The Ethics of Humanitarian Aid and Cultural Conflicts: The case of Female Genital Mutilation. By: Leah Gervais. October 25, 2015

Transcription

1 The Ethics of Humanitarian Aid and Cultural Conflicts: The case of Female Genital Mutilation By: Leah Gervais October 25, 2015

2 Ethical conflicts that arise with humanitarian international work, particularly medical work, are inevitable. This is a result of varying cultural, governmental, and religious practices. Humanitarian organizations are presented with moral dilemmas, which simultaneously pull them towards their moral obligations in two opposite directions. On the one hand, humanitarian workers feel strongly about defending human rights, particularly in communities that do not respect internationally protected human rights. They may feel the obligation to work towards eliminating such practices in defense of victims, and they do not want to contribute to such violations. On the other hand, victims of human rights violations can be in grave need of aid and often suffer most from lack of care or medical attention. Some humanitarian organizations, such as Medicins Sans Frontieres choose to function independently for this reason, meaning they do not factor concerns presented by political, military or religious agendas into their decisions to provide medical aid. They can thus focus on achieving their goals of providing care and alleviating suffering. 1 The dilemmas that humanitarian organizations are faced with can be particularly complicated when their decisions are accompanied with the possibility of harming more than helping. Female Genital Mutilation (FGM) is a clear example of a tradition practiced in a foreign culture that presents humanitarian medical organizations with an ethical dilemma on how to effectively and morally involve themselves. Applying the framework described above, leaders of humanitarian organizations are torn. FGM is considered a human right violation, so in the interest of human right protection, humanitarian medical organizations may feel they are committing an ethical violation by providing sterile instruments for 1 Fox, Renée C. Doctors without Borders: Humanitarian Quests, Impossible Dreams of Medecins Sans Frontieres. Johns Hopkins UP, Print.

3 purposes of FGM or restoring a woman to her mutilated state (if applicable) after childbirth. Paradoxically, the practice of FGM can especially warrant medical aid and attention precisely because it is a human right violation and can cause intense physical and psychological damage. Humanitarian medical organizations are left with the difficult decision on how to act. If they provide sterile and safe medical supplies for purposes of the operation, and if they perform the operation after childbirth if a woman has been temporarily altered from her mutilated state, they can reduce harm for these women and risks that come with FGM performed without sterile instruments or unprofessionally. However, doing so could increase the accessibility of FDM, increase difficulties in eradicating it, and continue allowing human rights violations. Considering the humanitarian goals of treating patients with dignity, providing care and alleviating suffering in connection with the aforementioned moral dilemma and applicable bioethical principles (examined below), it is not an ethical violation for humanitarian medical organizations to provide medical aid towards FGM. Humanitarian goals and bioethical principles prioritize humanitarian care towards individuals and express the danger of using individuals towards broader goals. The fight for human rights is not necessarily most effective through humanitarian medical organizations nor is it their main goal. Humanitarian medical organizations can perform more good given their resources and achieve their goals through providing medical care than in fighting for human rights through the omission of care.

4 Principles of Bioethics In their 2001 publication, Principles of Biomedical Ethics, Beauchamp and Childress established the now widely used four main principles of bioethics. 2 They are: (i) respect for autonomy, (ii) beneficience, (iii) justice, and (iv) non-malifence. Applying these principles to the ethical dilemma presented by FGM presents strong arguments in both directions, demonstrating the true difficulty of the situation. Yet, the moral obligation is stronger in providing medical aid, even considering human rights conflicts, because doing so reduces the most harm. Respect of patients autonomy is the first principle. As Beauchamp and Childress explain it, to respect an autonomous agent is, at a minimum, to acknowledge that person s right to hold views, to make choices, and to take actions based on personal values and beliefs. Such respect involves respectful action, not merely a respectful attitude. It also requires more than noninterference in others personal affairs. 3 To respect the desires of a patient that stem from their culture and security is to respect their right to take actions based on personal values and beliefs. In the case of FGM, a woman s status in her community can be damaged without the mutilation, so her choice to uphold that status in having the procedure ought to be respected. 4 The second principle, beneficience, is, a moral obligation to act for the benefit of others. No demand is more important when taking care of patients: the welfare of patients 2 Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, Print. 3 Beauchamp, Tom L., and James F. Childress. "Respect for Autonomy." Principles of Biomedical Ethics. New York, NY: Oxford UP, Print. 4 Momoh, Comfort. Female Genital Mutilation. Oxford: Radcliffe Pub., Print.

