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To the Editor,
I appreciate the interesting and important discussion regarding informed consent and cultural values ("Culture Clash Over Intersex" HCR, July-August 2003). While I ultimately agree with Dreger and Wilson that physicians should not cooperate with deception of a patient regardless of his parents' cultural values, I find their closing statement ("...if they feel the child's well-being is at serious risk, seek legal help in protecting this child from what might amount to neglect or abuse") a bit extreme and devoid of cultural sensitivity. While respecting cultural differences does not mean that we set aside our own moral or ethical convictions, it does mean, as Sytsma stated, that we "try to understand why a culture values what it values, to withhold wholesale condemnation of individuals belonging to that culture for holding such values, to be open-minded to the possibility that the values of another culture may be either equally tenable or morally superior to our own, and to refrain from imposing our own values on a culture whose circumstances are such that doing so would lead to harm."
In addition to the inclusion of psychological and social work professionals in the treatment team, which Dreger and Wilson rightfully argue for, I would like to see, with the permission of the parents, members of the family's ethnic and spiritual communities participate in explaining why the child deserves to know about his condition. I would also like physicians to appeal to the leaders of these communities before rushing to the legal system, especially since Middle-Eastern people and immigrants have reasons to fear and distrust American legal system due to its surveillance of Middle-Eastern communities after the 9/11. Finally, the medical community needs to make further efforts to increase the number of Middle-Eastern people (and other members of marginalized communities) in the medical profession, including among medical ethicists, which will help us communicate better with patients with Middle-Eastern background and their families in the future.
Emi Koyama
Director, Intersex Initiative (www.intersexinitiative.org)
Portland, Oregon