Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Glob Public Health. 2023 Jan;18(1):2180065. doi: 10.1080/17441692.2023.2180065.
Global health practitioners and policymakers have become increasingly vocal about the complex challenges of identifying and quantifying the causes of death of the world's poorest people. To address this cause-of-death uncertainty and to minimise longstanding sensitivities about full autopsies, the Bill and Melinda Gates Foundation have been one of the foremost advocates of minimally invasive autopsy technology (MIA). MIA involves using biopsy needles to collect samples from key organs and body fluids; as such, it is touted as potentially more acceptable and less invasive than a complete autopsy, which requires opening the cadaver. In addition, MIA is considered a good means of collecting accurate bodily samples and can provide the crucial information needed to address cause-of-death uncertainty. In this paper, we employ qualitative data to demonstrate that while MIA technology has been introduced as a solution to the enduring cause-of-death uncertainty, the development and deployment of technologies such as these always constitute interventions in complex social and moral worlds; in this respect, they are both the solutions to and the causes of new kinds of uncertainties. We deconstruct the ways in which those new dimensions of uncertainty operate at different levels in the global health context.
全球卫生从业者和政策制定者越来越多地意识到，确定和量化世界上最贫困人口死因的复杂性挑战。为了解决这一死因不确定性问题，并尽量减少对全面尸检的长期敏感性，比尔及梅林达·盖茨基金会一直是微创尸检技术（MIA）的主要倡导者之一。MIA 涉及使用活检针从关键器官和体液中采集样本；因此，它被吹捧为比需要打开尸体的完整尸检更具可接受性和侵入性更小。此外，MIA 被认为是收集准确身体样本的好方法，并且可以提供解决死因不确定性所需的关键信息。在本文中，我们使用定性数据表明，尽管 MIA 技术被引入作为解决长期死因不确定性的一种方法，但此类技术的开发和部署始终构成对复杂社会和道德世界的干预；在这方面，它们既是新的不确定性的解决方案，也是新的不确定性的原因。我们解构了这些新的不确定性维度在全球卫生背景下不同层面上的运作方式。
