Michel Anteby – Questrom School of Business, Boston University
Mara Guerra – Imperial College London
Lin Dong – Imperial College London
The paper explores the morality of the market, in which scholars have dominantly focused on the category of traded goods as the main source of market legitimacy. By exploring the micro-foundations of market legitimization from a practice-based view, this paper introduces the way goods are traded as a source of morality and explains why some trades are deemed morally acceptable while other trades of the same goods are not. Drawing on the case of the human cadaver market, it finds that professional clinical anatomists (i.e. academically housed programs) rely on narrative distinction, geographically insulation and specific practices of trade to distinguish them from an alternative sphere of commerce led by “body brokers” (i.e. independent ventures).
Question 1. The literature on professions usually explores fields with high prestige such as management consulting, law and medical treatment. The setting of human cadaver market does not indicate a strong linkage with profession intuitively. Such a context usually would make us think about stigma literature. There are several places in this paper that actually remind us about stigma management and institutional logics.
a) Have you considered these ways of theorizing while you were working on this article?
It is difficult to study individuals dealing with human cadavers and not think about stigma. Clinical anatomists themselves knew this well and, in an uncanny way, I suspect the prevalence of stigma in their line of work was the reason they opened up to me. They wanted to prove the image wrong. I did not judge them when interacting with them. On an occasion, an anatomist even tested my potential repugnance to his trade: I was a few feet away in a large office and he unexpectedly shouted, “Catch!” Had I not caught the plastinated body part he threw at me, I would have probably failed his test by enacting the stigma.
But it is not because you operate in a stigmatized field that you need to contribute to the literature on stigma. Similarly, it is not because you notice institutional logics at play that you need to contribute to the literature on logics. What really struck me as I was collecting data were the commercial tensions that permeated the field. That’s what people really wanted to talk about and they directed my attentions towards the literature on markets and morals.
b) When developing the framing for the paper, what led you to focus on the role of professionals and the practice-based view of legitimacy? Did you encounter any challenges that were particularly caused by its unique context?
In terms of framings, I explored several options. One was the French literature on the conventions in markets (e.g., Olivier Favereau, André Orléan, and Laurent Thévenot), but I did not see how I could add to it. Another attempt centered on the literature on performativity (e.g., Donald MacKenzie, Fabian Munies, and Lucia Siu), but again the contribution was unclear. By contrast, when I started digging into the literature on professions, it spoke directly to many of the field participants’ concerns. Also, scholars working in that literature seemed excited about my findings, which made me feel that there was traction. Like in most inductive qualitative research, framing is the key challenge. Yet I don’t believe the specific context (i.e., trades in human cadavers) made it more challenging.
c) What would be your advice for those attempting to frame this special context?
My advice for anyone trying to frame a context – whether dealing with cadavers or any other topic – is to initially try a frame, but lightly. Be willing to trade dresses if it does not fit. Not all clothes suit all bodies…. The core findings (i.e., the body of an article) will dictate the dress and picking the right ones might require multiple fittings.
In my view, no context is “special.” Labeling the trade in human cadavers as a special context is already passing judgment on those involved in these trades. For sure, the context might be unusual or less mainstream. Yet clinical anatomists and body brokers do not feel special. From their perspective, their work is quite mundane. I would caution all of us to think of others as “special” and us as “normal.” Such thinking only allows us to deny our own distinctiveness and estrange others.
Question 2. This study mainly captures professionals’ effort to gain legitimacy. Legitimacy is an audience-specific construct.
a) Based on your observations and interviews, how did professionals persuade key stakeholders such as potential donors and regulators to perceive them as legitimate (e.g. direct communication? promotion material? Others?)?
Legitimacy is an audience specific construct, but we should not forget that the audience need not be outsiders. Andreas Glaeser (see Divided in Unity: Identity, Germany, and the Berlin Police. Chicago: The University of Chicago Press, 2000) and Patrick Reilly (see “The Layers of a Clown: Career Development in Cultural Production Industries,” AMD, 2017) nicely show how, respectively, police officers and stand-up comedians perform in part for their peers. In those settings, the key audience is partly internal and, for clinical anatomists, I also suspect, that the internal dynamics prevailed. Clinical anatomists were basically speaking to and performing for each other.
