A Philosophy of Nursing Forum
Saturday, January 16, 2010
 
Bear:

First, let's consider your point, in the first three paragraphs of your comment, about penectomy. It is correct that penectomy involves transecting the urethra, whereas FGM ordinarily will not. It is not similarly correct to say or suggest that penectomy has no history, and that it would result in death absent modern medical intervention. In fact, penectomy has been performed for thousands of years under circumstances remarkably similar to those attending FGM, as a part of the eunuch process, and it still occurs infrequently in India. See the article in Indian J Urol. 2007 Jul–Sep; 23(3): 317–318 for the grizzly details, along with the accompanying picture. It is instructive, I think, to compare THAT picture to some of the available pictures of female genitalia post FGM, and then compare both of THOSE to one of the innumerable pictures available on the WWW of a circumcised penis. I think my analogy is apt indeed, although like all analogies, it does not achieve a perfect correspondence.

Now, on to your final paragraph. The first two sentences are:

FGM and male circumcision are both barbaric practices with little to justify them. A classic case of culturally defined stupidity and irrational justification in both western and non-western cultures and clear violations of the rights of the victims.

These two sentences make the following claims about MNC: 1) male neonatal circumcision is an elective “cultural” phenomenon or practice not COMPELLED by medical necessity; 2) MNC is stupid and/or irrational; 3) purported justifications of the practice of MNC are “irrational”; and 4) and election by a parent to have a male neonate circumcised violates that neonate's “rights”. I think claim number 1 is true. In Ireland, for example, I gather that a parent will only rarely elect circumcision for a newborn son (Irish readers can correct me if I am wrong about this), and this decision is not irrational. I think it is perfectly rational to elect MNC or to decline MNC. However, I do not think this is true of FGM. A decision to have a daughter “circumcised” is never rational.
Circumcision, a reply to Bear's objections
I flatly deny claims 2, 3, and 4. I suspect the purported truth of #2 depends on the purported truth of #3. That is, I think that if #3 is false, and there are good reasons for a parent to elect MNC, then a fortiori MNC is then neither “stupid” or “irrational”.

I don't see anything in your comment which justifies claim #3, other than characterizations of the research on the topic as just 1) “appearing” to show that MNC confers some benefit, and 2) “thinly veiled rationalizations.” I have, to date, reviewed over 400 published, peer reviewed studies relating to MNC, as did Benatar and Benatar. I have studied research methods, at the graduate level, under the tutelage of one of the best scientists in her field, and am quite sure that I can tell the difference between rational, responsible inquiry and “thinly veiled rationalization.” I am confident Drs. Benatar and Benatar can as well. The corpus of scholarly, scientific study of the practice of MNC is voluminous, and is published in journals that are not in the habit of publishing articles which either a) merely “appear” to show something, or are merely 2) “thinly veiled rationalizations”.

As regards claim #3, I agree with Benatar and Benatar: the evidence supports the following conclusions: men who are circumcised as neonates are at slightly less risk than uncircumcised men of contracting syphilis, gonorrhea and HIV AIDS (if in a high risk group), and at slightly greater risk of contracting canker and non-gonococcal urethritis; they are at a reduced risk for the most invasive forms of penile cancer; and at reduced risk for UTI. Actually, I think most MNG opponents concede that the evidence DOES show what I claim it does. This is especially clear in light of a careful review of the responses to the Benatars' original target article. None of the respondents, even those which were clearly hostile to the practice of neonatal circumcision, argued that there was NO warrant for believing that neonatal circumcision provides (minimal) medical benefits. All of them focused, instead, on whether such benefits were sufficient to justify the practice in light of what various respondents took to be clear contra-indications associated with the practice. Here, I think, absence of evidence equals evidence of absence. Credible arguments against the position that there are minimal medical benefits to neonatal circumcision simply do not exist.

I assume, then, that those who oppose MNG are claiming that there are contra-indications associated with neonatal circumcision which unequivocally and significantly outweigh any medical benefits of the practice that we might have warrant for accepting as real. And, further, that these contra-indications are so significant that the practice should not be permitted. Bear's next to last sentence alludes to one such purported contra-indication – pain.

