Surrogate consent: Difference between revisions
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The harm principle may be seen as a more realistic standard to apply in pediatric surrogate medical decision-making. The intent of the harm principle is not to identify a single course of action that is in the minor’s best interest or is the physician’s preferred approach, but to identify a harm threshold below which parental decisions will not be tolerated and outside intervention is indicated to protect the child.<ref name="bioethics2016" /> | The harm principle may be seen as a more realistic standard to apply in pediatric surrogate medical decision-making. The intent of the harm principle is not to identify a single course of action that is in the minor’s best interest or is the physician’s preferred approach, but to identify a harm threshold below which parental decisions will not be tolerated and outside intervention is indicated to protect the child.<ref name="bioethics2016" /> | ||
</blockquote> | </blockquote> | ||
The harmful, injurious effect of child circumcision not only to the child, but also to society, however circumcision brings in huge amounts of money, so the Bioethics Committee is effectively muzzled with regard to [[circumcision]].<ref name="bollinger2012">{{REFweb | |||
|url=https://www.academia.edu/6442587/High_Cost_of_Circumcision_3.6_Billion_Annually | |||
|title=High Cost of Circumcision: $3.6 Billion Annually | |||
|last=Bollinger | |||
|first=Dan | |||
|author-link=Dan Bollinger | |||
|publisher=Academia | |||
|website=https://www.academia.edu | |||
|date=2012 | |||
|accessdate=2025-05-02 | |||
|format= | |||
|quote=As the saying goes, follow the money. Now you know why neither the [[American Academy of Pediatrics]], American Medical Association, [[American Academy of Family Physicians]], or the [[American College of Obstetricians and Gynecologists]] haven’t condemned this unnecessary surgery, and why their physician members are quick to recommend the procedure to expectant parents. | |||
}}</ref> | |||
==Consent for circumcision of minors== | ==Consent for circumcision of minors== | ||
If a boy is to be [[circumcised]], then someone must grant effective consent. The boy may not do it for himself because of his minority status. [[Circumcision]] of boys is a medically-unnecessary, non-therapeutic, harmful excision of functional tissue that causes loss of various functions. Hill (2003) raised the question of who can grant effective consent for such an injurious operation.<ref>{{REFjournal | If a boy is to be [[circumcised]], then someone must grant effective consent. The boy may not do it for himself because of his minority status. [[Circumcision]] of boys is a medically-unnecessary, non-therapeutic, harmful excision of functional tissue that causes loss of various functions. Hill (2003) raised the question of who can grant effective consent for such an injurious operation.<ref>{{REFjournal | ||
Revision as of 23:15, 2 May 2025
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This article is work in progress and not yet part of the free encyclopedia IntactiWiki.
A surrogate is one who takes the place of another.[1]
Surrogate consent is consent for medical and/or surgical treatment that is granted by a substitute for the patient. Surrogate consent is used when the patient is mentally or legally incapable of granting consent.
Surrogate consent is regulated by law. In the United States, surrogate consent is regulated by state law, which varies from state to state.[2]
Guidance from the Bioethics Committee of the American Academy of Pediatrics
The Bioethics Committee of the American Academy of Pediatrics has provided important guidance on adapting general principles to pediatric practice. The Committue published an important statement applicable to surrogate consent in February 1995. It contains many general principles for the guidance of pediatricians but avoided directly considering circumcision, the big moneymaker.[3]
The Bioethics Committee of the AAP revisited informed consent in August 2016 with a statement[4] and a companion technical report.[5]
The statements address consent for treatment of disease in pediatric patients, however they have relatively little to say about non-therapeutic procedures such as circumcision of the newborn. The 1995 statement did say:
Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. Although impasses regarding the interests of minors and the expressed wishes of their parents or guardians are rare, the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent.[3]
This statement would cover doctors who refuse to perform harmful non-therapeutic circumcision on boys, however it is not clear if it ever has been applied to refusal to perform injurious circumcision.
