Neonatal Male Circumcision: Clearly Beneficial for Public Health or an Ethical Dilemma? A Systematic Review.

Autor:	Morris B; Faculty of Medicine and Health, The University of Sydney, Sydney, AUS., Rivin BE; Schools of Medicine and Public Health, Department of Global Health, University of Washington, Seattle, USA.; Bioethics, Uplift International, Seattle, USA., Sheldon M; Medical Humanities and Bioethics Program, Feinberg School of Medicine, Chicago, USA., Krieger JN; Urology, University of Washington, Seattle, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Feb 23; Vol. 16 (2), pp. e54772. Date of Electronic Publication: 2024 Feb 23 (Print Publication: 2024).
DOI:	10.7759/cureus.54772
Abstrakt:	Contrasting ethical and legal arguments have been made concerning neonatal male circumcision (NMC) that merit the first systematic review on this topic. We performed PRISMA-compliant keyword searches of PubMed, EMBASE, SCOPUS, LexisNexis, and other databases and identified 61 articles that met the inclusion criteria. In the bibliographies of these articles, we identified 58 more relevant articles and 28 internet items. We found high-quality evidence that NMC is a low-risk procedure that provides immediate and lifetime medical and health benefits and only rarely leads to later adverse effects on sexual function or pleasure. Given this evidence, we conclude that discouraging or denying NMC is unethical from the perspective of the United Nations Convention on the Rights of the Child, which emphasizes the right to health. Further, case law supports the legality of NMC. We found, conversely, that the ethical arguments against NMC rely on distortions of the medical evidence. Thus, NMC, by experienced operators using available safety precautions, appears to be both legal and ethical. Consistent with this conclusion, all of the evidence-based pediatric policies that we reviewed describe NMC as low-risk and beneficial to public health. We calculated that a reduction in NMC in the United States from 80% to 10% would substantially increase the cases of adverse medical conditions. The present findings thus support the evidence-based NMC policy statements and are inconsistent with the non-evidence-based policies that discourage NMC. On balance, the arguments and evidence reviewed here indicate that NMC is a medically beneficial and ethical public health intervention early in life because it reduces suffering, deaths, cases, and costs of treating adverse medical conditions throughout the lifetimes of circumcised individuals. Competing Interests: Brian Morris is a member of the of the Circumcision Academy of Australia, a not-for-profit, government registered, medical society whose website https://circumcisonaustralia.org provides evidence-based information on male circumcision to parents, practitioners and others, as well as contact details of doctors in Australia and New Zealand who perform the procedure. Some of Brian Morris’ research is supported by U.S. National Institutes of Health Center of Biomedical Research Excellence grant 1P20GM125526-01A1 but none of this funding was used for the present study, nor did the funder have any influence on the study. (Copyright © 2024, Morris et al.)
Databáze:	MEDLINE
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