Jeffrey P Bishop. Journal of Medicine and Philosophy. Volume 29, Issue 4, 2004.
I. Introduction
No issue challenges contemporary Western liberalism and its relationship with indigenous cultures like that of sunna, female circumcision, clitorectomy, or genital mutilation. Western liberalism after all does hold tolerance as important to inquiry and it is quite difficult for one to tolerate something that grates against Western notions of the good. Many people, where these practices remain part of the culture, understand Western attempts to see the practices eradicated as more subtle, though no less intrusive, versions of imperialism. In fact, in a series of articles published in the Kennedy Institute of Ethics Journal, Robert Baker, Tom Beauchamp and Ruth Macklin all spar over issues of common moral theory in the face of multiculturalism, showing us that the West itself is trying to sort through its principlism (Baker, 1998a, pp. 201-231, 1998b, pp. 233-273, 1998c, pp. 423-453; Beauchamp, 1998, pp. 389-401; Macklin, 1998, pp. 404-422). Baker offers a critical analysis of principlism and concludes, after applying a Nietzschean and Foucauldian analysis, that moral fundamentalism—morality founded on the fundamental principles of normative bioethics, namely autonomy, justice, beneficence, and non-maleficence—does not in fact survive these postmodern critiques; yet in his second article, he claims that the contractarian tradition allows one to bridge multicultural perspectives and allows one to make transtemporal and transcultural moral judgments (Baker, 1998c, pp. 423-453). Beauchamp, in his article, points out that Baker’s attempt at a social contract is a form of the very moral fundamentalism that he critiques, because he presumes the fundamental principles that Beauchamp holds. Beauchamp thus concludes that the fundamental moral principles remain intact. The point here is that all three of these authors assume Western answers solving problems of multiculturalism, demonstrating that they themselves operate within a tradition of inquiry.
In this essay, I will examine the issue of female circumcision by assessing some of the current literature against the practice, with the intention of assessing how the partisans characterize the practice. I will first describe the procedure clinically and then describe it as it functions within the cultural traditions that practice female circumcision. I will specifically look at Macklin in the above-cited article and in her book Against Relativism (1999). Because I critique a critic of the practice, one could simplistically conclude from what follows that I write in support of the practice. I am in no way writing to support the practice. I mean first to show that because these practices cohere within a web of beliefs, they are rational from within that tradition and thus do not need to be justified according to criteria established by liberal individualism. Second, I mean to show that Macklin’s analysis is fundamentally foreign to, and therefore not applicable to, the traditional practices of female circumcision, at least not in the way that Macklin thinks it is. I conclude that the liberal tradition does not rise above mere assertion of its own position, claiming itself to be rationally justified and in position to offer transhistorical and transcontextual truth claims, which are therefore applicable to the debate about female circumcision. Finally, I will show that Alasdair MacIntyre’s understanding of traditional modes of moral inquiry, which include assessment of practices and rituals of a tradition, can allow the participants in the debate about female circumcision to progress beyond the current impasse in dialogue. In short, this essay uses the debate about female circumcision as an opportunity for the West to see some things about itself.
II. The Procedure and the Problem of Naming
A. Clinical Descriptions
From a purely medical perspective these procedures cannot be justified. It has been estimated that 80 to 129 million women in twenty-seven African countries and ten non-African countries have undergone circumcision. Prevalence rates in Africa have been estimated to be between 5% in Zaire to 98% in Somalia. Several sources agree that the practice is decreasing, though this decrease is occurring in urban areas amongst educated upper and middle class people (Gordon, 1991, pp. 3-14; Lane & Rubinstine, 1996, pp. 31-40). Those in rural areas and the economically deprived are continuing the practice.
Health care advocates usually describe three different procedures, though several other classificatory schemes exist. I will give brief descriptions of the procedures, which I, as a physician, must admit are quite gruesome. The first and most benign of the practices removes the prepuce—the skin that covers the clitoris, which is the anatomical analogue to the foreskin removed during male circumcision (Toubia, 1994, pp. 712-716). This procedure is very rare given the intricate anatomy of the region, the fact that many times there are no anesthetics used, and the likelihood that the child undergoing the procedure is thrashing about due to pain. Thus, for all practical purposes, the second type of procedure is done. In the second procedure, the clitoris itself is excised and the procedure may include the removal of parts of the labia minora as well. Asma El Dareer has suggested that in the Sudan, this procedure came about as a compromise between the midwives who performed the more extensive procedure, described below, and British colonial legislation, which, in 1946, forbade the more extreme procedure (El Dareer, 1982, p. 4). However, given the widespread use of this more intermediate procedure and the difficulty in performing the less extensive procedure, it seems that this intermediate procedure probably predates the British ban.
The more anatomically involved practice is called infibulation—the removal of the clitoris, the labia minora and parts or all of the labia majora. The incised edges are sometimes stitched together in urban and some rural areas of Sudan and Egypt. In remote rural areas, the legs of the child or young woman may be bound together to prevent the wound from being reopened. The result is that the two edges will grow together, creating a layer of skin and scar tissue covering the urethra and a substantial portion of vaginal introitus. The vagina is covered to varying degrees depending on which ethnic group is performing the procedure. Usually a small-caliber, cylindrical object, like a stick, is inserted between the two edges posteriorly to maintain an opening for the evacuation of urine and passage of blood when the woman achieves puberty and begins to menstruate (El Dareer, 1982, pp. 1-20). During the woman’s first sexual intercourse this small opening may be stretched by penile penetration or sometimes she may even be cut with a knife resulting in more bleeding and pain. At the time of birthing a child, the midwife will again cut the vaginal covering of skin and scar tissue to widen the outlet. After childbirth, the edges will usually be stitched back together to re-cover the outlet, again with a narrow opening. The reinfibulation is performed to maintain the tightness, which is done to please the woman’s husband.
