MEDICAL CASE You are a general practitioner and a mother comes into your office with a child who is complaining of flu-like symptoms. Upon entering the room you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy’s torso. You ask the mother where the bruises came from and she tells you that they are from a procedure she performed on him known as “cao gio” which is also known as “coining”. The procedure involves rubbing warm oils or gels on a person’s skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing.When you touch the boy’s back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother.
Questions Should we completely discount this treatment as useless, or could there be something gained from it? When should a physician step in to stop a cultural practice? Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine? Do you think that the physician should report the mother? RESPONSE Points to consider: Mother’s belief in the cultural practiceBoy suffering from bruises but enduring until doctor’s touch Positive use of warm oil (aromatic oils) Role of the doctor Ethical issues Answer to questions: Should we completely discount this treatment as useless, or could there be something gained from it? There is a positive use of massaging with aromatic oils. In this particular case it could be truly for the purpose of improving circulation. (Define massaging). The concern however is the mode of application. Yes, warm oil but to what temperature? Why rub with a metal or coin? The hot oil and the metal could have caused the bruises.
When should a physician step in to stop a cultural practice? The public interest of the doctor should get him interested in preserving future generations from this practice. He would have to take an empathic leap across time and across conditions. The doctor is on oath that “ He remembers that he remains a member of society with special obligations to all his fellow human being, those of sound mind and body as well as the infirm” Therefore we suggest that the physician should step in to stop a cultural practice, A) When the adverse effects of the practice gets to the knowledge of the physician.This could be a permanent or irreversible disability or life threatening situation. b) When the outcome of the practice gets into the public domain and therefore the physician’s jurisdiction.
For instance following an act of genital mutilation when the child is sent to the physician for examination and recommendation. This might be the best time for the physician to make his case because the evidence would be clear to see and appreciated by all concerned.However it is important to note that breaking traditional medicine or cultural practices is not easy since they have been in use for centuries and are still in use because of their therapeutic properties.
Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine? Yes, in order not to get them prejudiced against the use of modern medicine. Cultural practices are really valued by the communities. They have stood the length of time and any attempt to wash them away will be met with some resistance.
The physicians would have to exercise a lot of caution. Introduction of modern medicine to them would have to be done with a lot of education. Do you think that the physician should report the mother? Ethical considerations: Prima Facie duties: On the face of it one may be quick to condemn the mother of causing injury to the son. However the explanations given by the mother portrays that her action was out of love for her son. Her intentions were good.
This would get her a nod from Fletcher’s thoughts on Agape love. Enshrined in this is the goodwill.The mother did not intend to harm her child. She was only applying her cultural beliefs and practices. She went through the procedure with the intention of improving the health of her son. The golden rule suggests that we do unto others what we would have them do unto us.
The boy certainly must have suffered pains during the rubbing of the coin on the skin. Could the mother have overlooked this? Would she allow herself to be subjected to such an ordeal? Her strong belief in the practice would make go through this and therefore give her nod to the golden rule.Moreover, if the physician had found himself in place of the woman under the circumstance in which she applied the treatment, would he have approved of himself being reported? There again, we say the woman will pass the golden rule test.
Universalism: Would other people in the community act the same way given the situation above? The ecology features implicit norms, predominant values, established routines, underlying decision premises and pressures for obedience and loyalty. This woman identifies strongly with the community and has absorbed its standards as her own.She merely did what any other mother in her community would have done. TV test: Would the woman feel comfortable explaining to a national TV audience why she took this action? We believe she would because of her strong believe in the practice. She was neither afraid nor shy in explaining to the doctor what Ciao gio was. From the above considerations we would recommend that the physician does not report the mother. He could rather document the incidence and use it to advocate for a change in the practice.
Some research could be done into the medicinal properties of the oil and the appropriate mode of application.If research found that the product is good, then it would be fair to let the community know to give them some pleasure. At this point, the best mode of application can then be introduced to them. This way we can get them to accept modern methods of applying medications. Thus we meet the “win-win” relationship defined by Pareto.
He defines efficiency as the transactional state where at least one party is better off, most are well off, and none are worse off. The use of coercive power will work here. We cannot change the practices of this community by force or in any manner that will seem repulsive to them.We would not want them to feel ignorant and “dumb” in their practices We conclude by saying that the doctor, like all other leaders (by virtue of the position he holds in the consulting room) is a trustee for the vulnerable.
References: 1. The Hippocratic Oath of medicine practice 2. Lewis, CarolW. (1991),The Ethics Challenge in Public Service,San Francisco: 3. Fisher, C. & A Lovell, (2006) business Ethics and Values: Individual, Corporate and International Perspectives.
4. )Prof Kwame A Domfeh,Handouts on Ethics in Management.