an “undercover mission: to unearth what makes him tick and use the findings to help the Walt Disney Company reassert itself as a cultural force among boys.”

The article describes a series of covert techniques employed by Peña, including some that would never be approved by any univer-

sity human subjects review board. For example, her team concealed from research participants (both the boys and their parents) the fact that Disney was employing them. Furthermore, the team didn’t share their results with those studied; instead, they only provided results to Disney. The entire process seems designed to manipulate children and their parents for profit, while keeping research participants largely in the dark.

If the Times piece is accurate, Peña’s “team of anthropologists” is conducting research that blatantly violates various precepts of the AAA’s Code of Ethics, and that illustrates a widening regulatory black hole. What, if anything, can the AAA do about people who call themselves anthropologists (because they have anthropology degrees) but aren’t subject to the regulatory authority of a univer-sity or government agency because they work for a private company or for themselves? On a similar note, what about those who have advanced anthropology degrees, but who teach in other univer-sity departments (such as political

Anthropologists are not detectives, and we are trained to hold anthropologist–informant relations as a sacred trust. But surely this does not mean that one has to be a bystander to international crimes against vulnerable populations.