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Editors' Note 编者注
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1353/nib.2023.a909655
James M. DuBois, Ana S. Iltis, Heidi A. Walsh
Editors' Note James M. DuBois, Ana S. Iltis, and Heidi A. Walsh Dionne Deschenne was 30 weeks pregnant with her son when she contracted a serious case of pneumonia, requiring her to have an emergency C-section. Her son spent weeks in the NICU after his premature birth. Deschenne writes, "Under the conditions, I relied on the hospital staff to help me understand the risks, benefits, and necessities of each procedure or test they recommended. We formed a relationship of mutual respect." One day when Deschenne's doctor was making rounds, a nurse asked if she wanted to have her son circumcised while the doctor had time and was available. "The nurse bringing up circumcision was one with whom I had built a relationship of trust over the previous days. I considered her a trusted advisor. I asked her what the benefits would be? What would the risks be? Would my son experience pain? Was operating on such a tiny and ill baby safe?" Authors in this issue of "Narrative Inquiry in Bioethics" pondered similar questions. In the symposium, "Newborn Male Circumcision," we aimed to explore the decision making process of parents when choosing whether to have their infant male children circumcised. Through the symposium, we hoped to gain insights about what information or resources parents lack or would find helpful as they decide. "Overall, even though it was a very difficult decision, I think it was the right one for my son and our family," says Anonymous Two, one of 14 authors who contributed a story. "I don't think it's right for others to judge parents that make the choice to circumcise their sons. I don't think it's an easy choice for most of them—it certainly wasn't an easy choice for me." Twelve stories are included in the symposium; two additional narratives are published in the online supplement. Nine of the 12 parent authors opted to circumcise their infant sons, though the reasons they stated for doing so varied. Most of the parent authors relied on cultural or social beliefs, religious guidance, or a desire for sameness with the infant's father. Parents who didn't circumcise their male infants discuss their convictions about autonomy, bodily rights, and the medical benefits of circumcision versus the harm or pain caused by the procedure. The symposium editor, Heidi A. Walsh, makes the observation that "while shared decision making is not an overarching theme in the stories, the authors demonstrate that circumcision decisions are not straightforward for many parents and discussion with a trusted healthcare provider could have been helpful." The four commentary articles by Lauren L. Baker, Laura M. Carpenter, Shawn D. O'Connor and Claudio J. Kogan offer important insights into the authors' stories. Comatose survivors of cardiac arrest often die after life-sustaining therapy is withdrawn. Family members, acting as surrogate decision makers, are frequently asked to decide whether their loved one should continue to receive ongoing mechanical ventilation or o
