Pub Date : 2023-06-01DOI: 10.1353/nib.2023.a909666
Lisa Braver Moss
Proudly Jewish—and Averse to Circumcision Lisa Braver Moss I've always had a strong sense of my Jewish identity—and I've always had grave misgivings about circumcision. It used to seem that these [End Page 86] statements were at odds with one another. Now I'm on a mission to integrate the two. I'm married to a man who's also Jewish. In the late 1980s, we had two sons, whose circumcisions I agreed to. Brit milah (the covenant of circumcision) is intended as a spiritually meaningful act symbolizing the agreement between God and the Jewish people. But for me, the experience was so upsetting that I didn't feel God's presence. In spite of all the arguments in favor—the weight of tradition, wanting my boys to be accepted in the Jewish world, and so on—I came to regret my acquiescence. I began to explore reasons to question circumcision from a Jewish point of view, publishing articles in Jewish magazines and speaking at conferences. Rather than focusing on the medical pros and cons, I wrote about Jewish law and ethics, and spoke with many rabbis. I was hoping to deepen Jewish dialogue on this topic, which was oddly off-limits in a culture that values intellectual inquiry. Besides helping me understand more about Judaism, my research and writing was a way of living with my guilt. I had succumbed to—and put my boys through—a tradition that went completely against my maternal instincts. This schism had made me doubt myself as a new mother. What kind of parent was I if I couldn't be a fierce protector of my newborn baby? It was not a positive or welcoming way for me to enter into motherhood. I blamed myself. I hadn't done medical research before my boys were born, trusting instead in the longevity of the tradition and the claim that circumcision is more hygienic. I bought into the medical justifications for circumcision—all of which, I later learned, fail to acknowledge the erogenous nature of foreskin tissue and its physiological function. If I'd known more; if I'd thought more deeply about infant trauma; if I'd taken my own spirituality more seriously—I would have fought for a different outcome, despite the pressure I felt as a Jewish person. Years went by. I wrote a novel about Jewish circumcision, then co-wrote a book of alternative bris ceremonies for families opting out of circumcision. Slowly, I came to understand that blaming myself for agreeing to circumcise my sons was not only a waste of time, but also missed the larger point. I'm not alone in my objections to this ancient tradition. Indeed, many Jewish parents get through the event with white knuckles, emotional detachment, alcohol, or sedatives rather than with genuine religious feeling. Shouldn't their spiritual authenticity matter? Shouldn't mine have mattered? In Judaism, every commandment (of which circumcision is one) should be approached with kavanah, or spiritual intent. Thus, my non-spiritual feelings about the circumcision tradition are problematic from a Jewish point of view. I should
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Pub Date : 2023-06-01DOI: 10.1353/nib.2023.a909676
Laurie Evans
My Circumcision Decision:A Journey of Inquiry, Courage and Discovery Laurie Evans Before becoming a mother, I was teaching parents to massage their babies and offering trainings for professionals. To promote my work, in 1984, I exhibited at the Whole Life Expo in New York City. When I returned to my booth after a break, I noticed someone had left a pamphlet by Edward Wallerstein, who wrote "Circumcision: An American Health Fallacy." Since I am naturally curious, I read it. Disturbed, I thought of tossing it. But, how could I be teaching a nurturing technique for newborns and avoid this topic? As a Jewish woman, how would I make the decision for my own future sons? Little did I know this one piece of paper would lead me on a path of inquiry that would change my life. One of the presenters at this conference was Dr. Robert Mendelsohn, an Orthodox pediatrician. Although Dr. Mendelsohn realized some parents would allow circumcision for religious reasons, he was honest enough to dispel every medical myth and explain the harm of removing normal functioning tissue. He also described possible complications from removing the foreskin, including infection, hemorrhage, and although rare, death. To learn more, I read whatever I could find on the topic. I attended midwifery and childbirth conferences to promote my work and prepare for when I became pregnant. I decided to ask about circumcision, but the conversations were awkward and I received little helpful information. I found that circumcision was a taboo topic; few people wanted to talk about it. Why? Doctors who perform circumcisions, nurses who recommend it, and parents who consent to it do not want to face the reality of the harm they cause. Instead of facing the pain, they avoid the topic, and the procedure continues. Most men do not want to discuss or think about their own circumcisions. I learned that we need to have compassion during these conversations. A Jewish ritual ceremony (bris) is performed on the eighth day after the boy's birth, and includes circumcision and prayers. At a bris, friends and relatives are invited to observe and