5 is medicine s context and justification. 5 FGM is a deeply rooted cultural tradition and the lack thereof could harm women in these communities. 6 This is difficult to grasp because of cultural differences, but as Beauchamp and Childress express, we have universal moral obligations of beneficence to others- i.e., obligations to all including moral strangers - when (a) those others are in major need and (b) our meeting that need would not impose on us significant risks, costs, or burdens. 7 Considering FGM is a human right violation, it follows that patients of FGM are in major need and increasing the safety procedure while it is still practiced is in their best interest. Justice, the third principle, is, the principle of universal fairness. It requires that all individuals have equal opportunity and that people are treated as an end in themselves not as a means to an end. 8 The refusal of humanitarian medical aid to women undergoing FGM based on the premise that performing the procedure encourages a violation of human rights is not inline with this principle of justice. Restoring a woman to her mutilated state following childbirth may increase the accessibility of FGM overall, a practice that does not give individuals equal opportunity. However, the refusal to perform FGM on these grounds means treating each patient as a means to an end, rather than an end in themselves. While both options pose potential consequences, the more just course of action is to treat the individual, despite larger scale implications that treatment may have. 5 Beauchamp, Tom L. "The 'Four Principles' Approach to Health Care Ethics." Principles of Health Care Ethics. By Richard E. Ashcroft, Angus Dawson, Heather Draper, and John R. McMillan. 2nd ed. Chichester, West Sussex, England: John Wiley & Sons, Print. 6 Momoh, Comfort. Female Genital Mutilation. Oxford: Radcliffe Pub., Print. 7 Gillon, R. "Defending 'the Four Principles' Approach to Biomedical Ethics." Journal of Medical Ethics 21.6 (1995): Web. 8 Jones-Devitt, Stella, and Liz Smith. Critical Thinking in Health and Social Care. Thousand Oaks, CA: Sage Publications, Print.

6 The final principle is non-malifence. Beauchamp applies this to physicians as vowing that they are obligated to avoid doing harm to their patients. 9 Though the procedure of FGM causes harm, omitting medical care has the potential to cause more harm. FGM is typically performed by village members with razor blades or broken glass, resulting in an unsafe and high-risk recovery. 10 Refusing medical aid is not minimizing harm. Principle Establishment and Application Refusing humanitarian medical aid to women who want FGM done safely on the grounds that: aiding in a practice that violates human rights is therefore an ethical violation, creates a dangerous principle for humanitarian work. FGM is an extreme, brutal practice with indications of gender inequality and even child abuse. 11 To protest care here on the grounds that it is aiding a human right violation seems logical, yet detracts from the core of humanitarian medical organizations: reducing harm and providing care. If applied more broadly or to a practice that is not so extreme, the principle of refusing aid to cultural practices that violate human rights could lead to other communities and cultures being excluded from humanitarian aid despite their need. For instance, communities that marry girls at a young age or that prioritize medical treatment 9 Beauchamp, Tom L. "The 'Four Principles' Approach to Health Care Ethics." Principles of Health Care Ethics. By Richard E. Ashcroft, Angus Dawson, Heather Draper, and John R. McMillan. 2nd ed. Chichester, West Sussex, England: John Wiley & Sons, Print. 10 Ladjali, Malika, Tracey W. Rattray, and Rupert J W Walder. "Female Genital Mutilation." British Medical Journal 307 (1993): 460. Web. 11 Tseng, Wen-Shing, and Jon Streltzer. Cultural Competence in Health Care. New York: Springer, Print.

7 to men. These practices violate equality for women, an internationally proclaimed human right. So, if this principle is established, those who need the most aid will suffer the most. Identifying Humanitarian Values Based on the goals of humanitarian medical organizations, the principles of bioethics, and the consideration of the danger refusal of care would create for similar situations; it is not an ethical violation for medical organizations to provide sterile instruments for FGM or to re-perform the surgery to women. Importantly, this does not endorse the practice of FGM nor does it argue against humanitarian efforts working towards eradicating such cultural practices. Ignoring the potential to reduce harm with medical aid, however, will not be effective in eradicating the practice. As Peters and Wolpers state, FGM is a part of a persistent global situation in which women remain powerless because they lack access to resources, jobs, and education in which women s bodies are controlled by a male-dominated social ideology. A global action against FGM cannot undertake to abolish this one violation of women s rights without placing it firmly within the context of efforts to address the social and economic injustice women face all over the world. 12 Providing care to those in who would benefit, even if the care conflicts with human rights, does not thus sacrifice obligations to fight for human rights. Rather, humanitarian organizations must be clear about their missions, whether it be to provide medical care or to fight for gender equality, and work simultaneously in defense of human rights and in alleviating suffering. It is through the efforts and success of each 12 Peters, Julie, and Andrea Wolper. "Female Genital Mutilation." Women's Rights, Human Rights: International Feminist Perspectives. New York: Routledge, Print.

8 approach, simultaneously, that both moral obligations presented with FGM can be fulfilled.