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Paper short abstract:

I follow the moral assumptions in diabetes guidelines as they travel to a rural hospital in a Totonac community in Mexico, showing how medical staff and diabetes patients differently negotiate ideas about ethics and individual responsibility.

Paper long abstract:

Anthropologists have shown how diabetes prevention and treatment in public health and clinical settings tend to frame the disease in moral terms, emphasizing individual responsibility over environmental determinants and making moral claims about people’s lives. This presentation examines how notions of individual responsibility in diabetes care shape ideas about ethical decision-making in practice, and how these dynamics vary across contexts. Drawing on archival research and fieldwork conducted in Mexico City and Ixtepec, Puebla, I follow the moral and ethical assumptions embedded in national diabetes guidelines as they travel from the U.S. to a rural hospital in a Totonac community in Mexico.

I explore how medical staff in the rural hospital in Ixtepec reinterpret these assumptions based on their beliefs about the local population as only partially capable of ethical decision-making. I then examine how these local moral framings of diabetes are received and negotiated by local patients. I show how Totonac understandings of diabetes as a matter of personal destiny partially invert the moral claims put forward by medical professionals. These understandings influence local ideas about ethical behaviour in relation to diabetes management, ultimately revealing equivocations between national health care norms, their local enactments, and indigenous knowledge.