4. mu·ti·late
 Show Spelled[myoot-l-eyt] Show IPA
 –verb (used with object), -lat·ed, -lat·ing.
 1. to injure, disfigure, or make imperfect by
removing or irreparably damaging parts: Vandals
mutilated the painting.
 2. to deprive (a person or animal) of a limb or
other essential part.
 Use mutilate in a Sentence
 See images of mutilate
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5. Origin:
1525–35; < Latin mutilātus (past participle
of mutilāre to cut off, maim), equivalent to
mutil ( us ) maimed, mutilated + -ātus -ate1
 —Related forms
 mu·ti·la·tion, noun
 mu·ti·la·tive, mu·ti·la·to·ry /ˈmyut l əˈt
ɔr
i, -ˈtoʊr i/ Show Spelled[myoot-l-uh-tawr-
ee, -tohr-ee] Show IPA, adjective
 mu·ti·la·tor, noun
 self-mu·ti·lat·ing, adjective
 self-mu·ti·la·tion, noun
 un·mu·ti·lat·ed, adjective
 un·mu·ti·la·tive, adjective
 —Synonyms
1. damage, mar, cripple.

6.  is an act or physical injury that
degrades the appearance or
function of any living body, usually
without causing death.

7. USAGE OF TERM
 The term is usually employed to describe the
victims of accidents, torture, physical assault, or
certain premodern forms of punishment. Mutilation
can also refer to forgery of documents, letters and
brochures, letters of recommendation and other
pieces of evidence or testimony.
 Some ethnic groups practice ritual
mutilation, e.g. scarification, burning, flagellation, t
atooing or wheeling, as part of a rite of passage. In
some cases, the term may apply to treatment of
dead bodies, such as soldiers mutilated after they
have been killed by an enemy.

8. USE AS PUNISHMENT
 Maiming, or mutilation which involves the loss of, or incapacity
to use, a bodily member, is and has been practised by many
societies with various cultural and religious significances, and is
also a customary form of physical punishment, especially
applied on the principle of an eye for an eye.
 The Araucanian warrior Galvarino suffered this punishment as a
prisoner during the Spanish conquest of Chile.
 In law, maiming is a criminal offence; the old law term for a
special case of maiming of persons was mayhem, an Anglo-
French variant form of the word.
 Maiming of animals by others than their owners is a particular
form of the offence generally grouped as malicious damage. For
the purpose of the law as to this offence animals are divided
into cattle, which includes horses, pigs and asses, and other
animals which are either subjects of larceny at common law or
are usually kept in confinement or for domestic purposes.

9.  USE AS PUNISHMENT
 Maiming, or mutilation which involves the loss of, or
incapacity to use, a bodily member, is and has been
practised by many societies with various cultural and
religious significances, and is also a customary form
of physical punishment, especially applied on the principle
of an eye for an eye.
 The Araucanian warrior Galvarino suffered this punishment
as a prisoner during the Spanish conquest of Chile.
 In law, maiming is a criminal offence; the old law term for a
special case of maiming of persons
was mayhem, an Anglo-French variant form of the word.
 Maiming of animals by others than their owners is a
particular form of the offence generally grouped as
malicious damage. For the purpose of the law as to this
offence animals are divided into cattle, which includes
horses, pigs and asses, and other animals which are either
subjects of larceny at common law or are usually kept in
confinement or for domestic purposes.

10.  Voluntary sex reassignment
Some transgender people choose to undergo sex reassignment surgery as part of their gender
transition. Male-to-female transgenders, mtfs (Male-to-female-sex), or transwomen may
undergo castration, with or without vaginoplasty, while female to male, ftms (Female-to-male-
sex), or transmen transgenders may undergo phalloplasty or metoidioplasty, with or
without oophorectomy or hysterectomy. Transgender people who wish to make this surgical
transition are referred to as transsexuals.
 Involuntary sex assignment
If a baby is born with ambiguous genitalia due to an intersex condition, it may not be clear whether
the child is female or male. In certain cases, the child's chromosomal makeup is neither female nor
male, but a combination. In these cases, the baby is usually given a sex assignment, and in many
cases, the child's genitals are surgically altered to conform to those of the assigned sex. This practice
is met with strong dissent from advocates for genital integrity. As cosmetic surgery is not medically
necessary for health, they argue that the individual should be free to make the choice whether to
pursue cosmetic surgery upon their genitals. Advocates state that the surgery can damage the
individual's ability to experience sexual arousal and can render the individual incapable of orgasm.
Another concern is that sex assignment holds a significant element of guesswork, and that an
individual's sex assignment may turn out to be incorrect. If, for instance, an individual is assigned
female, their phallus is usually surgically reduced in size, and the shape of a vulva may be created.
If, upon maturing, the individual identifies as male; their phallus is still gone, and the individual may
require further surgery to try to reverse the erroneous sex assignment. Those who oppose medically
unnecessary genital surgery, and genital surgery coerced or performed without consent comprise
the genital integrity movement. The case of David Reimer, the victim of a botched circumcision who
was raised as a girl alongside his twin brother, bears many parallels to this issue.

