Governing the Global Clinic - (Chicago Law and Society) by Carol a Heimer

About the Book

"HIV emerged in the world at a time when medicine and healthcare were undergoing two major transformations: globalization and a turn toward more legally inflected, rule-based ways of doing things. It accelerated both trends. Although pestilence and disease are generally considered the domain of the biological sciences and medicine, social arrangements-and law in particular- also play a crucial role in shaping outcomes. Drawing on years of research in HIV clinics in the United States, Thailand, South Africa, and Uganda, Governing the Global Clinic examines how growing norms of legalized accountably have altered the work of healthcare and how the effects of legalization vary across different national and local contexts. A key feature of legalism is the use of universalistic language, but, in practice, rules are usually imported from rich countries (and especially the United States) to poor ones with vastly different available infrastructures and resources with which to implement them. Inequalities between countries are deeply consequential both because of the difficulties associated with adapting the laws of resource-rich countries to poorer ones and because of the distrust of poor countries by those who are monitoring compliance. Challenging readers to reconsider the impulse to use law (in both its "hard" and "soft" forms) to organize and govern social life, Governing the Global Clinic asks many hard questions. These include: When do rules solve problems, and when do rules instead create new problems? When do rules get decoupled from ethics, and when, in contrast, does the use of rules lead to deeper moral commitments? When do rules reduce inequality? And when do they reflect, reproduce, and even amplify inequality?"--

Book Synopsis

A deep examination of how new, legalistic norms affected the trajectory of global HIV care and altered the practice of medicine.

HIV emerged in the world at a time when medicine and healthcare were undergoing two major transformations: globalization and a turn toward legally inflected, rule-based ways of doing things. It accelerated both trends. While pestilence and disease are generally considered the domain of biological sciences and medicine, social arrangements--and law in particular--are also crucial.

Drawing on years of research in HIV clinics in the United States, Thailand, South Africa, and Uganda, Governing the Global Clinic examines how growing norms of legalized accountability have altered the work of healthcare systems and how the effects of legalization vary across different national contexts. A key feature of legalism is universalistic language, but, in practice, rules are usually imported from richer countries (especially the United States) to poorer ones that have less adequate infrastructure and fewer resources with which to implement them. Challenging readers to reconsider the impulse to use law to organize and govern social life, Governing the Global Clinic poses difficult questions: When do rules solve problems, and when do they create new problems? When do rules become decoupled from ethics, and when do they lead to deeper moral commitments? When do rules reduce inequality? And when do they reflect, reproduce, and even amplify inequality?

Review Quotes

"In this intellectual tour de force, Heimer tells the story of contemporary medicine as a cascade of formal laws, administrative rules, clinical guidelines, research protocols, ethics regulations, and reporting requirements. Heimer's meticulous multisite, transnational ethnographic research convincingly demonstrates that we need to pay attention to how healthcare professionals make universal rules fit local conditions. The result is a call to action: the seemingly unstoppable legalization of medicine generates a unique configuration of global health inequities but also offers tools to redress health imbalances."--Stefan Timmermans author of "Postmortem: How Medical Examiners Explain Suspicious Deaths"

"Extraordinarily original and audacious in scope, Governing the Global Clinic reports richly detailed fieldwork from five HIV/AIDS clinics on three continents. Heimer's work is theoretically ambitious, based on meticulous field research, and develops a rigorous yet rich understanding of the detailed processes of 'institutionalization' in global health as they both constitute and transform the enterprise of AIDS research and treatment. Heimer draws a compelling picture of how local clinic staff attempt to apply their own ideals of fairness and compassion while adapting to the funders' demands for adherence to formal rules."--Ann Swidler coauthor of "A Fraught Embrace: The Romance and Reality of AIDS Altruism in Africa"

About the Author

Carol A. Heimer is a research professor at the American Bar Foundation and professor emerita of sociology at Northwestern University.