The 2016 statement identifies the harm principle and states:
The harm principle may be seen as a more realistic standard to apply in pediatric surrogate medical decision-making. The intent of the harm principle is not to identify a single course of action that is in the minor’s best interest or is the physician’s preferred approach, but to identify a harm threshold below which parental decisions will not be tolerated and outside intervention is indicated to protect the child.[4]
The harmful, injurious effect of child circumcision not only to the child, but also to society, however circumcision brings in huge amounts of money, so the Bioethics Committee is effectively muzzled with regard to circumcision.[6]
Consent for circumcision of minors
If a boy is to be circumcised, then someone must grant effective consent. The boy may not do it for himself because of his minority status. Circumcision of boys is a medically-unnecessary, non-therapeutic, harmful excision of functional tissue that causes loss of various functions. Hill (2003) raised the question of who can grant effective consent for such an injurious operation.[7]
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See also
References
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Quote:Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. Although impasses regarding the interests of minors and the expressed wishes of their parents or guardians are rare, the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent.
|}} - ↑ a b
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}}.|}}{{#if:The law has evolved to require a full disclosure to the patient of the facts necessary to form the basis of a reasonable, informed consent. Informed consent incorporates 3 duties: disclosure of information to patients and their surrogates, assessment of patient and surrogate understanding of the information and their capacity for medical decision-making, and obtaining informed consent before treatments and interventions.|
Quote:The law has evolved to require a full disclosure to the patient of the facts necessary to form the basis of a reasonable, informed consent. Informed consent incorporates 3 duties: disclosure of information to patients and their surrogates, assessment of patient and surrogate understanding of the information and their capacity for medical decision-making, and obtaining informed consent before treatments and interventions.
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}}{{#if:| ({{{season}}})|}}; | }}{{#if:138| 138|}}{{#if:2|(2)|}}{{#if: e20161485|{{#if:|: [{{{article}}}]|}}{{#if:e20161485|: e20161485|}}{{#if:|: {{{pages}}}|}}.|}}{{#if:27456510| PMID.|}}{{#if:| PMC.|}}{{#if:10.1542/peds.2016-1485| DOI.|}}{{#if:| DOI.|}}{{#if:2025-05-02| Retrieved {{#switch:{{#invoke:String|len|s=2025-05-02}}
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}}.|}}{{#if:Autonomy (from the ancient Greek autos [self] and nomos [rule or law]) can be seen as derived from Kantian moral philosophy, with key elements of liberty, the capacity to live life according to your own reasons and motives, and agency, the rational capacity for intentional action. A formulation of Kant’s categorical imperative notes that we are obliged to act out of fundamental respect for other persons by virtue of their personal autonomy.|
Quote:Autonomy (from the ancient Greek autos [self] and nomos [rule or law]) can be seen as derived from Kantian moral philosophy, with key elements of liberty, the capacity to live life according to your own reasons and motives, and agency, the rational capacity for intentional action. A formulation of Kant’s categorical imperative notes that we are obliged to act out of fundamental respect for other persons by virtue of their personal autonomy.
|}} - ↑
{{#if:Bollinger|{{#if:Dan Bollinger|{{#if:|Bollinger {{{init}}}|Bollinger{{#if:Dan|, Dan|}}}}|{{#if:|Bollinger {{{init}}}|Bollinger{{#if:Dan|, Dan|}}|}}|}}|}}{{#if:2012|{{#if:Bollinger| ({{#switch:{{#invoke:String|len|s=2012}}
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}}). }}|{{#if:Bollinger|. |}}}}{{#if:https://www.academia.edu/6442587/High_Cost_of_Circumcision_3.6_Billion_Annually%7C{{#if:High Cost of Circumcision: $3.6 Billion Annually|High Cost of Circumcision: $3.6 Billion Annually
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|[<title> parameter missing!]}}{{#if:| (PDF)|}}}}{{#ifeq:|yes| (archive URL)|}}{{#if:| [{{{trans-title}}}]{{#if:| ({{{language}}})|}}|}}{{#if:https://www.academia.edu%7C, https://www.academia.edu|}}{{#if: |, {{{work}}} [deprecated REFweb parameter used: use <website> instead]|}}{{#if:Academia|, Academia|}}{{#if:2025-05-02|. Retrieved {{#switch:{{#invoke:String|len|s=2025-05-02}} |0 |1 |2 = |3 |4 |5 = {{#time:Y|2025-05-02 }} |6 |7 |8 = {{#time:F Y|2025-05-02 }} |9 |10 = {{#time:j F Y|2025-05-02 }} |#default = error }}|}}.{{#if:As the saying goes, follow the money. Now you know why neither the American Academy of Pediatrics, American Medical Association, American Academy of Family Physicians, or the American College of Obstetricians and Gynecologists haven’t condemned this unnecessary surgery, and why their physician members are quick to recommend the procedure to expectant parents.|
Quote:As the saying goes, follow the money. Now you know why neither the American Academy of Pediatrics, American Medical Association, American Academy of Family Physicians, or the American College of Obstetricians and Gynecologists haven’t condemned this unnecessary surgery, and why their physician members are quick to recommend the procedure to expectant parents.
