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Conflicting clinical duties
  1. Michael J Selgelid, Associate Editor

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The first three articles in the Clinical Ethics section of this issue of Journal of Medical Ethics address potential conflicting duties of physicians. The first paper, by Niklas Juth and Niels Lynöe (see page 215, Editor's choice), reports results of an empirical study of Swedish physicians’ attitudes regarding the provision of virginity certificates or hymen restorations requested by women, often from the Middle East, concerned with “honour-related threats”. Such requests may be motivated by the aim to avoid “honour killings [which] are triggered by allegations of extramarital sexual relations and are considered a way of restoring a family's honour”. While virginity certificates are meant to confirm a woman's lack of sexual experience, hymen restorations may be sought in order to “produce red spots on the sheets during the wedding night,” and thus play a similar role.

Because Sweden lacks guidelines about how such requests should be managed, Juth and Lynöe conducted a survey designed to demonstrate Swedish general practioners’ (GPs’) and gynaecologists’ willingness, or lack thereof, to provide such services. A small majority of physicians indicated they would be willing to provide such services under certain circumstances, but a large minority indicated unwillingness to provide them under any circumstances.

Juth and Lynöe explain the unwillingness of many physicians to provide virginity certificates or hymen restorations by drawing parallels with zero tolerance policies regarding other practices considered to be unacceptable. Though provision of clean syringes to IV drug users may have various benefits, for example, many oppose needle exchange programs due to concerns that they signal acceptance of a practice (i.e., IV drug use) for which there should be zero tolerance. Likewise, according to Juth and Lynöe, despite the obvious benefits virginity certificates or …

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