Routine Infant Male Circumcision
While female genital mutilation has garnered a great deal of attention in recent years, male genital mutilation or circumcision has been for the most part overlooked in research reports. (Redactive Publishing, 2010, paraphrased) The objective of this study is to conduct an examination of routine infant male circumcision. This will involve a summarization and critical analysis of the current literature and reliable published evidence in this area of inquiry. The work of Bocquet et al. (2009) examines the issue of bleeding complications following ritualistic circumcision and reports on six children who are stated to have no family history of hemorrhagic disease and no personal problems of thrombopenia or hemostatis, who were admitted within 1 year at the emergency department for hemorrhagic complications of nonmedical circumcisions, of which one had glans amputation.” ( Five of the children were newborns. All of the newborns had compensated shock with tachycardia and poor perfusion of the extremities, requiring IV saline expansion and/or blood transfusion. Three patients required surgical intervention. For the three others, bleeding stopped with compressive (two children) or noncompressive dressing (one child). The six children remained under observation at the hospital for at least 1 day and up to 8 days.” ( ) Reported in this six children was “severe bleeding complications…leading to surgery under general anesthesia for three and to blood transfusion for three.” ( ) Bleeding incidence following circumcision is reported to vary between 0.1% up to 35%. The bleeding is more often than not only minor and controlled well by manual pressure however, it is reported “more severe bleeding can lead to a surgical hemostasis, with the risk of urethra lesion.” ( ) It is reported that a large study in Israel in 2001 reported “no significant difference between medical and ritual circumcisions.” ( ) An Australian study reports that all of the 136 parents in the study would recommend to other parents that their boys be circumcised. (Xu and Goldman, 2008) As well the work of Bouclin (2005) reports that in Canada, circumcision is a normalized process. The work of Bhattacharjee (2008) reports that presently approximately one-sixth of all newborn males in the world undergo ritual circumcision. Zampieri, Pianezzola, and Zampien (2008) report that it is not agreed upon by anthropologists as to the origination of male circumcision. Research has shown that the foreskin is the “principle location of erogenous sensation in human males” and removal of this foreskin serves to reduce sensations. Ethical concerns of circumcision are addressed in the work of Benatar and Benatar (2003) who report that there is a deep division of opinion about neonatal male circumcision. Benatar and Benatar (2003) report that individuals who hold that circumcision of minors is not moral do so on the basis of removing the child’s foreskin equals mutilation of the child and other object to neonatal circumcisions on the basis that the child lacks the capacity to give informed consent. The work of Sheldon (2003) states that when considering harm in the case of neonatal circumcision it is necessary to consider each individual case since in the case where the parents claim that circumcision is a requirement to place the child into a proper relationship with God it would be nigh impossible to challenge this sort of claim. When circumcision is merely parental preference it is easier to challenge but male circumcision that religiously-based is different when compared to the socially-based circumcision of females. Waldreck (2003) reports that “legal theorists have observed that norms of often regulate behavior at least as effectively as the law. In part, norms are effective because of the costs that are associated with non-compliance.” Waldreck concludes the opinion by stating, “Anyone wishing to see a decrease in circumcision rates faces a collective-action problem. At present, circumcision is consistent with American notions of good parenting. Stubbornly and circularly, this association is likely to persist so long as most parents continue to circumcise, because conceptions of good parenting are informed and influenced by what significant numbers of parents choose to do. Moreover, the parent who might be inclined toward noncircumcision (and could therefore begin to help challenge the social meaning of circumcision) has little incentive to not circumcise, because of the esteem-based or reputational consequences within that parents group and because the norm colors the assessment of other considerations. Thus, for the norm to change, parents have to act collectively. That is, enough of them have to simultaneously choose noncircumcision to make the stigma associated with the foreskin disappear and to color the decision-making process with a norm that favors noncircumcision.” (2011) Henerey (2004) reports that male circumcision is used most often in surgical operations in the U.S. The work entitled “Neonatal Circumcision: Healthy Practice or Barbaric Procedure? Reports that “campaigners and practitioners are in the midst of a heated debate about the benefits of this surgery.” (Duffin, 2011) Professor of immunopathology at University College London, states in the report that the Jews have been “performing neonatal circumcision for thousands of years. It is part of our religious and cultural tradition and is not a health measure. It is a parental decision…” (Duffin, 2011) Duffin notes that Thymos: Journal of Boyhood Studies stated in a 2010 publication “more than 100 babies die annually from circumcision complications in the U.S.” (Duffin, 2011) This is stated to be due to the short period of time following blood loss for effective treatment and the time it takes to reach the hospital. The British Medical Association expresses the belief that a “lack of consensus” exists concerning health benefits of circumcision. (Duffin, 2011, paraphrased) The work of Schultheiss (2010) examines the ethics surrounding non-therapeutic neonatal male circumcision and states that defenses of the use of male circumcision includes those related to: (1) medical defenses; and (2) cultural defenses.) Schultheiss reports that Benatar and Benatar (2003b) examined the issue and reported that “the potential medical harms and benefits approximately balance each other. Reported as one common argument in defense of circumcision holds that men who are circumcised are in the receiving end of more pleasurable experiences sexually and that this can be attributed to the “desensitization of the glans” since the foreskin being removed results in men taking, “on average longer to reach orgasm after beginning coitus.” (2010) However, there are not any conclusive studies in this area of the research to reference in the debate surrounding neonatal circumcision. According to the Current General Medical Council (GMC) guidelines, any doctor no wishing to conduct circumcision that is non-therapeutic, or NTC are required to “invoke conscientious objection. In fact, as reported in the work of David Shaw (2009) that the entire argument on neonatal circumcision can be framed by considering that many individuals who are Jewish and Islamic hold male circumcision to be centric to religious practice and any ban on this practice would be a violation of fundamental human right. The fundamental human right however, appears to be that of a right to exercise religious freedom rather than the fundamental human right of circumcision. Children may be born in their parents views as being a believer in that religious faith at birth. This creates ethical and legal questions as well as professional considerations for the practitioner. Stated as well by Shaw is the principle of doing no harm means that avoiding surgery is necessary “…unless there is a clear potential medical benefit to the patient, and this does not apply in the case of NTC.” (2009) Zuzana Khan, pediatric staff nurse and Whipps Cross University Hospital London states she would provide consent to circumcision but it “should be done in a clean environment, using sterile equipment…” and performed by a practitioner hat is well-trained. (2011) Henerey (2004) Holds that male circumcision is used as a normative control and “In each normative system, an intangible fear of unknown perils is used to promote the manifest ritual of circumcision, with the promise of reconciling the generalized fear.”
