Circumcision: A Dilemma

Introduction

Circumcision is a complex phenomenon that can result in ethical dilemmas. To put it simply, circumcision consists of surgical operations on female and male genitals. For males, it typically involves the removal of the prepuce (foreskin) or its parts (Jacobs & Arora, 2015). Female genital circumcision is more varied. It can include not very harmful operations that puncture the clitoral hood and more dangerous ones that affect the hood, clitoris, and labia (Vissandjée, Denetto, Migliardi, & Proctor, 2014). The most extreme approaches can involve the removal of the clitoral glans, as well as inner and outer labia (Gordon, 2017). Dangerous female circumcision may be more correctly termed as female genital mutilation.

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The main reasons for circumcision are religious and health-related. For example, circumcision can be used in the case of phimosis, but some people also have it performed to prevent health issues (Gordon, 2017; Jacobs & Arora, 2015; Reis-Dennis & Reis, 2017). Additionally, some attempts at restricting sexuality with the help of circumcision have also been observed (Svoboda, 2017; Vissandjée et al., 2014), and aesthetic reasons can be cited (Jacobs & Arora, 2015). Circumcision is typically performed on underage people; infants and young children can be subjected to the procedure by their parents because it is less risky in childhood (Jacobs & Arora, 2015). As a result, it is apparent that multiple human rights and ethical issues arise in connection with circumcision. Given the wide variety of the types of procedure, their discussion should be nuanced. However, it can be suggested that unless a particular instance of circumcision can be characterized as a medical right, it is likely to be connected to serious ethical and human rights problems, which a nurse can and should address.

When circumcision is required for health reasons, the attitudes toward it are likely to be positive (Jacobs & Arora, 2015). However, non-therapeutic circumcisions tend to cause negative, positive, and neutral attitudes. Here, it should be noted that all the approaches to circumcision can be approved by particular communities. For instance, while female genital mutilation brings immense negative outcomes, certain groups find advantages in it. Said advantages include the promotion of culture and traditions, the discouragement of adultery and prevention of “disgrace,” which is associated with female sexuality, and the value of a rite of becoming a woman (Gordon, 2017). The latter two outcomes are viewed as beneficial for the victims themselves. Apparently, the main reasons for such opinions are cultural; the people who belong to a culture that supports female genital mutilation may view it as appropriate, useful, and necessary. The people who do not have similar affiliations are likely to oppose it or take a neutral position. Medical organizations tend to criticize the procedure because of its disastrous health outcomes (Gordon, 2017; Vissandjée et al., 2014). However, the situation is more complex when non-therapeutic male circumcision is concerned.

Cultural factors, naturally, are also of importance for male circumcision; religious reasons are quite common. Apart from that, this procedure is typically viewed as harmless or beneficial. Therefore, at least one reason for its support is connected to the evidence, which indicates its positive outcomes. Male circumcision is indeed associated with some health benefits, including reduced infection transmission (for instance, human immunodeficiency virus and papillomavirus) (Jacobs & Arora, 2015). Also, Jacobs and Arora (2015) point out that in communities that value circumcision, it can provide sexual, emotional, and spiritual advantages. It should be emphasized that the mentioned benefits can be debated (Burgess & Murray, 2015). Still, some evidence indicates that there are positive outcomes of non-therapeutic circumcision, which may affect related attitudes.

However, male circumcision can also have lasting negative effects. The human foreskin has a few proven functions, including physical and immunological protection; furthermore, it is a source of sexual pleasure (Svoboda, 2017). The removal of this part of the skin deprives people of its positive effects and causes pain. Moreover, it can be argued that the removal of the skin without any medical reasons is already a form of harm since it affects a body’s integrity (Dijk, 2017; Reis-Dennis & Reis, 2017; Svoboda, 2017). Reis-Dennis and Reis (2017) and Svoboda (2017) point out that this kind of surgery is irreversible, which is why its nonmedical application is even more questionable.

Svoboda (2017) also notes that many men who were subjected to the procedure as infants experience negative emotions about the event. Hammond and Carmack (2017) demonstrate that circumcision can result in psychological and self-esteem issues. Finally, it is important to remember that unnecessary surgery holds the risks of injury, and traumas have been evidenced to occur, even though they are relatively rare (Hammond & Carmack, 2017; Jacobs & Arora, 2015; Svoboda, 2017). In summary, there are physiological, psychological, sexual, and other negative outcomes of non-therapeutic circumcision in males (Hammond & Carmack, 2017). The procedure cannot be called harmless, which may be one of the reasons why people oppose it, especially when child circumcision is concerned.

There is still no common decision regarding the non-therapeutic circumcision of male children. For instance, the American Academy of Pediatrics states that the benefits which are associated with the procedure are greater than related risks (Svoboda, 2017). On the other hand, the Royal Dutch Medical Association stated in 2010 that it would not view non-therapeutic circumcision of male infants and children as appropriate. However, the latter organization did not focus on the medical outcomes; rather, it adopted a human rights perspective. In particular, the Association views infant circumcision as problematic because it is “in conflict with the child’s right to autonomy and physical integrity” (Dijk, 2017, p. e225). The association claims that such changes to a child’s anatomy can only be justified by medical necessities; in any other case, they should be regarded as a breach of human rights. Thus, it is necessary to consider the ethical and human rights issues that are associated with circumcision.

