Manual Working Ethics: How to Be Fair in a Culturally Complex World

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Legal condemnation has had notable socio-cultural consequences in host countries such as Canada. Macklin documented the experience of a Sudanese family in St. Though the charges were eventually withdrawn by the prosecution due to lack of evidence, the state intervention in this case resulted in the detention of the parents in custody and the apprehension of their two children by child welfare authorities.

Macklin notes that police, child welfare authorities, and lawyers acted with cultural insensitivity. It is additionally highlighted that long term emotional and social damage to the complainant, the accused and the family was incalculable. In instances where health care professionals are faced with the legal obligation to notify statutory bodies of the occurrence or risk within the host society of FGC, ethical considerations of article 41 need to be carefully weighed with their legal requirement to report. This is where the relative nature of the definition attributed to harm becomes of concern.

Selected communities do not necessarily view the practice of FGC more often, re-infibulation post-delivery as potentially harmful; rather the lack thereof may lead to psychosocial harm experienced by girls and women at risk of being ostracised by members of their community. Indeed, many authors converge by highlighting the fact that criminalising practices of FGC may have unintended adverse effects, such as the risk of clandestine practice of FGC within host countries, alternate practices such as a ritual nick or that parents send their girl child to the home country to undergo these practices in unsafe conditions [ 6 , 9 , 15 ].

Issues associated with the practices of FGC in the West have notable gray areas, including but not limited to the requests for re-infibulation of the vaginal canal after childbirth or notification of the courts about previously performed practices. Re-infibulation within medical settings has been a common occurrence across the western world, often brought forward as a potential harm-reduction strategy in order to minimise health hazards associated with potentially risky behaviours.

Such practice is argued to offer safer and culturally acceptable alternatives that bear the least amount of psychosocial harm [ 17 ]. In Italy, the United States and the Netherlands, proposed policy developed in partnership with selected practising communities has provoked great controversy. In an historic case in Seattle in , physicians at the Harborview Medical Centre suggested a symbolic procedure of pricking the clitoral hood be performed in order to appease traditional Somali families.

It was argued that such a procedure would be less invasive than circumcision as performed on male babies and would minimise the risk of individuals seeking FGC services illegally within the host country or sending the child abroad to the home country. Though this proposal was approved by a committee of health professionals and medical ethicists it was met with public outcry which prevented it from moving forward.

Equality Now suggested to members of the American Academy of Paediatricians, an awareness-raising discussion in collaboration with practising immigrant communities about these highly sensitive and ethical practices leading to potentially harmful consequences including tampering with a recognised human rights violation against girls and women [ 21 , 22 ].

The suggested alternative ritual was a prick of the clitoral hood with a small needle, done under local anaesthesia on children old enough to provide consent. An Italian bioethics committee judged this proposal to be ethical, yet international public protest prevented its adoption [ 1 ]. Selected analyses of a human rights framework juxtapose western acceptance of male circumcision and female genital constructive surgery in European and North American countries with clear condemnation of FGC practices among immigrants from practising countries [ 23 ].

Very recently, a German court in Cologne ruled against circumcising young boys for religious reasons [ 24 , 25 ]. It should be noted that Germany does not carry a law against male circumcision, as opposed to the one against FGC, creating additional uncertainties about procedures related to both sexes. After months of debate, in December , German lawmakers overturned this law granting parents the right to authorize male circumcision by a trained practitioner.

In the same vein as the arguments made throughout this paper, Equality Now reinforces the fact that it is critically important for relevant local and community groups to be involved at all levels to address this sensitive issue within the diversity of relevant communities. Culturally sensitive awareness-raising, education and outreach programs need to be sternghtened in order to protect a new generation of american girls.

To be effective, approaches addressing FGC need to be holistic and include education and outreach components as well as measures for legal protection and accountability [ 22 ]. While getting better informed and trained about the consequences of these practices and the premises underlying them, health care professionals need to reflect upon the intricate ethical complexity of the contribution of determinants such as ethnicity, migration, sex and gender in the social construction of FGC practices among migrants in western countries where there is, in pllel, a rise in female genital reconstruction surgeries.

