Earp Brian D, Shahvisi Arianne, Reis-Dennis Samuel, Reis Elizabeth
Yale University and The Hastings Center, USA.
Brighton and Sussex Medical School, UK.
Nurs Ethics. 2021 Nov-Dec;28(7-8):1294-1305. doi: 10.1177/0969733020983397. Epub 2021 Mar 15.
The American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and other largely US-based medical organizations have argued that at least some forms of non-therapeutic child genital cutting, including routine penile circumcision, are ethically permissible even when performed on non-consenting minors. In support of this view, these organizations have at times appealed to potential health benefits that may follow from removing sexually sensitive, non-diseased tissue from the genitals of such minors. We argue that these appeals to "health benefits" as a way of justifying medically unnecessary child genital cutting practices may have unintended consequences. For example, it may create a "loophole" through which certain forms of female genital cutting-or female genital "mutilation" as it is defined by the World Health Organization-could potentially be legitimized. Moreover, by comparing current dominant Western attitudes toward female genital "mutilation" and so-called intersex genital "normalization" surgeries (i.e. surgeries on children with certain differences of sex development), we show that the concept of health invoked in each case is inconsistent and culturally biased. It is time for Western healthcare organizations-including the American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and World Health Organization-to adopt a more consistent concept of health and a unified ethical stance when it comes to child genital cutting practices.
美国助产士学院、美国疼痛管理护理学会、美国儿科学会以及其他主要位于美国的医学组织认为，至少某些形式的非治疗性儿童生殖器切割，包括常规的阴茎环切术，即使是在未经同意的未成年人身上进行，在伦理上也是允许的。为支持这一观点，这些组织有时会诉诸于从这些未成年人的生殖器上切除性敏感、无病变组织可能带来的潜在健康益处。我们认为，这些以“健康益处”为由来为医学上不必要的儿童生殖器切割行为辩护的做法可能会产生意想不到的后果。例如，这可能会创造一个“漏洞”，通过这个漏洞，某些形式的女性生殖器切割——即世界卫生组织所定义的女性生殖器“ mutilation”（残害）——可能会被合法化。此外，通过比较当前西方对女性生殖器“mutilation”以及所谓的双性生殖器“正常化”手术（即对具有某些性发育差异的儿童进行的手术）的主流态度，我们表明在每种情况下所援引的健康概念是不一致的且存在文化偏见。现在是西方医疗组织——包括美国助产士学院、美国疼痛管理护理学会、美国儿科学会以及世界卫生组织——在儿童生殖器切割行为上采用更一致的健康概念和统一的伦理立场的时候了。
