ABSTRACT:
The idea that decolonisation does not end with the departure of political rule by colonial powers, nor even with the shattering of economic shackles, but extends to a re-evaluation of what is counted as knowledge, is powerful and popular in some circles. It is most easily applied to the least practical subjects: e.g. evaluating art or poetry. It is most difficult to apply in the most practical subjects: e.g. constructing bridges or designing weapons. In medicine, there is a particular challenge. On the one hand, medicine, like poetry, is deeply imbued with culturally specific values and ideas. A diversity of beliefs about life, death, health, sickness, the supernatural, the afterlife, and so forth is built into all medical traditions. On the other hand, medicine is practical, and the goal of curing the sick (and the standards of success in achieving this goal) appears to be largely shared. People of all cultures will “shop around” for the most effective treatment. Thus clinical medicine and especially public health authorities sometimes face a challenge. Should health authorities override local beliefs about effective interventions when they conflict with (what I have elsewhere called) Mainstream Medicine? To override may be unjust in an epistemic sense; not to do so may be unjust in a humanitarian sense. In this paper, I argue that overriding is the only option, but that two further tools must be used in its application. An attitude of Medical Cosmopolitanism must be adopted towards the disagreement; and the stability of the recommendation—its likely survival of future research—must be honestly assessed. I further argue that this is not a case of “re-colonising” medicine but one in which the concepts of decolonisation and epistemic justice are simply inapplicable.