celebrate. It is part of my heritage. I tried to talk to my relatives about the information I had found, but everyone refused to discuss it. This avoidance made my decision very difficult. Then, for the first time, I was invited to a bris; I didn't want to attend. However, I had been at the boy's birth, so I decided to go to offer support. During the circumcision, my reaction was intense: I wanted to take the baby and run. I felt like an accomplice. I wanted to grab people by the [End Page E2] shoulders and scream, "How dare you?" I vowed I would never attend another bris, and I made the decision to write publicly instead of anonymously. I still had doubts, because I didn't know one intact adult male. What if I were to have a son, keep him intact, and he developed a complication later in life? I have learned that doctors are not taught non-invasive solutions, so most
劳里·埃文斯(Laurie Evans)在成为母亲之前，我教父母给婴儿按摩，并为专业人士提供培训。为了推广我的作品，1984年，我在纽约的终身博览会上展出了我的作品。当我休息后回到我的摊位时，我注意到有人留下了一本爱德华·沃勒斯坦(Edward Wallerstein)的小册子，他写的是《割礼:美国健康谬论》(Circumcision: An American Health Fallacy)。因为我天生好奇，所以我读了它。我很不安，想把它扔了。但是，我怎么能在教授新生儿养育技巧的同时避免这个话题呢?作为一名犹太妇女，我该如何为自己未来的儿子做决定?我一点也不知道这张纸会引导我走上一条改变我一生的探索之路。这次会议的演讲者之一是罗伯特·门德尔松(Robert Mendelsohn)医生，他是一位东正教儿科医生。尽管门德尔松医生意识到有些父母出于宗教原因会允许包皮环切，但他足够诚实地消除了所有医学上的神话，并解释了切除正常功能组织的危害。他还描述了切除包皮可能出现的并发症，包括感染、出血，以及尽管罕见的死亡。为了了解更多，我读了所有我能找到的关于这个话题的书。我参加了助产和分娩会议，以促进我的工作，并为怀孕做准备。我决定询问包皮环切术，但谈话很尴尬，我没有得到什么有用的信息。我发现割礼是一个禁忌话题;很少有人愿意谈论这件事。为什么?实施包皮环切术的医生、推荐包皮环切术的护士和同意包皮环切术的父母都不愿面对自己造成伤害的现实。他们不去面对痛苦，而是回避这个话题，然后这个过程继续下去。大多数男性不愿讨论或考虑自己的包皮环切手术。在这些谈话中，我学到了我们需要有同情心。犹太仪式(bris)在男孩出生后的第八天举行，包括割礼和祈祷。在布里斯，朋友和亲戚被邀请观察和庆祝。这是我遗产的一部分。我试着和我的亲戚们谈谈我发现的信息，但每个人都拒绝讨论它。这种回避使我很难作出决定。然后，我第一次被邀请参加割礼;我不想参加。然而，我参加了这个男孩的出生，所以我决定去支持他。在割礼过程中，我的反应非常强烈:我想带着孩子跑掉。我觉得自己像个帮凶。我想抓住人们的肩膀大喊:“你怎么敢?”我发誓我再也不参加割礼了，我决定公开写作，而不是匿名。我仍然心存疑虑，因为我不认识一个完整的成年男性。如果我生了个儿子，让他完好无损，而他后来出现了并发症怎么办?我了解到，医生没有被教导非侵入性的解决方案，所以大多数在婴儿期后进行的包皮环切是不必要的。一位犹太医生建议一位79岁的老人做包皮环切术，因为他长了持续的皮疹，治疗无效。我们组织建议他局部使用嗜酸乳杆菌。他照着建议去做之后，疹子就消失了，所以他取消了割礼。1985年，我怀孕了。和我交谈过的许多女性一样，我不想面对割礼的决定，所以我祈祷生个女孩。我们的分娩教育老师分享了关于男性包皮环切术的知识，这让我和丈夫聊了起来。这些紧张的互动以僵局告终。我想知道这个决定会对我的婚姻产生怎样的影响。我的长子是个女孩，这让我如释重负。时间站在我这一边。有一天，我在纽约散步时，偶然遇到了我的分娩老师。她要去联合国反对女性割礼。我30多岁，有一个教学硕士学位。我学过按摩和解剖学。然而，我从未听说过这种部落仪式。我有……
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Pub Date : 2023-06-01DOI: 10.1353/nib.2023.a909663
Petrina Fadel
My Personal Experience with Circumcision Petrina Fadel On October 2, 1981, I sat down to watch "NBC Magazine" on television, with a segment about infant circumcision called "The Casual Cut," by Douglas Kiker. (To watch, see youtube.com/watch?v=vm6Y0HJo034) I listened to doctors say there were no valid medical reasons for performing circumcisions on baby boys. One doctor said that circumcisions were done mainly for parental preference. In horror, I saw a newborn baby boy being circumcised without anesthesia. Edward Wallerstein, author of the book "CIRCUMCISION: An American Health Fallacy," told how circumcision is not practiced in most other countries. He called it a "cop out" that American doctors do not stop performing infant circumcisions, but instead take a neutral position by saying they'll let the parents decide. I was stunned. Why had most parents never heard this before? I did not know this when my first daughter was born in 1972, a year after the American Academy of Pediatrics wrote that "there are no valid medical indications for circumcision in the neonatal period." Before my second daughter was born in 1977, I was asked during my hospital admission if I wanted my baby circumcised if I had a boy. No doctor had ever mentioned the word circumcision, but now a woman in admissions was soliciting me for this surgery, despite "No Solicitation" signs posted on their doors. When I thought back to being questioned this way, I got angry. I did not understand why doctors would do such a ghastly thing to baby boys, something no national medical association in the world recommends. I know now that the driving force in medicine is money. I read Wallerstein's book to educate myself, and spoke with my friend who was a La Leche League leader. Together we signed a letter to the editor that I wrote and mailed to local newspapers, telling people the facts about circumcision. I was reluctant to put my name alone on this letter, since people in the United States do not talk openly about circumcision. For me, this was the first step in a long journey. I learned of a childbirth group fighting against infant circumcision and contacted them. I arranged for a speaker to come speak about circumcision to two local childbirth classes. I learned that genital cutting is practiced not only on baby boys in the United States, but also on females in Africa and the Middle East. I inwardly wept as I read about the inhumane things done to girls there. I thought of my own daughters. No child, male or female, should ever be subjected to genital mutilation. In 1982, my third daughter was born. When I questioned my doctor during my prenatal care, he told me that circumcisions were medically unnecessary, that he had seen infants die from them in medical school, but he circumcises babies anyway if parents want that done. He called himself "the reluctant rabbi." I told my doctor to write "No Circumcision" on my chart if I had a boy. While he delivered my daughter by Cesarean sectio
