Student with an ethics question

  1. Let me preface this by saying I am in no way trying to start a debate about the morality of any medical procedure.

    Now that the disclaimer is out of the way, I am a student- who plans to one day become a CNM, so I will want to work in OB Nursing after I graduate. I know that OB nursing means encountering many sensitive issues, but for the purpose of illustration, I have chosen circumcision of male infants because it is considered elective in nearly all cases. If you are opposed in principle to routine infant circumcision, how do you handle the probability that you will in the course of your job be asked to assist in one? Is there a way to refuse on moral grounds while still satisfying your obligation to your employer? What about your obligation to your patient? The interests of the mother and the baby may be different in this case (for the sake of argument I assume the baby prefers not to be circumcised) how can you be an advocate for both patients when their interests are opposed?

    I am interested in hearing how nurses handle situations where personal ethics conflict with job requirements. If there is a conflict at all. Am I making an issue out of nothing?

    Kim
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  2. 14 Comments

  3. by   fergus51
    If you search for circumcision on this site, you will find a very heated debate with TONS of nurses opinions.

    Personally, I don't believe there is a real medical reason for it, but if the parents religious or gut feeling is that they want their son circed, I will educate them about the procedure and support their decision. I don't assist with any of them as the NICU nurses do. I was asked once but said I didn't want to for personal reasons if someone else was willing to do it instead of me. There was another nurse so I didn't have to. I don't think I should be forced to participate in a circumcision if nurses are allowed to object to other procedures such as abortion or hanging blood products because of their personal beliefs. Why should this be any different? (Kind of a rhetorical question, though I am sure someone will have an answer for me )
  4. by   fergus51
    ps
    In our medical system, the parent is the one who decides what is best for the child, not the nurse, so I don't see a conflict there. And I think that you should be upfront with your employer before you are hired if you do not want to assist with circs.
  5. by   kimtab
    Ummmm...okay, sorry to bother you.

    If this post was inappropriate, it was unintentionally so. I am just questioning how I am going to be able to handle doing my job in situations where I might not believe in what I'm doing. I understand if no one wants to discuss it.

    Kim
  6. by   kimtab
    I would like to apologize for the mopey tone of my last post. I had the feeling that I was being shooed off, but I was reminded that without the nuances of inflection and body language that accompany face-to-face speech, meanings can be misinterpreted.

    Thank you for the link, it is a very interesting discussion.

    Kim
  7. by   kennedyj
    To be honest I don't know of many CNM's who routinely do circumcisions. There is enough debate out there on circs to allow you enough leeway to get out of it if you want. Most say it is a surgical procedure and is preferred to be done by the OB/gyn physicians because they have more surgical skills. this is rubbish because I don't know of any who circ. It is usually the pediatrician's who do them.

    A circ is so simple anyone can learn it in about 5 minutes.
    An RN can circ under direct supervision and some hospitals will certify RN in circs but most don't due to the legal debates. I know a few EMT/techs who have circ'd under MD supervision. If you have 10 kids to circ you line em up on two restraints, a doc on one and a nurse on the other. That way you are under supervision and circ away.