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Human Rights and Ethical Issues

From the perspective of ethics and human rights, therapeutic circumcision is the least controversial one. While it can be done to a young child who cannot consent, medical necessity and the right of the child to care justifies it and its negative outcomes (Dijk, 2017). However, nowadays, non-therapeutic circumcisions remain common. In the case of female genital mutilation, the general opinion is that it is an issue, which is associated with cultural differences. The procedure results in “death, infection, gangrene, and post-traumatic stress,” among other problems (Gordon, 2017, p. 2). Most commonly, the decision to circumcise women comes from religion-based ideas about female sexuality, which are sexist (Vissandjée et al., 2014). Therefore, female genital mutilation causes much harm while also indicating a form of discrimination, which makes it a violation of human rights and the ethical principle of non-maleficence.

Female circumcision is not very controversial because it is difficult to contest the mentioned issues. Cultural differences, while they should be taken into account, are unlikely to justify discrimination and mutilation. Rather, female genital mutilation is a problem that has its roots in the cultural specifics of various peoples, which is why it requires sensitive approaches (Gordon, 2017; Vissandjée et al., 2014). The truly problematic circumcision is the one that is applied for non-therapeutic reasons to male children. The procedure is less harmful and can arguably be good for one’s health. However, from the ethical perspective, two critical issues should be mentioned.

First, for ethical care, it is essential to follow the principle of non-maleficence. Given that non-motivated circumcision is not harmless, the procedure does not correspond to this guideline (Jacobs & Arora, 2015). Second, it should be highlighted that children have the right to the integrity of their bodies and autonomy (Dijk, 2017; Jacobs & Arora, 2015). These rights can be violated when parents make decisions for them, especially when an irreversible surgery is being discussed. Therefore, from the perspectives of ethical guidelines and human rights, it is difficult to justify the circumcision of male children.

An opposite view has also been proposed. Jacobs and Arora (2015) point out the significance of cultural differences, which may affect the attitudes toward circumcision, lack of circumcision, and human rights. The lack of circumcision in such environments can result in negative outcomes, especially psychological or social ones. However, as was mentioned, it is difficult to use cultural differences to justify bodily harm or discrimination.

In this regard, Jacobs and Arora (2015) also note that children’s rights to autonomy might conflict with their rights to health. Given that the procedure does yield some health benefits, the authors suggest that the circumcision of male minors can be justifiable from the perspective of human rights and ethics. However, it should be noted that the health benefits of circumcision may require additional research (Burgess & Murray, 2015). Thus, non-therapeutic circumcision in both males and females seems to be questionable from ethical standpoints.

The Role of a Nurse

As healthcare providers, nurses may face issues related to circumcision. Additionally, as advocates for human rights, nurses would be expected to take relevant action. When child mutilation, which would endanger the child’s life, safety, or health, can occur, a nurse would be expected to report the issue and attempt to protect the patient from harm. However, when the less dangerous types of circumcision are of interest to grown people or the parents of a child, a nurse should help them make an informed decision. This outcome can be achieved by explaining the medical and ethical aspects of the procedure.

As a healthcare provider, a nurse is likely to have an improved understanding of the matter; for instance, the presented evidence can be used during such consultations. However, it is important to keep the conversation culturally sensitive since ritual circumcision is often connected to major aspects of one’s cultural identity (Gordon, 2017; Vissandjée et al., 2014). Additionally, healthcare providers, including nurses, need to contribute to the study of the issues related to circumcision and help policy-makers make informed decisions. Thus, the role of nurses in resolving circumcision problems is notable.

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Conclusion

Circumcision is a term that is used for multiple procedures, some of which can reflect the human right to healthcare. However, when circumcision is not motivated by health concerns, it is typically associated with ethical ones. Non-therapeutic circumcision is often performed on young children, which deprives them of their right to autonomy and bodily integrity. Additionally, the positive outcomes of circumcision are not very well-proven, but their harm is documented. The cultural aspects of circumcision are of importance when dealing with the issues. By helping individual patients and their families and being politically active, nurses can help to resolve the problems that are associated with circumcision.

References

Burgess, S., & Murray, S. (2015). Cutting both ways: On the ethical entanglements of human rights, rites, and genital mutilation. The American Journal of Bioethics, 15(2), 50-51. Web.

Dijk, G. (2017). Non-therapeutic circumcision: The ethical position of the Royal Dutch Medical Association. The Journal of Sexual Medicine, 14(5), e225. Web.

Gordon, J. (2017). Reconciling female genital circumcision with universal human rights. Developing World Bioethics. Web.

Hammond, T., & Carmack, A. (2017). Long-term adverse outcomes from neonatal circumcision reported in a survey of 1,008 men: An overview of health and human rights implications. The International Journal of Human Rights, 21(2), 189-218. Web.

Jacobs, A., & Arora, K. (2015). Ritual male infant circumcision and human rights. The American Journal of Bioethics, 15(2), 30-39. Web.

Reis-Dennis, S., & Reis, E. (2017). Are physicians blameworthy for iatrogenic harm resulting from unnecessary genital surgeries? The AMA Journal of Ethic, 19(8), 825-833. Web.

Svoboda, S. (2017). Nontherapeutic circumcision of minors as an ethically problematic form of iatrogenic injury. The AMA Journal of Ethic, 19(8), 815-824. Web.

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Vissandjée, B., Denetto, S., Migliardi, P., & Proctor, J. (2014). Female genital cutting (FGC) and the ethics of care: Community engagement and cultural sensitivity at the interface of migration experiences. BMC International Health and Human Rights, 14(1), 1-10. Web.

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