1981年10月2日，我坐下来看《NBC杂志》的电视节目，里面有一个关于婴儿割礼的片段，名叫“随意切割”，由道格拉斯·基克尔(Douglas Kiker)主持。(观看，见youtube.com/watch?v=vm6Y0HJo034)我听医生说，对男婴进行包皮环切手术没有正当的医学理由。一位医生说，做包皮环切手术主要是出于父母的意愿。我惊恐地看到一个刚出生的男婴在没有麻醉的情况下接受割礼。爱德华·沃勒斯坦是《包皮环切术:美国人的健康谬论》一书的作者，他讲述了包皮环切术在大多数其他国家是如何不实行的。他称这是“逃避责任”，美国医生没有停止为婴儿做包皮环切手术，而是采取中立立场，说他们会让父母来决定。我惊呆了。为什么大多数父母以前从未听说过这个?1972年，当我的第一个女儿出生时，我还不知道这一点。一年前，美国儿科学会(American Academy of Pediatrics)写道，“在新生儿时期，没有有效的医学指征需要包皮环切术。”在1977年我的第二个女儿出生之前，我在住院期间被问到，如果我生的是男孩，我是否要给我的孩子做包皮环切手术。以前没有医生提过包皮环切这个词，但现在有个住院的女人在招揽我做这个手术，尽管她们的门上贴着“禁止招揽”的牌子。当我回想起被这样盘问时，我很生气。我不明白为什么医生会对男婴做出如此可怕的事情，世界上没有任何国家医学协会建议这样做。我现在知道医学的驱动力是金钱。我读了沃勒斯坦的书来教育自己，并与我的朋友交谈，他是国际母乳会的领导人。我们一起签署了一封给编辑的信，我把信寄给了当地的报纸，告诉人们关于割礼的事实。我不愿意在这封信上单独署名，因为美国人不公开谈论割礼。对我来说，这是漫长旅程的第一步。我了解到一个反对婴儿割礼的分娩组织，并联系了他们。我安排了一位演讲者来给当地的两个分娩班讲割礼。我了解到，切割生殖器的做法不仅适用于美国的男婴，也适用于非洲和中东的女性。当我读到那里对女孩所做的不人道的事情时，我在心里哭了。我想到了自己的女儿们。任何儿童，无论男女，都不应遭受外阴残割。1982年，我的第三个女儿出生了。当我在产前护理期间询问我的医生时，他告诉我，从医学上讲，包皮环切术是不必要的，他在医学院看到过婴儿死于包皮环切术，但如果父母想要，他还是会给婴儿包皮环切术。他称自己为“不情愿的拉比”。我告诉我的医生，如果我生的是男孩，在我的病历上写上“不包皮环切”。当他给我女儿剖腹产时，他对我说的第一件事就是:“现在你不用担心割礼了。”他的话听起来像是在无视我的感受。因为我不支持伤害儿童的医生，我后来给他写了一封信，告诉他为什么他失去了我这个病人。我相信“第一，不伤害”，尽管有些医生不这么认为。手术后休养期间，我在医院的走廊里散步。突然，我听到婴儿撕心裂肺的尖叫声，从婴儿室紧闭的窗帘后面传来。我无意中听到别人说这个男婴正在接受割礼，我看到婴儿的父亲站在大厅里开玩笑。我无法忍受这个可怜的孩子被迫忍受的痛苦。我冲回自己的房间，关上门，用手指堵住耳朵，试图挡住他那可怜的哭声。我不能。婴儿的尖叫声如此之大，如此绝望，以至于他们传到了……
{"title":"My Personal Experience with Circumcision","authors":"Petrina Fadel","doi":"10.1353/nib.2023.a909663","DOIUrl":"https://doi.org/10.1353/nib.2023.a909663","url":null,"abstract":"My Personal Experience with Circumcision Petrina Fadel On October 2, 1981, I sat down to watch \"NBC Magazine\" on television, with a segment about infant circumcision called \"The Casual Cut,\" by Douglas Kiker. (To watch, see youtube.com/watch?v=vm6Y0HJo034) I listened to doctors say there were no valid medical reasons for performing circumcisions on baby boys. One doctor said that circumcisions were done mainly for parental preference. In horror, I saw a newborn baby boy being circumcised without anesthesia. Edward Wallerstein, author of the book \"CIRCUMCISION: An American Health Fallacy,\" told how circumcision is not practiced in most other countries. He called it a \"cop out\" that American doctors do not stop performing infant circumcisions, but instead take a neutral position by saying they'll let the parents decide. I was stunned. Why had most parents never heard this before? I did not know this when my first daughter was born in 1972, a year after the American Academy of Pediatrics wrote that \"there are no valid medical indications for circumcision in the neonatal period.\" Before my second daughter was born in 1977, I was asked during my hospital admission if I wanted my baby circumcised if I had a boy. No doctor had ever mentioned the word circumcision, but now a woman in admissions was soliciting me for this surgery, despite \"No Solicitation\" signs posted on their doors. When I thought back to being questioned this way, I got angry. I did not understand why doctors would do such a ghastly thing to baby boys, something no national medical association in the world recommends. I know now that the driving force in medicine is money. I read Wallerstein's book to educate myself, and spoke with my friend who was a La Leche League leader. Together we signed a letter to the editor that I wrote and mailed to local newspapers, telling people the facts about circumcision. I was reluctant to put my name alone on this letter, since people in the United States do not talk openly about circumcision. For me, this was the first step in a long journey. I learned of a childbirth group fighting against infant circumcision and contacted them. I arranged for a speaker to come speak about circumcision to two local childbirth classes. I learned that genital cutting is practiced not only on baby boys in the United States, but also on females in Africa and the Middle East. I inwardly wept as I read about the inhumane things done to girls there. I thought of my own daughters. No child, male or female, should ever be subjected to genital mutilation. In 1982, my third daughter was born. When I questioned my doctor during my prenatal care, he told me that circumcisions were medically unnecessary, that he had seen infants die from them in medical school, but he circumcises babies anyway if parents want that done. He called himself \"the reluctant rabbi.\" I told my doctor to write \"No Circumcision\" on my chart if I had a boy. While he delivered my daughter by Cesarean sectio","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135195643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1353/nib.2023.a909661
Thomas McDonald
