Running head: NEONATAL ETHICAL ISSUE 1

Neonatal Ethical Issue: Circumcision

Jocelyn Alexander

Old Dominion University

NEONATAL ETHICAL ISSUE 2

Neonatal Ethical Issue: Circumcision

The purpose of this paper is to examine a controversial debated issue and present both

sides equally. The issue this paper will discuss is the neonatal controversial topic of

circumcision. It will discuss what caused the issue and why is it of concern, as well as identify

what audience should be interested in this topic and examine the opposing positions on

circumcision.

Circumcision Procedure

When males are born, they have a fold of skin that covers the end of the penis which is

called the foreskin. Circumcision is the surgical removal of the foreskin, exposing the end of the

penis. Circumcision is an elective procedure and is not required by law or by hospital policy.

Approximately, 55% to 65% of all newborn males are circumcised in the United States each

year, though this rate varies by region (Circumcision, 2016). For example, western states have

the lowest circumcision rates while the north central region have the highest. Routine

circumcisions are usually performed during the first 10 days (often within the first 48 hours),

either in the hospital or, for some religious ritual circumcisions, at home. If the parents or

guardian decide to have their son circumcised at the hospital, the physician will perform the

procedure before they bring the baby home. In some instances, doctors may decide to delay the

procedure or forgo it altogether. For example, premature infants or those who have special

medical concerns may not be circumcised until they're ready to leave the hospital. In addition,

infants born with physical abnormalities of the penis that need to be corrected surgically often

aren't circumcised at all because the foreskin may eventually be used as part of a reconstructive

operation (Circumcision, 2016). Following circumcision, it is important to keep the area as

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clean as possible and to call the doctor immediately if any problems are noticed. It typically

takes between 7 to 10 days for the penis to heal following the procedure.

Elective newborn circumcision has long been a topic of debate and continues to remain

so today. Circumcision is one of the oldest procedures and it has been suggested that it arose as a

means of defining masculinity, a religious sacrifice, or a rites of passage (History of

Circumcision). In the past, it was necessary to belong to a group and in certain cultures this is

still the case; it was considered a rite of passage as part of the transition from childhood to adult

status. Also, in the past and still present today, it was common within Islam and Judaism who see

circumcision is as a symbolic offering to God as well as a confirmation of faith. Some

individuals find it difficult to accept the various religious and cultural reason for circumcision. In

addition, some consider it to be cruel and dangerous procedure which causes long term damage

and argue that it is a breach of human rights and unnecessary. Considering circumcision is still

popular in todays society, it remains controversial while some support the procedure and others

do not.

Audience for Circumcision

Competent adult patients have the moral and legal right to make decisions about their

own medical care. However, infants and young children are not able to make complex decisions

for themselves, so the authority to make medical decisions on behalf of the child usually is

controlled by the childs parents or guardian. In regards to circumcision, the main audience is

either the parents or guardian whom will be making the decision whether to circumcise or leave

the child uncircumcised. The reason these individuals are interested in this topic is because they

should consider the risks and benefits of the procedure when taking into account their ultimate

decision for circumcision.

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A recent study that is relevant to the audience was done in 2013 to determine which

factors consider to be most important when pursuing elective circumcision procedures in

newborn male children. There were a total of 230 participants attending prenatal classes over a 3-

month period. The main outcome measures were parents plans to pursue circumcision, personal

and family circumcision status, and factors influencing parents decision making on the subject

of elective circumcision. The results of the study were the reasons that parents most often gave

for supporting male circumcision were hygiene (61.9%), prevention of infection or cancer

(44.8%), and the father being circumcised (40.9%); the reasons most commonly reported by

parents for not supporting circumcision were it not being medically necessary (32.0%), the father

being uncircumcised (18.8%), and concerns about bleeding or infection (15.5%) (Rediger &

Muller, 2013). Other factors that were considered for supporting the circumcision were personal

preference, religion, the doctors advice, the appearance is better, and to look like other boys.

