Informed consent and conscientious objection are easy to fulminate about, but tricky to discuss with consistency. Take, for instance, the delicate topic of requests for hymen restorations and virginity certificates. Worldwide, an estimated 5,000 women were victims of honour killings in 2000. If a young woman from a culture which sanctions honour killing approaches a doctor, what should he or she do?
Refusal is not a popular or even, in some jurisdictions, a legal option for doctors who are asked to refer for an abortion or to prescribe contraception. But a request which reinforces “patriarchal norms” is different.
Swedish ethicists surveyed about 1000 general practitioners and 1000 gynaecologists. They report in the Journal of Medical Ethics that a small majority would agree to the woman’s request. However, a large minority, supported by the Swedish community, insist that they would never do so. In other words, conscientious objection to patriarchal norms is socially acceptable, even if it involves refusing a woman’s fully informed request for a medical procedure:
“the political message in Sweden is that hymen operations should be considered a non-option and that the appropriate response to such requests should be information about the medical aspects of sexuality and human rights and, if necessary, referral to police or social authorities for protection. The main argument for this practice is that Swedish society should take a stand against practices expressing control of female sexuality. The official Swedish viewpoint hence expresses a zero tolerance policy against patriarchal norms and values.”
Opposition to these practices in Sweden is so vehement that doctors try to dissuade women. If this fails, it is not illegal to perform them, but they do so reluctantly and secretly.
The authors favour the pragmatic policy followed by doctors in the Netherlands. There doctors inform women of the issues involved, but do the procedure if they insist. This allows them to give women better health care.
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