‘Harmful’ Cultural Practices in the Consultation Room: General Practitioners’ Moral Views and Dealing with Issues of Gender and Culture.

General practitioners (GPs) are most likely the first health professionals migrant women turn to when seeking help with questions related to gender and culture. For instance, Dutch GPs receive requests to issue a virginity certificate. They may have female patients in their practice who are genitally cut and may wonder whether these women intend to have their daughters cut also, or suspect forced (child)marriage or honor related violence. In all these cases GPs have to decide on prevention and intervention.

We wanted to know what kind of so-called harmful cultural practices (‘HCP’s) GPs encounter in their consultation room, whether they experience moral conflicts (personal and professional) and how they balance personal and bioethical principles to make a decision.

In dealing with ‘HCP’-related interventions medical ethical principles (autonomy, beneficence, non-maleficence, and justice), that should offer GPs moral guidance, are insufficient. For instance, an individualistic notion of the person that is presumed by the classical notion of autonomy does not match the women’s socially embedded lives. In communities that practice female genital cutting the practice is not experienced as harming the body, but as perfecting it. Yet, how does this differ from European women’s desire for a perfect vagina that makes them turn to cosmetic surgery? It is not clear how health workers should take into account the way migrant women themselves, based on their cultural backgrounds, give meaning to concepts like autonomy, harm, well-being or bodily integrity, especially when these run counter to Western medical beliefs.

Based on in-depth interviews with fourteen GPs in the Netherlands, we discuss how they dealt in their practice with the above-mentioned questions. In our discussion, we will also compare between ‘HCP’s that take migrant women as their object with Western ‘HCP’’s, like anorexia and ‘HCP’s that take men as their object, like male circumcision.