Einverständniserklärung

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

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. Information is not making it to parents. Studies have shown that doctors provide parents with almost no accurate or useful information about circumcision. After several generations of promotion of and near universal neonatal circumcision in the United States, most Americans are profoundly ignorant of a normal body part and its valuable functions.

Surrogate consent

Parents act as surrogates for their minor children who are too young to personally grant consent. Surrogate consent ethically is limited to the granting of consent for diagnosis and treatment of disease.

Provision of relevant information

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 purposefully silent on the foreskin's nature and functions, sexual, and psychological harms of having the most erogenous part of the penis amputated. For all of these reasons, their public statements should not be used as a basis for informed consent.

Svoboda et al. {2000) commented:

Even more troubling in the common occurrence of parents being presented with the circumcision question for the first time when a mother is in labor at a hospital. Surgeon George W. Kaplan notes that "all too often the consent to circumcise is included in a sheaf of papers that the mother signs hurriedly on her way to the delivery room. No discussion has been held regarding the merits of the procedure or of the inherent risks." Kaplan characterizes this practice as "inexcusable". Raising the circumcision issue for the first time upon the mother's arrival at the hospital to give birth amounts to manipulation and coercion. Because the physician and the hospital benefit financially from the parent's decision, such a practice raises grave concerns about unethical profiteering.

Physician behavior

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.

Another study found that physicians were less likely to circumcise their own sons. This suggests that doctors are very well aware that circumcision is a harmful, painful, traumatic non-therapeutic surgery (in short, a ritual); but they do not appear to share this knowledge with parents. Doctors usually omit information on the nature of the foreskin and its functions.

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

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.

Pain and anesthesia

Horror of Circumcision.

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

The use of local anesthetics significantly drives up the costs of surgery and the time to execute a circumcision amputation, so may not be used. When anesthetics are used, they can only reduce the pain, not eliminate it. 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, including altered perceptions of pain, post-traumatic stress disorder (PTSD), and a possibly of adult self destructive behavior.

It appears that the major reason to administer analgesia to infants undergoing circumcision may be to minimize parents' feeling of guilt and to get their consent for a profitable amputation.

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.

A circumcision of a boy may be therapeutic or non-therapeutic. Therapeutic circumcision may be justified only 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 (1995) considered the power granted to parents to grant surrogate consent for diagnosis and treatment of a child. The Committee says that a parent may give "informed permission" for investigation and treatment of disease. The difference between informed consent and informed permission is unclear. When a child is ill, it is the practice to allow a parent to grant informed permission for diagnostic tests and appropriate treatment.

Infant boys are born with a healthy foreskin. No disease or deformity is present to be diagnosed or treated. Circumcision of an infant boy is neither a diagnostic procedure nor a treatment for disease. The limited parental surrogate powers to grant informed permission recognized by the Bioethics Committee do not extend to the granting of permission or consent for the non-therapeutic circumcision of a minor child.

If the circumcision industry had actually followed this sound ethical guidance, then the circumcision of male infants would have ended abruptly. The medical industry has chosen to ignore this advice and allow parents to grant surrogate consent for non-therapeutic circumcision of male children, so that the physician income derived from circumcision may be maintained.

Svoboda et al. (2000) examined the ethics and legality of informed consent for non-therapeutic neonatal circumcision. With regard to ethics, they concluded:

Amputating a highly sensitive and functional part of the body is extremely intrusive and should be undertaken only in situations of extreme urgency. Neonatal circumcision as it is routinely performed in this country clearly does not satisfy this criterion. It is therefore unethical and unlawful, and no parental permission should be effective.

Regarding legality, they concluded:

Consent to neonatal circumcision has not been directly considered by the the courts; therefore our analysis, out of necessity, relies on established legal precedents of cases that share common elements with neonatal circumcision. With near uniformity, these precedents indicate that any consent given for neonatal circumcision would not be valid. Court decisions are in part influenced by the culture in which they occur. However, circumcision has been gradually falling out of favor in the last few decades. When the balance of public opinion shifts to opposing the practice, the legal system will become more accepting of lawsuits and lobbying for the protection of baby boys. Consequently, the legal system will no longer be able to ignore the conflict between the practice and the legal and ethical duties of medical professionals. In the meantime, the medical community should personally reexamine the ethics of the practice.

Adler (2013) considered the legality of non-therapeutic circumcision of boys. He concluded in part:

This article has addressed whether circumcision is legal, and has shown that it is not. To summarize the law, boys, like girls and adults, have absolute rights under the common law to personal security and bodily integrity, and to freedom or the autonomy to make important and irreversible decisions about their bodies that can be delayed, like circumcision, for themselves. …

… A physician's legal duty is to provide competent medical care to pediatric patients independent of their parents' desires. Thus, physicians cannot take orders from parents to operate on children for reasons having nothing to do with medicine. Parents' religious rights in turn are subordinate to their sons' absolute rights to genital integrity and autonomy, and parents cannot risk harming their children, let alone actually harm them for religious reasons. Furthermore, physicians and parents have a legal duty to protect boys from circumcision.

A court of appeals in Cologne, Germany Cologne circumcision court judgment ruled in 2012 that non-therapeutic male circumcision is an assault on the child, an injury to the child, and a violation of the child's rights under the Basic Law of Germany. No American court has so ruled. Until such time as an American court issues such a ruling, non-therapeutic circumcision of children in America, driven by the financial incentive is expected to continue.