Other factors that were considered not supporting circumcision were it hurts too much, baby has

no input in decision, and the appearance looks better. Ultimately, all of these factors influence

parents decision in regards to circumcision for their newborn male infant and the risks and

benefits should be discussed thoroughly in order to make an informed choice.

Arguments in Favor of Circumcision

Individuals that are in favor of circumcision believe that the pros ultimately outweigh the

cons and support their decision for different reasons. An individual would argue that

circumcision has benefits such as better hygiene, decreased risk for infection, and preventative

reasons such as from penile cancer, sexually transmitted diseases, urinary tract infections (UTIs),

and HIV. Parents that support circumcision want to reduce the risk of penile problems, such as

irritation, inflammation, and infection, which are more common in uncircumcised males. It's
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easier to keep a circumcised penis clean, although uncircumcised boys can learn how to clean

beneath the foreskin once they're older (Rothberg, 2007). Although, arguments are still ongoing

about whether circumcision is an effective means of preventing HIV, some other types of

sexually transmitted diseases such as syphilis and herpes simplex tend to occur in men who have

not been circumcised. Circumcision protects against syphilis due to the fact that the foreskin is

an ideal breeding ground for bacteria to flourish in as well as allowing them to pass through and

into the bloodstream; the removal of the foreskin will prevent this from occurring

(Preventative reasons, 2016). It is also argued that males that are circumcised have a decreased

risk for UTIs. This may be due to the fact that bacteria which cause a UTI, gather inside the

foreskin before passing through into the bloodstream and once there will cause an infection

(Preventative reasons, 2016). In addition, circumcision can treat different medical conditions

such as phimosis, paraphimosis, frenulum, and balanoposthitis (Medical reasons, 2016).

Another popular reason for circumcision is based on the religious and cultural beliefs of

the family. Both the Jewish and Islamic faiths practice circumcision as a statement of faith and

belonging or an act of purification and hygiene. There are tribes in certain parts of the world,

such as Africa and Asia, who still practice circumcision; it is seen as an affirmation of cultural

identity as well as a rite of passage for young boys. Some tribes in West Africa use circumcision

as part of an initiation ceremony for young boys to mark their passage from boyhood to

manhood (Religious/Cultural reasons). Circumcision is seen as a way of removing any

female characteristics so that the boy can become a man. Parents who embrace these religions

will usually be aware of the procedures they must follow for the circumcision ritual. Lastly, some

people would argue circumcision has psychological benefits as well. An often-heard argument

involves the so-called locker-room syndrome, which is claims adolescent boys will make fun
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of their uncircumcised peers (Rothberg, 2007).

Arguments Against Circumcision

Individuals who do not support circumcision would argue that it is an unnecessary

procedure, is considered a cosmetic procedure, its cruel, it is a breech of human rights, and too

many complications to occur such as hemorrhage, wound infection, meatitis, and urinary tract

infections. One would say that this procedure is unnecessary that can cause more problems down

the road. For example, if the procedure was done incorrectly it could cause repeated infections

which can lead to meatal stenosis, a narrowing of the urinary opening. An individual that does

not support circumcision would also argue that every infant has a right to bodily integrity and

removing healthy tissue from an infant should only be permissible if there is an immediate

medical indication (Svoboda, 2013). In the case of infant male circumcision, there is no evidence

that indicates the immediate need to perform the procedure.

