(2) Then here I put in beliefs and values. And then over here I'm going to talk about extrinsic or external factors. So let's move this way. We all operate with beliefs and values because these are the things that give meaning to our lives. I believe this makes my life meaningful, purposeful, and therefore I value it. So none of us is free of profoundly held beliefs and convictions about what matters and what is worthwhile. The problem is that for the most part, these convictions are unexamined, that are held at the unconscious level.
I think part of the challenge that confronts each of us is bringing up suppositions, presumptions, convictions, to the surface so that we can look at them and either consciously affirm them or reject and adopt new ones. I think this is part of the process of growing up. We grow up largely subscribing to the beliefs and values of our parents. And as we move into adulthood, we bring many of these out on the table and we say, "Yes, I do want to affirm this but I'm not any longer going to buy into that." I can remember going through that process with respect to my father's convictions. There were some things I really endorsed and others where I said no way, I'm not going to follow that. I don't believe that. I think that's part of the human condition.
The problem is that these beliefs and values are largely not amenable to rational persuasion. You don't talk somebody out of their beliefs, because these are held with passion. People are ready often to die for what they believe in. I see this in the medical arena, for example, with Jehovah's Witnesses who believe blood products to be unacceptable and who will say that they are willing to suffer for the sake of that belief, even if the consequence of not getting blood products is death. That's preferable to consciously betraying their convictions.
Respect for beliefs and values: cultural differences
This gets us back into the area of the limits of respect for beliefs and values that may be quite different from those in the mainstream. The most dramatic example of that I can think of has to do with female genital mutilation. There are groups, cultural and religious, who believe this is a good thing to do that it enhances the desirability of the woman or the girl, that it makes her a better marriage prospect. But most of us regard this as barbaric, especially when it's performed on a ten year old girl on a kitchen table with a razor blade without anesthetic. Some countries have moved to criminalize female genital mutilation. We haven't got that far yet. Pat Schroeder was going to introduce legislation to criminalize but I don't think that legislation has gone anywhere.
So we do have cultural groups in our country who continue to practice this. And they will argue from within their belief system that this is a good thing. Whereas, I for one, think it's barbaric. So, there's a tension between beliefs and values pertaining to the group and the common good and that's a tough one. Institutions have values, whole societies have values. It's not just individuals. Stanford Medical School prides itself on its research, on producing not just physicians but physicians who will be leaders in the profession, and third, on clinical care, taking care of patients. Those are the priorities: research, producing leaders in the medical profession, and then taking care of patients. You go to Sequoia Hospital or El Camino Hospital and the priorities are reversed. The first thing is taking care of patients, not much research is going on, and certainly there aren't too many leaders in the medical professions at those institutions. So institutions have values. And then societies have distinctive values, as well.
Lynn Payer wrote a book called Medicine and Culture, which I find fascinating. She was stationed in Paris as an overseas correspondent for The New York Times, I think, and observed that in what was then West Germany, the United Kingdom, France, and the United States, very different decisions were being made for similar problems, for the same problem, not because the science differed in these countries but because of national values that pushed people in one direction rather than in another. So, in the debate about genetics and genetic engineering, genetic testing, there are many belief and value systems that we have to be aware of. When we were talking earlier about the technological imperative, that is a value system. It places very high value on accelerated technological progress whether or not that is a good thing. So, that's a second component.