Paradoxical Pillars: Cultural Dilemmas in Medical Ethics
This excerpt is from Chapter 5 of my upcoming book, A Case of Culture, available for purchase starting January 23, 2022. Learn more about the book here.
Do no harm. These are the immortal words of the Hippocratic Oath. Kept alive from the White Coat Ceremony at the beginning of a medical student’s foray into medicine all the way until the end of the physician’s career, this concept of non-maleficence is a defining pillar of medical ethics in Western medicine. In fact, medical ethics in the West is upheld by four such pillars:
- Autonomy: the individual’s right to make decisions for themselves
- Justice: equal treatment of every individual
- Beneficence: aiming to always work in the best interest of the patient
- Non-maleficence: do no harm
Guided by these pillars of medical ethics, the physician must counsel the patient to make an appropriate decision about their health such that it puts them at the least amount of risk and greatest amount of benefit. However, an important yet oft-forgotten part of “do no harm” is recognizing and understanding that different patients might hold different beliefs from providers about what harm means to them. In other words, what a patient sees as beneficial and healthy might actually be seen as harmful by the physician, and vice versa. As Prerna Balasundaram, a graduate of International Affairs at the George Washington Elliott School, explains on the Matters of State podcast, “Cultural competency is an essential component of a doctor being able to do no harm. If a doctor wants to adhere to their code of medical ethics, they must be well versed in cultural competency.”
Prerna shares the story of a Western OB-GYN doctor she interviewed who practiced for some months in Haiti where birthing practices are incredibly different from the US. After giving birth, Haitian women sit on steaming pots filled with local herbs as per custom. This doctor was horrified to find that so many women who sat on these pots were getting second-degree burns on their pelvic area from the steam and required immediate medical attention as a result. This birthing practice violates the fourth pillar of non-maleficence in Western medical ethics, and therefore could reasonably be rejected by Western doctors. But in a community that has a different ethical system altogether, would it be right for the doctor to deny women the right to practice this ritual which they believe plays a beneficial role in the mother’s and baby’s health? Would it be right for the doctor to remove this patient’s autonomy for the sake of upholding non-maleficence…in other words, tearing one pillar down for the sake of another?
In this article series, I share excerpts and stories from my book, A Case of Culture. If you would like to learn more about what happens next, you can find the rest of the story in Chapter 5 of my book, releasing this January 23 on Amazon, Barnes and Noble, and other retailers. If you enjoyed this book excerpt, please consider subscribing to this weekly excerpt series and sharing it with your network. To learn more about the book, visit my website. If you would like to connect with me, you can reach me here via email at firstname.lastname@example.org or @snigdhanandiauthor on Instagram and Facebook.