|}} - ↑ Error creating thumbnail: {{#if:Hill|{{#if:George Hill|{{#if:G|Hill G|Hill{{#if:|, |}}}}|{{#if:G|Hill G|Hill{{#if:|, |}}|}}|}}|}}{{#if:|{{#if:|{{#if:|, [[{{{author2-link}}}|{{{last2}}} {{{init2}}}]]|, [[{{{author2-link}}}|{{{last2}}}{{#if:|, {{{first2}}}|}}]]}}|{{#if:|, {{{last2}}} {{{init2}}}|, {{{last2}}}{{#if:|, {{{first2}}}|}}|}}|}}|}}{{#if:|{{#if:|{{#if:|, [[{{{author3-link}}}|{{{last3}}} {{{init3}}}]]|, [[{{{author3-link}}}|{{{last3}}}{{#if:|, {{{first3}}}|}}]]}}|{{#if:|, {{{last3}}} {{{init3}}}|, {{{last3}}}{{#if:|, {{{first3}}}|}}|}}|}}|}}{{#if:|{{#if:|{{#if:|, [[{{{author4-link}}}|{{{last4}}} {{{init4}}}]]|, [[{{{author4-link}}}|{{{last4}}}{{#if:|, {{{first4}}}|}}]]}}|{{#if:|, {{{last4}}} {{{init4}}}|, {{{last4}}}{{#if:|, {{{first4}}}|}}|}}|}}|}}{{#if:|{{#if:|{{#if:|, [[{{{author5-link}}}|{{{last5}}} {{{init5}}}]]|, [[{{{author5-link}}}|{{{last5}}}{{#if:|, {{{first5}}}|}}]]}}|{{#if:|, {{{last5}}} {{{init5}}}|, {{{last5}}}{{#if:|, {{{first5}}}|}}|}}|}}|}}{{#if:|{{#if:|{{#if:|, [[{{{author6-link}}}|{{{last6}}} {{{init6}}}]]|, [[{{{author6-link}}}|{{{last6}}}{{#if:|, {{{first6}}}|}}]]}}|{{#if:|, {{{last6}}} {{{init6}}}|, {{{last6}}}{{#if:|, {{{first6}}}|}}|}}|}}|}}{{#if:|{{#if:|{{#if:|, [[{{{author7-link}}}|{{{last7}}} {{{init7}}}]]|, [[{{{author7-link}}}|{{{last7}}}{{#if:|, {{{first7}}}|}}]]}}|{{#if:|, {{{last7}}} {{{init7}}}|, {{{last7}}}{{#if:|, {{{first7}}}|}}|}}|}}|}}{{#if:|{{#if:|{{#if:|, [[{{{author8-link}}}|{{{last8}}} {{{init8}}}]]|, [[{{{author8-link}}}|{{{last8}}}{{#if:|, {{{first8}}}|}}]]}}|{{#if:|, {{{last8}}} {{{init8}}}|, {{{last8}}}{{#if:|, {{{first8}}}|}}|}}|}}|}}{{#if:|{{#if:|{{#if:|, [[{{{author9-link}}}|{{{last9}}} {{{init9}}}]]|, [[{{{author9-link}}}|{{{last9}}}{{#if:|, {{{first9}}}|}}]]}}|{{#if:|, {{{last9}}} {{{init9}}}|, {{{last9}}}{{#if:|, {{{first9}}}|}}|}}|}}|}}{{#if:|; with {{{coauthors}}} [deprecated REFjournal parameter used: <coauthors> - please use <last2>, etc.]|}}{{#ifeq:no|yes|, et al.|{{#if:Hill|.|}}}}{{#if:| ({{{publisher}}})|}} {{#if:https://www.researchgate.net/profile/George-Hill-3/publication/371599857_Can_Anyone_Authorize_the_Nontherapeutic_Permanent_Alteration_of_a_Child's_Body/links/648b8819c41fb852dd0949be/Can-Anyone-Authorize-the-Nontherapeutic-Permanent-Alteration-of-a-Childs-Body.pdf%7CCan anyone authorize the nontherapeutic permanent alteration of a child's body?{{#if:| Error creating thumbnail: |}}{{#ifeq:|yes| (archive URL)|}}|Can anyone authorize the nontherapeutic permanent alteration of a child's body?}}{{#if:| []{{#if:| ()|}}|}}{{#if:Am J Bioeth|. Am J Bioeth{{#if:| ()}}.|}}{{#if:2003| {{#switch:{{#invoke:String|len|s=2003}}
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