迪翁·德谢尼(Dionne Deschenne)在怀孕30周时感染了严重的肺炎,需要紧急剖腹产。她的儿子早产后在新生儿重症监护室呆了几个星期。Deschenne写道:“在这种情况下,我依靠医院的工作人员来帮助我了解他们推荐的每项手术或检查的风险、益处和必要性。我们建立了一种相互尊重的关系。”一天,当德尚的医生在查房时,一位护士问她是否想趁医生有时间和有空的时候给她的儿子做包皮环切手术。“那位提出包皮环切的护士是我在前几天建立起信任关系的人。我认为她是一个值得信赖的顾问。我问她有什么好处?风险是什么?我的儿子会感到痛苦吗?给这么一个生病的小婴儿做手术安全吗?”本期《生命伦理学的叙事探究》的作者也思考了类似的问题。在“新生儿男性包皮环切术”研讨会中,我们旨在探讨父母在选择是否为男婴进行包皮环切手术时的决策过程。通过这次研讨会,我们希望深入了解家长在做决定时缺乏哪些信息或资源,以及哪些信息或资源对他们有帮助。“总的来说,尽管这是一个非常艰难的决定,但我认为这对我的儿子和我们的家庭来说是正确的,”匿名者2说,他是14位为这篇文章撰稿的作者之一。“我认为别人评判那些选择给儿子行割礼的父母是不对的。我认为这对他们中的大多数人来说不是一个容易的选择,对我来说当然也不是一个容易的选择。”专题论文集收录了12个故事;在线增刊中还发表了另外两篇叙述。12位父母作者中有9位选择对他们的婴儿进行割礼,尽管他们这样做的原因各不相同。大多数父母的作者都依赖于文化或社会信仰、宗教指导或与婴儿父亲相同的愿望。没有给男婴做包皮环切手术的父母会讨论他们对自主、身体权利的信念,以及包皮环切手术的医疗益处与手术造成的伤害或痛苦。研讨会编辑海蒂·a·沃尔什(Heidi a . Walsh)观察到,“虽然共同决策不是故事中的首要主题,但作者证明,对于许多父母来说,割礼的决定并不简单,与值得信赖的医疗服务提供者讨论可能会有所帮助。”劳伦·l·贝克、劳拉·m·卡彭特、肖恩·d·奥康纳和克劳迪奥·j·科根的四篇评论文章对作者的故事提供了重要的见解。心脏骤停的昏迷幸存者经常在停止生命维持治疗后死亡。作为替代决策者的家庭成员经常被要求决定他们的亲人是否应该继续接受持续的机械通气或其他维持生命的治疗,考虑到一旦这种治疗被撤销后死亡的高风险。有时,医生和家庭成员不同意什么是在病人的最佳利益,这给家庭和医疗保健提供者造成痛苦。由Rachel Caplan等人撰写的“心脏骤停后的医生家庭冲突:一项定性研究”,检查了24名心脏骤停患者的医疗记录中的主题,这些患者的家人表示,尽管医生建议撤回维持生命的治疗,但他们希望继续为其家庭成员寻求生命支持。在记录在案的家庭成员和医疗服务提供者之间的对话中,家庭成员提到的不想撤销生命支持的四个突出主题出现了,包括对奇迹的信仰,“扮演上帝”的不恰当,与患者共度更多时间的价值,以及医疗服务提供者和家庭成员对患者状况的不同看法。作者总结说,通过仔细倾听、提问和参与谈话,临床医生可以帮助减少冲突、改善沟通,并帮助家属为患者做出最好的决定。本期的案例研究由Leenoy Hendizadeh等人撰写,并作为我们与凯撒医疗机构合作案例研究的一部分提交。
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引用次数: 0
Full Collection of Personal Narratives 个人叙事全集
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1353/nib.2023.a909677
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引用次数: 0
Surprised Divide 惊讶的划分
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1353/nib.2023.a909657
Anonymous One
Surprised Divide Anonymous One Anonymous One Not long after our daughter was born, my wife and I were expecting a son. We were busy new parents, so her pregnancy with our second child went by quickly and without a lot of the fuss that a first pregnancy brings. To our surprise, our son was born a few weeks early but aside from a little jaundice he was a happy, healthy baby. My parents were caring for our daughter while we were at the hospital. After my son's birth, we were excited for them to bring our daughter up to the hospital to visit her new baby brother. The hospital photographer came by and took photos of our two kids together and photos of our son swaddled and sleeping soundly in a basket. Other family members stopped by to meet the new baby as well. It was a happy time. Little did we know that a couple of hours later we would be faced with a communication breakdown. My wife and I usually pride ourselves on how well we are able to communicate and plan our future. I grew up heavily Catholic, attending parochial schools through high school graduation. Meanwhile, my wife's family are Unitarian Universalists. You could not have two more polar opposite religions! We are used to having different points of view. We have always talked through many of life's choices and have both had to make compromises in order to have a successful relationship. It was on that happy day of my son's birth that we