    I personally like the Mogan clamp to the Plastibell.
    Last edit by kennedyj on Sep 4, '01
  8. by   rdhdnrs
    Hi,
    I work in high-risk ob at a med center so we get into all kinds of ethical dilemmas as do most nurses. We do terminations for lethal fetal anomalies, which causes a problem for some of our staff, nurses and residents alike.
    This is how I handle it: By the time a patient gets to me for a procedure or for care, she has already decided on a course of action. In ALL cases, the patient has the autonomy and assuming she gets the correct information, the wherewithal to make her own decision about her own body or her own child. My job, and my calling, is to take care of the patient. It is NOT my job to judge, second-guess, or condemn her for a decision that I have no way of knowing how agonizing it was to make. Who am I to presume that I know better about her life than she does?
    I don't mean to sound harsh, but where do we draw the line? If you work in the ER do you refuse to take care of the suicide victim because you're morally opposed to suicide? The gunshot victim because he was a drug dealer?
    I believe we are called to respect the dignity of every person, and take care of them as they are when they come to us, because that's all we really know about them.
    Good luck,
    Lisa
  9. by   KRVRN
    Don't forget you may come across women that are there for an abortion. For instance a woman that just doesn't want a baby as opposed to a woman whose baby has died or something. You'll have to consider whether you're okay with that also. Will you be okay with taking care of that woman? What if you will be the one to adminster the meds that will start the process?
  10. by   Aimee.K
    That's a hard one that I really don't think there are any easy answers to. I am in my OB rotation and it seems a question a lot of people have. Also, there seems to be some confusion over pain control, issues in sexual pleasure in adult hold and cosmetic mistakes. I really don't know how I would handle your concerns other then fall back on the typical.... Patient Education. I think that it is important that the families a re able to make an informed choice free from the feelings on one side or the other... this has got to be difficult for you though... Good luck with your choices!
    Aimee
  11. by   Aimee.K
    I'm kinda on the line about infant circumcision. I really don't know what I believe. Pain seems to be a big issue in the debate but, both sides seem resonable as to whether or not to use anethesia. Some doctors who circumcise acknowledge the associated pain and then dismiss it by saying, "It only lasts for a minute," implying that it is acceptable to subject an infant to unnecessary pain as long as it is temporary. I know that the infants pain is real however, many of the physicians I have talked to say that the use of lidocaine places the infant at a high risk for a reaction and also may cause more pain by the displacement of the tissue and "bee sting" effect. Additionally, the use of a "buffered lidocaine" to take the sting out has increase fluid causing more pain r/t tissue displacement. He also said that the emla cream can cause a infant to have a reaction increasing pain anymore.

    As far as where I stand on the to do or not to do subject, I still don't know. I'm not sure what I will do even with my child when I have one. I do feel however it is tuff to be a nurse and draw a line as to what you feel you can and can't do. A lot more serious stuff is going to pull at your heart strings... methodone addicted babys, DNR patients and many more serious problems.

    Good luck with which ever way you go.
    Aimee

    Look up the web site: http://www.circumcision.org/response.htm
  12. by   fiestynurse
    There is no such thing as "routine" circumcision, as kimtab has referred to. It is an elective procedure that requires INFORMED consent from the parent. And as kennedyj has mentioned, CNMs usually don't do circumcisions or assist with them. The Pediatricians generally do them after performing a physical exam on the infant and consulting with the parents. The nursery nurses help set-up and assist. Many are done in the Peds clinic as an outpatient. Some Pediatricians like the baby to recover a little from the birth before performing the procedure.
    In addition, circs are being done less and less. I would say maybe 40% don't circ in my community. Also, because it is considered an elective surgery, many insurances will not pick-up the costs.

    Nursing is full of ethical dilemmas, but our own personal beliefs can never interfere with the care of the patient. There are very very few procedures or treatments that a nurse can refuse to participate in for moral or religious reasons. Usually it involves the care of abortion patients. These things must be discussed ahead of time with each prospective employer.
  13. by   kennedyj
    as a CNM you will have your share of ethical debates. another one is to routinely cut an epis. There are many debates out there that say never do one but if you do this and you get a nasty uretheral tear because you should have done a little snip you could be doing harm ( and this is not really like the parent electing for a circ- you will make the decision). Another is whether to use a vacuum or push a few more times or use forceps (if specially trained). Another is to start pitocin every time someone doesn't go into fast labor. You are entering probably the field with the most ethical problems, but on the other hand it is also one of the most exciting where you have probably the greatest impact of families in a positive setting.

    Jared
  14. by   OBNURSEHEATHER
    How interesting! Several people have said it's the peds that do the circs. Totally opposite here. NOT ONE ped does their own circ, it's always the OB's. Also, at my facility the CNM's aren't doing their own circ's. They are done by the 24 hour on call doc.

    Heather

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