There are numerous complications that result from the practice of clitoridectomy the intermediate procedure. Clearly bleeding occurs during the procedure and in the days after, as well as during intercourse and childbirth. In addition, infections, including serious urinary and vaginal infections, around the time of the procedure and shortly after are common. More serious complications can result with the more extensive infibulation. Bleeding is more extensive both at the time of the procedure and years later with intercourse and childbirth. In addition, there is a higher risk of urinary retention, urinary tract infections, and vaginal and pelvic infections than with the less involved procedures. There are psychological consequences as well as sexual consequences, both of which have not yet been fully studied. All of the women who have undergone these procedures, save those who only have the removal of the prepuce, will not be able to have sexual pleasure from clitoral stimulation after the procedure (Toubia, 1995, pp. 12-19), though there is data to the contrary (Gruenbaum, 2001, pp. 149-152).
With childbirth, if the midwife is not present to cut the scar tissue covering the vaginal outlet, there will be more difficulty in delivering the child’s head, resulting in a higher chance of anoxic brain injury in the child and death in the mother. In addition, without a precise cut to deinfibulate the vaginal outlet, there will be higher chances of vesiculo-vaginal and recto-vaginal fistulas and increased chances of infections. Clearly, given the extensive nature of and the subsequent health problems that arise from these procedures and the overall harm that comes from them, it is difficult for anyone in the West to see how these practices can be justified, myself included.
B. Cultural Descriptions
Yet, so far I have only described the procedure in the empirical terminology of medical science. It is difficult for those of us in the West to see how this practice could be perpetuated in any culture. The practice must offer something of value to the culture for it to have flourished for so long. Robert Baker, taking a practical Western view, thinks the practice has value in that it reduces sexual pleasure, thus reducing desire resulting in a form of birth control (Baker, 1998a, pp. 441-442). Yet this explanation remains one that assesses the value of a practice in terms of its utility—a value that we in the West find important. Utilizing a less favorable interpretation, feminists tried to find the roots of this practice in the sexist tendencies of these patriarchal societies. However, its perpetuation is much more complicated than simply claiming patriarchal oppression, as this practice is continued by social pressure placed on the younger women by the older women of the community and not just from patriarchal pressure. In fact, the procedures are actually done by the women in the community, usually a midwife with several women to aid in holding the young women and girls (Gruenbaum, 2001, p. 39). I am not claiming that the oppression of women by men is not part of the dynamics of its continuation, but that there is much more at work here than a simple causal relation between oppression and the practice itself.
There are popular stories about what might happen to a woman if she is not circumcised. Some ethnic groups will claim that the woman’s clitoris will grow to the size of a penis or she will become promiscuous like a man if she does not have the procedure. Popular lore has it that women who are not circumcised will not be as attractive to men and an uncircumcised woman will not be marriageable. There is clearly some pressure from men in that men will not marry an uncircumcised woman because many believe that the procedure will protect the virginity of the girl and will also cure and prevent sexual deviance (Toubia, 1995, p. 37). Moreover, some ethnic groups consider the normal vaginal opening to be ugly and not as sexually appealing as the infibulated vulva.
However, examining the anthropological literature, one finds it is not uncommon for people to alter their bodies as a sign of transition from childhood into adulthood, as well as for purely aesthetic reasons (Gruenbaum, 2001, p. 103). One only has to look at the practice of male circumcision or tattooing that occurs in many cultures throughout the world. Moreover, women’s beliefs about beauty are linked to these practices, as are notions about what it means to be a woman. Several authors have pointed out that it is not unlike breast enhancement surgery or penile implants in men, which serve to promote one’s own sexual identity—at least as that sexual identity is perceived in American culture (Gruenbaum, 2001, pp. 71-75). Yet, even these explanations diminish the importance of the symbolic value that arises in the traditional ceremony of circumcision—there is little in the way of symbolic value in breast augmentation or penile implants in men in Western cultures. Ellen Gruenbaum points out that the procedure itself, independent of its outcome—a circumcised woman—conveys ‘‘age status, marriage ability, gender identity, social status, ethnicity, and even moral quality’’ to those who participate in the practice (Gruenbaum, 2001, pp. 66-67). Thus, the social meaning of the procedure is more significant than utility, as claimed by Baker, and is tied to socially constructed definitions of beauty and personhood and one’s place in that community.
Nahid Toubia, an ardent critic of the practice, offers some of the reasons given for its justification.
Beauty/Cleanliness:
- Female genitals are unhygienic and need to be cleansed.
- Female genitals are ugly and will grow to become unwieldy if they are not cut back.
- FGM [female genital mutilation] is the fashionable thing to do to become a real woman.
Male Protection/Approval:
- FGM is an initiation into womanhood and into the tribe.
- The non-circumcised cannot be married.
- FGM enhances the husband’s sexual pleasure.
- FGM makes vaginal intercourse more desirable than clitoral stimulation.
Health:
- FGM improves fertility and prevents maternal and infant mortality.
Religion:
- God sanctifies FGM.
Morality:
- FGM safeguards virginity.
- FGM cures ‘‘sexual deviance,’’ i.e. frigidity, lesbianism, and excessive sexual arousal (Toubia, 1995, p. 37).
That one might claim counter-factual points on each of these reasons is of little consequence to the role played by the practice and its meanings to the culture. These beliefs about the practice are embedded in a web of beliefs about the world and are not mere reasons given independent of the web. To believe that God sanctifies the practice is not merely a reason given to justify it. It ties the significance of identity to one’s place in the world as it is perceived; this place defines health, not in the narrow Western definition of health, but health in its broadest, spiritual sense as wholeness. To believe that the uncircumcised vulva is ugly is tied to the web of beliefs about aesthetics, which in turn is related to notions of balance and harmony, even balance and harmony within the community. Each reason is not just a reason in a list or table, but all cohere as embedded in the web of beliefs about the world and one’s place in it.
