Tag Archives: Ethics/Medical

The principles of professional conduct concerning the rights and duties of the physician, relations with patients and fellow practitioners, as well as actions of the physician in patient care and interpersonal relations with patient families.

Royal college strengthens its guideline on female genital mutilation

BMJ. 2015 Jul 9;351:h3709. doi: 10.1136/bmj.h3709.

Royal college strengthens its guideline on female genital mutilation.

Torjesen I

EXTRACT

The Royal College of Obstetricians and Gynaecologists has revised its guideline on female genital mutilation to clarify healthcare professionals’ legal responsibilities, the requirements to notify cases, and the management of women who have undergone mutilation who are pregnant or giving birth.

The update comes after the first attempted UK prosecution of a doctor for female genital mutilation. Dhanuson Dharmasena, a trainee registrar in obstetrics and gynaecology at the Whittington Hospital in north London, was acquitted earlier this year...

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Improve reporting of female genital mutilation, MPs tell doctors

BMJ. 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1467 (Published 18 March 2015)

Improve reporting of female genital mutilation, MPs tell doctors

O’Dowd

EXTRACT

Doctors must be encouraged to report cases of female genital mutilation (FGM) to tackle what is still a woefully under-reported crime, MPs have claimed.

In a report1 based on their follow-up inquiry on FGM published by the parliamentary Home Affairs Select Committee on 14 March, MPs said that “buck passing” for failure to prosecute the crime had to stop…

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Do the Benefits of Male Circumcision Outweigh the Risks? A Critique of the Proposed CDC Guidelines

Front Pediatr. 2015 Mar 18;3:18. doi: 10.3389/fped.2015.00018. eCollection 2015. FREE

Do the Benefits of Male Circumcision Outweigh the Risks? A Critique of the Proposed CDC Guidelines

Earp BD

ABSTRACT

The Centers for Disease Control and Prevention (CDC) have announced a set of provisional guidelines concerning male circumcision, in which they suggest that the benefits of the surgery outweigh the risks. I offer a critique of the CDC position. Among other concerns, I suggest that the CDC relies more heavily than is warranted on studies from Sub-Saharan Africa that neither translate well to North American populations nor to circumcisions performed before an age of sexual debut; that it employs an inadequate conception of risk in its benefit vs. risk analysis; that it fails to consider the anatomy and functions of the penile prepuce (i.e., the part of the penis that is removed by circumcision); that it underestimates the adverse consequences associated with circumcision by focusing on short-term surgical complications rather than long-term harms; that it portrays both the risks and benefits of circumcision in a misleading manner, thereby undermining the possibility of obtaining informed consent; that it evinces a superficial and selective analysis of the literature on sexual outcomes associated with circumcision; and that it gives less attention than is desirable to ethical issues surrounding autonomy and bodily integrity. I conclude that circumcision before an age of consent is not an appropriate health-promotion strategy.

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Awareness and predictors of female genital mutilation/cutting among young health advocates

FREEInt J Womens Health. 2015 Feb 20;7:259-69. doi: 10.2147/IJWH.S78664. eCollection 2015.

Awareness and predictors of female genital mutilation/cutting among young health advocates

Abolfotouh SM, Ebrahim AZ, Abolfotouh MA

ABSTRACT

The act of female genital mutilation/cutting (FGM/C) is considered internationally as a violent act against girls and women and a violation of their human rights. This study sought to assess the awareness and predictors of FGM/C in young Egyptian health advocates. A cross-sectional study of 600 medical students from a total of 2,500 members of the International Federation of Medical Students’ Associations (IFMSA)-Egypt, across all Egyptian medical schools, was conducted using a previously validated online Google survey. The overall prevalence of circumcision was 14.7/100 female students, with a significantly higher prevalence in students from rural areas (25%) than in non-rural areas (10.8%, P=0.001), and in those residing in Upper (southern) Egypt (20.6%) than in Lower (northern) Egypt (8.7%, P=0.003). The students’ mean percentage score for knowledge about the negative health consequences of FGM/C was 53.50±29.07, reflecting a modest level of knowledge; only 30.5% had a good level of knowledge. The mean percentage score for the overall attitude toward discontinuation of the practice of FGM/C was 76.29±17.93, reflecting a neutral attitude; 58.7% had a favorable attitude/norms toward discontinuation of the practice. Of circumcised students, approximately one-half (46.8%) were unwilling to have their daughters circumcised, and 60% reported no harm from being circumcised. After controlling for confounders, a negative attitude toward FGM/C was significantly (P<0.001 in all cases) associated with male sex, residency in Upper Egypt, rural origin, previous circumcision, and the preclinical medical phase of education. The low level of knowledge among even future health professions in our study suggests that communication, rather than passive learning, is needed to convey the potentially negative consequences of FGM/C and to drive a change in attitude toward discontinuation of this harmful practice.

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Surgeon acquitted of carrying out female genital mutilation in a prosecution criticised by obstetricians

BMJ. 2015, 350, h703

Surgeon acquitted of carrying out female genital mutilation in a prosecution criticised by obstetricians

Dyer C

EXTRACT

An NHS trainee obstetrician who faced the first prosecution in the United Kingdom for female genital mutilation has been acquitted after the jury deliberated for less than half an hour.

