From the Editor
Several themes in this issue of the Hastings Center Report deserve mention. Entirely fortuitously, several shorter pieces in this issue discuss the nature of the doctor-patient relationship and the need for physicians to engage patients personally rather than only technically. Pediatrician Douglas Opel proposes that physicians who reveal their own medical problems and worries can have better discussions about the patient's. Medical student Dhruv Khullar describes the benefits of acknowledging his medical limitations with patients and the goal he has set of understanding the patient's health care needs from the patient's perspective. Edvin Schei and Eric Cassell argue that the patient's need—and the physician's capacity to help—gives the physician power within the physician-patient relationship, and that the secret to good clinical medicine is to use that power well.
Another topic found in this issue is the shifting terrain of the debate about the use of animals in medical research. Over the last year, a Hastings project funded by The Esther A. and Joseph Klingenstein Fund has sought to track the changes with the help of a range of experts who have shared and discussed their views and whose final essays are published in a special supplement to this issue. (Additional resources can be found at http://animalresearch.thehastingscenter.org.)
Perhaps the most prominent topic in the issue, however, is the physical modification of women's genitals. Both articles address this topic, and though there are significant differences between the two articles, both circle specifically around the question of whether the modification of women's genitals may be driven by cultural norms of womanhood and how women differ from men, and both comment not just on the questions but on the social debate about them.
Hastings scholar Josephine Johnston discusses pharmaceutical and surgical interventions to limit the virilization of women's genitals caused by congenital adrenal hyperplasia. In 2010, some essays that addressed this topic in Bioethics Forum, the blog of the Report, launched a highly contentious debate among scholars in bioethics—a debate that to many seemed to leave the rails. Johnston tries to sort out what happened—what the issues are and how the debate went wrong. In her conclusion, she calls for tolerance twice over—tolerance of functional but different genitalia, but also tolerance of the different decisions that parents make about interventions. The cases are too complex and require balancing too many different considerations to settle on any hard and fast rules for deciding them.
The lead article, which comes out of a panel session held at the 2011 conference of the American Society for Bioethics and Humanities, discusses the procedures known variously as female circumcision, female genital mutilation, female genital cutting, and (in this article) female genital surgery. The article largely sets aside the most extreme forms of these practices, but argues that the debate about the other forms has often misrepresented both the practices and the people and cultures who carry them out. The article does not argue for a particular policy position on female genital cutting, although criticizing the practice's critics gives the impression of defending it.
Given the sharp moral concern around the world on this topic, we decided to solicit several responses to the article, and we would welcome further commentary as well. In the coming year, we hope to do more to encourage ongoing exchanges among authors and readers—while maintaining the careful and temperate inquiry that, as Johnston notes, can be easily overwhelmed.—GEK