ABSTRACT
Preventive newborn male circumcision has been at the center of scientific debate for many years. The reason for promoting preventive newborn male circumcision is the reduction of the incidence of UTIs (in the first six months of life), penile cancer, transmission of STDs/HIV infection/AIDS. However preventive interventions in the newborn involving violations of bodily integrity elicit several ethical questions. In this article, we reviewed the literature regarding circumcision, the prevention of UTIs, penile cancer, transmission of STDs/HIV infection/AIDS and complications of this practice in the neonatal period. The very limited reduction of incidence of UTIs and the uncertain preventive role of newborn male circumcision towards penile cancer, STDs/HIV infection and AIDS, makes it difficult to justify male circumcision in newborns. Moreover, the challenge in obtaining a unanimous opinion on newborn male circumcision derives from the fact that, as a preventive intervention, it requires evaluation criteria that are not comparable to those of therapeutic treatments. Since preventive male circumcision determines permanent alteration of the body, some authors believe that it can be used only in subjects that are capable of giving their valid consent. In the case of a newborn, the "childs best interest" should be used as a standard, but preventive newborn male circumcision does not satisfy it
La circuncisión masculina como tratamiento preventivo en recién nacidos ha estado en el centro del debate científico durante muchos años. Las razones para promover la circuncisión masculina preventiva en niños han sido la reducción de la incidencia de infecciones del tracto urinario (en los primeros seis meses de vida, UTIs), el cáncer de pene, la transmisión de VIH/SIDA y de otras enfermedades de transmisión sexual. Sin embargo, las intervenciones preventivas neonatales, que implican una violación de la integridad corporal del niño, presentan varias cuestiones éticas. En este artículo, revisamos la literatura con respecto a la circuncisión, la prevención de las UTIs, el cáncer de pene, la transmisión de VIH/SIDA y otras enfermedades de transmisión sexual y las complicaciones de esta práctica en el período neonatal. La muy limitada reducción de la incidencia de las UTIs y la incertidumbre en cuanto a la función preventiva de la circuncisión masculina en recién nacidos en relación con el cáncer de pene, la infección de VIH/SIDA y otras enfermedades de transmisión sexual, hace que sea difícil justificar la circuncisión masculina de tipo preventivo en neonatos. Por otra parte, los desafíos que aparecen en la obtención de una opinión unánime sobre la circuncisión masculina del recién nacido derivan del hecho que, como una intervención preventiva, se requieren criterios de evaluación que no son comparables a criterios de los tratamientos terapéuticos. Puesto que la circuncisión masculina preventiva determina una alteración permanente del cuerpo, algunos autores creen que puede ser utilizada sólo en los sujetos que son capaces de dar su consentimiento válido. En el caso de un recién nacido, "el mejor interés del niño" debe ser el estándar de referencia, pero la circuncisión masculina con carácter preventivo en niños recién nacidos no satisface este estándar
Subject(s)
Humans , Male , Infant, Newborn , Circumcision, Male/ethics , Sexually Transmitted Diseases/prevention & control , Third-Party Consent/ethics , HIV Infections/prevention & control , Penile Neoplasms/prevention & control , Phimosis/surgery , Risk AssessmentABSTRACT
Preventive newborn male circumcision has been at the center of scientific debate for many years. The reason for promoting preventive newborn male circumcision, is the reduction of the incidence of UTIs (in the first six months of life), penile cancer, transmission of STDs/HIV infection/AIDS. However preventive interventions in the newborn involving violations of bodily integrity elicit several ethical questions. In this article, we reviewed the literature regarding circumcision, the prevention of UTIs, penile cancer, transmission of STDs/HIV infection/AIDS and complications of this practice in the neonatal period. The very limited reduction of incidence of UTIs and the uncertain preventive role of newborn male circumcision towards penile cancer, STDs/HIV infection and AIDS, makes it difficult to justify male circumcision in newborns. Moreover, the challenge in obtaining a unanimous opinion on newborn male circumcision derives from the fact that, as a preventive intervention, it requires evaluation criteria that are not comparable to those of therapeutic treatments. Since preventive male circumcision determines permanent alteration of the body, some authors believe that it can be used only in subjects that are capable of giving their valid consent. In the case of a newborn, the â³child's best interestâ³ should be used as a standard, but preventive newborn male circumcision does not satisfy it.