11.  In disease or medical necessity
 If the genitals become diseased, as in the case
of cancer, sometimes the diseased areas are surgically
removed. Biological females may undergo vaginectomy, while
males may undergo penectomy.Reconstructive surgery may be
performed to restore what was lost, often with techniques
similar to those used in sex reassignment surgery.
 Similarly, during childbirth, episiotomy is sometimes
performed to increase the amount of space through which the
baby may emerge. Advocates of natural
childbirth and unassisted birth state that this intervention is
often performed without medical necessity, with significant
damage to the person giving birth.
 Hymenotomy is the surgical perforation of an imperforate
hymen. It may be performed to allow menstruation to occur. An
adult individual may opt for increasing the size of her hymenal
opening, or removal of the hymen altogether, to
facilitate sexual penetration of her vagina.

12. Female genitals
 Cosmetic surgery of female genitalia, known as elective genitoplasty, has become pejoratively known as designer
vagina. In May 2007, an article published in the British Medical Journal blasted the "designer vagina" craze, citing
its popularity being rooted in commercial and media influences. Similar concerns have been expressed in Australia.
 Female genital cutting
 Female genital cutting (FGC), also known as female genital mutilation or female circumcision, refers to "all
procedures involving partial or total removal of the external female genitalia or other injury to the female genital
organs whether for cultural, religious or other non-therapeutic reasons. It is not the same as the procedures used
in gender reassignment surgery or the genital modification of intersexuals. FGC is practiced throughout the
world, but the practice is concentrated more heavily in Africa, Indonesia, and the Middle East. There is much
controversy surrounding infibulationprocedures, due to concerns regarding the safety and consequences of the
procedure. In the past several decades, efforts have been made by global health organizations, such as the
WHO, to end the practice of FGC. However, because of its importance in traditional and religious life, FGC
continues to be practised in many societies.

 Hymenorrhaphy
 Hymenorrhaphy refers to the practice of thickening the hymen, or, in some cases, implanting a capsule of red
liquid within the newly-created vaginal tissue. The newly-created hymen is created to cause physical
resistance, blood, or the appearance of blood, at the time that the individual's new husband inserts his penis into
her vagina. This is done in cultures where a high value is placed on female virginity at the time of marriage. In these
cultures, a woman may be punished, perhaps violently, if the community leaders deem that she was not virginal at
the time of consummation of her marriage. Individuals who are victims of rape, who were virginal at the time of
their rape, may elect for hymenorrhaphy.

13. Vaginoplasty and labiaplasty
Some women
undergo vaginoplasty or labiaplasty procedur
es to alter the shape of their vulvas to meet
personal aesthetic standards. The surgery
itself is controversial, and critics refer to the
procedures as "designer vagina".

14. INFIBULATION
 Infibulation, in modern usage, is a practice of surgical closure of
the labia majora (outer lips of the vulva) by sewing them together to
partially seal the vagina, leaving only a small hole for the passage of
urine and menstrual blood. The legs are bound together for
approximately two weeks to allow the labia to heal into a barrier. The
procedure is usually done on young girls before the onset of puberty, to
ensure chastity (Chastity is sexual behavior of a man or woman
acceptable to the moral norms and guidelines of a
culture, civilization, or religion.). It is usually performed at the same time
as removal of the clitoris. The labia minora (inner lips of the vulva) are
often also removed.
 Infibulation is used by practitioners to render women sexually
inactive, unlikely to engage in intercourse, and the visibly intact barrier
of infibulation assures a husband he has married a virgin.
 The barrier produced by infibulation is usually penetrated at the time of
a girl's marriage by the forcible action of the penis of her new
husband, or, if he is unsuccessful, by cutting the connected tissue
surgically.

15. Description of the different types
of female genital mutilation
Female genital mutilation is usually performed by
traditional practitioners, generally elderly women in
the community specially designated for this task, or
traditional birth attendants. In some
countries, health professionals trained midwives and
physicians are increasingly performing female
genital mutilation. In Egypt, for
example, preliminary results from the 1995
Demographic and Health Survey indicate that the
proportion of women who reported having been
circumcised by a doctor was 13%. In contrast, among
their most recently circumcised daughters, 46% had
been circumcised by a doctor.