discovered we forgot to discuss one important topic. As our family was gathered in my wife's hospital room, joyfully celebrating the newest addition, the doctor entered the room to check on my wife and said it was time to do the circumcision if we wanted. Without hesitation, I responded in the affirmative, then the doctor and I looked over at my wife, who was staring at us with saddened, conflicted eyes. I was confused. Didn't she want the same thing for our son that I did? Surprisingly we never discussed this decision, at least not that I remember. I don't recall her ever telling me she was against it. My wife stated that she wasn't prepared to make a decision because she didn't know what our son would want and she was worried about him experiencing pain. She worked hard for 9 months to grow this baby boy, and he was so little. I understood her anguish in the thought of letting someone alter his tiny body. I am circumcised myself. My background provided me guidance and an expectation that this would be happening, so it was a nonissue for me. I never considered a scenario in which my son would not be circumcised. In truth, it felt ridiculous to even contemplate not circumcising him. My words of reassurance that it would be fine and my explanation to my wife that this was just one of the many decisions we would need to make for him and our other child did little to settle her. It was clear that no one (including me) had discussed this with my wife prior to this point, which was unfortunate. The doctor described the process and tried to reassure my wife that
女儿出生后不久,我和妻子就盼着生个儿子。我们都是忙碌的新父母,所以她怀第二个孩子的过程很快就过去了,没有像第一次怀孕那样大惊小怪。令我们惊讶的是,我们的儿子提前几周出生了,除了有点黄疸外,他是一个快乐、健康的婴儿。我们在医院的时候,我父母在照顾我们的女儿。儿子出生后,我们很兴奋,因为他们带着女儿去医院看望她刚出生的弟弟。医院的摄影师过来拍了我们两个孩子在一起的照片,还有我们儿子裹着襁褓在篮子里熟睡的照片。其他家庭成员也顺路过来见了见宝宝。那是一段快乐的时光。我们一点也不知道,几个小时后,我们将面临通讯故障。我的妻子和我通常为我们能够很好地沟通和规划我们的未来而感到自豪。我从小到大都信奉天主教,高中毕业前都在教会学校就读。与此同时,我妻子的家人是一神论者。你不可能有两个完全相反的宗教!我们习惯了有不同的观点。我们总是谈论生活中的许多选择,为了拥有一段成功的关系,我们都不得不做出妥协。就在我儿子出生的那一天,我们发现我们忘了讨论一个重要的话题。当我们一家人聚集在我妻子的病房里,高兴地庆祝新添的孩子时,医生走进病房检查我妻子的情况,说如果我们愿意的话,可以做包皮环切手术了。我毫不犹豫地做出了肯定的回答,然后医生和我看了看我的妻子,她正用悲伤而矛盾的眼神盯着我们。我很困惑。她不是和我一样想要我们的儿子吗?令人惊讶的是,我们从未讨论过这个决定,至少在我的记忆中没有。我不记得她跟我说过她反对。我妻子说她还没准备好做决定,因为她不知道我们的儿子想要什么,而且她担心他会经历痛苦。她辛辛苦苦地工作了9个月才把这个小男孩养大,他还那么小。一想到让别人改变自己小小的身体,我能理解她的痛苦。我自己也受了割礼。我的背景为我提供了指导,并预期会发生这种情况,所以这对我来说不是问题。我从没想过我儿子不割包皮的情况。事实上,连不给他做包皮环切的想法都让人觉得可笑。我安慰妻子说一切都会好起来的,并向她解释说,这只是我们需要为他和我们的另一个孩子做出的众多决定之一,但这并没有让她平静下来。很明显,在此之前没有人(包括我)和我的妻子讨论过这个问题,这很不幸。医生描述了整个过程,并试图让我妻子放心,说这是一个安全的小手术。这仍然让我的妻子处于矛盾的状态。当时我家里的其他男人也来看望我,他们向我妻子保证,这是我们儿子想要的。她不情愿地同意了割礼,我猜是迫于同辈的压力。我相信是一群包皮环切手术的男人告诉她我们的儿子也想做包皮环切手术,这才影响了她。坦白说,我很高兴当医生过来帮我的时候他们正好在那里。但是,当我们的儿子离开房间接受手术时,我的妻子仍然感到矛盾和悲伤。我们都对彼此的反应感到惊讶。我对这个问题的看法是出于期望和传统的立场,而她担心不知道……
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引用次数: 0
Making Choices—Newborn Male Circumcision 做出选择——新生儿男性包皮环切
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1353/nib.2023.a909671
Shawn D. O'Connor
Abstract: Newborn male circumcision has potential benefits and advantages as well as disadvantages and risks. Families will at times have medical questions regarding newborn male circumcision that clinicians must be prepared to answer.