Gruenbaum describes the meaning of the ritual for a small village in the Sudan in some detail. This practice has communal significance and brings about communal coherence. The women gather together to support the child and mother through the procedure. In the evening of the day of the procedure, visitors stop by with gifts for the girls. They are ornamentally dressed before and after the procedure. For this group of Sudanese, it is not so much a rite of passage as much as it serves as a symbol for the group’s cherished values. However, in other groups like the Maasai or the Gikuyu people of Kenya, it is much more a marking of adulthood, as this procedure is not done until the marriageable age. As with many rites of passage, the ceremony marks the communal acknowledgement of adulthood. For the Gikuyu particularly, it is tied to the marriage ceremony itself, as it occurs at the time of the marriage agreement and several weeks before the marriage itself, which completes the marking of adulthood for the young woman. Morality, aesthetics and community are all tied together in this procedure, this rite of passage (Gruenbaum, 2001, pp. 48-69).
Thus, one can even ask if the practice is really the same practice, if in different groups it points to or signifies something different. To call the practices the same simply because they take place in the same anatomical space of the body or in the same geographic regions of the world misses the importance of the practices for each group as understood within the web of beliefs of that particular group. The point is that it is difficult for Westerners to see a list of reasons as anything but a factually refutable list, because we do not have access to the web of beliefs within which these practices cohere. It is our ignorance of the relationship of those beliefs that makes it difficult for us to see it as anything other than genital cutting. In short, just because these practices of genital cutting occur in the same anatomical region in the body, does not at all mean that we can capture them under one name. To superimpose on the body of African women the merely material consciousness of Western scientific thinking does violence to the coherence of their webs of belief about the world. I shall return to this point later.
C. The Problem of Naming
As a Western physician, I cringe at the thought of the practice and, initially in this paper I refer to it as a procedure in purely clinical terms, giving rise to the question of naming. By attempting to capture these practices, which convey different meanings to different practicing groups, under one name, we engage the power of naming. Clearly, the nature of the procedures placed in terms of clinical medicine takes on a power of its own. Do we refer to the procedures as circumcision? Gordon thinks that referring to these practices as circumcision is little more than a euphemism, clearly preferring another denominator—mutilation (Gordon, 1991, p. 4). Or do we refer to the practices as surgeries the way we might to the repair of cleft palate or breast enhancement? Do we refer to the procedures as mutilation, as Gordon does (Hosken, 1982; Rahman & Toubia, 2000; Toubia, 1995)? Or do we refer to the procedures by their traditional names?
Those who practice the least involved version of this ritual refer to it as sunna, the Arabic word for ‘‘duty’’ (Gordon, 1991, p. 4) or ‘‘tradition’’ (Gruenbaum, 2001, pp. 2-3). Many who practice female circumcision think the Qur’an commands it or that Islam at least recommends it, though the practice is not unique to Islam; nor is it at all clear that Islam endorses it.3 Though there is debate among the adherents of Islam of whether the practice is part of Islam, the point is that the procedure, as I have called it, has a deeper significance than the descriptive definitions and names given by Westerners. The more involved procedure, infibulation, carries the traditional name of tahara farowniyya, Arabic for Pharaonic circumcision, establishing its roots in the time of the Pharaohs of Egypt in the traditional lore of the community (Gordon, 1991, p. 5). The significance of the practice, then, is traced to the continuity of a tradition. It links the people who practice circumcision today to those who went before them.
Alasdair MacIntyre has stated: ‘‘every tradition is embodied in some particular set of utterances and actions and thereby in all the particularities of some specific language and culture’’ (MacIntyre, 1988, p. 371). That means that the practice itself is part of a fabric of beliefs that make up the entire cultural tradition and that its meaning and significance cannot be abstracted from the practice without losing some of the significance of the practice, especially when translated into the languages of modernity. MacIntyre points out two peculiarly important features for naming something in the primary language of traditional cultures: (1) the naming of persons and places has more significance than the mere location of a place on the map or the individual to whom reference is made, and (2) the name communicates more and other than what a person actually says (MacIntyre, 1988, p. 378). MacIntyre gives as an example the traditional Irish name for Londonderry. It was Londonderry to those who were English speaking Protestants, while it was Doire Columcille—literally meaning St. Columba’s oak grave—to the Irish Catholics. To embrace the one, is to deny the legitimacy of the other.
Sunna, as the name of a particular kind of practice, designates not just the practice, but also the meaning of the practice for those who perform it as a rite of passage for the Maasai or the Gikuyu, or the meaning of the practice as the literal embodiment of the cherished values of the group in the Sudan. Certainly the name implies that a woman has a duty, bound by tradition, to have the rite performed, but also the concept of duty is itself tied up in the particular practice. The pain borne by those undergoing the practice informs the community of what duty itself is. The practice embodies the concept of duty and the women bear the bodily mark of tradition. The practice and the concept of duty within that tradition are in a dialectical relationship and linked through a web of beliefs that transcend the practice itself and the reasons given for its continuation.
By naming these practices in clinical terms anatomically situated on the female body or even as surgical procedures, and by understanding them solely in clinical terms and health outcomes as defined by Western medicine, one harnesses the power inherent to the clinic as a naming and defining institution (Foucault, 1994, pp. 88-106). By applying words like mutilation, the practices lose legitimacy, which is a status granted by the Western medical establishment, thus taking on the illegitimacy of any practice that stands outside any legitimacy-granting institution. Loretta Kopelman argues that the values of medicine can be generalized, or perhaps universalized, to all cultures (Kopelman, 1994, pp. 55-71, 1997, pp. 221-237, 1998, pp. 249-259). For Kopelman, medicine acts as a point of convergence, where diverse cultures, from developed to developing, can agree. We all want good health. But, is health really something we all agree upon? This point is merely assumed and not developed by Kopelman. Yet, this hardly seems possible. Health is itself an aspect of life that is valued and linked together within a web of beliefs and traditional notions of wholeness, human nature, the good, and one’s place in the world. Health takes on a more holistic, spiritual framework in pre-modern cultures and societies than they do in the United States, where you find heart health, breast health, brain health and colon health, all falling out along the mechanistic Western understanding. In fact, we within the West cannot even agree upon a consistent definition of health other than the mechanistic one offered by contemporary medical science. Thus to appeal to Western notions of health as the means to deem these practices as wrong, and then to rename these practices accordingly, misses the relevance of naming.
