Ethics for International Medicine by Wall Anji E.;

Author:Wall, Anji E.;
Language: eng
Format: epub
Publisher: Dartmouth College Press

Case 2.5: Providing Supplies for Female Genital Mutilation

A physician, after applying for a six-month medical aid experience, is notified that she will be working in a rural village in Mali, Africa. In the orientation session preceding her trip, the physician is told about the organization’s health initiatives in this village, one of which is handing out sterile scalpels to women who perform female genital mutilation (FGM). Another initiative in the village is providing tetanus shots to girls before they participate in FGM. In the orientation session, the organizational representative explains that they do not agree with FGM or allow medical aid workers to participate in these rituals, but they do want to make FGM safer for the girls who are subjected to it.4

In preparation for the trip, the physician reads several articles about FGM to gain an understanding of what it is and why it is so controversial. Through her readings, the physician is shocked by the barbaric nature of this ritual and by the significant immediate and long-term complications associated with FGM. She cannot understand why anyone would subject a child to this practice, and questions whether or not she should participate in initiatives that could legitimate or encourage it.

CASE ANALYSIS

Before arriving in Mali, the physician can begin by reflecting on her own perceptions of female genital mutilation using the assessment questions. Because this case addresses an ethical issue that arises before she arrives on location, the analysis focuses on the physician’s perceptions of the practice. Before making a final decision, it is important that the physician learns more about the community’s practice of FGM, because there can be wide variations in this ritual, some of which are not excessively harmful to participants.

Stakeholders

The physician is the central stakeholder at this point in the case because she is in the process of considering how to address a cultural practice in the community where she will be serving. After she gets to Mali, she will have to identify the other main stakeholders, which will likely include community leaders, women who perform FGM, girls who have had or who are planning to have FGM, and community members who oppose this practice.

Medical Facts

From what the physician has read about FGM, it can lead to serious medical problems, such as bleeding, infection, and complications in childbirth. These potential medical problems may not be prevalent in the community where the physician will be serving, depending upon how extensive the local FGM procedures are. So it is important for her to learn about the adverse medical effects of FGM in the community before judging it as dangerous. If the women and girls in the community do not experience the adverse effects associated with FGM, then their ritual may not be as dangerous and barbaric as the physician perceives it to be.

Goals and Values

Assuming that the practice of FGM in the community does result in serious adverse medical outcomes, the physician would have the ultimate goal of ending this practice. However, given that she is only serving

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