Immediately implement procedures and controls to stop asking parents pregnant with boys and/or parents of newborn boys if they want a circumcision performed.
In most states, it is illegal for any medical professional to solicit for a medically unnecessary surgery. Asking if a parent wants the procedure done and/or simply giving a parent a circumcision consent form may qualify as such a solicitation and may be grounds for a lawsuit, if the parent does not specifically request either the surgery or the consent form.
Your operational procedures should adhere to your own organizational ethical guidelines.
American Nurses Association - Nurses code of ethics: 1.4 The right to self-determination
Respect for human dignity requires the recognition of specific patient rights, particularly, the right of self-determination. Self-determination, also known as autonomy, is the philosophical basis for informed consent in health care. Patients have the moral and legal right to determine what will be done with their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed judgment; to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment; to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or penalty; and to be given necessary support throughout the decision-making and treatment process. Such support would include the opportunity to make decisions with family and significant others and the provision of advice and support from knowledgeable nurses and other health professionals. Patients should be involved in planning their own health care to the extent they are able and choose to participate.
American Academy of Pediatrics - Rights of the child with regard to medical management decisions - https://www2.aap.org/sections/bioethics/PDFs/Curriculum_Session10.pdf
The child has a right to life, which includes a right to treatment that has a reasonable chance of resulting in a significant extension of life. He also has a right to mercy, here defined as the right not to be made to experience unnecessary suffering. This would include pain that results from treatment that offers no significant benefit to him. He has a right to justice, here defined as fair and equal medical treatment (Beauchamp and Childress; Cummings and Mercurio). Though not relevant to this case, it should also be noted that a child has a right to be informed and to participate in decision-making as appropriate for age and mental state.
American College of Obstetricians and Gynecologists – Informed Consent
Informed consent is an ethical concept that has become integral to contemporary medical ethics and medical practice. In recognition of the ethical importance of informed consent, the Committee on Ethics of the American College of Obstetricians and Gynecologists (ACOG) affirms the following eight statements:
1. Obtaining informed consent for medical treatment, for participation in medical research, and for participation in teaching exercises involving students and residents is an ethical requirement that is partially reflected in legal doctrines and requirements.
2. Seeking informed consent expresses respect for the patient as a person; it particularly respects a patient's moral right to bodily integrity, to self-determination regarding sexuality and reproductive capacities, and to support of the patient's freedom to make decisions within caring relationships.
3. Informed consent not only ensures the protection of the patient against unwanted medical treatment, but it also makes possible the patient's active involvement in her medical planning and care.
4. Communication is necessary if informed consent is to be realized, and physicians can and should help to find ways to facilitate communication not only in individual relations with patients but also in the structured context of medical care institutions.
5. Informed consent should be looked on as a process rather than a signature on a form. This process includes a mutual sharing of information over time between the clinician and the patient to facilitate the patient's autonomy in the process of making ongoing choices.
6. The ethical requirement to seek informed consent need not conflict with physicians' overall ethical obligation of beneficence; that is, physicians should make every effort to incorporate a commitment to informed consent within a commitment to provide medical benefit to patients and, thus, to respect them as whole and embodied persons.
7. When informed consent by the patient is impossible, a surrogate decision maker should be identified to represent the patient's wishes or best interests. In emergency situations, medical professionals may have to act according to their perceptions of the best interests of the patient; in rare instances, they may have to forgo obtaining consent because of some other overriding ethical obligation, such as protecting the public health.
8. Because ethical requirements and legal requirements cannot be equated, physicians also should acquaint themselves with federal and state legal requirements for informed consent. Physicians also should be aware of the policies within their own practices because these may vary from institution to institution.
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