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To Circ or Not to Circ, Article Review Example

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Article Review

To Circ or Not to Circ: Indications, Risks, and Alternatives to Circumcision in the Pediatric Population with Phimosis

Statement of the Ethical Issue and Principles

The ethical issue in this case concerning circumcision which is the removal of foreskin of the penis for religious, medical, cultural or by parental choice, should be regarded as a valid prevention process against infections and diseases, or is an infringement on the personal rights of males, as well being barbaric and mutilating.

Summary

Circumcision, regarded as the world’s most controversial operation, has been declining in frequency globally possible due to the high levels of vacillation by the well know US  American Academy of Pediatrics regarding its potential health benefits and advantages , as compare to the associated risks and disadvantages.

Arguments that Phimosis, a condition  in which the narrowed foreskin of the penis cannot be  retracted , is a rarity occurring less than 1% , has been discounted, in that according Stuart (2005), evidence has been found that that the frequency rates among youths  are pointing to between 2.4% and 14%.

The decrease in neonatal circumcision, particularly in the United States has resulted in a number of Pediatricians are being visited by uncircumcised male infants and older boys, and have to be recommending them to Pediatric Urologist for operations to remove Phimosis.

Medical experts describe the condition can be either physiologic or pathologic, and when applied to neonates, is regarded as an inability to retract the foreskins, due to naturally occurring adhesions between the prepuce and the glans. Infant Phimosis when detected resembles the trunk of an elephant but the epithelial tissues can be removed by the often playful tendencies of the affected victims.

True Phimosis or the pathological form, may be due to several reasons can occur at any stage, and parents lacking knowledge regarding infants becoming phimolic may cause them to experience traumatic tearing, lacerations, bleeding and scars. Steadman (2006)

There are also three different forms of Phimosis that parents who fail to circumcise their children may be exposed to and these are Frenelum Breve, Phimolic Rings, and Chronic Balenosposthitis,Steadman(2006) which all requires medical intervention as well as therapy to cure the behavioral habits and psychological attitudes.

Physical Assessments to infants and older boys who may be engaging in sexual intercourse, has to be done to differentiate between Physiologic Phimosis, where the penis has non- retractable foreskins and true Pathologic Phimosis, because health risks which may require additional surgeries to remove conditions such as meatal stenosis, which  produces urine streaming, dysuria, and occult hematuria. Steadman (2006)

Seventy years of research on the benefits on circumcision has produced a collection of studies which points to the fact that it has been able reduce Urinary Tract Infections, Sexually Transmitted Diseases, HIV, Penile Cancer, HPV, and Cervical Cancer. Steadman (2006)

Parents having children affected with Physiological Phimosis can be beneficiaries of information regarding the cost of inpatient circumcision by providers in their therapy packages.

Providers in general in the USA are able to reimburse hospitals for inpatient neonatal circumcision procedures, despite the contention of a minority group according to Cadman, Gafri and McNamee.(1984), that the benefits does not justify the cost, which Bollinger (2005) contends amounted to US $2.1 billion in 1999.

Circumcision is warranted among certain groups of boys and contra indicative in others. Males suffering from UTI’S, a history of Balanosposthitis, Cogenital Urologic Anomalies such as Viscouretetral Reflux, a history of Paraphimosis, Bollinger (2005)  Continuous Intermittent Catherization, and Balanitis Xerotica Obliterans, are indicators of the needs for circumcisions. Stuart (2005)

However, males born premature with multiple anomalities, a history of family bleeding concealed or buried penis, Bilateral large Hydroceles, Penile Abnormalities, and Cogenital Penile Lymphedema, falls in the contraindications category regarding the need for circumcision.

Parents having children that displayed no medical conditions that place them in any of these two categories are able to access alternative treatments for circumcision. Topical Steroid Therapy, especially 0.05% Betamethasone with a 65% to 95% efficacy, surgical treatments, Dorsal Slits, Full Dorsal Slits with Transverse Closures, Lateral Preputial Plasty, Triple Incision Plasty, Pascotto/Giancotti Preputial Plasty, La Vega Slit, Balloon Dilation and the Ebbehoji Procedure are all available alternatives treatments to circumcision. Steadman (2006)

Conclusions and Recommendations

Circumcision is a subject of critical importance in the drive to ensure healthy male children are delivered to families and societies in general, so that they can reproduce and take up roles vital to the development and advancement on mankind.