Subject(s)
Child Welfare/ethics , Circumcision, Male/ethics , Penile Neoplasms/prevention & control , Sexually Transmitted Diseases/prevention & control , Urinary Tract Infections/prevention & control , Child , HIV Infections/prevention & control , Humans , Infant , Infant, Newborn , MaleABSTRACT
Since its inceptions, the standard of best interest of the child was linked to decisions about suspend life-sustaining treatments in neonatal units and evaluation of treatments applied to children in terms of their quality of life. This origin has conditioned the interpretation of the standard from two extremes: a vitalistic one, and a non vitalistic interpretation that triumphed in Western bioethics and has led to the consecration of the standard of best interest of the child in the Convention on the Rights of the Child of United Nations. A detailed analysis reveals a simplistic, utilitarian and proportionalist standard, which change the basis of parenthood. We therefore believe that the standard of the best interest of the child is not the best for the child in neonatal intensive care units and especially not in the process of withhold or withdrawal life-sustaining treatments.
Subject(s)
Bioethical Issues , Child Welfare , Intensive Care, Neonatal/ethics , Neonatology/ethics , Adolescent , Aging/psychology , Child , Child, Preschool , Euthanasia, Active/ethics , Euthanasia, Active/legislation & jurisprudence , Euthanasia, Passive/ethics , Euthanasia, Passive/legislation & jurisprudence , Human Rights , Humans , Infant , Infant, Newborn , Intensive Care Units, Neonatal , Intensive Care, Neonatal/legislation & jurisprudence , Parents , Pediatrics/organization & administration , Personal Autonomy , Quality of Life , Societies, Medical/standards , Third-Party Consent/legislation & jurisprudence , United Nations/standardsABSTRACT
Desde sus inicios, el estándar del mejor interés del niño estuvo unido a las decisiones de suspensión de tratamientos de soporte vital en unidades de neonatología y a la evaluación de los tratamientos aplicados al niño en función de su calidad de vida. Éste origen ha condicionado la interpretación del estándar desde dos extremos: uno vitalista y uno no vitalista que ha triunfado en la bioética occidental y ha llevado a la consagración del estándar del mejor interés del niño en la Convención de Derechos del Niño de Naciones Unidas. Un análisis detallado nos descubre un estándar simplista, utilitarista y proporcionalista, que ha cambiado el fundamento de la paternidad. Por ello creemos que el estándar del mejor interés del niño no es lo mejor para el niño en las unidades de neonatología y especialmente en los procesos de decisión sobre mantener o suspender los tratamientos de soporte vital
Since its inceptions, the standard of best interest of the child was linked to decisions about suspend life-sustaining treatments in neonatal units and evaluation of treatments applied to children in terms of their quality of life. This origin has conditioned the interpretation of the standard from two extremes: a vitalistic one, and a non vitalistic interpretation that triumphed in Western bioethics and has led to the consecration of the standard of best interest of the child in the Convention on the Rights of the Child of United Nations. A detailed analysis reveals a simplistic, utilitarian and proportionalist standard, which change the basis of parenthood. We therefore believe that the standard of the best interest of the child is not the best for the child in neonatal intensive care units and especially not in the process of withhold or withdrawal life-sustaining treatments
Subject(s)
Child , Female , Humans , Male , Child, Hospitalized/education , Child, Hospitalized/legislation & jurisprudence , Child, Hospitalized/psychology , Personal Autonomy , Bioethics/education , Bioethics/trends , Clinical Competence , Ethicists/education , Ethicists/legislation & jurisprudence , Ethicists/standardsABSTRACT
The debate over compulsory or merely recommended vaccination remains open, albeit latent, in those countries that have mandatory vaccine schedules. Despite the advantages of preventive immunization from the point of medical, economic and social features, it's clear, in the current status of medical ethics, that the exercise of patient autonomy calls for personal responsibility in the election of treatments and, in fact, the vaccines. Therefore, it is necessary to change the simple idea of prevention as <
Subject(s)