摘要新生儿男性包皮环切术既有潜在的利与利,也有潜在的弊与风险。家庭有时会有关于新生儿男性包皮环切的医学问题,临床医生必须准备好回答。
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引用次数: 0
A Brit Milah for Eliezer Herschel ben Yonatan Aryeh 一个英国米拉给以利以谢·赫歇尔和约纳坦·阿里耶
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1353/nib.2023.a909668
Molly Sinderbrand
A Brit Milah for Eliezer Herschel ben Yonatan Aryeh Molly Sinderbrand For observant Jews, the choice to circumcise one's son is not a choice. Technically, it is a contractual obligation; the belief is that male circumcision is part of a holy covenant with God. The word for ritual circumcision, brit milah or bris, literally means "covenant [of circumcision]." Circumcision is a physical symbol of a relationship with the divine. It is the commandment that encompasses all other commandments. It is, thankfully, only required of men (women, they say, are naturally closer to divinity). Circumcision is when a baby boy enters the Jewish community, eight days after birth, and when he gets his name. He becomes somebody. To choose otherwise— and some may choose otherwise—is to choose not to be part of the contract, and by extension, not be part of the Jewish community. And a community is one of the most valuable things a person can have. I was not always an observant Jew, though I was raised in a Jewish household. I essentially fell into observance over a period of 10 years, starting with studying ancient Hebrew with a language-loving rabbi in high school and eventually leading to weekly attendance at an orthodox shul, which I joined shortly after first tasting the vegan cholent at kiddush. It was much easier to make friends in [End Page 91] the Jewish community than in my competitive and mildly misogynist graduate program, and frankly, I liked them better. I received kindness and support when I needed it, and gave it back equally, especially around having children. Having children is difficult under any circumstance, but it is especially difficult in social settings where it is seen as abnormal, strange, or even selfish. The Jewish community normalized having children and created a respite from the judgment of the secular world. When I was pregnant at work, I got comments like "It looks like you're having twins!" and "Are you sure you don't have pre-eclampsia? You look awfully large"; at shul, I got pep talks, encouragement, and the traditional "b'sha'a tova"—"may it happen at a good time." Eventually, after having two kids in a two-bedroom rowhome, my husband and I moved to a mostly-Jewish suburb just outside the city. It is the kind of place where everyone says "Gut Shabbes" (a good Sabbath) to each other on Saturdays, but not one in which all the men wear black hats and study Torah all day (though some do). That is, folks live Jewish lives, but interact with the outside world as well. After a few months, it felt like home. This was the context in which I decided—or rather, did not have to decide—to circumcise my son. It was the natural result of the decision to be part of a community that places value (and even membership) on the ritual of circumcision. I made that decision years earlier and have been continuously reaffirming it since. Every day I wake up is a day I decide to be an observant Jew, and I decide to do so in order to be a member of an observ