16.  Type I
 In the commonest form of this procedure the clitoris is held
between the thumb and index finger, pulled out and amputated
with one stroke of a sharp object. Bleeding is usually stopped by
packing the wound with gauzes or other substances and
applying a pressure bandage. Modern trained practitioners may
insert one or two stitches around the clitoral artery to stop the
bleeding.
 Type II
 The degree of severity of cutting varies considerably in this
type. Commonly the clitoris is amputated as described above
and the labia minora are partially or totally removed, often with
the same stroke. Bleeding is stopped with packing and
bandages or by a few circular stitches which may or may not
cover the urethra and part of the vaginal opening. There are
reported cases of extensive excisions which heal with fusion of
the raw surfaces, resulting in pseudo-infibulation even though
there has been no stitching. Types I and II generally account for
80-85% of all female genital mutilation, although the
proportion may vary greatly from country to country.

17.  Type III
 The amount of tissue removed is extensive. The most extreme form involves
the complete removal of the clitoris and labia minora, together with the
inner surface of the labia majora. The raw edges of the labia majora are
brought together to fuse, using thorns, poultices or stitching to hold them in
place, and the legs are tied together for 2-6 weeks. The healed scar creates a
hood of skin which covers the urethra and part or most of the vagina, and
which acts as a physical barrier to intercourse. A small opening is left at the
back to allow for the flow of urine and menstrual blood. The opening is
surrounded by skin and scar tissue and is usually 2-3 cm in diameter but may
be as small as the head of a matchstick.
 Type IV
 Type IV female genital mutilation encompasses a variety of
procedures, most of which are self-explanatory. Two procedures are
described here.
 The term "angurya cuts" describes the scraping of the tissue around the
vaginal opening. "Gishiri cuts" are posterior (or backward) cuts from the
vagina into the perineum as an attempt to increase the vaginal outlet to
relieve obstructed labour. They often result in vesicovaginal fistulae and
damage to the anal sphincter.
 There is no mention of removing only the clitoral hood as described by Dr.
Nowa Omoigui.

18. MALE GENITALS
Male circumcision involves the removal of the foreskin. It
may also involve frenectomy, the removal of
the frenulum. A related procedure
is preputioplasty, which is used as a treatment
for phimosis. This procedure is most often performed
upon infant boys. It has religious significance in
the Jewish religion and inIslam. It spread into Western
culture, and peaked in the early 80s. The bioethics of
neonatal circumcision are a subject of intense
debate, with circumcision advocates promoting it as
beneficial, and supporters of genital integrity
opposing it as harmful and/or a violation of the
individual's human rights. Some adults who were
circumcised as infants engage in foreskin
restoration, a method of stretching the penile skin in
order to partially recreate the foreskin.

19. Penile subincision
 is a form of body modification consisting of a urethrotomy, in
which the underside of the penis is incised and the urethra slit
open lengthwise, from the urethral opening (meatus) toward the
base. The slit can be of varying lengths.
 Subincision is traditionally performed around the world, notably
in Australia, but also in Africa, South America and
the Polynesian and Melanesian cultures of the Pacific, often as
a coming of age ritual. The practice has been taken up in
the western world in recent years for the purpose of sexual
pleasure or aesthetics.
 Disadvantages include the risk of surgery, which is often self-
performed, and increased susceptibility to sexually transmitted
infections (STIs). The ability to impregnate
(specifically, getting sperm into the vagina) may also be
decreased.

20. PENIS REMOVAL / Penectomy
 Removal of the human penis was sometimes used as a
means of demonstrating superiority: armies were sometimes
known to sever the penises of their enemies to count the
dead, as well as for trophies, although usually only
the foreskins were taken. The practice of castration (removal
of the testicles) sometimes also involves the removal of all or
part of the penis, generally with a tube inserted to keep
the urethra open for urination. Castration has been used to
create a class of servants or slaves (and especially harem-
keepers) called eunuchs in many different places and eras.
 In the modern era, removal of the human penis is very rare
(with some exceptions listed below), and references to
removal of the penis are almost always symbolic. Castration is
less rare, and is performed as a last resort in the treatment
of androgen-sensitive prostate cancer.

21. Infibulation
 Infibulation refers to suturing of the foreskin. In ancient
Greece, performers infibulated themselves by using a clasp or
string to foreskin and draw the penis over to one side.
 Male circumcision involves the removal of the foreskin. It may also
involve frenectomy, the removal of the frenulum. A related
procedure is preputioplasty, which is used as a treatment for
phimosis. This procedure is most often performed upon infant
boys. It has religious significance in the Jewish religion and in Islam.
It spread into Western culture, and peaked in the early 80s. The
bioethics of neonatal circumcision are a subject of intense
debate, with circumcision advocates promoting it as beneficial, and
supporters of genital integrity opposing it as harmful and/or a
violation of the individual's human rights. Some adults who were
circumcised as infants engage in foreskin restoration, a method of
stretching the penile skin in order to partially recreate the foreskin.
Some academics use the term male genital cutting or male genital
mutilation in reference to male circumcision.

