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The Nature of the Issue
Male circumcision (MC) is a highly debated topic among medical professionals, religious people, and human rights activists. Currently, the decision to agree to this procedure does not belong to children in many countries, while other states try to change their legal structure to make the process more complex for parents and underage persons. In the U.S., MC is usually performed on the basis of informed consent, where parents of an infant male decide whether he should or should not be circumcised (McLaughlin Jr., 2016). This choice can be based on medical, religious, or other reasons. In some countries, MC is viewed differently depending on peoples ethical and cultural backgrounds. Furthermore, therapeutic problems and complications also come into question when reviewing this method.
On the one hand, circumcision is seen as having many benefits to a persons health. According to Tobian, Kacker, and Quinn (2014), MC leads to such positive outcomes as the reduction of heterosexual HIV acquisition, lower rates of genital ulcer disease (GUD), and the decrease in transmitting or developing a number of other conditions. The scholars argue that MC is cost-effective and is a relatively simple procedure to be performed more frequently. This conclusion was also supported by the World Health Organization in 2007, which stated that MC is effective and important for male health (Tobian et al., 2014). Moreover, the American Academy of Pediatrics contributed to the medical debate as well, commenting that MC could be a valuable tool in reducing some health problems in males (Tobian et al., 2014). Nevertheless, it should be noted that the organization did not advocate for making MC a routine operation. Instead, it was proposed as an option for parents to consider.
The shift from viewing MC not as a medical but as a human rights issue could be related to the societal differences in peoples perception of childrens bodily functions. McLaughlin Jr. (2016) presents a historical overview of MC and argues that it should be considered a human rights problem. In this discussion, the author notes that, in older cultures, MC was utilized not for its health benefits but for religious and cultural reasons. He states that such procedures were designed to enhance gender differences and emphasize traditional societal roles between the sexes (McLaughlin Jr., 2016, p. 34). Thus, its primary function was not to solve health-related issues but to exercise pain affliction and reduce sexual sensations. This point of view presents one with the idea that MC can be treated as a social issue.
Another possible connection between MC and other human rights concerns is the neglect of a childs decision-making autonomy. Circumcision is usually performed on infant males, and parents become central authoritative figures in this regard. Therefore, one might argue that MC is performed on children without their consent, making the operation invasive and involuntary. As it was mentioned above, MC is often related to religious beliefs, which means that parents ideology is usually the primary driver of agreeing to it.
Parents actions are often considered to be beneficial for their children. However, they can also be done in their own self-interest. For example, McLaughlin Jr. (2016) mentions a case where a childs father converted to Judaism, a religion that views MC as a required procedure. This persons son, being eight years old at the time, did not want to undergo the operation but could not legally debate his right to refuse and was afraid of disobeying his parent. The court decided that the boy had the right to choose whether he wanted to be circumcised and that the custody over him would be transferred to his mother if the father did not adhere to his sons wishes (McLaughlin Jr., 2016). Here, the duality of the problem is visible the parent choosing for his eight-year-old son could potentially lose custody of him, while other parents are generally allowed and encouraged to circumcise their newborns. Thus, the issue of human rights comes into question.
Peoples Opinions
The complicated nature of MC, as well as its benefits and drawbacks, creates a division in the stances of people. First of all, individuals who support MC can highlight its health-related advantages. As noted above, MC may lead to reduced HIV acquisition. This argument is used primarily in countries with high rates of HIV, such as Kenya, Uganda, or South Africa (Tobian et al., 2014). Homfray et al. (2015) also note that MC can reduce the rates of sexually transmitted infections (STIs). These arguments become valuable for many medical professionals who support MC. New data regarding MC continues to appear in various research studies.
The concept to which many supporters of circumcision adhere is that the procedure is necessary and can be completed because its positive outcomes outweigh the negative ones. This balance between the results becomes the foundation of many peoples advocacy for MC. Tobian et al. (2014) go as far as to state that MC is underutilized and barriers to its widespread implementation should be analyzed and eliminated. Nonetheless, there exist other points of view that are not defined by health-related reasons.
