The sublime is not always beautiful. Sometimes it arrives as a confrontation, a disturbance, a rupture. In healthcare, it can come in the form of a cultural belief or practice that does not merely differ from Western clinical norms, it clashes viscerally, unavoidably, with them.

These are moments of ethical clarity and discomfort. And yet, they are often misunderstood. They are flattened into “cultural misunderstandings” or pathologised as ignorance. However, this misses what they truly are: sublime collisions between systems of meaning, each coherent within itself, but utterly incompatible with the other.

This article explores those moments when the sublime offends and how clinicians, ethicists and systems of care must respond. It also makes a critical distinction between cultural humility and cultural relativism, a distinction that must be clear if public services are to act ethically in a pluralistic world.

When Cultural Practice Becomes Ethical Obstruction

Let us begin plainly: not all cultural practices are morally defensible. Some are not misunderstood, but they are understood all too well, and it is precisely that clarity that demands action.

Female Genital Mutilation (FGM) is one such case. To describe it as a “sensitive cultural issue” is to obscure the reality of the non-consensual cutting (literally, mutilation) of a young girl’s body in the name of purity, tradition or family honour. It is a practice embedded in community, belief and ritual. It is a form of violence. And standing before it, the healthcare professional feels the full weight of the sublime: a practice ancient, sacred to some, and yet wholly unacceptable by the standard of justice, autonomy and human rights of Western societies. Scarification of adolescent males could be another example of this.

This is not a space for “appreciating diversity”, but for ethical confrontation.

FGM is not the only case. Consider the following:

·       A family that withholds prescribed antipsychotics from a daughter because they believe mental illness is a test from God or a sign of spiritual possession.

·       A parent who refuses chemotherapy for their child, insisting instead on herbal or ritual remedies.

·       A community leader who discourages vaccination during an outbreak, asserting that divine protection is sufficient.

·       A dying patient’s treatment decisions overridden by a patriarchal family member, against the patient’s will.

This kind of cases happens daily. They are not extreme cases. They place healthcare professionals in a liminal-ethical space: torn between listening to the cultural beliefs and the duty to protect life, autonomy and wellbeing.

The Moral Tension

These moments are contact zones between fully formed moral worlds that both run deep. One is governed by evidence, consent and safeguarding. The other by honour, spiritual logic, kinship or sacred obligation.

In these spaces, the sublime does not inspire awe, but ethical disorientation. It sparks confusion. They are morally overwhelmed by the implications of what they are seeing. What feels like care to one system is harm in another. What feels like protection to one family could feel like a betrayal to the healthcare professional, who must act decisively and with resolve.

Cultural Humility is not Cultural Relativism

We have to make a crucial distinction. Cultural humility is a practice of ongoing self-reflection, curiosity and ethical attention. It means recognising the scale and depth of other worldviews. It means listening before judging. It means avoiding the trap of thinking your own worldview is neutral or superior by default. Hence, the ‘humility’ part of the label. Conversely, cultural relativism says, “we cannot judge”, that all beliefs are equally valid, all practices contextually justified. Cultural humility focuses on listening, but also has some red lines that must be drawn.

For example, FGM is a red line. Medical neglect under the guise of spiritual belief is a red line. Withholding medication from a mentally ill family member who cannot advocate for themselves is a red line.

Encountering this and not having any ethical clarity becomes complicity.

What does ethical action look like?

Ethical action in the face of the offensive sublime is clarity grounded in moral responsibility and cultural depth.

It means:

·       Intervening where necessary to protect the vulnerable.

·       Refusing to idealise cultural practices simply because they are “traditional” or “sacred”.

·       Building trust even while setting firm boundaries.

·       Collaborating with cultural insiders, such as community leaders, interpreters and healers, who can help shift narratives from within.

·       Acknowledging the scale of what is being confronted and not simply to justify it but to respond with proportional seriousness.

The Internal Conflict: The healthcare professional at the threshold

These encounters can also reshape the healthcare professional. They leave a mark. There is a before and an after. It can produce moral injury, quiet grief and even a crisis of faith in one’s own role.

This is part of the sublime. It’s not about encountering the vastness, but the shaking of one’s moral clarity under pressure. There need to be systems in place that support healthcare professionals through situations like these, emotionally and not just ethically.

Holding the Line

There is a common anxiety in liberal societies: that to intervene against cultural practice is to become oppressive. This is a false binary. You can act with ethical confidence and cultural care. You can say ‘this is not right’ without saying ‘I am better’, drawing lines without raising walls.

When the sublime brings friction and shakes us to the core, we are called to meet it with integrity. We can say that we see the depth of belief and the vastness of the conviction, but we must prevent this harm. Not because a culture is inherently wrong, but because preventing the harm and protecting the innocent are too important to leave unchallenged.

Thank you for reading,

Mark Gibson

Leeds, United Kingdom, May 2025