That being said, all participants needed to secure donations. The clinical anatomists affiliated with academic medical centers were the least aggressive. They often relied on other hospital staff members who could suggest a whole-body donation as an option when interacting with future donors. By contrast, the independent ventures were very well organized. I vividly recall meeting one of their “sales representatives” – her title was obviously different, probably more like “outreach” coordinator. She was a very energetic baby boomer and dressed as if she had been plucked from a dollhouse. Her role was to visit retirement homes and inform residents of the possibility to donate their body to science. I wish I could have tagged along!
b) Could you also elaborate more on how independent ventures responded to these efforts? How did the target audience respond to the efforts of both academically housed programmes and independent ventures and how did they evaluate the two spheres?
Donors’ reactions to the above contrasted approaches to securing cadavers is a question that Mikell Hyman and I took on in another article that we published in Social Science & Medicine (see “Entrepreneurial ventures and whole-body donations: A regional perspective from the United States,” 2008). We show in particular that donors to an independent venture were younger and more racially diverse than those in an academic housed body donation program “sourcing” in the same geography (Baltimore). Importantly, donors in both programs shared a similar socio-economic background. Thus, independent ventures did not appear to prey on less “educated” donors. In a counter-intuitive way, we posited that independent ventures might benefit from a legitimacy boost among African-American potential donors given how poorly supposedly “legitimate” institutions treated them in the past (e.g., The Tuskegee Syphilis Experiment).
Question 3. In your opinion, what other markets do you think face similar legitimacy challenges where the practice-based view of moral market is particularly relevant?
Many contested markets (such as contract pregnancy and ghostwriting) probably all operate on a similar model of practice-based view legitimacy as long as regulation remains loose. For example, an “appropriate” contract pregnancy often entails the surrogate giving up the infant right after birth and not spending time with the infant. Breaches to such a rule would probably “taint” the transaction. Similarly, a “good” ghostwriter is meant to write a memoire after having spent time and done interviews with “the talent” and even cross-referencing the story s/he is told with data from alternate sources. All these steps lend “legitimacy” to transactions that can easily be contested. My study’s findings, therefore, call attention to the need to spell out with both clarity and precision the practices that might render commerce moral.
Question 4. We would like to know more about your choice to explore this intriguing context, human cadaver market. Can you tell us about the motivation to undertake this project? What was your initial idea of this project and how did it evolve in this process?
Before I started this study, a friend was finishing his residency in pathology at Columbia University. I once went to pick him up at work and saw his laboratory. The lab, to be honest, seemed quite boring to me, but it was located near the medical school’s whole body donation program: that setting seemed way more exciting to me, not to mention off limits to visitors. The initial encounter with a closed off section of the hospital proved too tempting not to pursue. If the barrier to entry was high enough, I thought, few other researchers probably had accessed it, and that was a good enough reason (for me) to get started. Fields with high barriers to entry have always proven attractive to me.
Question 5. What are the most important learning/impressive moments of working on this project? Did you have any tips for PhD students interested in studying these types of cases?
First, my suggestion is to refrain from judging field participants when operating in stigmatized settings. Approaching them as individuals who are simply doing their work is a precondition for accessing such fields. Second, persistence is needed. I recall flying out to Las Vegas for a convention of clinical anatomists and handing-out a basic survey to a room of hundreds of clinical anatomists. Upon exiting the room, I collected only a dozen surveys. I remember being quite disheartened, to say the least, by such a low response rate! But I only needed one or two sites to start my project, and luckily the dozen who answered were happy to welcome me. Finally, every PhD student will need to figure out what will keep her/him engaged for multiple years. So I encourage students to find the cases that will sustain their interest over time. Future readers and colleagues will pick up on this interest, even years down the road. In other words, do not pick a “type” of case, but a case that speaks to you, even if you are still unclear how/why it speaks to you. You will later have time to figure out what type of case it is…