22. Types of MGM
 Type I - excision or injury of part or all of the skin and specialized mucosal
tissues of the penis including the prepuce and frenulum
(circumcision, dorsal slit without closure).
 Type II - excision or injury to the glans (glandectomy) and/or penis
shaft, (penectomy) along with Type I MGM. Any procedure that interferes
with reproductive or sexual function in the adult male.
 Type III - excision or destruction of the testes (castration, orchidectomy)
with or without Type II MGM.
 Type IV - unclassified: includes pricking, piercing or incision of the
prepuce, glans, scrotum or other genital tissue; cutting and suturing of the
prepuce over the glans (infibulation); slitting open the urethra along the
ventral surface of the penis (sub-incision); slitting open the foreskin along
its dorsal surface (super-incision); severing the frenulum; stripping the skin
from the shaft of the penis; introducing corrosive or scalding substances
onto the genital area; any other procedure which falls under the definition
of MGM given above.
 The most common type of male genital mutilation is excision of the
foreskin (circumcision), accounting for the vast majority of all cases; the
most extreme form is excision or destruction of the testes
(castration), which constitutes a small percentage of all procedures.

23. The Who, What and Why of MGM
 In cultures where it is an accepted norm, male
genital mutilation is practiced by followers of all
religious beliefs as well as animists and non
believers. MGM is usually performed either by a
traditional practitioner, often with crude instruments
and without anesthetic, or in a health care facility by
qualified health personnel.
 The age at which male genital mutilation is
performed varies from area to area. It is performed
on infants a few days old, male children and
adolescents and, occasionally, on mature men.

24. The reasons given by families for having
MGM performed include:
 Psychosexual reasons: elimination of the sensitive tissue of the
foreskin and the stimulation that it provides, depriving the glans
of its protective environment to reduce sexual pleasure;
 Sociological reasons: identification with the cultural
heritage, initiation of boys into manhood, social integration and
the maintenance of social cohesion;
 Hygiene and aesthetic reasons: the foreskin is considered dirty
and unsightly and is to be removed to promote hygiene and
provide aesthetic appeal;
 Myths: babies don’t feel pain, a foreskin is hard to keep
clean, circumcision protects against certain diseases, male
circumcision is less barbaric than female circumcision;
 Religious reasons: Most Muslim and Jewish communities
practice MGM in the belief that it is demanded by the Islamic and
Judaic faiths. The practice, however, predates both religions.

25. Consequences of MGM
The immediate and long-term health consequences of male genital mutilation vary
according to the type and severity of the procedure performed.
Immediate complications include severe
pain, shock, hemorrhage, infection, excessive skin loss, skin bridges, glans
deformation, bowing, meatal stenosis, loss of penis, and injury to adjacent
tissue. Hemorrhage and infection can cause death. More recently, concern has
arisen about possible transmission of the human immunodeficiency virus (HIV)
due to the use of one instrument in multiple operations. Some researchers are
also promoting MGM as a tool to combat AIDS by touting studies that show a
link between medicalized circumcision and reduced rates of HIV
transmission, which is likely to increase the number of forced circumcisions and
related complications.
Long-term consequences include scar formation, keratinization, sexual
dysfunction, loss of sexual sensitivity, and increased friction and pain during
sexual intercourse.
Psychosexual and psychological health: Genital mutilation may leave a lasting
mark on the life and mind of the man who has undergone it. In the longer
term, men may suffer feelings of
anger, incompleteness, anxiety, depression, and lifelong psychological trauma.

26. Prevalence of MGM
Most of the boys and men who have undergone
genital mutilation live in 28 African countries, the
Middle East, the USA, and parts of Asia. They are
also found in Europe, Australia, and Canada.
Today, the number of boys and men who have
undergone male genital mutilation is estimated
at 650 million. It is estimated that each year, a
further 13 million boys are at risk of undergoing
MGM.

27. THEOLOGICAL ISSUES
"What does the Bible say about self-mutilation / cutting?"
Answer: In the Old Testament, self-mutilation was a common practice among
false religions. First Kings 18:24-29 describes a ritual in which those who
worshiped the false god Baal slashed themselves with swords and spears, as was
their custom. Because of the traditions of pagans, God made a law against this
sort of practice. Leviticus 19:28 says, “You shall not make any cuttings in your
flesh for the dead, nor tattoo any marks on you: I am the LORD.”
In the New Testament, cutting oneself was associated with someone who was
possessed by demons (Mark 5:2-5). It was characteristic of behavior caused by
evil spirits. Today, self-mutilation is rarely used for ritualistic practices or actual
demon possession, but instead usually by teen-agers and young adults who have
misplaced anger and pain that they are attempting to work out in destructive
ways. Instead of dealing with emotional pain, some people would rather bring
themselves physical pain, which actually serves as a relief from stress.
Unfortunately, though, this sense of relief is quite short-lived, and the desire to
be self-destructive quickly returns.

