Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7129 Volume 316 Education and debate Saturday 7 February 1998 Ethical dilemma Should doctors reconstruct the vaginal introitus of adolescent girls to mimic the virginal state? Commentary: The ethical issue is deceit D D Raphael The article of Logmans et al is presented as "an ethical dilemma." The chief point that strikes me is its apparent blindness to the real ethical issue involved. It considers and rightly rejects two objections to reconstructing the hymen - firstly, that it is analogous to clitoridectomy, which is agreed to be reprehensible, and, secondly, that it does not benefit the physical wellbeing of the patient. But these objections are trivial. The real ethical difficulty is that the operation involves collusion with deceit. Should a doctor participate in this? Deceit needs justification Who is being deceived? Is it just the families or the bridegroom too? It would not be proper for the doctor to say that he or she has a duty to the patient alone and has no responsibility for the morality of the patient's relationship with her husband. The proposed operation is intimately concerned with that relationship, and the doctor should not readily assist in deceit between spouses. Even if it is considered purely in terms of the patient's interest, the deceit can be harmful - it could be discovered one day and the fear of this might cause anxiety from the start. Should the doctor advise the patient to be quite open with the bridegroom, and perhaps offer to join her in persuading him to accept the situation? If that seems feasible, well and good; but the patient may say that the bridegroom shares the traditional attitude of his family and cannot be persuaded. If the doctor still refuses to be involved in deceit, the consequence may be a breaking off of the marriage, or shame and rejection. Should the doctor be prepared to see that happen and to be partly responsible for it? I think not. Or suppose the patient says that the bridegroom can perhaps be persuaded to accept the situation but his (and her) family cannot. Then the bridegroom will have to join in the collusion. The bride can ask the bridegroom to accept her past, but is it right for her to require him to join her in deceit? Can she predict whether he will be willing? The difficulties are fewer if the bridegroom is involved anyway. Then deceit affects only the families of the couple. It is not obvious that a doctor should refuse to collude with deceit of that character. One can hardly say that the doctor's duty extends beyond the patient and her intended husband to the wishes of their families. These are the questions that give rise to an ethical dilemma, not those discussed in the article. Imperial College of Science, Technology, and Medicine, London SW7 2BX D D Raphael, emeritus professor of philosophy Correspondence to: Professor D D Raphael, 54 Sandy Lane, Richmond, Surrey TW10 7EL Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline