Difference between revisions of "Informed consent"

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==Informed consent for non-therapeutic circumcision of minor boys==
 
==Informed consent for non-therapeutic circumcision of minor boys==
  
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A treatment decision should be guided by the best interests of the child, and must balance the potential benefit over the potential harm or risk.<ref> {{REFjournal
 
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A circumcision of a boy may be therapeutic or non-therapeutic. Therapeutic circumcision may be justified in rare cases when the foreskin is deformed, diseased, or damaged by irreparable trauma and the apparent benefit to the patient exceeds the risks and harms.
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However, the vast and overwhelming majority of circumcisions of children are performed to excise healthy, functional tissue from the body of a child who is too immature to grant consent.
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The Bioethics Committee of the American Academy of Pediatrics considered the power granted to parents to grant surrogate consent for diagnosis and treatment of a child.
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When a child is ill, it is the practice to allow a parent to grant consent for diagnostic tests and appropriate treatment.
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Revision as of 17:30, 23 July 2020

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This article is work in progress and not yet part of the free encyclopedia IntactiWiki.

 

Informed consent is a legal and ethical prerequisite for surgery in the United States and many other nations.

It is defined as:

Assent to permit an occurrence, such as surgery, that is based on a complete disclosure of facts needed to make the decision intelligently, such as knowledge of the risks entailed or alternatives.

The name for a fundamental principle of law that a physician has a duty to reveal what a reasonably prudent physician in the medical community employing reasonable care would reveal to a patient as to whatever reasonably foreseeable risks of harm might result from a proposed course of treatment. This disclosure must be afforded so that a patient—exercising ordinary care for his or her own welfare and confronted with a choice of undergoing the proposed treatment, alternative treatment, or none at all—can intelligently exercise judgment by reasonably balancing the probable risks against the probable benefits.[1]

Informed consent for non-therapeutic circumcision of minor boys

A treatment decision should be guided by the best interests of the child, and must balance the potential benefit over the potential harm or risk.[2]

A circumcision of a boy may be therapeutic or non-therapeutic. Therapeutic circumcision may be justified in rare cases when the foreskin is deformed, diseased, or damaged by irreparable trauma and the apparent benefit to the patient exceeds the risks and harms.

However, the vast and overwhelming majority of circumcisions of children are performed to excise healthy, functional tissue from the body of a child who is too immature to grant consent.

The Bioethics Committee of the American Academy of Pediatrics considered the power granted to parents to grant surrogate consent for diagnosis and treatment of a child.

When a child is ill, it is the practice to allow a parent to grant consent for diagnostic tests and appropriate treatment.


Information for parents regarding non-therapeutic circumcision of infant boys.

This section is for all parents of boys, but is addressed primarily to parents of boys who are located in the United States of America, who appear to be most uninformed or misinformed about the foreskin and circumcision.

The medical trade associations, such as the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American Urological Association have a primary responsibility to their fellows (members) of advancing the profitability of medical practice. Consequently their public statements regarding medically-unnecessary, non-therapeutic circumcision of boys are strongly biased in favor of promoting the practice, so that their fellows can earn more money for the additional service of circumcision. The public statements are silent on the human rights of the child-patient and the multiple physiological functions of the foreskin. They describe "potential" benefits which are imagined benefits that cannot be proved to actually exist. They understate the risks of the surgical procedure, which can include loss of the penis and death. They are silent on the sexual and psychological harms of having the most erogenous[3] part of the penis amputated. For all of these reasons, their statements should not be used as a basis for informed consent.

For some reason this information is not making it to parents. Studies have shown that doctors provide parents with almost no accurate or useful information about circumcision.

One study showed that 40% of parents believed that their doctors failed to provide enough information, 46% reported that their doctors failed to give them any medical information at all, and 82.8% of parents regretted their decision they made within the first six months of their son’s life.[4]

Another study found that physicians were less likely to circumcise their own sons.[5] This suggests that doctors are very well aware that circumcision is a non-therapeutic surgery (in short, a ritual); but they do not appear to share this knowledge with parents.

A busy physician can supplement their income by as much as $60,000 per year from circumcision surgeries alone.[6] This incentive can cloud a physician’s judgment when it comes to providing parents with information about circumcision.

Horror of Circumcision.

Many parents are surprised to hear that anesthetics are used in only a minority of cases.[7]

The use of local anesthetics significantly drives up the costs of surgery. When anesthetics are used, they can only reduce the pain. Infants can not be given general anesthesia because of the medical risks involved. In the recent past, anesthesia was rarely used, if ever. Because of this, circumcision has always been an extremely traumatizing experience causing an array of short and long term behavioral and developmental problems[8][9][10][11][12][13][14][15][16][17][18], including altered perceptions of pain[19][20][21], post traumatic stress disorder (PTSD)[22][23][24][25], and a possibly of adult self destructive behavior.[26][27][28]

Many circumcised men, some of whom are doctors, experience a strong denial of loss which in turn fuels an emotional compulsion to repeat the trauma to normalize their loss. [29][30][31][32][33]