Mitzvah of the Bris Thomas McDonald Having worked as a clinician in emergency medicine, internal medicine, and urgent care for a number of years, I've treated plenty of patients with skin infections. On a few rare occasions, some have casually mentioned that they were thinking about getting circumcised as adults to prevent reoccurring, frequent infections like Jock Itch. I think you're probably more likely to experience that kind of problem if you're uncircumcised. Jock itch is a fungal infection, and fungus likes dark, hot, sweaty places on our bodies. These infections are nothing serious—they are just sort of annoying for the patients experiencing them. I have two sons—both were circumcised, but my experience as a clinician did not play a role in the decision. My sons' mother is Jewish, while I grew up Catholic. I attended a Catholic high school and went to religious education classes until I was confirmed [End Page 77] as a teenager. Both of my parents are pretty serious Catholics. I can't remember ever missing a Sunday service. I always thought any sons I had would be circumcised, even before I was married and before I married someone who was Jewish. When we were expecting our first baby, my son's mother and I didn't really talk about circumcision or debate whether we should do it or not. Is it more socially acceptable to be circumcised versus not? I'm not exactly sure why, but I think the answer is probably yes. It seems like circumcision is the norm in our society. My son's mother wanted our son to be circumcised too but thought it would be great to have a bris. With my Catholic background, I didn't know the details about what was involved with a bris at the time. She explained that a person comes to the house (or to a relative's house) and circumcises the baby. All the relatives attend. It would be a party! At the time, the thought of throwing a party at a relative's home to celebrate a circumcision was amusing to me. Before the conversation with my son's mother, I assumed that the bris was probably done in the hospital with everyone attending there. But she went on to explain that a person who is trained to do it—a mohel—does this work as their main job and makes sure that the baby is anesthetized and that sterile techniques are used. To be clear, I didn't ever think that my sons wouldn't be circumcised. I just thought it would happen in the hospital rather than in Baba's living room, followed immediately by a meal of deli meat sandwiches. But the bris sounded like it would make a nice memory for the family, so I agreed to it. I was always (and still am) interested in Jewish traditions. I think they're pretty cool, so I was all in. I assume there could have been some pressure from my son's mother's family if the bris was something I didn't want to do, but that wasn't an issue since I was completely on board. There is an episode of Seinfeld called "The Bris" in which Elaine and Jerry are nervous about the duties they must perform for a bri
{"title":"Mitzvah of the Bris","authors":"Thomas McDonald","doi":"10.1353/nib.2023.a909661","DOIUrl":"https://doi.org/10.1353/nib.2023.a909661","url":null,"abstract":"Mitzvah of the Bris Thomas McDonald Having worked as a clinician in emergency medicine, internal medicine, and urgent care for a number of years, I've treated plenty of patients with skin infections. On a few rare occasions, some have casually mentioned that they were thinking about getting circumcised as adults to prevent reoccurring, frequent infections like Jock Itch. I think you're probably more likely to experience that kind of problem if you're uncircumcised. Jock itch is a fungal infection, and fungus likes dark, hot, sweaty places on our bodies. These infections are nothing serious—they are just sort of annoying for the patients experiencing them. I have two sons—both were circumcised, but my experience as a clinician did not play a role in the decision. My sons' mother is Jewish, while I grew up Catholic. I attended a Catholic high school and went to religious education classes until I was confirmed [End Page 77] as a teenager. Both of my parents are pretty serious Catholics. I can't remember ever missing a Sunday service. I always thought any sons I had would be circumcised, even before I was married and before I married someone who was Jewish. When we were expecting our first baby, my son's mother and I didn't really talk about circumcision or debate whether we should do it or not. Is it more socially acceptable to be circumcised versus not? I'm not exactly sure why, but I think the answer is probably yes. It seems like circumcision is the norm in our society. My son's mother wanted our son to be circumcised too but thought it would be great to have a bris. With my Catholic background, I didn't know the details about what was involved with a bris at the time. She explained that a person comes to the house (or to a relative's house) and circumcises the baby. All the relatives attend. It would be a party! At the time, the thought of throwing a party at a relative's home to celebrate a circumcision was amusing to me. Before the conversation with my son's mother, I assumed that the bris was probably done in the hospital with everyone attending there. But she went on to explain that a person who is trained to do it—a mohel—does this work as their main job and makes sure that the baby is anesthetized and that sterile techniques are used. To be clear, I didn't ever think that my sons wouldn't be circumcised. I just thought it would happen in the hospital rather than in Baba's living room, followed immediately by a meal of deli meat sandwiches. But the bris sounded like it would make a nice memory for the family, so I agreed to it. I was always (and still am) interested in Jewish traditions. I think they're pretty cool, so I was all in. I assume there could have been some pressure from my son's mother's family if the bris was something I didn't want to do, but that wasn't an issue since I was completely on board. There is an episode of Seinfeld called \"The Bris\" in which Elaine and Jerry are nervous about the duties they must perform for a bri","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135195653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1353/nib.2023.a909673