Dhanuson Dharmasena, then a junior registrar in obstetrics and gynaecology at the Whittington Hospital in north London, was accused of reinfibulating a Somali woman by sewing her labia together after the birth of her first child in 2012. But he told the jury that he had put only a small suture at the top of a cut he had made to deliver the baby, to stop bleeding, in an emergency situation.

The verdict of not guilty came after Mr Justice Sweeney, who presided over the 13 day trial at Southwark Crown Court, told the jury in his summing up that they would have to consider whether the doctor had been made a “scapegoat” …

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Female Circumcision: An Emerging Concern in College Healthcare

Journal of American College Health, 1997, 45(5), 230-232

Female Circumcision: An Emerging Concern in College Healthcare

Woolard D & Edwards RM

ABSTRACT

Female circumcision (clitoridectomy), a traditional practice in some Third World societies, is discussed, and related medical procedures are described. Medical and psychosexual implications for the patient are considered, and college health clinicians are encouraged to be prepared to see patients who have been subjected to the procedure and help these young women deal with attendant medical, emotional, and cultural issues. One female student’s experience at her college health service is described.

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GP accused of being involved in female genital mutilation fails to have charges thrown out

BMJ. 2014 May 18;348:g3363. doi: 10.1136/bmj.g3363.

GP accused of being involved in female genital mutilation fails to have charges thrown out.

Dyer C.

EXTRACT

A GP caught in a newspaper sting over female genital mutilation has failed in a bid to have General Medical Council charges against him thrown out on the ground of entrapment.

Ali Mao-Aweys faces an allegation that he offered to help arrange for the procedure to be done on a child or children in the United Kingdom, in meetings and a telephone conversation with an …

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[Female genital mutilation – the excision. Reflections of the ethics committee of the medical association Avicenne of France].

J Gynecol Obstet Biol Reprod (Paris). 2010 Feb;39(1):81-2. doi: 10.1016/j.jgyn.2009.10.003. Epub 2009 Nov 18.FREE

[Female genital mutilation – the excision. Reflections of the ethics committee of the medical association Avicenne of France]. [Article in French]

Messaadi N, Chaker A.

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[Legal aspects of ritual circumcision].

Klin Padiatr. 2009 Dec;221(7):409-14. doi: 10.1055/s-0029-1233494.

[Legal aspects of ritual circumcision]. [Article in German]

Schreiber M, Schott GE, Rascher W, Bender AW.

Abteilung für Kinderurologie, Urologische Klinik, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen. ms.schreiber@yahoo.de

ABSTRACT

Female circumcision (genital mutilation) is a criminal violation of human rights under German law. Even with consent of the person to be circumcised and/or her legal representative this procedure must not be carried out since a consent to female circumcision is unethical and therefore void. As much consent as there is on female circumcision the legal situation with ritual male circumcision is very unclear. In practice and unnoticed by the public male circumcision is carried out – be it for medical or ritual reasons – without deeper-going reflexions on the clearness of the medical indication or the legal situation with ritual circumcision. From the medical aspect there are big differences between female and male circumcision but also certain parallels. Various reasons, partly founded in prejudice and misinformation, make people refrain from regarding circumcision of boys also as illegal. Contrary to the prevailing opinion male circumcision also represents a bodily harm which a doctor can only carry out after a preoperative interview and with the consent of the affected person. Since ritual male circumcision does not serve the wellbeing of a child it is not possible for the parents to give their consent to the circumcision in lieu of the child. Male circumcision is only permitted if the child has given his consent and is thus only legally permitted if the child has reached an age at which he is mature enough to understand the meaning and extent of such an action which is hardly the case before he has completed his 16 (th) year.

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The issue of reinfibulation.

Int J Gynaecol Obstet. 2010 May;109(2):93-6. doi: 10.1016/j.ijgo.2010.01.001. Epub 2010 Feb 6.

The issue of reinfibulation.

Serour GI.

Department of Obstetrics and Gynecology, International Islamic Center for Population Studies and Research, Al Azhar University, Cairo, Egypt. giserour1@link.net

ABSTRACT

Reinfibulation is resuturing after delivery or gynecological procedures of the incised scar tissue resulting from infibulation. Despite the global fight against female genital mutilation/cutting (FGM/C), reinfibulation of previously mutilated or circumcised women is still performed in various countries around the world. A good estimate of the prevalence of reinfibulation is difficult to obtain, but it can be inferred that 6.5-10.4million women are likely to have been reinfibulated worldwide. Women who undergo reinfibulation have little influence on the decision-making and are usually persuaded by the midwife or birth attendant to undergo the procedure immediately following labor or gynecological operation. Although medicalization of reinfibulation may reduce its immediate risks, it has no effect on the incidence of long-term risks. Reinfibulation is performed mainly for the financial benefit of the operator, and cultural values that have been perpetuated for generations. Reinfibulation has no benefits and is associated with complications for the woman and the unborn child. Its medicalization violates the medical code of ethics and should be abandoned. International and national efforts should be combined to eradicate this practice.

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