TABLE 1.

Case 1. Female Genital Mutilation

Step 1. Case Description You are a medical doctor working for 4 weeks in north-east Africa, at a small countryside clinic where you are in charge. You are aware that female genital mutilation (FGM) is a widespread practice in those areas. One evening a local midwife, who works with you at the clinic, asks whether it would be possible to use the clinic to perform FGM in the evenings. You are aware that the midwife practices FGM herself. She says that performing the operation in the clinic would be beneficial because of hygienic reasons.

Step 2. Options What would you do and how would you justify it? FGM is a well-established cultural practice, and I have no right to be judgmental about it. Although I don’t support the FGM and make my position clear to the midwife, I am only a short-time visitor, and it is not realistic to change these practices so quickly. I allow for the use of facilities. FGM is a human rights violation, and allowing midwives to operate at my clinic would implicate me (and the international organization running the clinic) in those cruel practices. FGM will not be performed in my facilities. I organize a meeting among the local community leaders to discuss FGM. There I will be able to voice my opposition to it, but nevertheless I will declare from the onset that the participants of the meeting will have the final word. I don’t support FGM, but I take the perspective of the potential patient as the most important one. The girl will be mutilated no matter what I say or do, the only thing I can influence is whether the operation will take place in clean facilities or not. I agree to the use of facilities. I ask local medical staff about how and if such queries have been dealt with before and act according to their suggestions.

Step 3. Discussion

Step 4. Value Reflection (Examples) Option 3: You stand up for your principles and believe that human rights ought to be respected universally. You are also loyal to your organization. At the same time, you might be seen as abandoning the potential patient and violating the non-maleficence principle. Option 5: You take the principles of beneficence, non-maleficence as the most important ones. As a doctor you have a duty to particular persons. At the same time you give up your right (and perhaps a duty) to stand up for public health issues and human rights violations.