At the present time, ethics and law notwithstanding, non-therapeutic circumcisions of boys are performed with parental consent. Parents will be offered medically-unnecessary, non-therapeutic circumcision and encouraged to grant consent, the sole beneficiary being the bank accounts of the hospital and the doctor. The information supplied below is intended to inform and assist parents of boys.

The Bioethics Committee (2016) of the American Academy of Pediatrics updated its guidance on informed consent in pediatric practice, however it still does not recognize the child as a human being with rights under domestic and international law.

Wasserman et al. (2019) recognized children as persons entitled to respect.

Respect is something we owe to others to demonstrate that we recognize them as persons rather than objects. Patients (including children) are persons even if they do not reason well, particularly if have a kind of agency that is capable of expressing preferences. Once way to respect persons is to acknowledge that their preferences matter, something that may require soliciting those preferences, even in cases in which it would be ethically wrong to give them what they prefer. This is because it is disrespectful, and perhaps even dehumanizing to treat preference-expressing patients as mere bystanders or obstacles to their own care.

Although this may be a slight advance, Wasserman et al., speaking for the AAP, still do not recognize the human rights of children.

Das richtige Alter für die Beschneidung

Hill (2003) fragte, ob jeder seine Zustimmung zur medizinisch nicht indizierten, nicht-therapeutischen Beschneidung von Säuglingen geben kann.

Die Bioethiker Myers & Earp (2020) beantworteten Hills Frage. Sie prüften eingehend die Beweise für und gegen die angeblichen gesundheitlichen Vorteile der nicht-therapeutischen Beschneidung eines Neugeborenen, Säuglings oder Kindes für einen gesunden Menschen. Sie wogen diese gegen Schmerzen, Traumata und den Verlust von Körpergewebe und -funktionen ab. Sie kamen zu dem Schluss, dass die behaupteten gesundheitlichen Vorteile nicht ausreichen, um die Einwilligung einer Leihmutter zur nicht-therapeutischen Beschneidung zu stützen. Vor diesem Hintergrund kann „nur“ die betroffene Person ihre Einwilligung zu einer nicht-therapeutischen Beschneidung erteilen, und zwar „nur“ nach Erreichen des entsprechenden Alters für die Beschneidung. Dies ist erst der Fall, wenn ein Mann in seiner Gerichtsbarkeit das Schutzalter erreicht hat, das zwischen 16 und 18 Jahren variieren kann. Keine andere Person darf die Einwilligung zur nicht-therapeutischen Beschneidung eines minderjährigen Jungen erteilen. Die gegenwärtige Praxis in den Vereinigten Staaten und anderswo, die Einwilligung von Eltern zur nicht-therapeutischen Beschneidung zuzulassen, ist völlig unethisch, da sie die Befugnisse von Leihmutterschaften überschreitet.

Videos

Intaction (2022) hat ein Einführungsvideo bereitgestellt.

15 Square hat ein Video bereitgestellt.

Beschneidungsoperation bei Säuglingen

(Für dieses Video gilt eine Altersbeschränkung. Um es ansehen zu können, müssen Sie angemeldet sein.)

Ablauf der Säuglingsbeschneidung

Dies ist ein Video einer echten Säuglingsbeschneidung. Es ist mit einer Tonspur versehen, sodass man die Kommentare des Arztes und die Geräusche des Säuglings hören kann. Der Arzt verabreicht eine örtliche Betäubung, die die Schmerzen offenbar überhaupt nicht lindert. Der Säugling verstummt im Video bei etwa 6:15 Minuten, möglicherweise erlitt er zu diesem Zeitpunkt einen Schock. Nichts für Zartbesaitete:

• Trained medical professionals restrain infant to amputate part of its body while baby kicks and screams in pain [Ausgebildete medizinische Fachkräfte halten Säugling fest, um einen Teil seines Körpers zu amputieren, während das Baby tritt und vor Schmerzen schreit] (Englisch). Abgerufen 11. März 2022.

• Beschneidungsvideo

Siehe auch

• Menschenrechte
• Rechtsstreit wegen Beschneidung
• Schmerz
• Risiken und Komplikationen
• Unrechtmäßige Beschneidung
• Trauma

Weblinks

• Wagner, Richard. Informed Consent [Einverständniserklärung] (Englisch), emedicinehealth. Abgerufen 22. Juni 2020.
• (7. Oktober 2013). The Bioethics of the Circumcision of Male Children [Die Bioethik der Beschneidung männlicher Kinder] (Englisch). Abgerufen 21. Juli 2020.
• Costanza, Gary (28. Februar 2016). Is circumcision legal? Does it matter? [Ist die Beschneidung legal? Spielt das eine Rolle?] (Englisch), avoiceformen.com. Abgerufen 23. Juli 2020.
• The case against circumcision [Das Argument gegen Beschneidung] (Englisch), homebirthcenter.com, Mothering Magazine. Abgerufen 24. Juli 2020.
• The ethics of circumcision [Die Ethik der Beschneidung] (Englisch), http://www.circumcisiondebate.org, The Circumcision Debate. Abgerufen 24. Juli 2020.
• Physicians for Informed Consent [Ärzte für informierte Einwilligung] (Englisch). Abgerufen 25. August 2022.
• Garrett, Connor (3. März 2024). Assent vs Consent (in Regards to Bodily Autonomy and Circumcision) [Zustimmung vs. Einwilligung (in Bezug auf körperliche Autonomie und Beschneidung)] (Englisch), Intact America. Abgerufen 11. Juli 2024.