28. The Bible doesn't talk about self-mutilation in terms of
depression or anxiety, but it is very important that whoever is
making a practice of this seeks immediate psychological (and
hopefully Christian) counseling. They may need to obtain
medication to deal with a mental illness. This behavior also
indicates, or can lead to, drug and/or alcohol abuse, eating
disorders, identity disorders, and suicidal thoughts or even
attempts. First Corinthians 6:19 tells us how important our
bodies are to the Lord. We no longer belong to ourselves, but
instead we belong to Christ, who purchased us at a high price.
We should not abuse the greatest gift we have been given.
A person who is struggling with self-mutilation should seek
immediate counsel from a pastor and/or Christian counselor.
Self-mutilation is the result of an incorrect view of self and of
our personal value to God. A personal relationship with Jesus
Christ and a proper understanding of His love is the only true
cure for self-mutilation.

29. Self Mutilation
 1 Corinthians 6:19-20 Or do you not know that your body is a temple of the Holy
Spirit within you, whom you have from God? You are not your own, for you were
bought with a price. So glorify God in your body.
 Leviticus 19:28 You shall not make any cuts on your body for the dead or tattoo
yourselves: I am the Lord.
 Deuteronomy 14:1 “You are the sons of the Lord your God. You shall not cut
yourselves or make any baldness on your foreheads for the dead.
 1 Peter 5:7 Casting all your anxieties on him, because he cares for you.
 2 Timothy 1:7 For God gave us a spirit not of fear but of power and love and self-
control.
 Proverbs 8:36 But he who fails to find me injures himself; all who hate me love
death.”
 Hebrews 4:15-16 For we do not have a high priest who is unable to sympathize
with our weaknesses, but one who in every respect has been tempted as we
are, yet without sin. Let us then with confidence draw near to the throne of
grace, that we may receive mercy and find grace to help in time of need.
 1 John 1:9 If we confess our sins, he is faithful and just to forgive us our sins and to
cleanse us from all unrighteousness.
 1 Peter 5:6-7 Humble yourselves, therefore, under the mighty hand of God so that
at the proper time he may exalt you, casting all your anxieties on him, because he
cares for you.

30. ETHICAL ISSUES
 Ethics refers to the moral reasoning that underlies human relationships and the ways in which we treat
each other. Values form the basis for ethical practices and what one country or individual holds to be
important may not be viewed with the same level of esteem in another culture. The difficulty with female
circumcision comes from the deeply held beliefs about the practice and the moral reasoning that is used
by the people who support its continued practice.
 Misinformation and strongly held beliefs are usually what promotes the ongoing demand for female
genital mutilation. Here are some of the myths and the corollary truths about this practice.
 the clitoris never stops growing and will grow uncontrollably until it hangs on the ground - completely
false
 female circumcision improves fertility, menstruation and child bearing abilities - the opposite is true.
 men prefer circumcised women - it has been reported that a large number of African men have stated
preferences for uncircumcised women.
 it is a religious requirement - this is a social and not a religious custom. There is no stated requirement
within the Muslim or other religious teachings for female genital mutilation.
 female genital mutilation improves moral behaviour - the truth is that moral behaviour is based on
reasoning and an individual's personal value system not physical attributes.
 female circumcision helps to control emotions and improves a woman's mood, in other words women
"feel better" for having had it done - The truth is that the emotional scars from this procedure include a
feeling of betrayal most often directed towards the mother for having encouraged and sought out the
procedure to be performed on her own daughter.
All of these falsehoods stem from the assumption that an adult woman in the natural state is somehow flawed
on the physical, moral, and emotional level and that female circumcision will somehow fix all of those
flaws. Such assumptions are promulgated in societies where women are oppressed and do not have the
same social, economic, or legal status as men.

31.  Ethical issues that face the society includes the
question "How does a society protect children
when a cultural practice such as female
circumcision may be a normal and valued
practice? "
 Individual rights and freedoms may be used as
an argument to preserve cultural practices even
when relocating to another country.
However, ethical issues seldom are predicated
on individual rights and freedoms alone. Ethical
issues surrounding cultural practices such as
female circumcision require that the society as a
whole examine the moral obligation individuals
have to each other and specifically to the less
powerful and more vulnerable members of that
society.

32.  This obligation is recognized in countries that have child
protection laws where it is recognized that children have neither
the power nor the mental and emotional competence to act in
their own interests and that they are vulnerable to abuses from
other members of the society that have more power.
 In order to determine if an act is ethical the rights and values of all
parties must be considered. In addition the risk of harm must be
taken into consideration.
 Female circumcision must be considered an unethical act. It is
perpetrated on an innocent child who is powerless against the
strong cultural beliefs of the parents and the physical might of the
adults who perform the procedure. The child does not benefit in
any way and is in fact placed at considerable risk of harm, even
death.
 Many countries have made female circumcision illegal in order to
protect the female children of immigrant populations where this
practice might be considered normal. Canada has a law that even
makes in illegal for parents to take their daughter out of the
country to have the procedure performed.

