Department of Medicine, Centre for Medical Ethics and Law, Stellenbosch University, Stellenbosch, Western Cape, South Africa.
Department of Social Medicine, UNC Center for Bioethics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
J Med Ethics. 2018 Feb;44(2):86-90. doi: 10.1136/medethics-2016-103515. Epub 2017 Jul 29.
Traditional male circumcision is a deeply entrenched cultural practice in South Africa. In recent times, there have been increasing numbers of botched circumcisions by untrained and unscrupulous practitioners, leading to genital mutilation and often, the need for penile amputation. Hailed as a world's first, a team of surgeons conducted the first successful penile transplant in Cape Town, South Africa in 2015. Despite the euphoria of this surgical victory, concerns about the use of this costly intervention in a context of severe resource constraints have been raised. In this paper, we explore some of the ethical implications of penile transplants as a clinical and public health response to the adverse consequences of traditional male circumcision. Given the current fiscal deficits in healthcare and public health sectors, how can one justify costly, high-technology interventions for conditions affecting a small section of the population? Since botched traditional male circumcisions are preventable, is a focus on penile transplantation as a form of treatment reasonable? Finally, do such interventions create undue expectations and false hope among a highly vulnerable and stigmatised group of young men? In this paper, we argue that given limited healthcare resources in South Africa and competing healthcare needs, prevention is a more appropriate response to botched traditional circumcisions than penile transplants.
南非的传统男性割礼是一种根深蒂固的文化习俗。最近，未经训练和无良从业者进行的割礼手术失误越来越多，导致生殖器残缺，往往需要进行阴茎截肢。2015 年，南非开普敦的一个外科医生团队成功进行了世界首例阴茎移植手术。尽管这一手术的胜利令人欢欣鼓舞，但在资源严重受限的情况下，人们对这种昂贵干预措施的使用提出了担忧。本文探讨了阴茎移植作为对传统男性割礼不良后果的临床和公共卫生应对措施所涉及的一些伦理问题。鉴于医疗保健和公共卫生部门目前存在财政赤字，如何为影响一小部分人口的疾病提供昂贵的高科技干预措施呢？既然传统的男性割礼失误是可以预防的，那么将阴茎移植作为一种治疗形式是否合理呢？最后，这些干预措施是否会给一群高度脆弱和受污名化的年轻男性带来不必要的期望和虚假的希望？在本文中，我们认为，鉴于南非医疗保健资源有限且存在竞争医疗需求，预防是对传统割礼失误的更恰当的反应，而不是阴茎移植。