Pain is yet another informal fallacy – the red herring. Pain is NOT an argument against the circumcision of male neonates. It isn't even a valid argument against FGM, for that matter. It IS an argument against either practice when they are not accompanied by truly effective anesthesia and post-operative analgesia. But pain can be effectively controlled for far more serious operations – it can hardly be an insurmountable obstacle in this instance.

So what other “contraindication” could there be? The only one on offer is that the procedure somehow leaves the individual harmed, or diminished, in some way, and this usually takes the form of one or more versions of the “less pleasure” thesis I have already criticized. Until, and unless, I am offered ARGUMENTS against the position I have outlined regarding the “less pleasure” thesis, and the research which supports my position, I remain unmoved.

I suppose that it is possible that someone might think that only surgery which is medically necessary, as opposed to “in some way desirable”, should be permitted. I cannot imagine why. In fact, surgery is performed all the time for reasons other than “medical necessity.” Here is an example: otoplasty, or ear pinning. The procedure is almost never a medical necessity, since kids with large ears can ordinarily hear perfectly. It is, instead, elected for cosmetic reasons, and to help children avoid inevitable adolescent ridicule. The same is true for cleft palate and other maxillofacial surgery. These are procedures which are not, strictly speaking, medically necessary, but do confer benefits upon those who undergo them. The “not necessary” argument is less than compelling.

Finally, we come to the last sentence, the one about neonatal “rights”. I would argue that neonates do not have “rights” - what they have are interests that adults have a duty to protect and further. For the reasons I have already adduced, I fail to see that any male has an “interest” in either having, or not having, a foreskin, any more than they have an “interest” in having an appendix or tonsils. That is, whether their lives go well or badly in not going to depend to any degree on the presence of these tissues. And this marks the dramatic contrast between FGM and MNC, since every woman has an interest in having a clitoris, and their lives will go less well without their clitoris than they otherwise would.
 
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Post discussions for the week on Newsom's Blog: Shanda Bishop

1. Do you agree or disagree with Pesut and Johnson’s assertion that “philosophical inquiry has yet to be positioned as contributing substantially to the field of nursing’s inquiry.” Why or why not?
I agree with Pesut and Johnson’s assertion that “philosophical inquiry has yet to be positioned as contributing substantially to the field of nursing’s inquiry.” Although Pesut and Johnson alluded to a certain amount of scientific data which was used to support their assertion, none was proven in my opinion. There were no tangible tools or aims used to support the assertion. There was a use of reason to clarify concepts, analyze arguments and addresses problems related to ontology and epistemology of nursing (Pesut and Johnson 2007), but these also in my opinion showed no scientific data and better yet no tools to measure the results obtained.
I must mention however that I am torn over this subject. Philosophical inquiry implies to me that there are deep investigations into the subject matter at hand. We need to dig deep and deeper in nursing in order to answer unanswered and even answered questions in order to establish the substantiality of the field of nursing. I believe there is room for and even a need for the depth because we will gain much more understanding when philosophical inquiry is added.



2. Do you think that ignoring philosophy in nursing “puts nursing at risk”? Why or why not?
I definitely believe that ignoring philosophy in nursing “puts nursing at risk”. We need philosophy to explain the nursing problems that are ultimate and abstact (Fawcett, 1992). According to Pesut and Johnson the profession of nursing has many conceptual models which need explanation, this goal is accomplished through nursing philosophy.


3. What can the historical roots of nursing add to the scientific advancement of the profession?
According to Sapountzi-Krepia, Our historical roots began in the 19th century with Florence Nightingale. She used statistical data to establish the course of mortality rates during hospital stays during the 19th century. She was able to prove some phenomenal facts for example, as to croweded patient rooms and their contribution to the mortality rates of hospitalized patients (Nightingale, 1859b). Her works changed the course of nursing care from then until now by improving outcomes of the ill. The works she did also began the scientific advancement of nursing as a profession. In addition, to that she developed a framework for the training of nurses (Nightingale 1859a, 1892). Without her works, nursing would not have any kind of credibility as scientifically advanced profession. It is imperative that we continue to build on the great works that she started. We must also continue to learn from her works. This will help to build on the solid foundation which has already been established for our continued scientific advancement of nursing as a profession.
 
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