As MacIntyre points out, ‘‘naming has then become detached from naming as and naming for, and the relationship of the name to that which it names is reduced to that which hold between any identifying label successfully used and that of which it is used’’ (MacIntyre, 1988, p. 379). By naming these practices using the internationalized languages of modernity, as MacIntyre calls them, of which medicine could certainly qualify as one, the traditional value of the practices—cohesion of culture, what it means to be woman in that cultural tradition, and her status in that society—no longer have to be entertained as central to the understanding and justification of the practices. Thus, that which the practice embodies beyond its action is lost in the translation into the languages of modernity—medicine serving this role—as is our access to how a community, at least in part, defines itself, and justifies its practices. Thus to rename these practices in Western terms only satisfies the Western desire to control them.
Of course, Macklin and Beauchamp, from a philosophical point of view, will argue that both the practice and that which it embodies have no validity because it violates human rights and that which it embodies is the promotion of oppressive concepts of duty. Thus, they can only by force of appeal to principles and in ignorance of the significance of practices within a tradition assert that their version of respect for persons and justice—each of which is intricately tied to their notion of rationality—are the standards by which all cultures must be assessed. Macklin will claim that I have done nothing but explained how these practices are perpetuated and not at all justified them. I turn to this assessment next.
III. Explanation and Justification
While the practice establishes what it means for women to be integral parts of their community, many Western thinkers see these practices as an oppressive remnant meant to keep women in their place, which in part is no doubt true—but only in part (Macklin, 1999, p. 10). From a philosophical point of view, Macklin cannot understand how the imperative ‘‘maintain respect for tradition’’ can be used as a principle to justify practices like female genital mutilation, as she refers to it. ‘‘‘Maintain respect for tradition’ is a customary norm within many societies and operates as a conservative force for maintaining the status quo’’ (Macklin, 1999, p. 10). Macklin, who is firmly steeped in the Western philosophical tradition—specifically that version of the Western philosophy called liberal—can only see tradition as a negative factor. Tradition, for her, keeps people in general, and women in particular, ‘‘trapped’’ within the mores of the particular culture. Tradition usually blocks us from seeing the pure principles of ethics. On her rendering, traditions may or may not keep people from the truth as delineated by liberal intellectual inquiry of enlightened thinkers, but usually it protects the oppressive status quo.
It is clear that for Macklin the only way to justify the cultural practices is to find them justified in some universal moral principle—though not in moral absolutes. She essentially asks, ‘‘How can modern Africans defend a ritual like female genital mutilation?’’ This question is one that only becomes possible for a traditional society when the practice no longer coheres with its own web of beliefs—which means that practices do change and fall out of favor even within a particular tradition—or when it encounters another tradition that does not perform these rituals. As articulated by MacIntyre in Whose Justice? Which Rationality? (1988), prior to those internal challenges or the encounter with foreign questions, the adherents of a tradition need only to put this tradition in the crucible of their own culturally defined version of rationality. The practice makes sense because it coheres within the fabric of their beliefs about the world. It needs no further justification. Moreover, moral justification as a separate realm of justification standing outside of cultural instantiations about the good, or aesthetics, or practical rationality, is a modern invention, as shown by G.E.M. Anscombe (Anscombe, 1958, pp. 1-19). Thus, a justification outside historical and cultural circumstances is itself a product of modern philosophy. Macklin wants to hold the practices up to the principles established in liberal modernity—principles that the people in a traditional society cannot even begin to articulate in their own language, let alone in Macklin’s universalized and universally translatable language of modernity (MacIntyre, 1988, pp. 370-388). Macklin makes the claim that ‘‘[f]emale genital mutilation is defended explicitly and implicitly on grounds of ‘respect for tradition’ in countries where it is practiced’’ (Macklin, 1999, p. 65). Yet, this view oversimplifies justification as it occurs within any particular tradition. It is not that a person within that tradition says, ‘‘I am going to have my child circumcised because I respect my tradition.’’ Prior to foreign questions, the practice is justified to them precisely because it is part of what it means within that culture for a woman to be a woman.
Though not entirely analogous, it is justified in the same way that proms are justified in our society. The prom is a rite of passage, the practice of which embodies the norms of American values of sexuality and self-determination. Many harms come out of this uniquely American tradition—date rape, drunk driving, and occasionally even death. Yet it remains as a justified rite of passage to people because it is part of what it means to grow up in America, not because the participants say, ‘‘I respect my tradition, so I am going to this prom.’’ This is not to say that there have not been critics from within the United States concerning this practice. Rather, the goods implicit to the practice are the goods that the participants hold as such, and for one to participate in the practice is rational within that tradition, not because one grounds the tradition in some sort of principle such as ‘‘maintain respect for traditions.’’ I am not Sudanese or Gikuyu or Maasai. I am not able to give hard and fast justifications that cohere within their belief webs that might make these practices palatable to us as Westerners; that would require an anthropologist who has learned the culture as an almost second first language or someone from that culture who could put it in terms understandable by the Western mind-set. I am not trying to justify the practices; I am only showing that they are justified within the framework of those traditions because rational justification has its own standards generated within the tradition itself, not some standard that transcends all cultural phenomena.
