The issue of circumcision
Human genitals is a matter that is to be treated with utmost care. Yet, history remembers many examples of genital-related surgery actions that are, today, a point of contradiction in the field of medical studies, human rights, and ethics. Genital mutilations are mainly referred to as “a cultural practice” (Denniston & Milos, 2013, p. 1). However, the concerns about the legal and ethical side of such operations are persisting; also, medical studies tend to disagree on whether genital mutilations are at all beneficial for the patients. Some researchers state that the major cause of controversy is the cultural bias the opinions are based on, emphasizing the necessity of an unbiased study to reach a consensus (Pinto, 2012).
Indeed, the reasons to perform genital mutilation are provided in abundance, with the first ever registered written material on the subject being the Holy Scripture that prescribes circumcising, among other reasons, for the sake of cleanliness (Denniston & Milos, 2013). On the other hand, contemporary medical studies reveal both positive and negative consequences of such operations: neonatal circumcision in boys, for instance, is said to jeopardize the protection of glans, which is especially delicate in newborns. Also, the question of ethicality is ever so pressing due to the fact that neonatal and pre-adolescent circumcision is performed without the children’s consent or without their full understanding (American Academy of Pediatrics, 2013). That said, as long as an agreement is lacking, circumcision – male and female, in children and in young adults – will remain a serious issue in the fields of medical studies and human rights.
Human rights and ethical issues surrounding circumcision
Depending on the position on the subject of circumcision performed on newborns specifically, several questions can arise. Firstly, should a newborn be circumcised at all, given that there is no consent from their side? On the one hand, there is the parental authority to refer to. On the other hand, body change operations – if they are not required by the patient’s clinical conditions – are to be performed strictly with the patient’s informed consent. Burgess and Murray (2015) regard any culturally determined operations on newborns as unacceptable. The authors state that parental religious or any other cultural practices (e.g., Judaism, Islam, etc.) do not presuppose the child necessarily adopting these practices during their adulthood. Circumcision, they state, is used both to identify the child as belonging to this or that cultural stratum and deprive the child of any religious and cultural alternative. Consequently, circumcision performed without the child’s consent is a violation of their right to change – or not change – their bodies and to practice – or not practice – religion of their choice (Burgess & Murray, 2015).
It appears that, by relying on parental authority and performing a circumcision on an individual that is yet to be formed as a personality, physicians absolve themselves of any responsibility – and guilt. On the other hand, it is hard to assure that a strict position against neonatal and pre-adolescent circumcision is not culturally biased. A possible solution to this dilemma is that the operation be postponed until a child is psychically mature enough to adequately view the consequences – and whether they wish to belong to the same cultural stratum as their parents to the same extent as their parents do (Diekema, Mercurio, & Adam, 2011).
Is circumcision a medical or a human rights issue?
The question whether genital mutilation, especially in newborns and pre-adolescents, belongs to the field of medical or human rights studies is to be specifically connected with another question: whether there are adequate reasons to continue this practice. More than two decades ago, an article by Milos and Macris (1992) has set its goal at answering these questions. The article revealed that a modern practice of circumcising newborn boys is rooted mainly in preventing them from masturbating during the puberty period. Subsequently, some faux medical reasons to circumcise were adopted, e.g., curbing and preventing infections and STDs that are hardly relevant for children. Albeit the efforts made by Women’s Movement that pressed the issue of both male and female genital mutilation, the practice has evolved a number of biases that justify it, in the eyes of the public. The biases are both for medical studies and human rights to contravene.
The idea that circumcision helps prevent a variety of diseases from penile cancer and AIDS to urinary infections and phimosis are a product of inaccurate medical studies and telltale. The ideas that circumcision is aesthetical, painless, and helpful to the child’s socialization are a product of cultural bias and, in fact, a breach of human rights (Milos & Macris, 1992). The question whether medical benefits alone can justify the possible physical and psychological complications of the procedure is also controversial – mainly because the benefits are few and understudied. However, the child’s well-being is not entirely dependent on their clinical conditions (Diekema et al., 2011). In other words, the potential danger of the procedure cannot be regarded as a final factor in either performing or not performing the operation: such factors as consent should also be taken into account, making circumcision both a medical and a human rights issue.
The role of the nurse in relation to an ethical dilemma involving circumcision
The practitioners facing the dilemma of circumcision, especially among children, should have a good understanding of the controversy surrounding the subject. This, in turn, requires the practitioners’ awareness of the diversity of cultural values in this respect, the history and the circumstances in which circumcision took place, etc. Also, a nurse should be aware of the results of the current studies encompassing the issue – and regard them critically, at the same time. Finally, a nurse should be able to form an opinion on the subject and defend it with relevant arguments (Pinto, 2012). If a nurse decides against the operation, the nurse’s position should not influence that of the parents.
Given that parents are autonomous in deciding whether or not their newborn should be circumcised, it is beyond the nurse’s obligations to influence the parents’ decisions. In turn, if a nurse decides to circumcise a child, they should be aware of the pain-relief methods to employ, given that human – especially infants’ – genitals require proper analgesia when operated on (Hockenberry & Wilson, 2012). Also, a nurse should be able to inform the parents and give them time to think the information over. The information should be unbiased – either culturally or ethically – and detailed. The parents should be well aware of the consequences and possible risks that the operation might involve. The key concept here, therefore, is the lack of bias and promoting parental education on the subject, refraining from personal assumptions and basing all decisions on relevant evidence.
References
American Academy of Pediatrics. (2013). Cultural Bias and Circumcision: The AAP Task Force on Circumcision Responds. Pediatrics, 131(4).
Burgess, S., & Murray, S. J. (2015). Cutting both ways: on the ethical entanglements of human rights, rites, and genital mutilation. The American Journal of Bioethics, 15(2), 50-51.
Denniston, G. C., & Milos, M. F. (2013). Sexual Mutilations: A Human Tragedy. Berlin, Germany: Springer Science & Business Media.
Diekema, D. S., Mercurio, M. R., & Adam, M. B. (2011). Clinical Ethics in Pediatrics: A Case-Based Textbook. Cambridge, UK: Cambridge University Press.
Hockenberry, M. J., & Wilson D. (2012). Wong’s Essentials of Pediatric Nursing. New York, NY: Elsevier Health Sciences.
Milos, M. F., & Macris, D. (1992). Circumcision: A medical or a human rights issue? Journal of Nurse-Midwifery, 37(2), 87-96.
Pinto, K. (2012). Circumcision controversies. Pediatric clinics of North America, 59(4), 977-986.