Rachel Caplan, Sachin Agarwal, Joyeeta G. Dastidar
Abstract: Comatose survivors of cardiac arrest may die following withdrawal of life-sustaining therapy (WLST) due to poor neurologic prognosis. Family members, acting as surrogate decision makers, are frequently asked to decide whether the patient should continue to receive ongoing life-sustaining therapy such as mechanical ventilation in this context of risk of death following removal. Sometimes, physicians and family members disagree about what is in the patient's best interest, and this conflict causes distress for both families and medical personnel. This article examines themes recorded in the medical records of 24 cardiac arrest patients at Columbia University Medical Center (CUMC) whose families chose to pursue continued life support despite physician recommendations for withdrawal. In documented conversations between patients' families and their providers, the most prominent themes included faith in miracles, the inappropriateness of "playing God," the value of more time with the patient, and differences in how providers and family members perceived the patient's status.
{"title":"Physician Family Conflict Following Cardiac Arrest: A Qualitative Study","authors":"Rachel Caplan, Sachin Agarwal, Joyeeta G. Dastidar","doi":"10.1353/nib.2023.a909673","DOIUrl":"https://doi.org/10.1353/nib.2023.a909673","url":null,"abstract":"Abstract: Comatose survivors of cardiac arrest may die following withdrawal of life-sustaining therapy (WLST) due to poor neurologic prognosis. Family members, acting as surrogate decision makers, are frequently asked to decide whether the patient should continue to receive ongoing life-sustaining therapy such as mechanical ventilation in this context of risk of death following removal. Sometimes, physicians and family members disagree about what is in the patient's best interest, and this conflict causes distress for both families and medical personnel. This article examines themes recorded in the medical records of 24 cardiac arrest patients at Columbia University Medical Center (CUMC) whose families chose to pursue continued life support despite physician recommendations for withdrawal. In documented conversations between patients' families and their providers, the most prominent themes included faith in miracles, the inappropriateness of \"playing God,\" the value of more time with the patient, and differences in how providers and family members perceived the patient's status.","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135194190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1353/nib.2023.a909662
Travis Cearley
Ease of Care Travis Cearley Roughly nine years ago, I was deer hunting on a friend's property just outside of Canaan, Missouri, where he had graciously provided me access to one of his premier tree stands. It was early in bow season and even though the calendar had suggested it was Autumn, the weather mirrored a classic Missouri August morning, muggy and thick. Dressed in my lightest hunting gear, I had just gotten settled—bow in lap, arrow knocked, binoculars ready—when I felt a stinging sensation in my calf. Slowly hiking up my pant leg so as not to make too many sudden movements, I saw a familiar yet harrowing sight: Seed ticks had invaded my socks, and I was covered from the mid-calf down with black pulsating parasites. I knew instantly (as many outdoorsmen know) that my hunt had come to an end. Somewhere on the hike down the hillside or the climb into the tree, I had stepped on a nest of ticks, and the rest of my morning was shot (no pun intended). I quickly clambered out of the stand, made my way back to my friend's house and proceeded to strip down in his front yard. Left with only one option, I placed all "infected" articles of clothing in a burn pile, took my naked self to the nearest hose, rinsed feverishly in his yard, and checked every inch of my body for burrowed residents. You see, removal—complete and thorough—is the only way to keep the tick from becoming an unwelcome guest, causing itching and burning, or even spreading disease. The seed tick is an especially menacing foe. He can be invisible to the naked eye. He is faster than you would expect. He travels in herds. However, all ticks, regardless of size, are capable of causing weeks of discomfort. This discomfort and concern multiplies based on where the tick chooses to lodge itself. You see, there is a spot on the base of a man's penis where the penis itself meets the scrotum—a private, quiet, warm and damp location—that is particularly enticing to the tick. As an avid outdoorsman and lover of nature, I have had my fair share of uninvited guests attempt to call this place home. Multiple times in my life, I have taken caution in the painstaking removal of ticks in all sorts of locations, and I will tell you, few tasks are more galling or difficult than removing one burrowed next to the crease of the scrotum just under the penis itself. It seems they are keenly aware of the small bit of extra skin that exists on this part of the male anatomy, and part of me believes that they are also aware of the difficulty it presents. [End Page 79] At the time of the Canaan seed tick attack, my wife was pregnant with our first son who was due to be born that coming December. I am now the father of three sons. As a family, being outside is our favorite pastime. We run, we play, we chore; and whenever we can, we spend time in the woods. Whether we are exploring the various state parks of Missouri or rambling through the treelines of the family farm, some of the happiest times we spend as a famil
