Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury

doi:10.1001/journalofethics.2017.19.8.msoc2-1708

Cited by 14 publications

(8 citation statements)

References 44 publications

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“…Much recent conversation has occurred in media and literature regarding the purported benefits, risks, and ethics of nontherapeutic circumcision (NTC) of male neonates in the US (Svoboda, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Opponents of the practice argue that RIC is ethically contentious, and results in a permanent nontherapeutic alteration to the body of a minor who is too young to understand or consent (Svoboda, 2017). The most recent available publication regarding circumcision complications found rates highly variable and ranges from 0% to 14% in global reports (UNAIDS, 2010).…”

Section: Introductionmentioning

confidence: 99%

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Self‐care promotion of the intact (non‐circumcised) patient: A review of available recommendations

Wodwaski

Munyan

2020

Specialist Pediatric Nursing

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Purpose: With routine infant circumcision rates declining in the United States, nurses are likely to encounter more intact (non-circumcised) male patients requiring genital hygiene, nursing interventions, and education accessing the health system. To date, a little emphasis has been placed on the care of the intact male patient in the nursing literature, resulting in ambiguity in care recommendations. The vagueness is problematic, as improper intact care, particularly in the pediatric patient, can result in forced retraction injuries, bleeding, scarring, and unnecessary intervention. In addition, with nurses conducting many of the tasks of hygiene and education for self-care, there is potential for impaired patient self-care and harm if nurses are not knowledgeable in intact care. Utilizing Orem's self-care theory as a framework, the aim of this effort is to perform a review of current recommendations on intact care to inform nursing practice with this population. As no evidence was found in the scientific literature, readily available consumer website resources were reviewed. Conclusion: Themes of hygiene and age of retraction emerged. While recommendations for hygiene practices were variable, all review sources (n = 12) were clear in advising against the premature retraction of the intact foreskin and identified this as a route for injury. Practice Implications: With no current literature available to summarize current nursing clinical or educational practices, dissemination of these recommendations is necessary to prevent patient injury and promote appropriate patient self-care. K E Y W O R D S forced retraction, intact care, Orem's theory of self-care, uncircumcised How to cite this article: Wodwaski N, Munyan K. Self-care promotion of the intact (non-circumcised) patient: A review of available recommendations.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Self‐care promotion of the intact (non‐circumcised) patient: A review of available recommendations

Wodwaski

Munyan

2020

Specialist Pediatric Nursing

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“…A categorical position is adopted by Andrew L. Freedman, a former member of the American Academy of Pediatrics Task Force on Circumcision, as he conceded that circumcision is fundamentally a religious or cultural practice in search of a ‘medical’ justification. 4 At opposing end of the debate stands the Center of Disease Control (CDC) and the American Academy of Pediatrics (AAP), both concluding that the benefits of neonatal circumcision greatly outweigh the risks, suggesting at the same time, that the procedure be made available to informed parents asking for it for their sons. 95 Situating itself somewhere equidistantly between these two poles, the Canadian Pediatric Society considers that the medical risk: Benefit ratio of routine newborn male circumcision is closely balanced and that it is challenging to make definitive recommendations for the entire male newborn population in Canada.…”

Section: Resultsmentioning

confidence: 99%

“…3 In recent years, the rate of neonatal circumcision has been dropping in the United States, but it still varies among certain populations. 2 Despite the prevalence of this procedure, there are a number of ethical and moral debates surrounding the practice of male circumcision, 4 especially regarding whether a neonate can give consent for his own circumcision. In June 2012, an appellate court in Germany ruled that nontherapeutic circumcision of boys is irreversible bodily harm that violates the child's right to autonomy and self‐determination and that the procedure should be delayed until an age where the boy can consent for himself.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of complications arising from male circumcision

2021

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Background: Neonatal male circumcision is the most common procedure performed on paediatric patients (Simpson et al., 2014) and one of the most common surgical procedures in the world (American Academy of Pediatrics, 2012).Methods: A search was conducted for articles about complications arising from male circumcision surgeries by entering the term 'male circumcision' into PubMed on June 16, 2020. Six thousand six hundred forty-one articles published from 1945 to 2020 were found. Seventy-eight articles were ultimately selected for the systematic review.Results: The 78 articles selected from the literature search were entered into one of three tables. The first table includes 15 articles pertaining to chart reviews and cohort studies and report complication rates. The second table reports specific complications from 51 case reports and case series, and the third table is a summary from 12 articles regarding physician questionnaires and society recommendations. Additionally, the 78 articles were used to compile a list of 47 specific complications arising from male circumcision surgeries.Conclusions: Complications from neonatal male circumcisions are common and healthcare providers need to be better informed of the potential complications of the surgery so that they can more effectively counsel their patients about potential risks, likelihood of complications and what can be done to prevent them. While experienced providers who practice in sterile settings have better outcomes with fewer complications, encouraging parents to take into account who is performing their son's circumcision, what was their training, how clean is their practice and how much experience they have and reminding them they have the option to decline the procedure entirely allow the parents to get a more complete picture and play an essential role in the decision-making process.

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“…In this supposedly enlightened twenty-first century, destructive genital cutting of non-consenting minors, carried out as a rite of passage, is patently unethical and the time has come to recognize once and for all that children's bodily integrity is a fundamental human right that must be respected. The societal pressure exerted on young healthy boys in the Philippines to endure destructive non-therapeutic genital cutting is clearly a flagrant abuse of power and violation of children's human rights [34,35].…”

Section: Discussionmentioning

confidence: 99%

Post-traumatic stress disorder (PTSD) among Filipino boys subjected to non-therapeutic ritual or medical surgical procedures: A retrospective cohort study

Boyle

Ramos

2019

Annals of Medicine and Surgery

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In the Philippines, non-therapeutic genital cutting is viewed as a culturally sanctioned rite of passage from boyhood to manhood. Strong social and peer pressure is exerted on boys aged between 8-16years to submit to destructive genital cutting, despite the fact that many men who have been subjected to genital cutting during infancy or childhood often describe their experiences in the language of violence, torture, mutilation, and sexual assault. Among a group of 505 Filipino boys subjected to ritual genital cutting (Tuli), 69% fulfilled the DSM-IV criteria for a diagnosis of PTSD, while among 1072 boys circumcised by medical operators or their assistants, 51% exhibited PTSD symptoms. Pursuant to ritual genital cutting, almost 3 out of every 4 boys exhibited PTSD-like symptoms.

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Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury

Abstract: Nontherapeutic circumcision (NTC) of male infants and boys is a common but misunderstood form of iatrogenic injury that causes harm by removing functional tissue that has known erogenous, protective, and immunological properties, regardless of whether the surgery generates complications.

Cited by 14 publications

References 44 publications

Self‐care promotion of the intact (non‐circumcised) patient: A review of available recommendations

Self‐care promotion of the intact (non‐circumcised) patient: A review of available recommendations

Systematic review of complications arising from male circumcision

Post-traumatic stress disorder (PTSD) among Filipino boys subjected to non-therapeutic ritual or medical surgical procedures: A retrospective cohort study

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