They are never purely about anatomy and physiology but are intrinsically entangled with cultural norms, identity and ideology. Public statements of strong concern followed this release by a number of medical experts and rights groups who argued that release of the guidelines was responsible for an increase of FGC practice in medical settings. Of concern was also the issue that guidelines could well be misinterpreted as an endorsement of the procedure, combined with an enticement for doctors to encourage the practice [ 28 ].

In addition, intercultural communication difficulties stemming from linguistic and other cultural barriers have been identified as key deterrents for many immigrant women and men in accessing health services [ 29 - 32 ]. Establishing proper and quality communication as the basis of an ethical clinical situation has been highlighted in ample empirical evidence as well as selected codes of ethics for health care professionals such as nurses and physicians in the context of linguistic barriers [ 33 ].


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A number of women emigrating from practising countries may have already undergone FGC upon arrival [ 34 ]. At some point, many of these women will be required to use the social and health care system, particularly during pregnancy and childbirth. While studies have demonstrated the immediate harmful health effects of FGC practices, in terms of uncontrolled bleeding and infection, selected long-term effects are not well understood and may vary. Some of the outcomes include vaginal infections, difficult second stage delivery, as well as ill-sustained menstrual and sexual pain.

Ill-health outcomes may affect not only those new to Canada but also those who have been in Canada for a long time but are slowly getting to know the health care system due to lack of knowledge in regards to access and general discomfort with health care providers [ 7 , 35 ]. However, when women were actually tested for pain in the vulvar region, Einstein found that all of her participants had at least one area of the vulva in which the pressure-pain threshold was lower than that for Canadian women with vulvar vestibulitis, a chronic vulvar pain condition. Einstein concludes by suggesting that her participants had chronic pain but to them it was just part of normal life [ 36 ].

Unfamiliarity, subtle discomfort and lack of guidelines or uptake of the latter may induce serious mismanagement of infibulation during delivery associated with the risk of psychological harm [ 37 ]. In addition, unnecessary caesarean sections have been reported among women from practicing countries due to the lack of familiarity and overall discomfort of Canadian health care professionals with the practice of infibulation [ 7 , 10 ]. Similar findings have been noted in Germany and other Western European countries [ 11 ]. In order to softly navigate through delicate subjects such as FGC at the interface of sex, gender and migration experiences while seeking care in host countries such as Canada, it is necessary to strengthen competence, congruency and compassion, along with the uptake of sensitive guidelines in partnership between medical and community organisations.

The Sexuality Education Resource Centre SERC , based in Winnipeg Manitoba, is among selected organisations in Canada that aims to provide sensitive and culturally competent care to girls, women and families when needed.

A case study illustrating the interactions between SERC and women they attend to will allow the reader to anchor the discussion provided above as SERC strives to give voice to those living experiences associated with FGC practices. The aim of this section is to enhance the importance of a deeply sensitive and reflexive practice with an illustration of the complexity of socio-cultural issues raised via a dialogic process between a diversity of women and men and members of a community organization.

Despite the fact that immigration is a notable reality in places like Toronto, Vancouver and Montreal, Winnipeg is increasingly receiving its fair share of immigrants. In Manitoba, immigration has increased exponentially in the past decade due to highly successful provincial programs and policies, most notably the Provincial Nominee Program along with the long standing commitment to assist in the relocation of refugees in Canada. Over the years, a number of families from select countries in Africa have sought refuge in Manitoba [ 39 ].

In the past decade, at least seven out of the top ten source countries of refugees have been African countries, namely Ethiopia, Sudan, Eritrea, Somalia, Egypt and Sierra Leone, where prevalence levels of FGC range from SERC's main mission is to promote sexual health through education.

Since , SERC has been working closely with specific migrant communities in Winnipeg to tackle this complex, rich and deeply culturally entrenched tradition. SERC seeks to work closely with women and their families, community members as well as service providers in order to reduce any risks associated with the practice of FGC as the families integrate into a new society with its specific cultural and at times contrasting values in regards to FGC.

