Macklin's Ethical Relativism In A Multicultural Society

In Macklin’s “Ethical Relativism in a Multicultural Society,” she discusses the difference between cultural tolerance and intolerance in the medical field. The main argument that follows is if physicians are obligated to follow contemporary ethics or in the case United States medical ethics or respect cultural difference of their patients and give treatment accordingly, especially when dealing with children. Macklin argues that while cultural tolerance should be practiced it is the “obligation of the pediatricians to educate and to even urge parents to adopt practices likely to contribute to the good health…of their children, and to avoid practices that will definitely or probably cause harm and suffering (Macklin, pp. 125). To state simply, Macklin is trying to discern when culturally diverse treatment can be practiced under the universal code of ethics and which are culturally relative. Based on this case:

“Mr.

G brings his 12-year-old daughter, Aliya, to Dr. Jordan’s office with the request that he perform the procedure on her. Although traditionally the procedure is performed without anesthesia or antiseptics, Mr. G says that he wants his daughter to have access to these, because he does not want her to suffer and wants her to be safe. Dr. Jordan does not find these concessions satisfactory, however. He believes that the practice, even with anesthesia, reflects an unacceptable disfigurement, repression, and control of women. Mr. G and his daughter insist that they want the procedure carried out; if not, they will seek the traditional method when they return to their home country for a planned visit.”
I argue that female genital mutilation (FGM) should not be covered under the universal code of ethics when dealing with cultural tolerance, parents should not be able to make harmful decisions for their children, and doctors are under no obligation to perform such rituals to conform to the beliefs and traditions of their patients such as in cases of

FGM.

I. Cultural Tolerance
Female genital mutilation is a coming of age ritual performed mostly in African and Middle Eastern countries. There are three types of FGM: (1) Clitoridectomy: partial or total removal of the clitoris (2) Excision: partial or total removal of the clitoris and the labia minora (3) Infibulation: cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris, and none of the procedures are performed for medical reasons. I argue that according the principle of non-maleficence, doctors are required to do no harm to their patient; therefore, doctors should not perform FGM for any reason that is non-medical. In the case study presented above, Mr. G wants his 12 years old daughter to go have a FGM procedure done in United States because it would be safer for her. Regardless where the procedure takes place, many risks come along with FGM. Complications that could occur include but not limited to severe pain, shock, hemorrhaging, tetanus or sepsis urinary tract infections, and an increased risk at childbirth. As Macklin said “the reluctance to impose modern medicine on immigrants from a fear that constitutes yet another instance of ‘cultural imperialism’ is misplaced (Macklin, pp. 126). Western physicians may respect that FGM is a practice done in other cultures, according to Macklin’s definition of multiculturalism, doctors do not have to respect that believe equally to their own of the procedure harms and/or denies the patient their human rights.

II. Child’s rights
In the eyes of the law, children are not capable of giving informed consent. Parents are therefore required to make the best decision regarding the safety and health of their child. According to Engelhardt:
If being a person is to be a responsible agent, a bearer of rights and duties, children are not persons in a strict sense. They are, rather, persons in a social sense: others must act on their behalf and bear responsibility for them. They are, as it were, entities defined by their place in social roles (for example, mother-child, family-child) rather than beings that define themselves as persons, that is, in and through themselves. Young children live as persons in and through the care of those who are responsible for them, and those responsible for them exercise the children's rights on their behalf. In this sense children belong to families in ways that most adults do not. They exist in and through their family and society (Engelhardt, pp. 2).

However, because of cultural differences there is a divide between western and non-western cultures on what is exactly best for the child. In cases in which families request their daughters to undergo female circumcision or female genital mutilation, there is a cultural tolerance question of whether or not the doctor is required to go through the procedure based on the cultural demands of the family or deny the request based on the universal code of ethics.
Both Mr. G and Aliya insist they want a FGM procedure. However, Aliya’s words must be taken with a grain of salt because FGM means family acceptance, symbolizes entrance into womanhood, and is a requirement for marriage. The father wants the procedure done to protect his daughter’s virginity and uphold the family honor. I argue that the reasons stated above are not reason enough for Mr. G to make such a life alternating decision for his daughter especially on United States soil that does not respect the tradition of FGM. The father has a responsibility to his daughter to make the best decision for her health and safety until she is of age in which she can make sound choices of her own. In regards to children, “the child has individual interests and needs that must be given consideration apart from those of the parents and others who purport to define children's interests,” (Catlin, pp. 197). Even though the father believes he is in the thinking he is doing the best for his child, as Macklin said, it is the doctors duty to educated the parent on what are and are not respectable treatment and procedure that can be performed on a child.

III. Doctor’s Obligation
In her paper, Macklin offers two examples of what doctors are obligated in cases of cultural difference: either follow the ethical and cultural practices of your own country or follow the ethical and cultural practices of the patient (Macklin, pp. 124). I argue that in extreme cases of cultural difference such FGM than the physician is obligated to reject the wishes of the patient and follow the ethical and medical procedures of in this case the United States. Although doctors try to practice cultural sensitivity in regards to patients of cultural, it is impossible to always act accordingly when their practices conflicts with the doctors code to protect. I argue that other cultures need to accept that by entering a new country with a different definition of acceptable treatments certain procedures cannot take place just like certain American could not take place in other countries. In addition, because FGM is not a medical procedure, a doctor is not obligated to perform the procedure. Now in Alyia’s case, Mr. G has given the doctor an ultimatum of either doing the procedure or accepting that the father would take the daughter back to their homeland and have the procedure done there. While the doctor still has the right to say no, he now has the weight on his shoulders knowing that whatever decision he makes, he cannot protect his patient. However, according to Macklin “if it is simply ‘the white man’s burden, medicalized’ to urge African families living in the United States not to genitally mutilate their daughters…then we are doomed to permit ethic relativism to overwhelm common sense” (Macklin, pp. 126). Meaning even though the G family wants the FGM, Dr. Jordan while he can respect respect their wishes he does not have to follow them.
We do not and should not harm children in the United States; regardless of the situation, it is the doctor’s duty to protect their patient. If that means cultural insensitivity when it come to harming children because extreme cultural tradition and rituals, than so be it.