Social Responsibility , Vaccination/ethics , Altruism , Attitude to Health , Humans , Immunity, Herd , Mandatory Programs/ethics , Mandatory Programs/legislation & jurisprudence , Motivation , Patient Acceptance of Health Care , Personal Autonomy , Preventive Medicine/ethics , Preventive Medicine/legislation & jurisprudence , Public Health , Refusal to Participate/ethics , Refusal to Participate/legislation & jurisprudence , Risk Reduction Behavior , Social Values , Vaccination/legislation & jurisprudence , Vaccination/trends , Vaccines/adverse effectsABSTRACT
In paediatric female patients the only option for restoring fertility after chemotherapy and radiotherapy is ovarian tissue banking. Even if this procedure is considered the most promising available, anyway it is still an experimental option due to the paucity of data. The possibility to offer an experimental preventive technique with potential benefits but with known risks arises a dilemma: what is the best interest for suffering child? Is it most important to minimize risk of the disease or to preserve the future fertility? However, if it is right to propose fertility preservation when physical and psychic risks are acceptable, we think it is not in the child's best interest to retrieve ovarian tissue from very young patients whose ovaries are small and for whom surgery is a high risk procedure. Moreover fertility preservation should not be offered if this could increase the risk of disease worsening.
Subject(s)
Cryopreservation/ethics , Fertility Preservation/ethics , Neoplasms/therapy , Pediatrics/ethics , Child , Child Welfare , Female , Fertility Preservation/adverse effects , Humans , Informed Consent By Minors , Ovary , Parental ConsentABSTRACT
The use of techniques of analysis of fetal nucleic acid present in maternal peripheral blood for noninvasive prenatal genetic diagnosis (NIPD) is a reality in clinical practice in the case of certain diseases. In the coming years, it will become part of routine prenatal screening and diagnostic techniques for fetal diagnosis. A bioethical reflection on the possible difficulties and problems of the use of these techniques is necessary. On one hand, these techniques will result in reduced costs of screening, an increase in the number of disabled fetuses detected, and a decrease in the number of indirect abortions caused by invasive techniques. On the other hand, the widespread use of NIPD could decrease the autonomy of women in the decision-making process; health authorities could use NIPD as a means of eugenic prevention of genetic diseases, for example, in Down syndrome cases; and finally, NIPD could increase the image of the disabled person as an individual that has to be excluded from society. For this reason physicians play an important role in the process of pre-diagnosis and post-diagnosis genetic counseling. As a result, we conclude that the use of NIPD to diagnose the existence of genetic diseases in the fetus in order to decide-in the case of a positive result-whether or not to perform an abortion implies and includes in itself the conditions that characterize a negative moral assessment.
ABSTRACT
The use of techniques that analyse the fetal nucleic acids present in maternal peripheral blood for the preparation of non-invasive prenatal genetic diagnosis, is a clinical reality in the case of certain diseases. In the coming years, it will become part of the routine monitoring for fetal diagnosis. This study analyzes the current status of these techniques as well as the major ethical issues arising from the relationship between - prenatal diagnosis and eugenic abortion, and the specific problems posed by - prenatal genetic diagnosis based an analysis of the nucleic acids present in maternal peripheral blood. Among the conclusions are the following: we make a positive ethical evaluation of the technique when it is aimed at pregnant women who are in a situation of high risk, defined on the basis of medical standards and ethics, without compromising the integrity of the fetus. We make a negative ethical evaluation when non-invasive prenatal genetic diagnosis has a eugenic purpose and will establish a connection between prenatal diagnosis and eugenic abortion in case of a positive result. Non-invasive prenatal diagnosis increases the image of the disabled person as an individual that has to be excluded from society. The widespread use of non-invasive prenatal diagnosis will decrease the autonomy of women / couples when it comes to making decisions. Health authorities may use non-invasive prenatal diagnosis as a way of â³preventingâ³ genetic diseases, since it will lower costs, increase the number of malformed fetuses detected and a decrease the number of indirect abortions involving invasive techniques.