Macklin insists on using a principle-based approach to tradition. She states:
‘‘Maintain respect for tradition’’ is a convenient injunction for people in power—usually defenders of the status quo—to keep the system that sustains their power intact. As a practical maxim, ‘‘maintain respect for tradition’’ may well have value for anthropologists conducting fieldwork. Researchers’ failure to adhere to the maxim would result in their being expelled from the culture under study or their being denied future access to it. Their role as social scientists is to describe, not to evaluate. But ‘‘respect for tradition’’ cannot serve as an ethical justification of an action, custom, or practice. It can only function as an explanation for why people continue to do what they have done for centuries. (Macklin, 1999, p. 59 [italics are Macklin’s])
Macklin uses the word tradition in a principle or rule-governed way. People within a tradition do not use ‘‘respect for tradition’’ as a principle, for it is always already the case that the tradition is respected insofar as they are part of the very fabric out of which general rules and principles for living in that society or culture; even if someone is a dissenter or a critic of the practice, she can see how it coheres, and she will be the one who stands the best chance of changing the practice. People living within a tradition may have general rules or principles that they follow, but these are born out of the tradition itself, and not the other way around. A tradition is the very backdrop and context within which some decision about action will be made. A tradition is the web of beliefs. A tradition gives to people their notions of telos, human nature, justice and rationality; these already exist as the premises that will allow the person to go on to make a judgment about action or to make a judgment as to when a principle derivative from within the tradition is applicable (MacIntyre, 1988, pp. 349-369). If Alasdair MacIntyre is correct, and I believe that he is, Macklin uses the concept of tradition in a way that no tradition actually uses it.
Macklin is also claiming that anthropologists have only explained how the tradition continues in a particular culture. She argues that explanation and justification are distinct from one another. That explanation and justification are distinct is certainly true, and the distinction is important for any question put to a particular tradition. While anthropologists may be able to explain such practices, they are clearly not trying to justify a practice. Macklin is correct that what the anthropologists give is an explanation—even while it is an explanation in the Western scientific language of the discipline of anthropology. An explanation does not justify according to Macklin’s rule- governed approach to justification. Yet, from within the tradition, the explanation for the role played by the practice within a culture—the meaning bestowed upon the adherents who participate in it and the promotion of cohesion within the community—is the justification of the practice. So what Macklin counts as explanation, from a Western social science perspective, is justification for the practice from within the tradition. As pointed out above, Toubia lists some of the reasons offered for continuation of the practice, but like Macklin, what Toubia does not show is how these reasons are held together by the coherence of a tradition, that is to say, by the web of beliefs. They are not merely reasons on a list.
Macklin will of course argue that these reasons are founded on beliefs and myths about the nature of the world and not founded on empirical science (Macklin, 1999, p. 708), a claim not unlike Kopelman’s delineated above. Moreover, she will claim that what counts as sacred, and therefore beyond scrutiny within this culture, cannot withstand the onslaught of her own principle-based approach. What is not clear from Macklin is why these reasons, linked by a web of beliefs, must stand up to the principles of liberal modernity except as a mere assertion that they must do so. She does explain why the reasons given by the adherents of the tradition do not stand up to her scrutiny; she even goes so far as to show how the four principles of liberal modernity—respect for persons, beneficence, non-maleficence, and justice—are justified in condemning the practice of female circumcision. She does not, however, question her own beliefs as to what counts as the good or on what grounds some entity shall be allotted the status of person, or what respect or justice means—each she accepts as authoritative from within the liberal tradition (MacIntyre, 1988, pp. 326-341). Like the reason-giving of those traditions which she critiques, Macklin’s justification for the so-called fundamental principles finds rationale only from within her own tradition.
Only once a culture or tradition takes Macklin’s principles as relevant to the dialogue can they be used to evaluate the traditional practices of a culture and, despite Macklin’s anecdotal evidence to the contrary, it is not clear to me that this is even something many of these cultures are willing to do. Macklin must be aware of this problem, for in Against Relativism she recounts story after story of people from around the world who cannot get their minds around the concepts she is introducing; moreover, the only people that are convinced by her principles are people who are already working toward goals that they share with Macklin and the rest of liberal modernity. Macklin is of course correct in her assessment of the practice if one already holds her principles and the traditions out of which these principles are born, and—a very important and—one is using a language that in some way has relevance for those who live in cultures practicing these traditions (MacIntyre, 1998, pp. 370-388). It is also important to note that members of the tribes that participate in these practices must be the ones who understand what Macklin is talking about and not just some generic person of African dissent. Attempting to understand the language of a culture and the practices within that culture on their own terms is the only test of whether this translation is possible. As MacIntyre points out, the language must become a ‘‘second first language’’ for dialogues to occur between traditions. At this point, all we have is shouting between two traditions where there appears to be little possibility for dialogue because there is little in the way of overlap, precisely because of the assertion of ‘‘normative’’ claims from within liberalism (MacIntyre, 1984, pp. 6-22).
IV. Traditional Practices and the Dialogue Between Traditions
I have thus far only shown that within these cultural contexts, these practices of female circumcision cohere within a web of beliefs about the world and are thus rational within that tradition. I have also claimed that these practices cannot be reduced to a single practice simply because they occur in the same anatomical region, because they symbolize more than can be translated into the modern medical language. I have also claimed that the liberal critique of these practices as not ethically justified—because the practitioners do not uphold the universal principles of liberal modernity—is irrelevant to the justification of these practices from within the tradition. And I have also argued that even the need for ‘‘moral’’ justification—justification that operates within a separate human realm that is independent of other social features of the life of those who participate in the practices—is itself a product of liberalism. These practices are justified within the web of beliefs precisely because they are accepted as conveying meanings about the world, duties, the good, and what it means to be a member of that community. I now want to turn to the possibility of dialogue between traditions of moral and rational inquiry by turning, in a more concerted way, to the work of Alasdair MacIntyre.