Addressing such a controversial issue has required a process-oriented, iterative approach to build community trust and successful partnerships, prerequisites for successful engagement on this sensitive and potentially stigmatizing issue. Additional context is provided by the fact that SERC subscribes to harm reduction, health promotion and illness prevention when it comes to sexual and reproductive issues.

The following definition of harm reduction has been adopted by SERC as it applies to a range of sexual and reproductive health issues including FGC: a set of strategies and tactics that encourages people to reduce harm to themselves and their communities, through the sharing of relevant information, facts and practical material tools that will allow them to make informed and educated decisions. It recognises the competency of their efforts to protect themselves, their loved ones and their communities [ 41 ]. Applying these approaches to this community-based project meant first learning more about the practice through a community lens and through that process engaging community.

Community members were hired to conduct different phases of the research. Community views were elicited through gender-segregated focus groups 7 with 48 women, 1 with 9 young men, 1 with 7 young women, 2 with 19 men and individual interviews with eight community members in leadership positions 5 men and 3 women , and professed religious leaders 6 men and 1 woman. Core members of the team conducted thematic analysis of the data, which were presented to participants invited to a feedback session. Further analysis was conducted with their feedback to refine our themes.

Addressing this taboo and culturally sensitive issue has enabled SERC to uncover assumptions and help readjust theworld-views of those coming from non-FGC practicing communities, steeped in Western feminist thought. While delivering service provider training, SERC facilitators tended to wrongly assume that women affected by FGC were knowledgeable of harms associated with the practice. Discourses are discordant.

The sexual desire also can be reduced. Even it can also affect the fertility. She can become infertile. Do you mean if some organs are injured as a consequence of female circumcision? Labour is a natural process. So this labour problem happens naturally. There is no link between circumcision and labour. It might have other problems. Interesting but kind of like the chicken and the egg. The knowedge and introspection that helps us understand ethics had to come from somewhere. It is all an adaptation of existing moral principles.

And as for morals being inherently relative, they too can be reasoned and understood better through thought, knowledge and introspection. As we change we adpat our ethics. To say something is innate, means we are born with the knowledge. We do not need to learn what pain is, we are born knowing that. We also know when we are being treated unfairly without being taught. So parents, culture, religion are not required to know the basics of ethics, its innate — pre-wired.

I will place the starting point at birth. A chicken and egg debate would only enter the mix if we try to determine if a fetus could know ethics and at what point in its development. That said, the distinction made between Ethics and Morality made on this website is new; and it should help to advance our knowledge of ethics and elevate the debates around ethical matters.

Many times you have to unlearn information before you can gain greater understanding of a topic. Most people assume that they get their source of ethical knowledge and understanding through their sources of moral authority — parents, religion, the state, etc. While these sources of moral authority may help them to achieve a greater level of ethical understanding than they may otherwise derive from themselves; this is not always the case.

Take the case of an abused kid. Can he or she know for certain that the abuse is unethical. He or she can use introspection and determine it for themselves. Jesus appeals to ethics while the mob appeals to their moral authority. So yes, morality and ethics are different. They are knowable via different means. Ethics does not change, it transcends time and place. Societies understanding of ethics and its means to ethically enforce ethical principles is limited.

Ethics At Work

Societies as well as individuals are all on a different arc of ethical understanding. Their structures of governance, laws created to enforce ethical matters, and means of enforcing them fall on a spectrum. When I read that ethics is innately knowable, the question that comes to mind is — but what is the source of this knowledge? Did this knowledge simply materialize out of nothing? And at what moment in the history of the world did this materialization occur? Did this innate knowledge of ethics exist 4.

I do not think so?


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Did this innate knowledge of ethics exist when one of our ancestors from the species Homo habillis was born 2 million years ago? These creatures were both ape-like and human-like in appearance. The innate knowledge of ethics must have arisen after the formation of the planet earth. I think it probably arose at some point in time during the evolution of the genus Homo. Lets agree that a human born 10, years ago was born with the knowledge of ethics. It appears to me that the ultimate source of ethics is a belief in a higher power.