External links

References

  1. ↑ REFweb Informed conesnt. Retrieved 27 June 2020.
  2. ↑ REFjournal Bioethics Committee, Canadian Paediatric Society. Treatment decisions for infants and children. CMAJ. 1 September 1986; 135: 447-8. PMID. PMC. Retrieved 23 July 2020.
  3. ↑ REFjournal Winkelmann, R.K.. The erogenous zones: their nerve supply and significance. Mayo Clin Proc. 21 January 1959; 34(3): 39-47. PMID. Retrieved 21 July 2020.
  4. ↑ REFjournal R., Adler, Ottaway, S., Gould, S.. Circumcision: We have heard from the experts; now let’s hear from the parents. Pediatrics. February 2001; 107(2): E20.
  5. ↑ REFjournal Topp, S.. Why not to circumcise your baby boy. Mothering. January 1978; 6: 69-77.
  6. ↑ REFbook Fleiss, Paul M.D. (Sept 2002): What your Doctor May Not Tell You About Circumcision. New York: Warner books.
  7. ↑ REFjournal Stang, M.J., Snellman, L.W.. Circumcision practice patterns in the United States. Pediatrics. 1998; 101(6)
  8. ↑ REFjournal Gunnar, M.R., Fisch, R.O., Korsvik, S., Donhowe, J.M.. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinolog. 1981; 6(3): 269-275.
  9. ↑ REFjournal Porter, F.L., Miller, R.H., Marshal, R.E.. Neonatal pain cries: effect of circumcision on acoustic features and perceived urgency. Child Dev. 1986; 57: 790-802.
  10. ↑ REFjournal Porter, F.L., Porges, S.W., Marshall, R.E.. Newborn pain cries and vagal tone: parallel changes in response to circumcision. Child Dev. 1988; 59: 495-505.
  11. ↑ REFjournal Emde, R.N., Harmon, R.J., Metcalf, D., et al. Stress and neonatal sleep. Psychosom Med. 1971; 33(6): 491-497.
  12. ↑ REFjournal Gunnar, M.R., Connors, J., Isensee, Wall L.. Adrenocortical activity and behavioral distress in human newborns. Dev Psychobiol. 1988; 21(4): 297-310.
  13. ↑ REFjournal Anders, T.F., Chalemian, R.J.. The effects of circumcision on sleep-wake states in human neonates. Psychosom Med. 1974; 36(2): 174-179.
  14. ↑ REFjournal Marshall, R.E., Stratton, W.C., Moore, J.A., et al. Circumcision I: effects upon newborn behavior. Infant Behavior and Development. 1980; 3: 1-14.
  15. ↑ REFjournal Marshall, R.E., Porter, F.L., Rogers, A.G., et al. Circumcision: II: effects upon mother-infant interaction. Early Hum Dev. 1982; 7(4): 367-374.
  16. ↑ REFjournal Lee, N.. Circumcision and breastfeeding. J Hum Lact. 2000; 16(4): 295.
  17. ↑ REFjournal Anand, K.J.S., Hickey, P.R.. Pain and its effects in the human neonate and fetus. New Engl J Med. 1987; 317(21): 1321-1329. Retrieved 21 March 2011.
  18. ↑ REFjournal Anand, K.J.S., Scalzo, Frank M.. Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior?. Biology of the Neonate. February 2000; 77(2): 69-82. Retrieved 21 March 2011.
  19. ↑ REFjournal Taddio, A., Goldbach, M., Ipp, E., et al. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet. 1995; 345: 291-292. Retrieved 21 March 2011.
  20. ↑ REFjournal Taddio, A., Katz, J., Ilersich, A.L., Koren, G.. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1997; 349(9052): 599-603. Retrieved 21 March 2011.
  21. ↑ REFjournal LaPrairie, Jamie L., Murphy, Anne Z.. Neonatal Injury Alters Adult Pain Sensitivity by Increasing Opioid Tone in the Periaqueductal Gray. Front Behav Neurosci. 30 September 2009; Retrieved 21 March 2011.
  22. ↑ REFjournal Boyle, G.J., Goldman, R., Svoboda, J.S., Fernandez, E.. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol. 2002; 7(3): 329-343.
  23. ↑ REFjournal Rhinehart, J.. Neonatal circumcision reconsidered. Transactional Analysis J. 1999; 29(3): 215-221.
  24. ↑ REFbook Ramos, S., Boyle, G.J. (2001): Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder, in: Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem. New York: Kluwer Academic/Plenum Publishers. Pp. 253-270.
  25. ↑ REFjournal Menage, J.. Post-traumatic stress disorder in women who have undergone obstetric and/or gynaecological procedures. J Reprod Infant Psychol. 1993; 11: 221-228.
  26. ↑ REFjournal Van der Kolk, B.A., Perry, J.C., Herman, J.L.. Childhood origins of self-destructive behavior. Am J Psychiatry. 1991; 148: 1665-1671.
  27. ↑ REFjournal Jacobson, B., Bygdeman, M.. Obstetric care and proneness of offspring to suicide. BMJ. 1998; 317: 1346-1349.
  28. ↑ REFjournal Salk, L., Lipsitt, L.P., Sturner, W.Q., et al. Relationship of maternal and perinatal conditions to eventual adolescent suicide. Lancet. 1985; i: 624-627.
  29. ↑ REFjournal Van der Kolk, B.A.. The compulsion to repeat the trauma: re-enactment, revictimization, and masochism. Psychiatr Clin North Am. 1989; 12(2): 389-411.
  30. ↑ REFjournal Goldman, R.. The psychological impact of circumcision. BJU Int. 1999; 83(Suppl. 1): 93-103.
  31. ↑ REFjournal Maguire, P., Parks, C.M.. Coping with loss: surgery and loss of body parts. BMJ. 1998; 316(7137): 1086-1088. Retrieved 18 March 2011.
  32. ↑ REFjournal Hill, G.. The case against circumcision. J Mens Health Gend. 20 August 2007; 4(3): 318-323.
  33. ↑ REFjournal Goldman, R.. Circumcision policy: a psychosocial perspective. Paediatr Child Health. 2004; 9(9): 630-633.
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