According to MacIntyre, a tradition begins with a certain set of premises, such as what defines human nature and the human good or human telos. These definitions are only possible from within a cultural, historical and linguistic context. That means that what counts as rational is bounded by the starting points, the perceived goal and the milieu within which it occurs. He states:
[D]ifferent individuals and groups express their views and attitudes in their own terms, whatever these may be. Some of these individuals or groups may be members of synagogues or churches or mosques and express their views as injunctions to obey divine law. Some may be adherents of some non-religious, say Aristotelian or quasi-Aristotelian, theory of the human good. Others again may espouse principles concerning, for example, universal human rights, which they simply treat as not requiring further grounding. What each standpoint supplies is a set of premises from which its proponents argue to conclusions about what ought or ought not to be done, conclusions which are often in conflict with those of other groups. (MacIntyre, 1988, p. 342)
Thus, someone from within one tradition may very well reason to a very different conclusion than another person from within another, both satisfying criteria for rationality from within their respective traditions and both being considered just within each of their traditions.
This gives rise to disagreements between traditions. The only way that these disagreements can be resolved is through enquiry aimed at delineating which of conflicting sets of premises are in question, but this requires some linguistic kinship between traditions, which may or may not exist (MacIntyre, 1988, p. 343). In Whose Justice? Which Rationality?, MacIntyre sketches a narrative history of three different traditions of intellectual enquiry—Aristotelianism, Augustinianism, and Humeanism—and delineates the outlines of a fourth—liberalism. Each tradition has its own set of standards for rational justification, authoritative texts, and internal arguments about the interpretations of those texts. Each differs on its list of the virtues, conceptions of selfhood, and metaphysical cosmologies. Each also has its own history of development with dialogue and debate from within the tradition, but also has a history of dialogue and debate from challenges put to the tradition by a different tradition (MacIntyre, 1988, pp. 349-350). MacIntyre continues:
Each tradition can at each stage of its development provide rational justifications for its central theses in its own terms, employing the concepts and standards by which it defines itself, but there is no set of independent standards of rational justification by appeal to which the issues between contending traditions can be decided. (MacIntyre, 1988, p. 351)
There is no place outside of a tradition from which one can objectively assess the tradition.
How do groups that must interact get past these impasses? Macklin concludes that either we must accept the challenge of post-modernity that there are no overarching principles that bind all cultures, or else conclude that there are such principles (Macklin, 1998, p. 419). While her conclusion is of course the latter, she fails in establishing that there are overarching principles that are applicable in all times and places. She ultimately only shows that she can use the principles of liberal modernity—autonomy, justice, beneficence and non-maleficence—to assess the practices of female circumcision, but never shows why these principles are even applicable to the traditions that endorse them. Her enquiry is only applicable from within the bounds of what counts as rational within the liberal intellectual tradition. She merely asserts that this liberal form of rationality with its four overarching principles is transferable to and translatable into all cultures and languages and are therefore applicable in all times and at all places.
These two choices—give in to relativism or assert the Western form of rational justification—are not the only possible ones. Another more difficult way is offered by MacIntyre: a way that he has convincingly claimed to be at work prior to the rise of modernity, at work within pre-modern cultures to this date, and at work within liberalism, even while liberal individualists, like Macklin, deny that it is at work; yet MacIntyre’s is not a meta-claim, for he fully acknowledges living with a tradition of inquiry that values the sorts of justifications given by those who engage in academic discourse of the late Middle Ages.
On this version of inquiry, which seems applicable here, change occurs when one of two kinds of challenges are made to a particular tradition. First, someone from within the tradition begins to question the authoritative beliefs or texts, allowing the adherents to explore rational possibilities for coherent responses. Clearly, new situations may lead someone to see the practices in a new light or to understand a practice in a different way. What Nussbaum and Sen point out about Indian philosophy is undoubtedly true of the myriad of African cultures and practices (Nussbaum & Sen, 1987, pp. 29-30). There is not nearly so much homogeneity between these cultures and their practices as we in the West might assume. Moreover, as Uma Narayan has pointed out, the internal conceptual resources will differ from group to group, making dialogue more or less difficult (Narayan, 1993, pp. 186-199).
Internal dissent is a very real possibility. These internal challenges will result in new questions about the practices and may even result in the abandoning of the practices. But this does not mean that Africans generically speaking must critique these practices, because there exists enormous diversity between tribes within the same geographic region, let alone across all the continent. A South African person may indeed have quite different kinds of values and concepts of virtue, than say Central or Northern Africans. The tribal differences between the Gikuyu and Maasai are such that they do not speak the same sort of cultural language. Thus, someone from within the Gikuyu clan must find that the practices no longer cohere for the Gikuyu. Internal dissent then means not that South Africans are in a position to critique those in the East who participate in these practices, but that those who speak the same cultural language must call them into question.
In addition to the internal challenges, a second kind of challenge comes when one tradition may encounter another with each tradition posing new questions to the other. Thus, each tradition must develop in order for it to withstand the dialectical questioning of another tradition. These occur by chance at times, when one group migrates into the region of another group, or by political force, as with imperialism/colonialism, or through United Nations sanctioned non-governmental organizations, which work to promote literacy and dialogue groups (Nussbaum & Sen, 2000, pp. 197-227). Here Macklin’s challenges come into play; but again not as some set of overarching principles. Hers is just one tradition that bumps up against and challenges another tradition; her challenges may or may not make sense to those she challenges. In other words, the reason normative bioethics challenges indigenous practices is not because they are transcultural or transhistorical, but merely because they do have some value in calling into question indigenous practices. But this must be a two way street, for at the same time cultures that participate in these practices do in fact call into question the normativity of Macklin’s tradition. In short, the liberal tradition itself is molded and shaped by such encounters, which means it is not transcultural or transhistorical.