Thank you for contributing to the conversation. Innate knowledge simply implies you are born with it; it comes prewired. Why this is the case, or when it came about is likely not knowable. Evolutionary scientists have some good theories on how this may have evolved; there is of course the religious explanation.

I do not think you need to introduce God into the mix. The source of our innate knowledge is not the important issue. So the biological facts of the human condition provide us with an innate knowledge of ethics. Biology is our source of this innate magic. As noted, many animals likely possess this same knowledge to some extent.

Where humans differ greatly is with their ability to understand ethics. Individual and cultural understandings of ethics differ widely from individual to individual; and from culture to culture… just as it did in the past. It is clear from the earliest human recordings that ethics was on the minds of these people. The moral laws that existed in antiquity and which exist today are societies way of dealing with educating and controlling members of society. You can look at moral laws as formalized memes that reflect the moral understanding of those in power within that society. The application of ethics is conditional.

As cultures have become more complex and trade has increased it has caused different cultures to interact more resulting in our collective ethical understanding improving on balance. The long arc of history has tended to bend towards increased understanding of ethics, although the march has not been steady in one direction and our ability to keep moving forward is not guaranteed.

It was burned to the ground by a group of ignorant and fearful Christians, responding to the power grab of a bishop at the time. The piety of the Christian faith and the human desires for power of its leadership lead to a 1,years of regression of science and ethical social liberalism a large over-generalization I admit. Knowledge and understanding are the light; fear and ignorance is the darkness. From my personal experience and reading of history I prefer to put my faith in science and reason; they have provided more light than any other source in human history.

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Look at the greatest sources of injustice and harm in the world. Is the source caused by memes that promote ignorance and fear or those that promote knowledge and understanding? Which ones are those requiring faith? Which ones are those requiring introspecting, reason, exploration? I think the answers to these questions are obvious. Your reply helps crystalize a question I have thought a lot about. Due to these differences in feelings, two individuals can develop very different concepts of ethical conduct, especially given the reality of cultural biases.

American history is full of examples of highly intelligent and educated individuals advocating views that justified genocide of native Americans and the enslavement of African Americans. I believe the same can be said of the views of Hitler and Mao, views that led to the murder of millions. Notwithstanding these murders, millions of countrymen of Hitler and Mao shared their views and supported the policies derived from these views.

If innate feelings are the source of an ethical code, I can envision such a code leading to a benevolent dictatorship, or to the tyranny of the majority. For these reasons I believe the source of ethics is important. I agree with Thomas Jefferson when he wrote. Like Jefferson, I believe in universal truths that are self-evident innate , truths that endow all human beings with certain unalienable Rights.

This leads me to believe that the ultimate source of ethics is a belief in a higher power. Answering this question was essentially the goal of this book, so I will point to the section in the book that address key issues. If we all perceive sensory things and emotional things differently; who among us is to be trusted as the arbiter of ethical truth? Understanding the correct ethical path is relatively easy, simply use the golden rule. The first part of the book is relatively short and provides a proof of this axiom. The section on understanding ethics addresses how an individual or group can derive ethical truths.

There are baseline requirements for understanding ethics. The section on when things go wrong tries to address two common forms of malice. The section on personal framing addresses how we all see the world through skewed eyes. With ethical understanding we can hopefully see the world more clearly and help others to do the same. Diving down the rabbit hole addresses your concerns straight on… at least I think so.

The driving analogy for ethics is used to illustrate through analogy the reality of a distribution of knowledge and understanding exists; which is a varied as the number of individuals. You can train people to get better but they have to care enough about improvement to do so. Some care deeply, others are deeply apathetic. In general the system works but it could always be improved. People and cultures vary in their development; the rules of the road vary a bit too. Good driving practices are timeless and transcend culture.

The discussion on cultural memes provides a window in how leaders can get good people to do bad things. I compared ethics to love because both exist in the mind, so they are hard to prove. Individuals and cultures acknowledge both love and ethics. Ethics is constant, ethical climates can ebb and flow. In sexy ethics , I discuss the how many of the seemingly relativistic moral codes as they apply to ethics often have core unchanging ethical principles that they are derived from.