{"title":"Ease of Care","authors":"Travis Cearley","doi":"10.1353/nib.2023.a909662","DOIUrl":"https://doi.org/10.1353/nib.2023.a909662","url":null,"abstract":"Ease of Care Travis Cearley Roughly nine years ago, I was deer hunting on a friend's property just outside of Canaan, Missouri, where he had graciously provided me access to one of his premier tree stands. It was early in bow season and even though the calendar had suggested it was Autumn, the weather mirrored a classic Missouri August morning, muggy and thick. Dressed in my lightest hunting gear, I had just gotten settled—bow in lap, arrow knocked, binoculars ready—when I felt a stinging sensation in my calf. Slowly hiking up my pant leg so as not to make too many sudden movements, I saw a familiar yet harrowing sight: Seed ticks had invaded my socks, and I was covered from the mid-calf down with black pulsating parasites. I knew instantly (as many outdoorsmen know) that my hunt had come to an end. Somewhere on the hike down the hillside or the climb into the tree, I had stepped on a nest of ticks, and the rest of my morning was shot (no pun intended). I quickly clambered out of the stand, made my way back to my friend's house and proceeded to strip down in his front yard. Left with only one option, I placed all \"infected\" articles of clothing in a burn pile, took my naked self to the nearest hose, rinsed feverishly in his yard, and checked every inch of my body for burrowed residents. You see, removal—complete and thorough—is the only way to keep the tick from becoming an unwelcome guest, causing itching and burning, or even spreading disease. The seed tick is an especially menacing foe. He can be invisible to the naked eye. He is faster than you would expect. He travels in herds. However, all ticks, regardless of size, are capable of causing weeks of discomfort. This discomfort and concern multiplies based on where the tick chooses to lodge itself. You see, there is a spot on the base of a man's penis where the penis itself meets the scrotum—a private, quiet, warm and damp location—that is particularly enticing to the tick. As an avid outdoorsman and lover of nature, I have had my fair share of uninvited guests attempt to call this place home. Multiple times in my life, I have taken caution in the painstaking removal of ticks in all sorts of locations, and I will tell you, few tasks are more galling or difficult than removing one burrowed next to the crease of the scrotum just under the penis itself. It seems they are keenly aware of the small bit of extra skin that exists on this part of the male anatomy, and part of me believes that they are also aware of the difficulty it presents. [End Page 79] At the time of the Canaan seed tick attack, my wife was pregnant with our first son who was due to be born that coming December. I am now the father of three sons. As a family, being outside is our favorite pastime. We run, we play, we chore; and whenever we can, we spend time in the woods. Whether we are exploring the various state parks of Missouri or rambling through the treelines of the family farm, some of the happiest times we spend as a famil","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135194195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1353/nib.2023.a909669
Lauren L. Baker
Abstract: Routine infant circumcision is one of the most common surgical procedures performed in the U.S. Despite its broad societal acceptance, the practice is not without controversy. The stories included in this symposium offer rich insight into the diverse set of attitudes, values, and beliefs related to the practice of circumcision. They additionally offer insight into the complex web of personal, interpersonal, and social dynamics that inform the circumcision choices parents make for their children, the reasons parents make them, and how others can influence decisional choices. More broadly, these narratives raise important ethical questions mirrored today in broader contemporary bioethical and public discourse on the scope and limits of parental authority to make decisions for their children, power dynamics in medical decision making, and the ethics of healthcare activism. In this commentary, I discuss three sets of themes related to the ethics of circumcision running through the symposium narratives, comment on the ethical tensions and questions which emerge from each set of themes, gently problematize some of the rhetoric surrounding the ethical permissibility of circumcision, and gesture towards the future of bioethical inquiry on circumcision discourse.