33.  In a country with specific legislation outlawing the practice of female
genital mutilation, health care professionals can refuse to perform the
procedure when it is requested and instead start educating parents
about the negative effects it may have on their daughter. They can
explore the parents' motivation to have their daughter undergo this
procedure and correct any false beliefs that may underlie their
motivations.
 The majority of the states in the US do not have any laws specifically for
female genital mutilation and instead rely solely on existing laws for
child protection. This process requires reporting child abuse to the
authorities. This is not likely to happen if the community values the
practice and believes it to be necessary for a young girl's well being in
adulthood.
 Additionally, relying solely on child protection laws labels the parent an
abuser for engaging in a cultural practice that is valued and normal for
them. A parent who subjects a daughter to female circumcision is very
often doing so under the mistaken belief that they are a good
parent, and may in fact not be abusive in any other way.
 The truth about female circumcision is that there are no benefits to an
individual or a society that even remotely supports its continued
practice. The fact that parents continue to create a demand for genital
cutting is evidence of the strength of cultural beliefs and values in
promoting practices that are morally wrong and physically disabling.

34.  Education is the only way to change the
attitudes and beliefs that keep such a practice
a cultural norm. In the meantime, because of a
society's moral obligation to protect
children, laws should be in place to make the
practice illegal.
 Every child has the right to an intact physical
body and a future that allows full expression of
their sexuality within whatever moral
boundaries they choose to adopt.

35. INFANT MALE CIRCUMCISION IS NOT IN THE
BEST INTERESTS OF THE HEALTH & RIGHTS OF
THE CHILD
 Scope of the Problem
 Current national rates: Australia 15%, Canada 20%, the United States 60%(3).
 In the U.S., over 1.25 million infants annually - more than 3,300 babies each day -
one child every 26 seconds.
 The surgery wastes more than $250 million health care dollars annually as well as
untold personnel hours.
 Globally, 20% of male children will be subjected to some form of non-medically
indicated genital mutilation.
 Early and Current Rationale
 (U.S.) physicians thought it logical to perform genital surgery on both sexes to
stop masturbation. This rationale was initiated in the English-speaking countries
during the 19th Century.
 The current medical rationale for circumcision developed after the operation
was in wide practice. To make sons resemble their circumcised fathers, to
conform socially with peers, to improve hygiene, to prevent phimosis, and as
prophylaxis for infant urinary tract infections, sexually transmitted
diseases, AIDS, and cancer of the penis/cervix.

36.  Decision Making
 The circumcision decision in the U.S. is emerging as a cultural ritual
rather than the result of medical misunderstanding among parents.
It is more an emotional than a rational decision.
 Other factors affect parents’ decisions, including esthetics, cultural
attitudes, social pressures and tradition.
 Ultimate decision may hinge on non-medical considerations.
 Circumcision has become cultural surgery.
 Foreskin Function
 When infant is incontinent, prepuce fulfills an essential function, to
protect the glans.
 The foreskin is more than just penile skin necessary for a natural
erection; it is specialized tissue, richly supplied with blood
vessels, highly innervated, and uniquely endowed with stretch
receptors. The foreskin contribute(s) significantly to the sexual
response of the intact male.
 This mucous-membrane contact [male foreskin and female labia]
provides natural lubrication...and prevents dryness responsible for
painful intercourse and chafing and abrasions that allow for entry of
STDs, viral/bacterial.

37.  Penile Development
 Development of the prepuce is incomplete in the newborn
male child, and separation from the glans, rendering it
retractable, does not usually occur until some time between 9
months and 3 years.
 (Infant) circumcision...traumatically interrupts the natural
separation of the foreskin from the glans.
 Circumcision interferes with penile development, surgeon
must tear skin from sensitive glans to permit removal.
 Immediate Risks and Complications
 Complications are often overlooked or un(der)reported.
Lacerations, skin loss, skin
bridges, chordee, meatitis, stenosis, urinary retention, glans
necrosis, penile
loss, hemorrhage, sepsis, gangrene, meningitis.
 Literature abounds with reports, morbidity and death from
circumcision Realistic (complication) figure is 2-10%.

