1 / 25

Implementing Male Circumcision Research or Programs: Bioethical Issues

Implementing Male Circumcision Research or Programs: Bioethical Issues. Ina Roy, M.D.,Ph.D. Focus. Informed consent issues Choice of target population. Related Issues. Harms and benefits Female Genital Mutilation (FGM). Common Methods . Weighing harms and benefits

trapper
Download Presentation

Implementing Male Circumcision Research or Programs: Bioethical Issues

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Implementing Male Circumcision Research or Programs: Bioethical Issues Ina Roy, M.D.,Ph.D.

  2. Focus • Informed consent issues • Choice of target population

  3. Related Issues • Harms and benefits • Female Genital Mutilation (FGM)

  4. Common Methods • Weighing harms and benefits • Focusing on basic principles

  5. Harms and Benefits

  6. Potential Benefits • Helps prevent certain STDs including transmission of HPV • Reduces UTIs in first year of life • Decreases the rate of cervical cancer in female partners • May help reduce the rate of HIV transmission

  7. Potential Harms • Potential harms from surgery • Bleeding • Infection • Damage to penile tissue and function • Physical pain • Emotional harms? • Disinhibition and associated high risk behaviours?

  8. Implementing Health-Care Research and Policies

  9. Principles • Autonomy and self-determination • Bodily integrity • Cultural self-determination

  10. Applying Principles to Policy • Choosing an appropriate target population for the intervention • Recognizing and integrating individual choices • Adapting programs to the local cultural environment

  11. Target Population Adults or Children?

  12. Adults • Understand information • Have experience with comparing risks and benefits • Can bring the values they hold to the weighting of risks and benefits

  13. Adults: Additional Considerations • Informed choice and/or consent less complex • Current population of concern • Sexually active

  14. Children: Rationale for Intervention • Circumcision less complex • Prepubertal MC associated with reduced HIV • Practioners of circumcision may have child-appropriate • Equipment • Experience • Skills

  15. Children: Intervention Criteria • Immediate harm to the child • Immediate harm to society

  16. Informed Consent • Informed • Educated about the procedure • Aware of opportunities for follow-up care • Consent • Assent to exactly and only that procedure • Assent to procedures costs

  17. Consent of the individual • More important if the intervention • Is irreversible • Has a process that may involve emotional or physical pain • May result in permanent damage including functional deficit

  18. Procedure description Risks Self Others Benefits Self Others Alternatives Informed Consent: Content

  19. Informed Consent: Context • Language and level • Appropriate to the person and culture • Opportunity for questions • Culturally appropriate environment

  20. Further considerations • Should there be a waiting period? • Should HIV positive persons be allowed / encouraged to participate?

  21. Cultural considerations • Individual consent becomes more important if the intervention • Is irreversible • Involves process that may cause emotional or physician pain • May result in permanent damage or functional deficit

  22. Concern about cultural hegemony • Allow for choice • Articulate both risks and benefits • Verify overall benefit to culture • Avoid creating coercive situation

  23. Female Genital Mutilation

  24. Special thanks to • USAID and PATH for the invitation and assistance. • Special thanks to Daniel Halperin, USAID, for his advice and encouragement during investigation of bioethical issues in HIV treatment and prevention. • The researchers on MC, too numerous to count, who are working with me on a more comprehensive article on ethical issues related to circumcision and HIV.

  25. Fink et al, "Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction" Journal of Urology, v. 167 issue 5 p 2113; 2002 Association between Male Circumcision and HIV transmission Buve” at al, Letter re: “Male Circumcision Could Help Protect Against HIV” Lancet v. 356 no 9235;2000 Bailey, Halperin, “Male Circumcision and HIV” Lancet v. 354 no 9192, 1999 Gray et al, “Male circumcision and HIV acquisition and transmission:” Cohort studies in Rakai Uganda AIDS v. 14 issue 15 p 2371 To et al, “Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection” Lancet, v. 352 no9143 Weiss et al “Male circumcision and risk of HIV infection in sub-Saharan Africa, “AIDS v. 16 number 5 p.810 Randomized Controlled Trials Kisumu, Western Kenya, Funded by the NIH and the Canadian Institutes of Health Research Rakai, Uganda NIH, John's Hopkins University

More Related