Concern mounts over female genital mutilationBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7256.262 (Published 29 July 2000) Cite this as: BMJ 2000;321:262
All rapid responses
I support Baroness Rendell's and Harry Gordan's campaign against
female genital mutilation (FGM). However, this is a complex issue, raising
important ethical concerns, particularly where FGM occurs in the context
of ethnic minories within the larger UK culture. In response, Brad
McCormick asserts that Western cultures should eliminate their own
cultural idiosyncracies before presuming to intervene in the practices of
other cultures. This positiion is unrealistic and effectively denies a
need to intervene in FGM. The risk for harm which FGM represents makes
fatalism unethical. Besides, any distinct ethnic group living in the UK
must to some extent be viewed as a subculture of that larger culture,
rendering a wholly non-interventionist position invalid.
To address this issue in an informed way, we need to know more
clearly what FGM represents to the girls and women to whom it is done. We
need to discover the extent to which they see themselves as the victims of
a barbaric assault, or as active and willing participants in a necessary
social act. We also need to understand the range and types of practices
collectively termed "FGM", in order to make distinctions to inform clear
thinking and constructive action to minimise harm, at the very least.
Some women who undergo FGM may not view themselves as victims and may
actively wish to undergo the rite. Their alternative could be to risk
cultural alienation and social exclusion. Should we attempt to gainsay
their views and deny their expressed wishes? Do we risk causing them
greater harm in so doing? McCormick couches the issue in terms of
semiotics. He is perhaps thinking in terms of FGM as a mode of cultural
inscription upon peoples' bodies and souls, essential elements of their
cultural identity and belonging. But I think we need to distinguish
between semiotic practices which are and are not acceptable to UK law,
morality, medical ethics and, increasingly, international standards of
bioethics1 and human rights. We could, for instance, distinguish between
different modes of cultural inscription: perhaps to construct a scale of
cosmetic decoration, piecing, tattooing and mutilation. Of course, we need
to make allowances for cultural specificity, but within clear parameters.
Some licensed UK medical practitioners may already be applying these
sorts of practical distinctions by providing minimal forms of female
circumcision: token nicks to satisfy honour and prevent much greater harm.
But should licensed medical practitioners be allowed to conduct even these
token operations, still less the radical excisions that other, unlicensed
operators provide? Currently, licensed medical practitioners exercise
quite a lot of individual autonomy, perhaps especially where private
patients are concerned. Perhaps their practice parameters should be more
clearly defined to exclude classes of operations deemed unnecessary or
harmful, or to specify acceptable versions. As with abortion, if licensed
practitioners are barred from FGM, would unlicensed FGM increase, with
severe consequences for these womens' health and wellbeing? As so often
with ethical questions we may find ourselves on the horns of a dilemma:
seeing a moral imperative to intervene, the consequences of which may be
Even so, we cannot avoid the responsibility for the health and human
rights of everyone living in the UK, including those who belong to ethnic
minority groups. They fall within UK law and we cannot allow a bland
cultural relativism to obscure the need to make decisions and take action
affecting their members. All females should have the right to be protected
against extreme forms of FGM, perhaps, even when they actively wish to
receive it. In view of its potentially harmful consequences, medical
practitioners and their representative organisations in the UK should be
actively investigating the ethical status of FGM along with practical ways
to support the health and safety of the women involved. A compromise may
be possible in the form of clearly defined minimal interventions (token
nicks) that would satisfy both medical ethics and the demands of groups
practising FGM. Not the ideal solution, perhaps, but it might be more
achievable than a total ban.
1 Singer PA. Medical ethics. BMJ 2000;321:282-5.
No competing interests declared.
Competing interests: No competing interests
One very sad and difficult aspect of FGM is, as
the article says: "Female genital mutilation is not
conventional child abuse. The parents who
put their children through this
procedure honestly believe that they are doing
the right thing".
The whole history of childrearing, as
such authors as Alice Miller (_For Your Own Good_,
_Thou Shalt Not Be Aware_, _The Drama of the
Gifted Child_) show us, is the physical
(don't forget about male circumcision!) and
psychological mutilation of the child as traditional
culture's way of perpetuating itself
into new generations. A key element of
this process is the inculcation into each
generation that what has been done to its members
is good (even: "makes one more fully human"!) and
therefore should be done to the next generation.
The cure for these semiotic viruses surely lies
in education, but this is made difficult by
even most of the most educated members of the
most advanced societies being unwittingly
infected with such beliefs as that *male*
circumcision is good, and even most of the
unreligious believe that *competition* is good
(e.g., capitalist economics, all the "tests"
to which students ars subjected...).etc.
Wherever there is any "rites of passage", there
is the same kind of unconscious traditional
culture as supports FGM.
Of course it is easy for Europeans (Americans,
et al.) to say FGM should be stopped, because it
is not a custom into the belief of the goodness
of which *we* have been childreared. And, yes,
surely FGM is objectively worse than (e.g.)
male circumcision, or SAT examinstions.
But, until we cure ourselves of our own
ethnic beliefs which we implicitly accept to be "the
*obviously* right and true", we may function as
"missionaries" to others, rather than as
enlighteners of all. If what distinguishes
European culture from all other ethnic
formations is (to use a phrase from
Sigmund Freud:) the project of making the
unconscious conscious, so that we can become
accountable for our form of life in all
its aspects, we need to start
with a thorough and ever again renewed
*self-analysis*, lest the old criticism of
us as "imperialists" continue to describe us.
Competing interests: No competing interests