38.  Long-Term Adverse Outcomes
 Poor surgical result is not recognized until years later. Adverse consequences of infant circumcision on men’s health
must be recognized by physicians, parents & legislators.
 Circumcision is a subtraction, removing one-third or more of entire penile skin - tragic loss of erogenous tissue.
 When sexually functioning tissue is removed, sexual functioning is altered. Penile changes are documented.
 Of 313 circumcised male respondents, 49.5% cited a sense of parental violation, 62% expressed feelings of
mutilation, and 84% reported some degree of sexual harm [progressive loss of glans sensitivity, excess stimulation
needed to reach orgasm, painful coitus and impotence].
 Body image survey found 20% of circumcised respondents cited dissatisfaction with their circumcision.
 Effects of Pain
 Newborn infant responses to pain are similar to but greater than those in adult subjects. The persistence of specific
behavioral changes after circumcision in neonates implies the presence of memory.
 Infant circumcision causes severe, persistent pain. Acetaminophen does not ameliorate pain of circumcision.
 Main structures for memory are functional in neonates and circumcision pain may have long-lasting effects.
 Maternal Bonding / Breastfeeding
 Circumcision affects mother-infant interaction.
 When an infant is subjected to intolerable, overwhelming pain, it conceptualizes mother as participatory and
responsible regardless of mother’s intent. Consequences for impaired bonding are significant.
 These are the first data suggesting a protective effect of breastfeeding against UTI.
 Breasts also produce large quantities of a hormone (GnRH) that may aid in development of a newborn’s brain.
 Infants feed less frequently after circumcision; observed deterioration may contribute to breast- feeding failure.
 A stressful, painful event such as circumcision appears to affect the feeding patterns.

39.  Questionable Benefits
 Good hygiene can offer many advantages over circumcision.
 Circumcision has no significant effect on the incidence of
common sexually transmitted diseases (STDs).
 Circumcision is not harmless and cannot be recommended
without unequivocal proof of benefit.
 Not one confirmed UTI case in a normal male infant. All cases
in infants with clear urinary birth defects.
 Antimicrobial management of UTI in infants is routine and
outcome generally good. It is inappropriate at this time to
recommend circumcision as a routine medically indicated
procedure.
 Reported benefits in preventing cancer and infant UTIs are
insignificant compared to surgical risks.
 Performing 100,000 mutilative procedures on newborns to
possibly prevent cancer in one elderly man is absurd.

40.  Medical Ethics
 It must be recognized that the child is normal as born and that circumcision
inflicts loss of a normal body part and leaves a scar. This is contrary to the
motto of medicine, “First Do No Harm.”
 The unnecessary removal of a functioning body organ in the name of
tradition, custom or any other non-disease related cause should never be
acceptable to the health profession...and breaches fundamental medical
ethics. Children too young to give consent must be treated as individuals.
The child must live with the outcome of decision.
 Obstetrical Involvement
 Seventy-four percent (74%) of the Ob/Gyns surveyed perform circumcision.
Ob-Gyn fees for circumcision range to $400, averaging $137 nationwide.
 Ob-Gyns not aware of preputial structure & function or growing numbers of
men undergoing foreskin restoration.
 Restoration Movement
 In North America many circumcised men are now becoming aware of the
mutilation and the harm this has done to them, and some are seeking
methods of replacing the lost prepuce.
 At the root of this reaction lies an awareness that a perfectly
normal, healthy -- indeed, the most sensually responsive -- part of their
penis was surgically amputated when too young/helpless to consent, refuse
or resist.

41. Children’s Rights
 All childhood circumcisions are violations of human rights. ...It
is the moral duty of educated professionals to protect health
and rights of those with little or no social power to protect
themselves.
 Circumcision is an issue of self-determination and autonomy.
 Imperative that children have the right to own their
reproductive organs and to preserve natural sexual function.
 Circumcisions for personal preference of the parent(s) deny
the infant the basic right to respect and autonomy.
 Every circumcision...is an assault on a child’s sexuality and a
violation of his right to an intact body.
 Why Does It Continue?
 Americans culturally acclimated/regard foreskin as non-
essential, pathologic.
 Cultural, social and historical perspectives around infant
circumcision control physicians and parents.

43. ORGAN DONATION

44.  Organ transplant surgery is a common complicated
surgery. There are many complications that may
arise for an individual that is undergoing an organ
transplant surgery. Understanding what such a
surgery entails is an important factor to understand
in order to appreciate how it can be a complicated
surgery.
 Organ transplant surgery can occur for several
different reasons. The main reason that such a
surgery occurs is because there are organs within an
individual’s body that are not functioning properly.
When organs do not function properly within the
body, the body’s main reaction is to start to shut
down. This can lead to a lot of
complications, especially if the body cannot
regularly maintain itself. Without an organ
transplant, many individuals will pass away from the
complications of the organs that they currently
have.

45. DEFINITION
 Organ donation is the removal of the tissues of the human
body from a person who has recently died, or from a living
donor, for the purpose of transplanting. Organs and tissues are
removed in a surgical procedure. People of all ages may be organ
and tissue donors. At the time of death the organ, tissue, or eye
recovery agency will make a determination, based on the
person's medical and social history, of which organs/tissues are
suitable for transplantation.
 Organ donation typically takes place after brain death, the
irreversible loss of all brain functions, including the brain stem.
Tissue donation can take place after brain death or cardiac death
(the irreversible loss of cardiovascular function). The laws of
different countries allow potential donors to permit or refuse
donation, or give this choice to relatives. The popularity of
donations varies substantially among countries.