对于严守戒律的犹太人来说,给儿子行割礼不是一种选择。从技术上讲,这是一种合同义务;他们认为男性割礼是与上帝圣约的一部分。仪式割礼这个词,brit milah或bris,字面意思是“割礼之约”。割礼是与神关系的身体象征。这条诫命包含了所有其他的诫命。值得庆幸的是,只有男人才需要这样做(他们说,女人天生更接近神)。割礼是指一个男婴在出生八天后进入犹太社区,并得到他的名字。他会出人头地。选择不这样做——有些人可能会选择不这样做——就是选择不成为契约的一部分,进而不成为犹太社区的一部分。社区是一个人能拥有的最有价值的东西之一。虽然我是在一个犹太家庭长大的,但我并非一直都是一个循规蹈矩的犹太人。在10年的时间里,我基本上养成了一种遵守犹太教的习惯,从高中时跟随一位热爱语言的拉比学习古希伯来语开始,到后来每周都参加一个正统的犹太聚会,我在基德什(kiddush)第一次品尝纯素酸奶后不久就参加了这个聚会。在犹太社区里交朋友比在我竞争激烈、略带厌恶女性的研究生项目里容易得多,坦率地说,我更喜欢他们。当我需要的时候,我得到了善意和支持,也同样给予了回报,尤其是在有孩子的时候。在任何情况下,生孩子都是困难的,但在被视为不正常、奇怪甚至自私的社会环境中,生孩子尤其困难。犹太社区将生儿育女正常化,并为世俗世界的评判创造了一个喘息的机会。当我在工作中怀孕时,我得到了这样的评论:“看起来你怀的是双胞胎!”和“你确定你没有先兆子痫吗?”你看起来太大了。”在开斋节,我得到了鼓舞和鼓励,还有传统的“b'sha'a tova”——“愿它在合适的时候发生。”最后,在一套两居室的排屋里生了两个孩子后,我和丈夫搬到了城外一个以犹太人为主的郊区。在这个地方,每个人都会在周六互相说“Gut Shabbes”(一个美好的安息日),但不是所有的男人都戴着黑帽子,整天学习托拉(尽管有些人会这样做)。也就是说,人们过着犹太人的生活,但也与外部世界互动。几个月后,这里就像家一样。这就是我决定——或者更确切地说,不必决定——给我儿子行割礼的背景。这是决定成为一个重视割礼仪式(甚至是成员资格)的社区的一部分的自然结果。我几年前就做出了这个决定,从那以后我一直在重申这个决定。我每天醒来的时候都决定做一个守规矩的犹太人,我决定这样做是为了成为一个守规矩的社区的一员。做包皮环切手术的决定是我加入这个社区的又一个决定,这个社区给了我很多快乐、支持和意义。为什么我要拒绝我的儿子和我自己的社区?此外,不需要做任何决定本身就是一种解脱。我听说过一些母亲——包括我自己的母亲——在一个房间里哭泣,需要安慰,不能在那里接受割礼。但我没有。尽管有相当严重的围产期抑郁和焦虑的病史,包括在事件发生前不到一周的自杀念头,但我完全没事。也许我的安慰来自于我已经有了两个孩子;这不是我第一次生孩子,虽然这是我第一次割礼。也许,在经历了近两年的COVID之后,包皮环切术似乎并不是什么大事。也许我只是很高兴有人能帮我抱一会儿孩子。但我认为至少部分原因是快乐……
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引用次数: 0
Newborn Male Circumcision 新生儿男性割礼
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1353/nib.2023.a909656
Heidi A. Walsh
Abstract: This symposium includes twelve personal narratives from parents about making the decision whether to circumcise their infant male children. The authors of the narratives include five fathers and seven mothers. Nine of the 12 parent authors opted to circumcise their infant sons, though the reasons they stated for doing so varied. Most of the parent authors relied on cultural or social beliefs, religious guidance, or a desire for sameness with the infant's father. Parents who didn't circumcise their male infants discuss their convictions about autonomy, bodily rights, and the medical benefits of circumcision versus the harm or pain caused by the procedure. The symposium includes four expert commentaries on the narratives that are informed and enriched by the commentators' expertise in pediatric bioethics, healthcare ethics, gender studies, Jewish law and tradition, and the medical and surgical techniques of circumcision.
摘要:本次研讨会包括12位父母关于决定是否对男婴进行割礼的个人叙述。这些故事的作者包括五位父亲和七位母亲。12位父母作者中有9位选择对他们的婴儿进行割礼,尽管他们这样做的原因各不相同。大多数父母的作者都依赖于文化或社会信仰、宗教指导或与婴儿父亲相同的愿望。没有给男婴做包皮环切手术的父母会讨论他们对自主、身体权利的信念,以及包皮环切手术的医疗益处与手术造成的伤害或痛苦。研讨会包括四篇专家评论,这些评论是由评论员在儿科生物伦理学、保健伦理学、性别研究、犹太法律和传统以及割礼的医学和外科技术方面的专业知识提供和丰富的。
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引用次数: 0
Declining Circumcision for My Premature Newborn 我的早产儿拒绝包皮环切
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1353/nib.2023.a909667
Dionne Deschenne