However, there are strong merits and demerits on both sides of the fence, but the rise in the use of alternative treatments and the associated cost factor may be answers to reduce the divide between those that see it as a form of mutilation on the one hand and those that see it in light of   religious importance behind the operation.

The contention that uncircumcised boys can be treated for Phimosis, using non invasive techniques and at low morbidity rates however, seems difficult to  hard to ignore by any objective persons supporting the traditional form of circumcision. The growth in the number of alternative treatments should also progressively reduce the intensity of the argument that refers to circumcision as being barbaric, humiliating, and an infringement on the rights of young make infants, because, in some case only the application of cream over a set period of time are required.

Significance of Circumcision to the Nursing Profession

The Nursing Profession stands to benefit from almost every development pertaining to the literature and practice regarding circumcision, in that they provide greater levels of information and techniques that will enable nurses to effectively deliver healthy male children to society, because diseases like Penile Cancer, HIV, Sexually Transmitted Disease, Urinary Tract Infections can be substantially reduce, and enable critical medical resources to be allocated in other areas of greater need.

In this case there is case of Beneficence. When individuals are circumcised, they are more likely to be more reliable as they are considered to be less likely to contract the sexual diseases. In such cases the sexual partners are less likely to shun circumcised individuals. Based on the fact that an individual is circumcised, the nursing profession can be considered to be doing their part in reducing the likelihood of individuals transmitting diseases.

In the nursing field, there are aspects of the matter of circumcision being a matter that should be kept in confidence. The nurses must ensure that they keep the matter private based in the fact that they handle the general tools that are crucial to the existence as well as reproduction of both men and women. In some cases circumcision is dine under the use of fidelity, in which patient-doctor interactions must be based on the explanation of the details of the operation and thus it  illustrates fidelity between the individuals. The matter of circumcision must be done in manner that should be done in a manner that should justify and give an accurate account of the operation.

Personal Views and Thoughts of Circumcision

A lack of marketing and promotions on the advantages of circumcision in the present society is not reducing the level of ignorance and taboo that prevails, and should the trend be reversed, many parents would become aware of the available therapies for males that has no medical conditions outside of the contra indications and indications regarding Phimosis, and take actions that would not be considered brutal by advocates on non circumcision in children of all ages. Steadman (2006)

The prevalence on compelling research information on circumcision from institutions like the University of Massachusetts, Memorial Center which are the progenitors of the 0.5% Betamethasone cream, the comparative studies of Saxena et al. (2000), among several others, which if publicized, would help to positively influence the level of taboo that prevails, and help elevate the prevailing science regarding the developments in circumcision. This would  help to reduce even the  level of  psychological suffering that male from infant to manhood endures, even during sexual relationship among married couples. Steadman (2006)

The cost factor which has risen to over $2.1 billion Stuart (2005) and the attendant low morbidity rates will be significantly reduced with the resistance to alternative treatment by those who oppose the traditional surgical approach to Phimosis, should also serve to attract greater number of parents to try the procedures, and in so doing contribute to well to the overall health of the society.

Ironically the suffering that infants and young boys suffer, are symbolic to what is happening on a wider scale in the society regarding circumcision, in that parents are suffering because of a lack of knowledge regarding how their problems can be solved, and without drastic interventions by government and the appropriate medical institutions, the male taboo will continue for years to come, and reduce the productive capability of families, communities and countries in the process.

The strength of cultures and religions surrounding circumcision and the lack of desire to become fully informed by many in the population will also make circumcision, an ethical concern for years to come, despite the scientific and empirical advancements in the field.

The aspect of Paternalism does apply in the case of circumcision in which the doctors must act in accordance to the protection of the patient. In the case individuals may have problems with their genitals; doctors must act in accordance to operating in the best interest of individuals. In such cases, confidentiality and fidelity will apply in order to ensure that individuals do not become social rejects.

References

Stuart. D (2005) the origins and consequences of taboo www.male.initiation.net/contents.html 03/08/06

Bollinger. D (2005) United States incidence: The Circumcision Reference Library www.webmed.com/article/3609/statistics/USA03/07/06

Steadman. B, Ellsworth. P (2006)To Circ or Not to Circ:/indications, Risks, and Alternatives to Circumcision in the Pediatric Population with Phimosis, Society of Urologic, retrieved from: http://www.medscape.comlviewarticle/541801 ?src=emailthis

Saxena. A, Schaar Schmidt. K, Reich, A, Willithal. G (2000) Non-Retractable Foreskin: A single centered 13 year experience International Surgery 85 pp.180-183

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