MacIntyre identifies three stages of development within traditions:
A first [stage] in which the relevant beliefs, texts and authorities have not yet been put in question; a second in which inadequacies of various types have been identified, but not yet remedied; and a third in which response to those inadequacies has resulted in a set of reformulations, reevaluations, and new formulations and evaluation designed to remedy inadequacies and overcome limitations. (MacIntyre, 1988, p. 355)
There is then a movement of traditions in which the contingencies of history, engagement with other traditions and social circumstances all play a part. This discussion is not limited to intellectual development though, because ‘‘beliefs are expressed in and through rituals and dramas .. .the reformulations of belief are not to be thought of only in intellectual terms; but as that through which thinking individuals relate themselves to each other’’ (MacIntyre, 1988, p. 355). That means that the ritual practices through which a tradition articulates itself are also changing and developing based on the changes and chances of social discourse. Again, as pointed out above, the challenges occur in both directions. Each tradition challenges the other. While MacIntyre is documenting the development of a series of Western traditions, his analysis possibly extends beyond the level of rational inquiry in the West to the practices of traditions that have little or no correlates in the West, again acknowledging that MacIntyre is the product of the West.
In addition, MacIntyre rejects the correspondence theory of truth as a construction of modernity, preferring to establish true and false judgments in terms of traditions of enquiry (MacIntyre, 1988, pp. 356-358). Truth and falsity are not formed by assessing a judgment against a fact. Moral enquiry done within a tradition recognizes that the falsity of a judgment is always only acknowledged in retrospect. It is not rational within any tradition to make a judgment while one knows it is false when making it. Based on the questions put to the tradition and the responses of that tradition, one can, in retrospect, claim that one had a false formulation in the previous construction of the judgment. On the other hand, the test for truth in the present is to
summon up as many questions and as many objections of the greatest strength possible; what can be justifiably claimed as true is what has sufficiently withstood such dialectical questioning and framing of objections. In what does such sufficiency consist? That too is a question to which answers have to be produced and to which rival and competing answers may well appear. And those answers will compete rationally, just insofar as they are tested dialectically, in order to discover which is the best answer to be proposed so far. (MacIntyre, 1988, p. 358)
That means that truth claims are constantly challenged. At some point they can become institutionalized and made authoritative, but they will only last as long as they withstand the dialectical challenges, both internal and external. If some are considered sacred and therefore beyond challenge, then many times the sacred texts are reinterpreted in order to maintain the rationality of the tradition, through the recognition of the inadequacy of the previous interpretation.
It is here that positions like that of Macklin and other anticircumcision activists fail. Their truth claims are made with appeal to principles that are only possible from within the Western liberal individualist tradition and yet are made out to be transcultural and transhistorical. They will also appeal to Western scientific explanation and they will appeal to Western legal standards, all of which only make sense within the Western liberal tradition. Thus, we see various tactics—all of which have failed—to change the practice of female circumcision by appeal to truth claims that can only be made from within the Western tradition.
As early as 1906, several colonial powers within Africa tried to control the practice of female circumcision with legislation. In no case did the prohibitions actually result in the cessation of the practices (Gruenbaum, 2001, pp. 202-209). Enforcement of the legislation was difficult. In one case the British authorities arrested a midwife who performed the circumcisions. The indigenous people revolted and tore down the jail where the woman was being held. To this date, the people of Rufa, a town on the Blue Nile, refer to this incident as ‘‘our Revolution’’ (Gruenbaum, 2001, pp. 206-207). The colonial government seldom again enforced the legislation. Because the legislation was imported from the colonial government and not born out of a genuine cultural movement to stop the practices, they failed (Gruenbaum, 2001, p. 207). These legislative actions made no sense within the local traditions, which embraced different premises and conditions of rationality from the colonial power.
In the 1970’s, several feminist social activists got involved in the condemnation of these practices. Sandra Lane and Robert Rubinstine make an interesting claim. They suggest that the women’s movement in the United States, which had taken on the female circumcision issue as their cause, in part stems from a cultural phenomenon occurring in the US beginning in 1966 with the publication of Masters and Johnson’s Human Sexual Response establishing the centrality of the clitoris in female orgasm (Gruenbaum, 2001, p. 139; Lane & Rubinstine, 1996, p. 35). They claim that feminists in the United States ‘‘linked their aspirations for autonomy and self-determination with control over their sexuality’’ (Lane & Rubinstine, 1996, p. 35). They point to several cultural phenomena like the 1973 National Organization for Women’s meeting where Betty Dodson showed slides of close-up photographs of women’s vulva, for which she received a standing ovation. In addition, Judy Chicago created a work of art called ‘‘The Dinner Party’’ in which she created thirty-nine ceramic dinner plates depicting the genitals of famous women throughout history. The point here is that the cultural milieu of the 1970’s gave birth to activists like Fran Hoskens, who in 1973 became the most vocal anticircumcision activist, lobbying the World Health Organization to work to denounce the practices (Lane & Rubinstine, 1996, p. 35). Hoskens refers to the practice as ‘‘sexual castration’’ (Gruenbaum, 2001, p. 139). The problem is that Hoskens’ activities usually presented a very intolerant and judgmental stance on these cultural practices. Her ‘‘eradication now!’’ platform contrasted strongly with the gradualist approach of the Sudanese government (Gruenbaum, 2001, p. 22).