The mentioned above cultural view of MC as being a necessary procedure also persists in many societies. According to Freedman (2016), the medical debate exists in the community of health professionals and may not cross the border of the academic sphere to influence other peoples decisions. Therefore, personal and societal beliefs may affect parents and activists judgments more than the discussed research. For instance, religious factors continue to transform peoples opinions about MC, especially the ones which had this practice for many years. Moreover, a level of cultural significance that was prescribed to the process of circumcising could also remain relevant to some persons. These arguments are valuable to people not because of personal experiences. Although some of them may be aware of possible consequences, they can view this method as a part of their cultural inheritance.
The opponents of MC also have multiple arguments for their claims. First of all, many negative consequences are highlighted as valuable barriers to utilizing circumcisions. El Bcheraoui et al. (2014) present a number of studies that find risks of MC connected to mens both physical and mental health. They also find that circumcision after the first year of a childs life leads to a higher possibility of unfavorable events (El Bcheraoui et al., 2014). Although this study finds that infant MC does not result in many adverse outcomes, it considers issues that are related only to ones immediate physical health. Activists, on the other hand, argue that people may develop psychological problems in the future as a result of being circumcised (McLaughlin Jr., 2016). The presence of both mental and physical considerations makes the issue complicated.
Second, some suggest that the balance between negative and positive outcomes should not be interpreted as a scale where the usefulness of the method becomes justified. Freedman (2016), for example, urges specialists and activists to forego the idea of utilitarianism in promoting MC and advises them to view the problem according to its multifaceted nature. For example, the scholar argues that parents decide to circumcise their child not because they are fully aware of the positive results but because they are driven by personal beliefs (Freedman, 2016). Therefore, the claim that MC is done with the best intentions in mind becomes untrue in such cases. The main argument for opponents of MC stems from the notion that children do not possess an adequate amount of authority or knowledge to make the decision to undergo the procedure. They compare MC to female genital mutilation, which was banned as an unnecessary and dangerous practice for similar reasons (McLaughlin Jr., 2016). Informed consent from parents is viewed as an invasion of childrens privacy.
Nurses Roles
The primary role of nurses in this debate is to educate all invested persons about the outcomes of circumcision. For example, nurses can teach parents and activists that MC can bring the rate of HIV and STIs down and lower the possibility of complications in some conditions. However, it is also important for healthcare professionals to note all adverse outcomes that may follow circumcising. The current state of policies on MC allows parents to ask for their child to be circumcised. This places the responsibility of education on all medical specialists, including nurses. It is crucial to make sure that parents understand how MC will affect their child. Another contribution to the debate that nurses can make is advocacy. For instance, they can make sure that proper information is assimilated in communities where circumcision is used not as a medical method but as a tool of cultural significance. Quality of care and updated rules of consent for such procedures can be monitored by nurses engaging in further research and education.
References
El Bcheraoui, C., Zhang, X., Cooper, C. S., Rose, C. E., Kilmarx, P. H., & Chen, R. T. (2014). Rates of adverse events associated with male circumcision in US medical settings, 2001 to 2010. JAMA Pediatrics, 168(7), 625-634.
Freedman, A. L. (2016). The circumcision debate: Beyond benefits and risks. Pediatrics, 137(5), 1-2.Â
Homfray, V., Tanton, C., Mitchell, K. R., Miller, R. F., Field, N., Macdowall, W.,& Mercer, C. H. (2015). Examining the association between male circumcision and sexual function: Evidence from a British probability survey. AIDS, 29(11), 1411-1416.
McLaughlin Jr., P.J. (2016). The legal and medical ethical entanglements of infant male circumcision and international law. Journal of Medical Law and Ethics, 4(1), 23-38.
Tobian, A. A., Kacker, S., & Quinn, T. C. (2014). Male circumcision: A globally relevant but under-utilized method for the prevention of HIV and other sexually transmitted infections. Annual Review of Medicine, 65, 293-306.
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