Declining Circumcision for My Premature Newborn Dionne Deschenne In 1993, I was pregnant with my first of three sons and was busy preparing for his arrival. Unlike most parents, who focus much of their time on decorating the nursery and buying supplies, I was researching the medical decisions that I would need to make in the moments and weeks following his birth. Having worked in a hospital while a pre-medicine student, I had heard the cries of babies undergoing tests and procedures shortly after birth and knew I needed to be clear on the necessity of those tests and procedures if I was going to consent to them for my baby. My husband was in the Navy and out to sea for six months, so I took a few college courses to pass the time. One was a philosophy course on ethics, and I chose the bioethics of infant male circumcision as the focal point of my coursework that quarter. This allowed me to work through my findings in a racially, religiously, and age-diverse classroom under the guidance of a skilled professor. I was shocked to learn that even the American Academy of Pediatrics (AAP) at that time acknowledged that there were no known medical benefits that resulted from circumcision. How, I wondered, could parents allow their newborns to undergo such a harrowing experience for no reason? As the months passed and the birth of our first son grew nearer, I had everything ready—all of the decisions made, the doctors prepared, and the hospital selected. All of that preparation went out the proverbial window when I contracted pneumonia at 30 weeks. I was admitted to the Naval Hospital and treated for a week before being airlifted to a nearby Army Hospital when my condition worsened. After a few days there, the doctor came in very early one morning to wake me. Our son's heart rate was slowing, and we were at risk of losing him. They needed to immediately perform an emergency Cesarean section to preserve his life. I was terrified, knowing the potential myriad adverse effects his pre-term birth could cause. We were rushed into the OR and within seconds I had an epidural in my back. Moments later, my perfect, tiny but silent baby was whisked from the room to be attended to by a highly skilled and immensely respected NICU team. My husband followed to keep a watchful eye on our son while I was taken to Recovery. A few hours later, I was allowed to join my husband and son in the NICU. Our baby was beautiful, but so tiny that my husband could hold him in one hand. He weighed four pounds and had an enormous needle in the top of his head. The nurse explained to me that the IV needle was in the best location for administering the IV fluids and medications that our baby needed. His pre-term birth had introduced the need for several tests and treatments I had not anticipated. This was immensely distressing for me as someone who wanted to research and understand so that I could make well-informed and ethical decisions. Keep in mind that this was in the days before smart
