Option 1
A mother of African origin takes her underage daughter to visit their doctor in Canada. She requests that the doctor perform a female circumcision, also known as, female genital mutilation (FGM), on her daughter. Thus, what is the doctor to do? I argue that the doctor is to refuse this request as his or her duty is to the law that criminalizes it and the medical ethics that denies it. As Martha Nussbaum states, FGM is an act of not merely surgery or tradition, but the “deprivation of normative human functioning in its risks to health, impact on sexual functioning, violations of dignity, and conditions of non-autonomy” (Nussbaum, 1999). In understanding the dilemma, we must not base our ethical inquiry solely on the relationship between doctor and parent, but equally with that of the underage patient who may have no choice over the matter but is an influential determinant in this succession of ethical proceedings. What is created is a triangular relationship wherein each shareholder is potentially affected by another and in turn influences each shareholder’s final decision. Firstly, the decision inherently lies with the doctor. The doctor has every right to reject the procedure as it would jeopardize his or her medical profession due to the illegality of FGM and the respect he or she owes to the integrity of bioethical standards. Secondly, it is with the mother of the child and her views on this procedure, or in her case, cultural practice, which dictates how the doctor must propose and carry out his or her acceptance or rejection. The mother, as a shareholder who has something to lose or gain in this triangulated ethical quandary has full parental autonomy over her child; and as a mother, she has the right to impose on her child, through this parental autonomy, the cultural institutions of her ethnic group that are deemed necessary. Yet, to even begin to evaluate this antagonistic relationship, we must understand the daughter’s position. The daughter has no say in regards to the position she holds as she is a minor. Even if she is to voice her opinion, she can only act as a vehicle of influence rather than one of autonomous self-determination. Thus, in what context does she predicate her stance on the decision at hand? I suggest her stance is assumed on three levels of conjecture. Firstly, the ethical level holds within it the moral value of beneficence and non-maleficence which entails the patient’s interests and well-being are met, while at the same time, making it the doctor’s fiduciary duty to uphold this; even more so with a minor. On another front, the juridical level holds that under the decree of law, the underage patient is incapable of consenting, thus, the responsibility falls on the parent, in this case the mother, and that responsibility should be kept in-check so as not to cause any unnecessary harm or ‘abuse.’ And finally, the maternal level which consists of the social, familial and maternal dynamics of the mother-daughter relationship. Albeit, unlike the ethical and juridical levels which imply a finite decision of “no”, that if compromised, ultimately will not benefit any of the tripartite’s shareholders, the maternal level is open to interpretation as no set criterion is ensconced within this stance on what is right and wrong. As a result, the maternal level poses a problem as it is unable to take an objective stand for the minor who is powerless to take one for herself.
In light of this triangulated relationship, what we see is that crisis arises through the mother’s relationship to both the doctor and her daughter. In the doctor’s case it becomes a question of cultural and ethical relativity and in the case of the daughter, it is a matter of the ambiguity bestowed upon the mother-daughter relationship, and the means by which an agreement or maternal union to do the ‘right’ thing can come about. Again, I propose that the doctor must refuse to perform this operation and refusal should always be based on grounds similar to that of Nussbaum’s assertion on FGM; however, only under the assumption that the doctor refuses to perform this operation does the dilemma truly manifest due to conflicting doctor-parent-patient interests. As FGM is a cultural practice of certain ethnic and social groups, regardless of whether it is deemed institutional or ‘cultish,’ one may argue that to deny this family of such an operation would be culturally insensitive. Yet, in analogising this medical situation we see that insensitivity may not be an issue. A Californian mother takes her underage daughter to visit a cosmetic surgeon in Canada. She requests that the surgeon performs an otoplasty (ear reshaping) on her daughter who intends on entering a children’s beauty pageant. Now, what is the doctor to do? Shouldn’t he decline this pointless procedure? Could it not be argued that in North America a construct in the idea of beauty has a cultural ideal attached to it, from media and television, to magazines and newspapers, from the embodiment of autonomy and democracy, to the utter fascination of stardom and celebrityhood? In such an instance, the surgeon would not treat the Californian mother’s request as one that is based on culture, but simply, poor parenting. In addition, what this analogy illustrates is a solution; a solution whereby the doctor of a dissimilar cultural origin could redirect the family to one who may be from or representative of their culture so as to eliminate the need for relativism. In addition to this argument, it could also be suggested that the mother is acting as a governing body over her daughter due to her right of parental autonomy and as such, she is subject to govern as she will; yet, it is within this notion that an inconsistency appears as the daughter herself has a right to autonomy as both an individual and a child, even though she is incapable of consent. As a result, the maternal level for understanding the decision by mother and daughter is purely subject to the cultural and maternal domination on the mother’s part over her daughter, which refuses the child not so much a consensual but meaningful say in the matter. Thus, in this situation the doctor should employ a dialogical approach when dealing with the mother and the daughter – not to mention himself – in an attempt to solidify their union, and moreover, their understanding of the procedure not only in regards to what it means for each shareholder but the context in which it is presented for decision-making, that is, in Canadian society.

References
Nussbaum, M.C. (1999) Sex & Social Justice. New York: Oxford University Press. 118-130