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":"32 1","pages":"0"},"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":"22 1","pages":"0"},"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":"5 1","pages":"0"},"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.
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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":"55 1","pages":"0"},"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
{"title":"The Difficult Road to Deciding on Circumcision","authors":"Anonymous Two","doi":"10.1353/nib.2023.a909664","DOIUrl":"https://doi.org/10.1353/nib.2023.a909664","url":null,"abstract":"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","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135194184","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.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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Pub Date : 2023-06-01DOI: 10.1353/nib.2023.a909658
Allan J. Jacobs
Circumcision:Ordinary and Universal in My Community Allan J. Jacobs My1 circumcision experiences are remarkable mostly for their ordinariness. My wife Danaë gave birth to our son Perseus2 while I was a resident in obstetrics and gynecology in a city where we had no family. Perseus was circumcised in a Jewish brit milah3 ceremony on the eighth day of his life, as were my wife's and my male ancestors back into ancient times. We were relieved because Perseus had just recovered from a potentially serious condition. After a difficult forceps delivery, his blood bilirubin rose almost to the point where he might have developed the dreaded kernicterus syndrome. Kernicterus can cause permanent severe motor, intellectual and visual impairment. It was unclear whether he would be discharged from the hospital in time. He had to spend a week in restraints under a bright light whose frequency degraded bilirubin. Happily, he came home the day before the scheduled brit. Our four parents attended the brit. Danaë's father was the sandek,4 being granted the honor of holding our son on his lap during the circumcision ceremony. The mohel, or circumciser, was the local Conservative rabbi. We were mildly anxious because he didn't do many circumcisions in this city with few Jews. Perseus cried briefly after he was circumcised. The circumcision undoubtedly was far less stressful than treatment of elevated bilirubin. The circumcision certainly was less painful than the prodding and sticks for the many blood tests he had to undergo in the hospital, not to mention the pain of his difficult forceps delivery. Perseus did not seem to have much discomfort in his penis afterward, and had no circumcision complications. After the brit, our parents and my resident colleagues ate refreshments and chatted for an hour or so. A brit milah is a happy occasion, but not an elaborate one. It marks the end of the joy, anxiety, and excitement of the child's birth and its aftermath and is followed by the less exalted rhythm of feedings, diaper changes, and sleep deprivation. At the brit, our boys are assigned Hebrew names and confirmed in the Biblical covenant between God and the Hebrew people established between God and Abraham, and reaffirmed between God and Moses. Regardless of the historical truth of the formation of the covenant, it is accepted as a myth tantamount to [End Page 71] truth. In other words, regardless of its literal truth, such a myth is to be regarded as true because it concretizes God's demands or a moral truth. The covenant is real for me whether or not there was a historical Abraham. As with other religious commitments, the obligation to circumcise our sons is unprovable, but binding. On this basis, Perseus's ancestors on both sides were circumcised in brit milah ceremonies for many centuries into the past. My two grandsons were circumcised as well. Achilles was circumcised among friends and relatives. The mohel was an experienced obstetrician who was certified to offici
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Pub Date : 2023-06-01DOI: 10.1353/nib.2023.a909672
Claudio J. Kogan
Abstract: This commentary draws upon the author's experience in bioethics and as a physician, ordained Rabbi, and certified Mohel (a Jewish professional qualified to perform infant male circumcisions (MC)). People's identity and adherence to a religious belief are frequently cited reasons for deciding whether to circumcise their male children. For Jewish and Muslim males, circumcision is considered essential. In this commentary, the author uses his medical, religious, and bioethical knowledge, expertise, and experience to address common arguments used in opposing nontherapeutic male circumcision of minors. In these narratives, half of the parents agreed with circumcision, and half did not. The parents against circumcision cite human rights violations, security, privacy, and bodily integrity issues and refer to circumcision as genital mutilation, while those who agree argue that circumcision should be done for religious reasons to prevent health issues, promote hygiene and cleanness, avoid cancer, or for later sexual enjoyment. After evaluating the evidence, the author states that parents should be free to either consent or decline MC for a son. Though a reoccurring theme in these narratives was for mothers to leave the circumcision decision up to their male partners, the author concludes that women have considerable power regarding the decision.
{"title":"Commentary on \"Circumcision\"","authors":"Claudio J. Kogan","doi":"10.1353/nib.2023.a909672","DOIUrl":"https://doi.org/10.1353/nib.2023.a909672","url":null,"abstract":"Abstract: This commentary draws upon the author's experience in bioethics and as a physician, ordained Rabbi, and certified Mohel (a Jewish professional qualified to perform infant male circumcisions (MC)). People's identity and adherence to a religious belief are frequently cited reasons for deciding whether to circumcise their male children. For Jewish and Muslim males, circumcision is considered essential. In this commentary, the author uses his medical, religious, and bioethical knowledge, expertise, and experience to address common arguments used in opposing nontherapeutic male circumcision of minors. In these narratives, half of the parents agreed with circumcision, and half did not. The parents against circumcision cite human rights violations, security, privacy, and bodily integrity issues and refer to circumcision as genital mutilation, while those who agree argue that circumcision should be done for religious reasons to prevent health issues, promote hygiene and cleanness, avoid cancer, or for later sexual enjoyment. After evaluating the evidence, the author states that parents should be free to either consent or decline MC for a son. Though a reoccurring theme in these narratives was for mothers to leave the circumcision decision up to their male partners, the author concludes that women have considerable power regarding the decision.","PeriodicalId":37978,"journal":{"name":"Narrative inquiry in bioethics","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135194193","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.a909670
Laura M. Carpenter
Abstract: This commentary examines twelve stories in which parents recount how they (and often their co-parent) decided whether or not to circumcise their newborn sons. Several debated whether this should be their decision to make. The stories offer an intimate glimpse into people's efforts to do the best for children in a context of incomplete and changing information and intense public controversy. The commentary explores the diverse meanings and contradictory commonsense beliefs that surround foreskin removal in the United States today. Considering these parents' reflections—and their silences—can help us appreciate the real-life consequences of debates about the ethics of male circumcision.
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