The phenomenologist Max Van Manen (1997) points out that there are definite ways of doing a research project which lends itself to a phenomenological approach. He argues that what methodological choice is made, and thus what methods are employed, need to reflect the concerns of phenomenology, which “tries to ward off any tendency toward constructing a predetermined set of fixed procedures, techniques and concepts that would rule-govern the research project” (Van Manen, 1997: 37). Adopting an ethnographic methodology can reflect the phenomenological need for openness towards its research topic, in that it permits contingency in the research process. Rather than being able to say exactly what will be done at each stage, an ethnographic methodology responds to the research findings as they unfold (Hammersley and Atkinson, 2007). It also offers a way of researching which allows for insight into how the ‘problem’ of donation and ethnicity has been produced, by following the various social actors, such as ICU staff and donation nurses, involved in the ‘problem’ on a daily basis.
In general terms, ethnography can be conceptualised as an approach to its subject. It is a way of looking at the world, with ‘culture’ and context operating as its key concerns. The origins of ethnography came out of the practices of anthropology, where the term was originally used in reference to a descriptive text about a ‘community’, usually outside of the
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Western world (Hammersley and Atkinson, 2007). In practice, ethnography usually involves employing a variety of (generally) qualitative methods to study people’s actions in their everyday worlds (the field). The use of triangulation, or ‘complementary’ methods (Barbour, 2001), is typical of ethnography, which, according to Hammersley and Atkinson (2007), usually obtains data from as wide a range of sources as possible. The most common method – and one which ethnography is most recognised for – is in the use of participant observation (Fox, 2004). This involves the researcher spending time with, and adopting an everyday role within the research ‘community’, and detailing these interactions in fieldnotes (a form of research diary). Ethnography also commonly involves the use of formal and informal interviews, and may include the use of quantitative approaches, such as questionnaires.
Traditionally, ethnography was based upon a naturalistic research process. This involved the idea that the social world should be studied in its ‘natural’ state, left undisturbed by the researcher. This usually translated into the anthropologist entering a small ‘community’ and spending an extended period of time there, in order to answer some sort of ‘problem’ regarding that ‘community’ (e.g. see Evans-Pritchard, 1937; Mead, 1943). One of the characteristics of such an approach, however, was the tendency to objectify these ‘communities’ in the description of their ‘culture’, as portrayed by the ‘objective’ ethnographer whose own values were rendered absent (Hammersley and Atkinson, 2007). This objective gaze of classical anthropology has been accused of complicity with imperialism, whereby reported ‘facts’ about non-Western ‘primitive’ societies – as seen through the eyes of the (usually) ‘white’, Western anthropologist – were taken as justification for the colonialist project (Said, 1989; Faubion, 2007). In this way, anthropology and its subjects were borne out of a reliance on, and subsequent representation of difference (Said, 1989). Parallels can be drawn between these traditions and the seemingly
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objective stance which has been taken in the UK research on organ donation and ethnicity. By directing the focus upon community ‘culture’ as a barrier to donation, members of ‘BME’ populations are effectively ‘other-d’, with wider medical contexts left unquestioned.
Today, such un-reflexive practice has been widely criticised in anthropology, and labelled as the “crisis of representation” (Marcus, 1998: 15). More recent forms of ethnography, as first proposed by Scholte (1969) in his call for a critical ethnography, have opened themselves out by adopting a more phenomenological orientation (e.g. Steedly, 1993; Tsing, 1994). This is done by blurring the boundaries between ‘self’ and ‘other’ – researcher and researched – in the writing of “positioned truths” (Abu Lughod, 1991: 142). Such an approach means showing that the ethnographer’s interpretations are the outcome of the research process: which produces the ‘world’ it describes, rather than taking this ‘world’ for granted (Hammersley and Atkinson, 2007). A phenomenological ethnography also interprets its phenomena by following the practices, settings, and sense making processes of those involved with the phenomena (e.g. Rosaldo, 1993). In my study, this therefore includes not just individuals from ‘BME’ backgrounds involved in donation, but also the health professionals who make the process happen.
In a similar vein, George Marcus (1998) has called for a re-thinking of anthropology’s traditionally holistic approach. He argues that the usual tactic of situating oneself within a bound ‘community’, which could be a village, or even a hospital ward, creates a “fiction” of a whole and “fully-probed micro-world”, rather than that which is constructed by the purposes of inquiry (much like the category of ‘BME’) (Marcus, 1998: 33). In pointing out the shortfalls of locally-focused ethnography, Marcus proposed a re-creation of the approach in the form of a multi-locale (or multi-sited) ethnography. This involves the ethnographer widening her lens across different places, people, and systems, so that neither side – such as transplant medicine (the macro) and ‘BME’ groups (the micro) – is polarised with the other.
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Employing a phenomenological, multi-sited ethnographic methodology therefore involves looking at different places and parties to represent the multiplicity of phenomena. In relation to organ donation and ethnicity these places and parties encompass, among others: donation and transplant professionals, Intensive Care staff and Intensive Care wards, ‘BME’ transplant recipients and organ donors, potential donor families and religious leaders, and organ donation guidelines and consent forms. In Emily Martin’s (1994) ethnography on the role of immunity in American culture, the multiplicity of immunity was represented by conceptualising the immune system as a field, rather than a ‘community’. For Martin, the immune system could only be understood by looking at it from numerous angles, through differently related actors and settings. These included analysing public representations of the immune system in advertisements, volunteering as a ‘buddy’ at a centre for HIV sufferers, and conducting observation in an immunology research lab.
In this study I have adopted a multi-sited ethnographic methodology to open up the phenomena of organ donation and ethnicity in a way that a qualitative interview study, or quantitative (questionnaire) approach (both of which have been used in previous research on the issue) would not allow. It broadens out an examination of the ‘problem’ from the perspective of different constituents, such as ‘BME’ families who have been requested to donate their relative’s organs, and the health professionals who navigate this ethically problematic field. As outlined in the research objective, the original focus for the study was to work outwards from the organ donation encounter. The meanings and practices of donation in relation to ethnicity were to be elucidated by starting with the donation encounter and allowing this to shape who I talked to, and where I went around this. In the next part, the methods, I detail the multi-sited field of organ donation and ethnicity, how I went about accessing this field, and the methods I drew on to do the research.
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