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Ethical Question ! HELP


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The Canadian Pediatric Association has recommended that circumcisions 'not be routinely performed'. They base this recommendation on their determination that 'the benefits have not been shown to clearly outweigh the risks and costs'. Doctors have no obligation to refer for, or provide, a circumcision, but many do, even when they are clearly not medically necessary. Ontario Health Insurance Plan (OHIP) no longer pays for unnecessary circumcisions. Consider the ethical problems that exist in this case.

 

What do you think guys? Can I have your opinion on this case?

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Hmmm this is a pretty tough one:huh:. I can't quite elaborate all the complexities of this in full sentences, but here are a few points we can consider (without being super well versed in law):

- Physicians do have the obligation to provide medically necessary services to their patients, regardless of their own personal beliefs as long as they do not impair your medical judgement and negatively affect the patients' wellbeing e.g. White supremacists, racists should receive equal care. 

- Circumcision, however, is not always medically necessary. Certain conditions do necessitate circumcision as a treatment. Surgeons have the right to refuse to perform certain procedures if they believe the risk to outweigh the benefit. I suppose such stipulation can be extended to paediatricians as well.

- Then the significance of personal rights and religious freedom have to be considered as well. A parent's decision to circumcise their baby might have religious backing. And it is then up to them to find physicians who are willing to perform this. Certain religious practices such as female genital mutilation are outlawed and can be considered abuse. Though circumcision does not amount to that, it is still highly elective in nature and OHIP public funds should not be allocated for elective treatments (and it is not for other surgeries like LASIK, cosmetics, or even certain circumstances of abortion etc.). 

- A way to harmonise this, while circumcision remains legal, is to encourage first that physicians specify on their professional profiles whether they accept circumcision, and second (if feasible), to have a database of some sort of these physicians so parents can find them of they choose to. 

- obviously this can all be pivoted to the personal choice of the child who is not cognitively competent at the time but this would probably be so much more complicated to consider in such a short amount of time. 

Just my two cents :confused:

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  • 1 month later...

Medicine has to follow the evidence . Many treatments in the past were originally covered and were later stopped because science progressed. 

Now the issue here is not of the medicine but actual patient paying for a procedure which they due to social cultural or religious belief deem a right. Now as a doctor if the parent mentions to me that they want to circumcise their child. I will try first to understand why they wish to circumsize, i will explain the latest research but most likely the parents who get kids circumsized do it for religious obligation and moral virtue. It has less to do wjth protection and safety. 

Now I will explain to them  that this is not covered but their are docs who do this procedure at a cost. Now if the family is upset I can most certainly try to connect with them someone at OHIP who may have more information of how to be granted an exception or find if some cost can be subsidizesd. 

Now I am not obligated to refer them but understanding this family has different ethical and cultural values and I treat the family I will refer them to someone, who can help them. 

Sidenote: I have paid for my son circumsize out of pocket it's about 200$ in GTA. Our family doctor just referred us to one. It's very similar to a doctor who doesn't support abortion but can refer  to a colleague. 

By law the parents are legal guardian and are responsible for.the kid. In the same way a mother has the choice to abort her fetus .

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