Papers

• “This check must not be left out, as some will always passively resist the treatment”: The limits of studying “informed consent” in colonial medical history Caroline Schep Leiden University

  Historians of medicine have long studied the development of our current concept of “informed consent”. The majority of these histories, however, focus almost completely on European and American history and concepts. For instance, the historical chapter in The Routledge Handbook of the Ethics of Consent (2018) practically exclusively discusses the origins of consent in ancient Greece and medieval Europe. Although anthropologists currently are criticizing the individualist character of “informed consent” – pointing towards the difficulties this gives in more collectivist or differently arranged societies and introducing alternatives such as “group consent” or “collective consent” – many historians of medicine still use “western” ideas about consent to study the past.

  When studying biomedical ethics in early twentieth century Southeast Asia, it is therefore of utmost relevance to critically examine what we understand by (informed) consent and in what ways we research this. In this paper, medical researches with new pharmaceuticals in late-colonial Indonesia (1900-1942) will be taken as a case study. Three obstacles that blur the concept of informed consent appear: the question of collective decision-making, the problems of illiteracy and source bias, and the position of Indonesian intermediaries. Can the current interpretations of group/collective consent help us understand the dynamics among Indonesian communities faced with experiments? How far can we even trace these dynamics and negotiations with the limited source material at hand? And to what extent did the Dutch use of Indonesian intermediaries, such as “magangs” in (mass) administering medicine, complicate negotiations and obscure colonial pressure and violence? Combining literature and a diverse set of sources (from medical journals to correspondence to Indonesian literature), this paper will attempt to illustrate these difficulties and propose preliminary solutions.

• Intervening for the Care for the Prospective Mothers: Medical Paternalism, Maternal Autonomy and Maternal Health Care in Early Twentieth Century Manila Alvin C. Cabalquinto Ateneo de Manila University

  Historiography on the history of public health in the early twentieth century has extensively discussed the dynamics among medical practitioners, social workers, and government officials. Such studies have examined maternal health as an issue of public welfare. However, recent studies on the colonial history of public health have pointed out the racial, engendered, and classist tendencies in framing public health issues and implementation of medical interventions. Moreover, such studies have pointed out the role of these colonies serving as laboratories for such medical interventions. Given such dynamics, this paper focuses on maternal health interventions in early twentieth-century Manila. Using government reports, medical journals, magazines, and pamphlets, this paper investigates the changes implemented in the establishment of biomedical practices in childbirth administration. It surveys the protocols implemented in prenatal care, childbirth attendance, and postnatal care. This paper then examines its meanings and its implications on the medical-ethical dynamics in the colonial setting. In doing so, it examines the patient/subject autonomy from the perspective of the colonial prospective mother. Ultimately, this paper seeks to understand the dynamics of medical paternalism and maternal autonomy in the colonial setting.

• Cholera in a Time of Vaccines: Vaccine Testing and Administration in American Colonial Philippines Bianca Angelien Claveria Leiden University

  Vaccination and hygiene were two notable interventionist (and at times, repressive) features of American colonial policy in the Philippines. Compared to their colonial predecessor’s perfunctory vaccination policies and ineffectiveness in getting as many Filipinos protected against diseases such as smallpox, the American medical officers proudly wore their compulsory vaccination programs as symbolic badges of beneficence. They were “saving the Orient from itself, leading its people onto the path of science, progress, and health.” An essential institution in America’s colonial crusade for health was the Biological Laboratory of the Bureau of Science. Developed and stored in this laboratory were a variety of sera and vaccines, and experimentation and clinical trials proved pivotal in ensuring their effectiveness. Vaccination programs paved the way for American medical authorities to build and expand their work across the archipelago, but with a working public health system and bureaucracy already set in place, they further tightened their chains of control instead on reforming Filipino customs and hygienic practices.

  The history of medicine and diseases in American Colonial Philippines are mainly biased on the role of hygiene and sanitation policies, as intrusive means of surveying, controlling, and curing the disease-ridden native body. Historiographies remain restricted in a very narrow “top-down” approach, with the Filipino natives depicted as docile and passive subjects of scientific and medical research. Vaccines in Philippine history have been made to appear as short-term approaches to rising cases of epidemics, when they could have been appreciated as integral reflections of the ethos and ethics of the country’s scientific and medical communities. The involvement of human subjects in the clinical vaccine trials of the Bureau of Science arguably poses more relevant queries on medical ethics: Were the subjects informed about the risks and benefits of their participation? In what ways was consent given? Was consent and participation in the trials incentivized? From whom and how were samples taken? What are the consequences should the subjects resist? This paper will survey the long history of cholera in the Philippines and present it as a promising case study for one to appreciate the shifting political and medical dynamics between hygiene policies and vaccination campaigns in the Philippines. Hygiene may have effectively reformed the everyday lives of Filipinos; however, one cannot merely overlook the lasting impacts of vaccination experiments and campaigns. Vaccination was (and remains to be) a powerful medical intervention that has saved thousands of lives, but unfortunately, it has also overwhelmed medical men with the infectious feelings of hubris and control.

Abstract