{"title":"Our Baby, Whose Choice? Certainty, Ambivalence, and Belonging in Male Infant Circumcision","authors":"Lauren L. Baker","doi":"10.1353/nib.2023.a909669","DOIUrl":"https://doi.org/10.1353/nib.2023.a909669","url":null,"abstract":"Abstract: Routine infant circumcision is one of the most common surgical procedures performed in the U.S. Despite its broad societal acceptance, the practice is not without controversy. The stories included in this symposium offer rich insight into the diverse set of attitudes, values, and beliefs related to the practice of circumcision. They additionally offer insight into the complex web of personal, interpersonal, and social dynamics that inform the circumcision choices parents make for their children, the reasons parents make them, and how others can influence decisional choices. More broadly, these narratives raise important ethical questions mirrored today in broader contemporary bioethical and public discourse on the scope and limits of parental authority to make decisions for their children, power dynamics in medical decision making, and the ethics of healthcare activism. In this commentary, I discuss three sets of themes related to the ethics of circumcision running through the symposium narratives, comment on the ethical tensions and questions which emerge from each set of themes, gently problematize some of the rhetoric surrounding the ethical permissibility of circumcision, and gesture towards the future of bioethical inquiry on circumcision discourse.","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135195642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1353/nib.2023.a909665
Tracy Wilson
To Cut or Not to Cut?That is the Question Tracy Wilson What is circumcision? In simple terms, it is the removal or excision of the foreskin of the penis. Seems so simple, right? In some families, it is that simple. In other families, it is a religious exercise. I am a doctorally-prepared Family Nurse Practitioner and started my nursing career in the NICU. I have seen my fair share of circumcisions. As a nurse, our role was to prep the room with whichever instrument the OB/GYNS preferred and then soothe the baby. Some OB/GYNS prescribed Sucrose, which is ultimately sugar water, for the babies to have while undergoing circumcision, while others wouldn't prescribe anything. What I learned in the NICU and by watching circumcisions being performed was that the doctor's preference determined the pain management protocol. Some doctors cared more about pain control, some cared [End Page 85] about presentation and ensuring the foreskin was cut properly, and some were just old school and had their preferences. I wanted to comfort the baby and make his world as comfortable as possible. Watching circumcisions being performed, I never formed an opinion about them. I really looked at circumcision like any other procedure. However, I did see some parents really toil over the decisions, especially fathers who did not want to "see their son tortured or mutilated like that" as one told me once. I didn't quite understand the comparison to mutilation, but I understood why he did not want his son to go through the procedure. It wasn't until years later that I understood the gravity of the decision when I became pregnant with our son and knew immediately it was a boy. Call it a mother's intuition, but I just knew. To circumcise my son was never a decision I had to deliberate very long because it was something I was accustomed to in my family. It wasn't until one of my relatives got married and had her first son that I became aware that this would ever be a weighty decision for someone in my family. I took it for granted all those years before working in the NICU because circumcision was superficial to me. I realized that it's not just a piece of foreskin to many people. For some circumcision is done for religious reasons, for others making the choice to circumcise is about sameness, or hygiene. For my extended family member, it happened to be about sameness. She didn't want her sons to look different from their dad. Since potty training was mostly going to be taught by their father, they wanted their sons to look like him. Many NICU parents told me they wanted their sons to look like their fathers, so this notion was familiar to me. After my extended family member explained why sameness mattered, I understood the reasons why some parents felt this way. There are other stories like this which we pondered upon when we got pregnant with our son, and I really began to reflect on whether we should circumcise or not. Then two additional frames of thoughts arose; one, I ensu
{"title":"To Cut or Not to Cut? That is the Question","authors":"Tracy Wilson","doi":"10.1353/nib.2023.a909665","DOIUrl":"https://doi.org/10.1353/nib.2023.a909665","url":null,"abstract":"To Cut or Not to Cut?That is the Question Tracy Wilson What is circumcision? In simple terms, it is the removal or excision of the foreskin of the penis. Seems so simple, right? In some families, it is that simple. In other families, it is a religious exercise. I am a doctorally-prepared Family Nurse Practitioner and started my nursing career in the NICU. I have seen my fair share of circumcisions. As a nurse, our role was to prep the room with whichever instrument the OB/GYNS preferred and then soothe the baby. Some OB/GYNS prescribed Sucrose, which is ultimately sugar water, for the babies to have while undergoing circumcision, while others wouldn't prescribe anything. What I learned in the NICU and by watching circumcisions being performed was that the doctor's preference determined the pain management protocol. Some doctors cared more about pain control, some cared [End Page 85] about presentation and ensuring the foreskin was cut properly, and some were just old school and had their preferences. I wanted to comfort the baby and make his world as comfortable as possible. Watching circumcisions being performed, I never formed an opinion about them. I really looked at circumcision like any other procedure. However, I did see some parents really toil over the decisions, especially fathers who did not want to \"see their son tortured or mutilated like that\" as one told me once. I didn't quite understand the comparison to mutilation, but I understood why he did not want his son to go through the procedure. It wasn't until years later that I understood the gravity of the decision when I became pregnant with our son and knew immediately it was a boy. Call it a mother's intuition, but I just knew. To circumcise my son was never a decision I had to deliberate very long because it was something I was accustomed to in my family. It wasn't until one of my relatives got married and had her first son that I became aware that this would ever be a weighty decision for someone in my family. I took it for granted all those years before working in the NICU because circumcision was superficial to me. I realized that it's not just a piece of foreskin to many people. For some circumcision is done for religious reasons, for others making the choice to circumcise is about sameness, or hygiene. For my extended family member, it happened to be about sameness. She didn't want her sons to look different from their dad. Since potty training was mostly going to be taught by their father, they wanted their sons to look like him. Many NICU parents told me they wanted their sons to look like their fathers, so this notion was familiar to me. After my extended family member explained why sameness mattered, I understood the reasons why some parents felt this way. There are other stories like this which we pondered upon when we got pregnant with our son, and I really began to reflect on whether we should circumcise or not. Then two additional frames of thoughts arose; one, I ensu","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135195649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1353/nib.2023.a909664