1993年,我怀了三个儿子中的第一个,正忙着为他的到来做准备。不像大多数父母把大部分时间都花在装饰婴儿室和购买用品上,我一直在研究在他出生后的那一刻和几周内我需要做出的医疗决定。作为一名医学预科学生,我曾在医院工作过,听到过婴儿出生后不久接受检查和手术的哭声,我知道,如果我同意为我的孩子做这些检查和手术,我需要清楚这些检查和手术的必要性。我丈夫在海军服役,每次出海六个月,所以我上了几门大学课程来打发时间。一门是关于伦理学的哲学课程,我选择了男婴割礼的生物伦理学作为我那个季度课程的重点。这使我能够在一个有经验的教授的指导下,在一个种族、宗教和年龄不同的教室里研究我的发现。我震惊地得知,当时连美国儿科学会(AAP)也承认,包皮环切术没有已知的医学益处。我想知道,父母怎么能让他们的新生儿无缘无故地经历如此痛苦的经历呢?几个月过去了,我们第一个儿子的出生越来越近了,我已经准备好了一切——所有的决定都做好了,医生做好了准备,医院也选好了。当我在怀孕30周时感染肺炎时,所有的准备工作都烟消云散了。我住进海军医院,治疗了一个星期,后来病情恶化,被空运到附近的陆军医院。在那里住了几天后,一天早上医生很早就来叫醒我。我们儿子的心率在减慢,我们有失去他的危险。他们需要立即进行紧急剖宫产手术来挽救他的生命。我很害怕,知道他的早产可能会造成无数的不利影响。我们被紧急送进手术室,几秒钟后我的背部就被硬膜外麻醉了。过了一会儿,我那完美、小巧但沉默寡言的宝宝被迅速带出病房,交由技艺精湛、备受尊敬的新生儿重症监护室团队照料。在我被送去康复室的时候,我丈夫跟在后面照看着我们的儿子。几个小时后,我获准和丈夫和儿子一起住进了新生儿重症监护室。我们的孩子很漂亮,但太小了,我丈夫只能用一只手抱着他。他重四磅,头顶上插着一根巨大的针。护士向我解释说,静脉注射针的位置最适合给我们的宝宝注射液体和药物。他的早产让我需要做一些我没有预料到的检查和治疗。这对我来说是非常痛苦的,因为我想要研究和理解,这样我就可以做出明智和道德的决定。请记住,这是在智能手机出现之前的日子。事实上,那时候我们甚至没有手机!为了做研究,我需要在医院里找到一本我可以阅读的医学文献,或者去图书馆。我肚子里塞满了订书钉,不能开车,又不想离开我的孩子,所以去图书馆是不可能的。在这种情况下,我依靠医院的工作人员来帮助我了解他们推荐的每一个程序或测试的风险、好处和必要性。我们建立了相互尊重的关系。我想这是由于那段时间我们进行了深入的交谈。在儿子在新生儿重症监护室的第一周结束时,我们之间的相互尊重很可能导致了一场引人注目的谈话。那天,我们的医生正在巡视,一位护士问我们是否想给儿子做包皮环切手术,因为医生……
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引用次数: 0
Proudly Jewish—and Averse to Circumcision 骄傲的犹太人——反对割礼
Q4 Medicine Pub Date : 2023-06-01 DOI: 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
骄傲的犹太人——反对割礼丽莎·布拉弗·莫斯我一直对自己的犹太人身份有强烈的感觉,而且我一直对割礼有严重的疑虑。过去,这些说法似乎是相互矛盾的。现在我的任务是将两者结合起来。我嫁给了一个也是犹太人的男人。80年代末,我们有了两个儿子,我同意他们做包皮环切手术。Brit milah(割礼之约)是一种有精神意义的行为,象征着上帝和犹太人之间的协议。但对我来说,这段经历是如此令人沮丧,以至于我感觉不到上帝的存在。尽管有很多支持的理由——传统的影响,希望我的孩子们被犹太世界所接受,等等——我开始后悔我的默许。我开始从犹太人的角度探索质疑割礼的理由,在犹太杂志上发表文章,并在会议上发言。我没有关注医学上的利弊,而是写了关于犹太法律和伦理的文章,并与许多拉比交谈。我希望加深犹太人对这个话题的对话,在一个重视知识探索的文化中,这是一个奇怪的禁区。除了帮助我更多地了解犹太教,我的研究和写作也是一种带着负罪感生活的方式。我屈从于——并让我的孩子们经受了——一种完全违背我母性本能的传统。这种分裂使我怀疑自己是一个新妈妈。如果我不能保护好我刚出生的孩子,那我还算什么父母?这对我来说并不是一种积极或受欢迎的方式。我责怪自己。在我的儿子们出生之前,我没有做过医学研究,而是相信割礼的传统是长久的,并且认为割礼更卫生。我接受了包皮环切术的医学理由——后来我才知道,所有这些理由都没有承认包皮组织的性本质及其生理功能。如果我知道更多;如果我能更深入地思考婴儿创伤;如果我更认真地对待自己的精神信仰,我就会争取一个不同的结果,尽管我作为一个犹太人感到有压力。许多年过去了。我写了一本关于犹太人割礼的小说,然后与人合写了一本关于选择不接受割礼的家庭的割礼仪式的书。慢慢地,我开始明白,责备自己同意给儿子行包皮环切手术不仅是浪费时间,而且还忽略了更重要的一点。并不是只有我一个人反对这个古老的传统。事实上,许多犹太父母度过了这个节日,他们的关节发白,情绪超然,酗酒或服用镇静剂,而不是带着真正的宗教感情。他们精神上的真实性难道不重要吗?难道我的不重要吗?在犹太教中,每一条诫命(割礼是其中之一)都应该带着kavanah,或精神上的意图来对待。因此,从犹太人的角度来看,我对割礼传统的非精神感受是有问题的。我应该告诉拉比我不相信割礼是上帝想让我做的。我希望我在做出一个反映我真实精神的决定时得到了指导。相反,对任何人来说,最重要的似乎是把事情办好。违背我的本能和精神不仅仅是我的失败——它也代表了制度的失败。犹太领袖和拉比没有受过训练,不会同情地回应那些反对割礼的人。即使只是质疑这种做法的父母也可能受到评判、训斥和屈尊俯就。决定不做割礼的父母可能会面临以上种种,甚至更多:在美国的一些犹太教堂,没有做割礼的男孩目前被拒绝接受成人礼。________在犹太人的世界里,我们倾向于把割礼视为一个单一的传统:我们假设每个犹太男性都受过割礼,没有人谈论或质疑这一点。事实是,在我们的整个历史中,有一些男性,由于各种原因,没有经历这个仪式……
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引用次数: 0
My Circumcision Decision: A Journey of Inquiry, Courage and Discovery 我的割礼决定:一段探索、勇气和发现之旅
Q4 Medicine Pub Date : 2023-06-01 DOI: 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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引用次数: 0
My Personal Experience with Circumcision 我的包皮环切的个人经历
Q4 Medicine Pub Date : 2023-06-01 DOI: 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……
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Narrative inquiry in bioethics
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