Da ethicks :P

tallaght01

An ethical dilemma we discussed the other day in an international health tutorial:

You're working in a developing country, with an aid agency that has a policy of not assisting in any way with female genital mutilation. This is a common policy for NGOs.

You're working late in the clinic on your own, when the local "female circumcisor" turns up. He asks you for clean blades to use for his procedures. He says that if you don't supply them, he will continue to perform these "circumcisions" with dirty, used blades.

So, what do you do?

All opinions, medically qualified or not, welcome. I'd especially be interested to hear what the students think For once, there's no wrong answer :P

RedXIV

I assume we're looking for answers a bit more relevant than "Take the rusty blades to his throat! YARRR!!"?

(although a tempting choice :cool:)

If i were put in that situation, I'd probably give clean blades. The best i could probably do without starting a crusade against this sort of thing is provide materials which would lower chances of infection.

Papa_Lazarou

I suppose if you put it this way. She is going to do it whether u give her the clean blades or not. If it was me in that position id probably give her the blades as hell u might aswell make that bit safer for those who have to go through it even if NGO's have the stance of not associating themselves with this act.

Well thats just my view anyway.

Fionnanc

I wouldn't give her the free blades. I don't approve of the practice and will not support it in any way. If given the blades she will probably advertise her business as sanctioned by you.
In summary, no.

tallaght01

I was put on the spot about this one in class. I answered that I'd give him a small few blades, so he'd keep coming back for new ones. I'd try and use the return visits as an opportunity to form a relationship with him (not in that way! :P ) and I'd try and exert some influence in the long term. Encourage use of proper pain relief, more conservative FGM that don't obstruct the birth canal and are less painful etc.

The procedure makes me sick. But it's all I could come up with in that situation. But I'm interested in what others think.

Carsinian Thau

Give the clean blades. It's going to happen anyway, it'd be better to at least lessen the risk.

tallaght01

Carsinian Thau wrote: »

Give the clean blades. It's going to happen anyway, it'd be better to at least lessen the risk.

But bear in mind that this procedure is usually not optional, and it happens to underage girls.

If the local rebel leader came to you and asked for condoms for his men to use on their captured kids, would you give them to him?

I really struggle with these issues.

Carsinian Thau

tallaght01 wrote: »

But bear in mind that this procedure is usually not optional, and it happens to underage girls.

If the local rebel leader came to you and asked for condoms for his men to use on their captured kids, would you give them to him?

I really struggle with these issues.

I know that the procedure is not optional and that it happens to underage girls (I actually think it's barbaric and unbelievably terrible) but I also know that I can't stop it.

Honestly, I think that I would give the condoms. I can't save these children so the best I can do is to try and make sure that the abuse they go through may not cause them to contract something.

If you can't do anything to prevent something terrible, would it not be best to at least try to help even if all you can do is get rid of dangerous blades or the possibility of VD?

Vorsprung

I'd see a parallel here between needle exchange programmes common in the West and the above secnario. It's gonna happen anyway, whether sterile techniques are used or not. So, if efforts can be made to strive towards a sterile procedure, as well as other efforts to directly reduce its prevelance, I'd actually agree with it.

nesf

Surely clean blades is the obvious answer? You're not assisting him doing it, since he already has blades, but you're improving the chances of not having complications for his "patients".

tallaght01

I think, nesf, if the answer was that simple, the opposite conclusion wouldn't have been reached by most NGOs, and it wouldn't have stimulated so much debate in my class, which has a high proportion of development workers.

I would agree with you, insofar as I'd give the blades. But I'd have serious misgivings about it.

I also don't think that it's directly comparable to the needle exchange programme. As the injectors aren't injecting anyone else.

nesf

tallaght01 wrote: »

I think, nesf, if the answer was that simple, the opposite conclusion wouldn't have been reached by most NGOs, and it wouldn't have stimulated so much debate in my class, which has a high proportion of development workers.

I would agree with you, insofar as I'd give the blades. But I'd have serious misgivings about it.

I also don't think that it's directly comparable to the needle exchange programme. As the injectors aren't injecting anyone else.

I think from a philosophical perspective, giving them fresh blades isn't causing the FGM to occur. The crucial point is that with or without your action the FGM is going to continue anyway. The problem comes from people being utterly disgusted and against FGM (I'd be one of these) not wanting to have anything to do with it despite the set up which provides that their intervention doesn't actually affect whether FGM occurs or not.

tallaght01

The argument that it's going to happen anyway, so it's ok to help them is on shaky ethical grounding.

But, let's say this particular practitioner does more "severe" FGM than his other local conterparts, and we're giving him fresh blades. Will more people send their kids to him to have FGM, than his local rival, who only does minimal "surgery"?

DrIndy

For everyone who has seen the new Star Trek Movie:

sounds like a Kobayashi Maru. Its lose/lose either way - so how can you lose least here or cheat to succeed?

I would advocate kidnap when he turns up at the clinic!

On a more serious note - this is very very tricky to answer - for instance, is he getting blades to give to more people to do more FGMs rather than simply being more hygenic?

Its a damned good ethical question though!

tallaght01

DrIndy wrote: »

is he getting blades to give to more people to do more FGMs rather than simply being more hygenic?

I had hoped to thwart his attemps at setting up a polyclinic by only giving him a small few at a time. But it's yet another issue to consider. And it's a real issue faced by someone in a developing country. He refused to give the blades.

nesf

tallaght01 wrote: »

The argument that it's going to happen anyway, so it's ok to help them is on shaky ethical grounding.

Ish. I think it falls on whether you can do anything to prevent it happening.

tallaght01 wrote: »

But, let's say this particular practitioner does more "severe" FGM than his other local conterparts, and we're giving him fresh blades. Will more people send their kids to him to have FGM, than his local rival, who only does minimal "surgery"?

That changes the set up substantially. If you can influence people to use a less severe form of FGM, it's pretty clear which is the preferable alternative assuming you're going to hand out clean blades anyway.

tallaght01

So, less severe, but with dirty blades is what you'd go for?

nesf

tallaght01 wrote: »

So, less severe, but with dirty blades is what you'd go for?

Less severe and clean blades, leaving the other guy with dirty ones. Though, honestly it's not much of a choice.

Svalbard

Give him the blades....if he agrees to watch a 'client' of his in labour with an obstructed birth canal.
Perhaps if he witnessed the consequences first hand he would change his ways?

Piste

I suppose we have some parallels to that in the west with needle exchance programs and the issue of do we sell condoms to young kids who ask for them.

All things being equal (i.e. so "safer" rival FGM practitioner with rusty blades) I'd give him the blades, I'd be thinking along the lines of "if we can't stop it we can at least improve it".

Basically you have to think of your role if you ask yourself "would the situation (in this case FGM) exist with or without me" and the answer is "yes" then all you can do is make it better, if the answer is "no", and you're a vital part of the situation then it's morally right (imo of course) to refuse to help.

tallaght01

nesf wrote: »

Less severe and clean blades, leaving the other guy with dirty ones. Though, honestly it's not much of a choice.

That option wasn't given to you :P

The guy who does more severe FGMs wants the clean blades. His more conservative mate down the road hasn't approached you.