I also acknowledge here and in other sections that cultures are typically the arbiters of justice; they define what is right and wrong, and the people implicitly agree by their obedience to the rules. People make up cultures and both have a tendency to be wrong a good deal of the time; so their is always room for improvement. Again, this is where ethical knowledge and understanding is useful.

I highly doubt anyone of faith will read it because to do so would be against the first commandment. The power of the meme of God for self-sensorship truly amazes me. I was raised in the Catholic faith but was liberal enough to question it and my search for knowledge and understanding led me to seek a better understanding of the people and world around me. By questioning and thinking about God I came to understand the meme.

God is a powerful idea, but it is simply that. This book is in part thanks to religion, to an unethical corporate culture, and to the power of an inquisitive mind. This was the second book I wrote, the first one was on corporate ethics; which has not been published yet. To discuss corporate ethics, I had to first define ethics.

If you are concerned about questioning your faith, if the thought of that creates an inner fear, then I will let you in on a little secret; there is nothing to fear.

Ethical practice for the playwork practitioner

I have been to that mountain top, there is no boogie man; just your own fear. Let go of the fear and start asking questions… the world will light up. Ethical knowledge has to be innate because otherwise we would lack free will. So unless you want to go down the philosophical road of Determinism, I suggest we all concede that ethical knowledge is innate whether biological or God-given if you prefer.

The philosophical argument against philosophical Skepticism is provided in how we know ethics. It continues in the Epistemology of Ethics. The issue with God or religion being the source of ethical knowledge, i. Hitler, Stalin, and all of the other crazies leaders made themselves gods. The state can use power memes of nationalism and authority to control people in the same way religion controls people with their memes.

When people are scared to speak up or silenced and obedience to authority is made a supreme virtue, then very bad things can happen. When people are encouraged to think freely and ask questions — which is what I promote, disagreements will occur but dialogue will also occur. Might is right. We can not avoid or ignore our flaws by wishing them away.

We are kinetic creatures, with reason and passions, good and evil tendencies, and everything in-between. As symbolized in Polarity , we can only take flight with knowledge and understanding. Fear and ignorance will hold us down. You may see religion as a source for light; and it may be for you and millions of others. If religion is a source for light for you it is likely because you want it to be, and you auto-filter out all of the bad stuff associated with it.

The contradictions, mythology, and blind faith is simply too much for me. I cannot simply accept a dictate on faith. I see such manipulation to be an inherent evil. If you can get people to believe half the stuff in religious text, you can likely get them to believe anything; which is very scary. The truly faithful are Fundamentalist, a fact most religious moderates reject. I see religion as a source of darkness, encouraging ignorance by answering questions with no answer; which retards curiosity in many to my amazement, not all.

If your answer for the unknown is God, then you stop asking questions because you have an answer. I would keep God out of a search for ethical knowledge and understanding. At best it provides a dead end, at worst it leads to Fundamentalism. I know from experience that there are many good religious people in this world; my guess is they would be good even without faith in God. There are great reasons for being good, simply obey the Golden Rule.

Religion may even be the best form of social control the world has ever invented, but that does not mean it is perfect or that it should stay static. I think religions could adapt to provide spiritual guidance for those who feel they need it while giving up its strangle hold on social issues.

Religions to some extent do and should provide ethical guidance of being good that does not involve mythology. Religions may have provided us the best means of social cohesion in the past, but with cultures coming together at a faster and faster rate, and the ease of weapons of mass destruction in the hands of many, the less magical thinking the better. All that said, the ideas presented here in this book ARE compatible with religion; I am personally not compatible with religion however. You can be religious and derive ethical truth from innate knowledge; which is what this book tries to prove and provide guidance on.

Thank you for such a thoughtful reply. I have thought about ethical issues for 40 years. I wrestle with ethical questions every day in my work. Your book and your comments have added to my knowledge base and understanding. This is true of all human societies, everywhere.

Once again, this is group ethics. The basis for these two dimensions is just as innate as for the first two. In fact, I would say authority and in-group are likely more innate, since, e. Your reference to wolf packs is interesting, as they are social animals.

Book Review: Working Ethics - How to be Fair in a Culturally Complex World

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