Working in the medical field, it is a given that the patients seen will come from a variety of cultural backgrounds, each with a set of norms or accepted standards, religious beliefs, and traditions which they base their lives around. Some of culture-specific challenges that physicians-in-training may encounter can be easy to work with, while the traditions and beliefs held by patients may pose an ethical concern due to the extreme nature some cultures may appear to a physician and other medical personnel who are not familiar with specific cultural aspects. Although course work and exposure to a variety of cultures may help to familiarize medical staff with non-Western cultures, it may not be possible to be fully prepared for certain cases. No matter how culturally competent the health professional may be, there may still be cases that catch him or her off guard, causing the need for a self assessment to identify possible prejudices or biases, and the need to separate personal beliefs from professional practice in regards to culturally sensitive practices.
Several cultures view the act of premarital sex or the behavior of their daughters serves as a representation of the family, and as such, any behavior that is deemed to be disgraceful will reflect poorly upon the family, possibly affecting their social standing within the community, the acceptance by others, and may lead to being shunned. Medical professionals need to be aware of such cultural standards in order to address and assist clients in the best way possible that is beneficial to both the individual and the family. When working in foreign countries, especially those which do not share the same cultural values that are traditional among Western society, it is imperative to keep abreast on the cultural norms and beliefs. Such an example can be seen in the case scenario involving an adolescent, unmarried girl coming in for treatment in Saudi Arabia who was discovered to be pregnant.
Being an American doctor practicing in Saudi Arabia can be a cultural awakening, as there are several traditions that differ between the two societies. In the scenario involving a pregnant adolescent girl, two of the doctors appeared to be familiar with the cultural norms of Saudi Arabia and acted in an appropriate manner for the situation in that specific location, the third doctor was not aware of the possible ramifications that could occur if the family found out about the pregnancy. While it is not clear from the scenario if the third doctor disagreed with the plans to help the adolescent to obtain an abortion based on personal or religious beliefs, the actions of the third doctor do show evidence of a lack of cultural competency. While abortion is prohibited in the Muslim faith under most circumstances, abortions that are carried out before the fetus is viable or “infused with life,” are not viewed as killing, and therefore are allowed (Dunn, 2011, p. 53). It is not clear if the third doctor was aware of the implications that could occur as a result of the family finding out that their daughter was pregnant, nor if the third doctor was educated on the policies surrounding abortion in Saudi Arabia.
The actions by the third doctor, of telling the family about the pregnancy could be viewed as a mistake, as although it may not have been foreseeable, brought about the death of the daughter due to her actions leading to the tarnishing of the family’s honor. Although the doctor may have felt that he was doing the right thing, it may have been an instance of one’s personal values interfering with the practice of medicine. The gender expectations of young women in Saudi Arabia should have been taken into account rather than the third doctor’s personal ethical beliefs. Going forward, if the third doctor were to continue practicing in Saudi Arabia, it would be of great benefit if he were to re-examine his cultural competency, working to separate his personal ethics from professional standards of care. Acknowledging that Western beliefs may often clash with those held by individuals of a non-Western society would be a good starting place for the third doctor and other medical professionals practicing in such an environment.
If I were the physician in the scenario, I would have assisted the two other physicians in assisting the adolescent in obtaining an abortion without discussing the issue with her parents. However, I would discuss it with the adolescent, to ensure that she was aware of what the options were, along with the possible outcomes based on her decision. My actions would be justifiable based on the legal regulations and the social guidelines that govern the life of women and families in Saudi Arabia. Cultural competency would be the foundation upon which my decision would be made, followed by the local and hospital regulations, trying to keep my personal beliefs out of the decision making process.
Dunn, N. (2011). Abortion, Ijtihad, and the rise of progressive Islam. Human Life Review,37(1/2), 53-62.