I contend then that those activists in the United States and the West who worked against female circumcision in the 1970s and 1980s did so as a result of the symbolic value that the clitoris held for them as educated, articulate, socially minded, and liberated women. The clitoris was symbolic of their own desire for sexual freedom and desire to overcome male domination, as they had experienced it. The clitoris represented the fruition of feminist philosophy, which grew out of the liberal intellectual tradition, even while critical of it (Nussbaum, 2000, pp. 197-227). Because the body is present to the perception of Western thought, one simply has to map American feminist thinking about the body onto the bodies of African women. The anti-circumcision activities of American activists were as much about a cultural trend within the West as it was about African cultural practices. As MacIntyre points out, in the practical reasoning (read ethical reasoning) of liberal modernity ‘‘it is the individual qua individual who reasons’’ (MacIntyre, 1988, p. 339). Thus, Western activists have ignored their own cultural traditions formed by the liberal intellectual tradition and are doing little other than asserting the concretions of their own culture.
The more recent critics have toned down their language and shifted their focus to women’s health concerns. Yet, Western conceptions of health may still escape any of the traditional tribal notions of health, as I have pointed out above. In fact, many educated African women have articulated a similar conclusion. They took umbrage at many of the stances of non-African women who denounced the practices because their critique of the practices came not out of an understanding of African cultures, but out of the sense of Western liberalism’s interference (Gruenbaum, 2001, p. 25). As Gruenbaum points out, many African women are upset with American activists who attempt to eradicate this one practice, but who care little for the starving children of these women who have been circumcised. The health concerns of these African women focuses on their starving children and not on their bodies. Conceptions of body and health are, after all, are a product of tradition. Certainly, we share some things in common, but the issues we hold as important may not be the same as those of African women and may have more to do with what is going on with us, than with them.
I am encouraged by the recent work of Ellen Gruenbaum, who has spent several years in Sudan in order to speak the language as well as understand culturally what is at work within these traditional practices. Gruenbaum, trained in the Western social science of anthropology, understands the justifications offered by these traditions and can respect these traditions for what they are. Moreover, she documents several examples where one tribe that performs the sunna, the less involved practice, comes into close contact with another that performs infibulation. She documents how the practices of each group began to change, as did the meanings of the practices. Gruenbaum remains fully a Westerner, who cannot justify the practices from within her own cultural tradition, which is as it should be. She does rather uncritically assume the foundations of human rights in the last two chapters of the book, not acknowledging that the concepts of rights are themselves embedded in a particular cultural tradition. However, she is able to do what MacIntyre calls moral inquiry from within a tradition. She understands that as the West continues to encounter different cultural practices incompatible with its conception of the good, it will be in a position to pose questions to the people within those cultures. These people will begin to question the reasons given for the practices and will find new ways to formulate the cultural significance of such practices, find new practices that convey the same cultural significance, or abandon the practices altogether.
On the other hand, the participants in these practices may reject some of the questions that the West poses. They may point out that the West is actually asking the wrong kinds of questions of traditional African practices. And if the dialogue between traditions is to be a real dialogue, they will ask Western traditions a series of questions that will challenge the Western liberal tradition itself. Will there be traditional Maasai or Gikuyu groups sitting in circle asking the hard questions of Hoskens or Macklin? Gruenbaum acknowledges the need for this kind of dialectic. She formulates questions that must be entertained by the West. She begins to articulate questions, not just asking the traditional cultures of Africa to justify themselves, but also asking her own Western liberal intellectual tradition to justify itself, particularly with regard to the political and economic systems born out of the Enlightenment (Gruenbaum, 2001, p. 202). African women, who are struggling to reformulate the role of these practices in traditional culture, are posing questions of the so-called Western Enlightenment, asking it to justify its practices, and conceptions and traditions; and Gruenbaum, a Western social scientist, understands that these questions are pertinent for the West.
What we have presently in the realm of international dialogue in bioethics are protests led by activists from within the traditions of the Western Enlightenment project against the practices of those cultural traditions, unaware of the tradition of liberal modernity. What MacIntyre offers from a philosophical perspective and what Gruenbaum offers from the anthropological perspective is a way past the present impasse, toward a more serious dialogue between traditions striving to coexist. MacIntyre’s description of moral enquiry may not offer the quick results sought by Westerners who want to see female circumcision eradicated, but it is an approach that allows traditional formulations to maintain the integrity of their own moral constructs, rational justification, and development in the face of new contingencies. For these practices to disappear, they will have to no longer be possibly justifiable from within the tradition itself and not because of some Enlightenment appeal to universally valid principles of rationality and rational moral enquiry. If these practices are to disappear, it will require the reformulation of the tradition itself, which will of course take time. But in that time, the tradition itself will be shifting so as to be rationally justifiable on its own terms, a rationality delineated by the tradition itself. This is not to say that all traditions are rationally coherent on their own terms. For even rationality itself, as MacIntyre points out, is open to the dialectical questioning from other traditions and from within the tradition itself.
It may of course be said of the analysis offered here that, in the way I have used MacIntyre’s notion of tradition, I have given this notion a place similar to that of principles; tradition, broadly defined, does occupy the overarching standpoint from which I have made my analysis. This assessment is of course correct; for I do not deny that I occupy a tradition fully and completely that of the Western intellectual tradition. Nor do I deny that I am using this Western idea of tradition as a lens through which to see and understand the web of beliefs of traditions foreign to the Western intellectual tradition. Thus, everything I have said about the practices of female circumcision—sunna—may not at all apply to the way the practices might find justification within their own web of beliefs; only the practitioners are in a position to judge. But this analysis was not offered to practitioners of sunna as some sort of way for them to justify these practices to the West. This analysis is not meant to be a justification of the practices. Rather, it is offered as a critique of Western liberalism, and as such, I have only to show that it is possible that the practices are justified within their own traditions—even if those practices are under assault from both internal and external sources—not to show explicitly how those justifications might cohere for them. That would presume too much on my part. Liberalism is completely a product of the West and I have offered a critique of it from a different kind of trajectory within the Western intellectual tradition. In short, I am claiming that the issues around female circumcision afford us the opportunity to evaluate some things about ourselves.