Anonymous Two
The Difficult Road to Deciding on Circumcision Anonymous Two Anonymous Two When I got my results back from my noninvasive prenatal testing, NIPT and found out I was going to have a little boy, one of my first thoughts was, "I don't want to circumcise him," which sounds silly because I just found out the gender of my baby and my first thought is about his genitalia. The idea of growing and carrying this perfect little baby for nine months and then hurting him was unthinkable to me. I simply did not want to hurt him. The idea of it made me feel sick. Anytime the subject came up, I would protectively put my hand over my belly. And I do admit there were a lot of times I wished I was having a girl so I didn't have to deal with the circumcision debate. There was a lot of conversation between myself and my husband about it. My husband was adamant about getting it done. He referred to uncircumcised penises as "snake penises" and said our son will be made fun of for being different. He said it would be easier for him to clean and when he's old, he won't have to worry about infection. I would counter with, "well what if he falls in love with a girl from a culture that doesn't circumcise? She will think his penis is weird." The more we talked about it, the more ridiculous it felt thinking that far in advance and all these hypothetical situations he might get in over his penis. My parents wanted it done for religious reasons, but that wasn't a factor for me. My mom kept saying it's in the Bible and it needs to be done. My boss is Jewish and she joked that I could just convert to Judaism and the choice would be taken away from me so I didn't have to stress over it. Everything I read on my mommy groups and sites like Reddit called male circumcision child abuse and stated how barbaric it was. Terms like "genital mutilation" were thrown around a lot, and I didn't want to be part of a group that was seemingly looked down upon by so many. I spent my whole pregnancy saying how much I did not want to circumcise my baby. About a week after he was born and we were starting to get settled, my husband started to call around trying to get him an appointment for circumcision. It was unusual to do it this way, as typically it's done when babies are still in the hospital. But the hospital wasn't doing circumcisions because it was elective, and they weren't doing elective procedures because of COVID. At his first doctor's appointment, I talked to our pediatrician about it. She is Indian and told me she didn't circumcise her boys and said that it was very normal in many parts of the world to not do it. I would watch her pull back the skin to check it for fibers and think, "Is it really that bad to keep it? It's just skin." Our pediatrician didn't do it, as she doesn't perform procedures in the office, and she gave us some names of doctors that were supposed to be doing it. My husband called them all and none of them were doing circumcisions either. Finally, my husband found a
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Pub Date : 2023-06-01DOI: 10.1353/nib.2023.a909660
Joyeeta G. Dastidar
Newborn Circumcision, With a Twist Joyeeta G. Dastidar While I'm currently an internal medicine hospitalist taking care of adults on the inpatient side, my residency entailed dual training in both Internal Medicine and Pediatrics. For four years, I'd switch every three months between working in the adult and pediatric hospitals. My first rotation was Newborn Nursery, where I rounded on healthy newborn babies. There was an aide whose job it seemed, was to swaddle and cuddle the babies. I had a flash of envy regarding how much more time the aides actually got to spend with the babies when compared with the pediatricians. During this time, and throughout my pediatrics residency, I had the opportunity to observe neonatal circumcisions. It seemed archaic: The baby boys had their arms and legs strapped down into place to give clear access to their penis. The restraints reminded me of a more sanitized version of medieval torture devices I'd seen at a museum. As the observer, I tried to help soothe the baby through shushing and patting and letting the baby lick sugar water from a syringe. These comfort strategies were not enough, and the babies invariably wailed during the procedure. They left the treatment room with a generous layer of petroleum jelly and an extra-padded diaper for protection. Years later, when my husband and I were pregnant with our son, we debated two things primarily. First, we didn't agree on what type of food to feed the baby. I'm vegetarian, whereas my husband is not. My husband won out in feeding the baby an omnivorous diet. Second, we debated whether to have the baby undergo a circumcision. On the one hand, we wanted the decision about circumcision to be up to our baby. However, we knew he'd only truly be able to decide much later in life, closer to adulthood. While we were aligned on this end, perhaps due to being male himself, my husband felt even more strongly than I on the point of preferring to let our son decide for himself. On the other hand, we knew it'd be much easier to get a circumcision done as a baby. As a bonus, if done as a neonate, our son would have no recollection of the procedure. In South Asia, where my family originated, the decision to circumcise often fell along religious lines. While grappling with agnosticism personally, I was raised in a staunchly Hindu household. In talking to my mother, she mentioned that circumcision was not something done in our faith. However, this was a one-time statement that my mother said in passing, knowing her input would be disregarded if we felt circumcision was in baby's best interest from a medical standpoint. [End Page 76] Our baby was born very premature and spent months in the NICU until he was closer to his due date. There were conflicting statements made regarding our baby's urologic diagnosis: Hypospadias was brought up by a pediatric resident rotating in the NICU. He mentioned it when he noticed the attending neonatologist taking a closer look at our son's penis. T
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