In addition, one would say that male circumcision also violates four core human rights

documents: The Universal Declaration of Human Rights, the Convention on the Rights of the

Child, the International Covenant on Civil and Political Rights, and the Convention Against

Torture (Svoboda, 2013). Many people believe that circumcision should be the childs decision

when they are old enough to make an informed decision for themselves since it is their own

body. In regards to the complications, a study was done that showed common complications of

circumcision include hemorrhage (35%), wound infection (10%), meatitis (8-20%), and UTI

(2%) respectively (Burgu, Aydogdu, Tangal, & Soygur, 2010). Parents would argue that these

complications could be reduced by 100% if the procedure was just not done at all considering it

is not necessary.
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Another argument people who do not support circumcision would argue is that it is a

cruel procedure and causes a great deal of pain to the infant. It is argued that infants cannot be

adequately anesthetized and they have heighted pain sensitivity after the procedure is done. A

study was performed to compare infants adrenal cortisol levels with and without anesthetic. In

this research study, 11 male newborns were circumcised with a local dorsal penile nerve block,

and 13 controls were circumcised without anesthetic. When the adrenal cortisol levels were

compared, the results were that the adrenal cortisol response to surgery was not significantly

reduced by the administration of lidocaine (Williamson & Evans, 2006).

Reflection/Conclusion

Throughout the research process of this paper, I learned that as a health care professional

educating the parents or guardian with accurate information of the benefits and risks for

circumcision in order to make an informed decision. A nursing study was done to study parental

decision making in male circumcision. The study consisted of close-ended survey responses were

analyzed through factor analysis to ascertain what types of beliefs parents used in their decision

making, whether they felt they had enough information, and who first asked them about their

decision. The results were that nurses were most likely to be the first health care professional to

ask parents about circumcision. Parental personal and cultural beliefs played an equal or more

important role in influencing decision making than medical information received, However,

some parents noted that there was a lack of access to accurate information regarding risks and

benefits of male circumcision (Sardi & Livingston, 2015). With that being said, nurses continue

to play a critical role in acquisition of knowledge surrounding male circumcision and serve as an

important liaison between parents and the proxy consent process. In addition, Ive learned that

the discussion of circumcision is best done early in pregnancy so parents have enough time to
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ask questions, gather other information, and make an appropriate decision without being rushed

or influenced by others beliefs.

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References

Brief history of circumcision: A guide to Circumcision. (n.d.). Retrieved November 29, 2016,

from http://www.medic8.com/healthguide/circumcision/cultural-religious-reasons.html

Burgu, B., Aydogdu, O., Tangal, S., & Soygur, T. (2010). Circumcision: Pros and cons. Indian

Journal of Urology: IJU: Journal of the Urological Society of India, 26(1), 1215.

Circumcision. (2016). Retrieved November 29, 2016, from

http://kidshealth.org/en/parents/circumcision.html

Cultural/religious reasons: A guide to Circumcision. (n.d.). Retrieved November 29, 2016, from

http://www.medic8.com/healthguide/circumcision/cultural-religious-reasons.html

Medical reasons: A guide to Circumcision. (2016). Retrieved November 30, 2016, from

http://www.medic8.com/healthguide/circumcision/medical-reasons.html

Preventative reasons. (2016). Retrieved November 30, 2016, from

http://www.medic8.com/healthguide/circumcision/preventative-reasons.html

Rediger, C., & Muller, A. J. (2013). Parents rationale for male circumcision. Canadian Family

Physician, 59(2), 110115.

Rothberg, L. (2007). The pros and cons of circumcision. Pediatric Nursing Journal, 50(7).

Sardi, Lauren., & Livingston, K. (2015). Parental Decision Making in Male Circumcision. The

American Journal of Maternal Child Nursing, 40(2): 110-115.

Svoboda, J. (2013). Circumcision of male infants as a human rights violation. J Med Ethics,

39(7): 469-474.

Williamson, P. S., & Evans, N. (2006). Neonatal Cortisol Response to Circumcision with

Anesthesia. Clin Pediatr, 25(8): 412-415.

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Honor Code:
This statement will be included on all work submitted for credit and signed. Assignments will
not be accepted without inclusion of the Honor Pledge. The Honor Pledge states:

I pledge to support the Honor System of Old Dominion University. I will refrain from any form
of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a
member of the academic community it is responsibility to turn in all suspected violators of
the Honor Code. I will report to a hearing if summoned.

Name: Jocelyn Alexander

Signature:Jocelyn Alexander
Date: 12/1/16