Bibliography
Benatar, M & Benatar, D 2003, ‘Between prophylaxis and child abuse: the ethics of neonatal male circumcision’, American Journal Of Bioethics, vol. 3, no. 2, pp. 35-48, CINAHL with Full Text, EBSCOhost.
Bhattacharjee, P 2008, ‘Male circumcision: an overview’, African Journal Of Paediatric Surgery, vol. 5, no. 1, pp. 32-36, Academic Search Complete, EBSCOhost.
Bo, X & Goldman, H 2008, ‘Newborn circumcision in Victoria, Australia: reasons and parental attitudes’, ANZ Journal Of surgery, vol. 78, no. 11, pp. 1019-1022, Academic Search complete, EBSCOhost.
Bocquet, N, Lortat-Jacob, S, Cheron, G & Chappuy, H 2010, ‘Bleeding complications after ritual circumcision: about six children’, European Journal Of Pediatrics, vol. 169, no. 3, pp. 359-362, Academic Search Complete, EBSCOhost.
Bouclin, S 2005, ‘An examination of legal and ethical surrounding male circumcision: the Canadian context’, International Journal of Men’s Health, vol. 4, no. 3, pp. 205-222, CINAHL with Full Text, EBSCOhost.
Duffin, C 2011, ‘Neonatal circumcision: healthy practice or barbaric procedure?’, Nursing Children & Young People, vol. 23, no. 8, pp. 6-7, Academic Search Complete, EBSCOhost.
Henerey, A 2004, ‘Evolution of male circumcision as normative control’, Journal of Men’s Studies, vol. 12, no. 3, pp. 265-276, Academic Search Complete, EBSCOhost.
Higson, A 2010, ‘Who’s looking after the boys?’, Midwives, vol. 13, no. 3, pp. 20-21, CINAHL with Full Text, EBSCOhost.
Khan, Z 2011, ‘Prevention over cure’, Nursing Children & Young People, vol. 23, no. 9, p. 11, Academic Search Complete, EBSCOhost.
Perera, C, Bridgewater, F, Thavaneswaran, P & Maddern, G 2009, ‘Nontherapeutic male circumcision: tackling the difficult issues’, Journal of Sexual Medicine, vol. 6, no. 8, pp. 2237-2243, Academic Search Complete, EBSCOhost.
Schultheiss, CE 2010, ‘The ethics of non-therapeutic neonatal male circumcision’, Penn Bioethics Journal, vol. 6, no.2, pp. 21-24, Academic Search Complete, EBSCOhost.
Shaw, D 2009, ‘Cutting through red tape: non-therapeutic circumcision and unethical guidelines’, Clinical Ethics, vol. 4, no. 4, pp. 181-186, Academic Search Complete, EBSCOhost.
Sheldon, M 2003, ‘Male circumcision, religious preferences, and the question of harm’, American Journal Of Bioethics, vol. 3, no. 2, pp. 61-62, CINAHL with Full Text, EBSCOhost.
Svoboda, J 2003, ‘Circumcision- a Victorian relic lacking ethical, medical, or legal justification’, American Journal Of Bioethics, vol. 3, no. 2, pp. 52-54, CINAHL with Full Text, EBSCOhost.
Waldeck, SE 2003, ‘Social norm theory and male circumcision: why parents circumcise’, American Journal of Bioethics, vol. 3, no. 2, pp. 56-57, Academic Search Complete, EBSCOhost.
Zampieri, N, Pianezzola, E & Zampieri, C 2008, ‘Male circumcision through the ages: the role of tradition’, Acta Paediatrica, vol. 97, no. 9, pp. 1305-1307, Academic Search Complete, EBSCOhost.
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