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Governing the Global Clinic

HIV and the Legal Transformation of Medicine

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 theGlobal 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?


416 pages | 13 tables | 6 x 9

Chicago Series in Law and Society

Law and Legal Studies: Law and Society

Sociology: Individual, State and Society, Medical Sociology

Reviews

“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"

Table of Contents

List of Abbreviations

1. Deep Law: Governing the Global Clinic
2. Where the Action Is: Taking Standardized Rules to Unstandard Clinics
3. The Mushroom Cloud of Rules
4. The Variability of Universals: What HIV Clinics Do with Clinical Guidelines
5. Rules, Credibility Struggles, and Institutionalized Skepticism in Clinical Research: Constructing Trustworthy Data
6. Disciplining Medicine: What Happens When Guidelines Are Hardened by Law
7. Strategic Uses of Ignorance in HIV Clinics
8. “Wicked” Ethics: Compliance Work and the Practice of Ethics in HIV Clinics
9. Moral Worth and the Legal Turn in Medicine: From Scientific Claims to Moral Obligations

Acknowledgments
Appendixes
Notes
References
Index

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