Moreton Stephen, Cox Guy, Sheldon Mark, Bailis Stefan A, Klausner Jeffrey D, Morris Brian J
CircFacts, Warrington WA5 1HY, Cheshire, United Kingdom.
Australian Centre for Microscopy & Microanalysis and School of Aeronautical, Mechanical and Mechatronic Engineering, University of Sydney, Sydney 2006, New South Wales, Australia.
World J Clin Pediatr. 2023 Dec 9;12(5):244-262. doi: 10.5409/wjcp.v12.i5.244.
The British Medical Association (BMA) guidance on non-therapeutic circumcision (NTMC) of male children is limited to ethical, legal and religious issues. Here we evaluate criticisms of the BMA's guidance by Lempert . While their arguments promoting autonomy and consent might be superficially appealing, their claim of high procedural risks and negligible benefits seem one-sided and contrast with high quality evidence of low risk and lifelong benefits. Extensive literature reviews by the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in developing evidence-based policies, as well as risk-benefit analyses, have found that the medical benefits of infant NTMC greatly exceed the risks, and there is no reduction in sexual function and pleasure. The BMA's failure to consider the medical benefits of early childhood NTMC may partly explain why this prophylactic intervention is discouraged in the United Kingdom. The consequence is higher prevalence of preventable infections, adverse medical conditions, suffering and net costs to the UK's National Health Service for treatment of these. Many of the issues and contradictions in the BMA guidance identified by Lempert stem from the BMA's guidance not being sufficiently evidence-based. Indeed, that document called for a review by others of the medical issues surrounding NTMC. While societal factors apply, ultimately, NTMC can only be justified rationally on scientific, evidence-based grounds. Parents are entitled to an accurate presentation of the medical evidence so that they can make an informed decision. Their decision either for or against NTMC should then be respected.
英国医学协会(BMA)关于男童非治疗性包皮环切术(NTMC)的指导意见仅限于伦理、法律和宗教问题。在此,我们评估莱姆珀特对BMA指导意见的批评。虽然他们关于促进自主性和同意的论点表面上可能很有吸引力,但他们声称该手术程序风险高而益处可忽略不计,这似乎有失偏颇,且与低风险和终身益处的高质量证据相矛盾。美国儿科学会和美国疾病控制与预防中心在制定循证政策时进行的广泛文献综述以及风险效益分析均发现,婴儿NTMC的医学益处远超过风险,且性功能和性快感并无减退。BMA未考虑幼儿NTMC的医学益处,这或许可以部分解释为何在英国这种预防性干预措施不受鼓励。其后果是可预防感染、不良医疗状况的发生率更高,给英国国民医疗服务体系带来痛苦和治疗这些疾病的净成本增加。莱姆珀特指出的BMA指导意见中的许多问题和矛盾源于该指导意见缺乏充分的循证依据。事实上,该文件呼吁其他人对围绕NTMC的医学问题进行审查。虽然社会因素存在,但最终,NTMC只能基于科学的循证依据进行合理辩护。父母有权获得准确的医学证据陈述,以便他们能够做出明智的决定。然后,他们支持或反对NTMC的决定都应得到尊重。