Difference between revisions of "Surrogate consent"
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| − | The perceived need to protect non-therapeutic circumcision induces an element of [[bias]] into the statements of the Bioethics Committee. | + | The perceived need to protect physician income from non-therapeutic circumcision induces an element of [[bias]] into the statements of the Bioethics Committee. |
==Consent for circumcision of minors== | ==Consent for circumcision of minors== | ||
Revision as of 12:48, 4 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] The surrogate has the duty to protect the rights of the patient.[3]
Contents
Significant United States Supreme Court decisions
The United States Supreme Court has made two decisions that protect the right to physical integrity.
The Union Pac. Ry. Co v Botsford, 141 U.S. 251 (1890) decision said:
No right is held more sacred or is more carefully guarded by the common law than the right of every individual to the possession and control of his own person, free from all restraint or interference of others unless by clear and unquestionable authority of law.
The Prince v Massachusetts, 21 U.S. 158, 159-60 (1944) said:
Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.
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.[4]
The Bioethics Committee of the AAP revisited informed consent in August 2016 with a statement[5] and a companion technical report.[6]
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.[4]
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.[5]
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.[7]
The perceived need to protect physician income from non-therapeutic circumcision induces an element of bias into the statements of the Bioethics Committee.
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.
Ross Povenmire (1998-9) argued strongly that parents lack the authority to grant surrogate consent for circumcision where there is no medical indicaton.[8]
Svoboda, Van Howe & Dwyer (2000) discussed the ethical and legal issues of consent for non-therapeutic circumcision.[9]
Hill (2002) raised the question of who can grant effective consent for such an injurious operation.[10]
Hill G. Can anyone authorize the nontherapeutic permanent alteration of a child's body?. Am J Bioeth. 2003 (Spring); 3(2) PMID. DOI. Retrieved 30 April 2025.</ref>
See also
References
- ↑
surrogate
, Merriam-Webster. Retrieved 30 April 2025. - ↑ Wynn, Shana (1 October 2014).
Decisions by Surrogates: An Overview of Surrogate Consent Laws in the United States
, American Bar Association. Retrieved 30 April 2025. - ↑
Anonymous. The Nuremburg Code (1947). BMJ. 7 December 1996; 313(7070): 1448. Retrieved 3 May 2025.
- ↑ a b Kohrman A, Clayton EW, Frader JE, Grodin MA, Moseley KL, Porter IH, Wagner VM. Informed consent, parental permission, and assent in pediatric practice. Committee on Bioethics, American Academy of Pediatrics. Pediatrics. February 1995; 95(2): 314-7. PMID. Retrieved 30 April 2025.
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 Katz Al, Macauley RC, Mercurio MR, Moon MR, Okun AL, Opel DJ, Statter MB. Informed Consent in Decision-Making in Pediatric Practice. Pediatrics. August 2016; 138(2): e20161484. PMID. DOI. Retrieved 30 April 2025.
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.
- ↑ Katz AL, Webb SA. Informed Consent in Decision-Making in Pediatric Practice — Technical Report. Pediatrics. August 2026; 138(2): e20161485. PMID. DOI. Retrieved 2 May 2025.
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.
- ↑ Bollinger, Dan (2012).
High Cost of Circumcision: $3.6 Billion Annually
, https://www.academia.edu, Academia. Retrieved 2 May 2025.
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.
- ↑ Povenmire R. Do Parents Have the Legal Authority to Consent to the Surgical Amputation of Normal, Healthy Tissue From Their Infant Children?: The Practice of Circumcision in the United States. Journal of Gender, Social Policy & the Law. September 1998; 7: 87-123. Retrieved 3 May 2025.
- ↑ Svoboda JS, Van Howe RS, Dwyer JG. Informed consent for neonatal circumcision: an ethical and legal conundrum
. J Contemp Health Law Policy. 2000 (Winter); 17(1): 61-133. PMID. Retrieved 3 May 2025.
- ↑ Hill G. Informed Consent for Circumcision. South Med J. August 2002; 95(8): 946. PMID. DOI. Retrieved 3 May 2025.
Quote:In the case of nontherapeutic circumcision of a boy, electing not to have circumcision performed is a reasonable, practicable, and viable alternative, so patients or their proxy representatives must be given all material information about circumcision and its risks, potential benefits and possible outcomes; they must also be informed about the risks, potential benefits, and possible outcomes of remaining uncircumcised.