46. Transplantable Organs
 The organs that can be donated include:
 Heart
 Patients with severe heart failure who cannot be helped any longer with medication and/or surgery
may benefit from a heart transplant.
 Liver
 Patients with liver failure may benefit from a liver transplant.
 Pancreas
 Patients with severe diabetes or renal failure may benefit from a pancreas transplant.
 Kidney
 Patients with kidney failure on dialysis may benefit from a kidney transplant. Most kidney donations
are from donors considered brain dead however a small percentage of kidney donations come from
living donors. Usually from a family member.
 Lungs
 Patients whose lungs cannot function properly with medication and/or surgery may benefit from a
lung transplant.
 Small Bowel (Intestine)
 Patients who suffer small bowel damage, either from infection or trauma, may benefit from a small
bowel transplant. Damage to the small bowel will hinder a patient from absorbing enough food to
survive.

47. Organ Donation Process
 Donor Identification
1. The physician pronounces brain death after evaluation, testing, and documentation of patient's condition.
Each state has its own criteria for determining brain death.
2. Hospital staff refers the potential donor to the Organ Procurement Organization for the initial evaluation.
3. The OPO will then perform chart evaluation and key information gathering. This includes a thorough
examination of the patient's past medical and current condition. The social history will be assessed after
the family has expressed interest in the potential donation.
 Obtaining Consent
After the OPO determines a patient meets criteria for donation, the consent process proceeds as follows:
1. Death is explained to the family. The physician or nursing staff usually informs the family of the death
initially. The OPO staff ensures that the family understands the brain death situation. (The potential donor
must be maintained on a ventilator so the family may believe the patient is still alive, even though brain
death has been determined)
2. The options for donation are carefully explained to the family. At this point all potential donations are
discussed (Tissue, Eye, Skin, etc) so the family is not approached multiple times for each donation option.)
3. If informed consent is obtained from the legal next of kin or legal power of attorney, consent forms are
read, signed, and witnessed.
4. A thorough questionnaire regarding the potential donor's medical and social history is presented to the
family.
5. Consent is obtained from the Medical Examiner/Coroner in the event that a donation may hinder a death
investigation.

48.  Evaluation and Maintenance of Potential Donor
After the proper consent process is complete and the patient is considered a
donor, the evaluation and maintenance process proceeds as follows:
1. Tests are performed to determine blood type (ABO) and DNA (HLA Typing).
2. Tests are performed to rule out any transmissible diseases.
3. Transplantable organs are evaluated for suitability and stability.
4. Hemodynamic (Circulation of oxygen-rich blood) functions are stabilized.
5. Organ recipients are identified.
6. Transplant teams are mobilized. In organ donation, the surgery team
responsible for the transplant is the team mobilized for the recovery. The OPO
does not perform the organ recovery.

49.  Evaluation and Maintenance of Potential Donor
After the proper consent process is complete and the
patient is considered a donor, the evaluation and
maintenance process proceeds as follows:
 Tests are performed to determine blood type (ABO)
and DNA (HLA Typing).
 Tests are performed to rule out any transmissible
diseases.
 Transplantable organs are evaluated for suitability and
stability.
 Hemodynamic (Circulation of oxygen-rich blood)
functions are stabilized.
 Organ recipients are identified.
 Transplant teams are mobilized. In organ
donation, the surgery team responsible for the
transplant is the team mobilized for the recovery. The
OPO does not perform the organ recovery.

50. LEGISLATION
 Opt-in vs. opt-out
 There are two main systems for voluntary systems "opt in" (anyone who
has not given consent is not a donor) and "opt out" (anyone who has not
refused is a donor). In some systems, family members may be required to
give consent or refusal, or may veto a potential recovery even if the donor
has consented.
 Because of various factors contributing to the rate of transplantations in a
country, including the rate of living donors, hospital connectivity, and
demand, there is no direct correlation between the legislative system and
the rate of donation. While some countries with an opt-out system like
Spain (34 donors per million inhabitants) or Austria (21 donors per million
inhabitants) have high donor rates and some countries like Germany (16
donors) or Greece (6 donors) with opt-in systems have lower
rates, Sweden, which has an opt-out system has a low rate as well (15
donors) figures. DrRafael Matesanz, President of the Spanish National
Transplant Organisation, has acknowledged Spain's legislative approach is
likely not the primary reason for the country's success in increasing the
donor rates, starting in the 1990s.

51. Bioethical issues
 Since the mid-1970s, bioethics, a relatively new area of ethics, has emerged at the forefront of modern clinical
science. Many philosophical arguments against organ donation stem from this field. Generally, the arguments are
rooted in either deontological or teleological ethical considerations.
 Deontological issues
 Pioneered by Paul Ramsey and Leon Kass, few modern bioethicists disagree on the moral status of organ
donation. Certain groups, like the Roma (gypsies), oppose organ donation on religious grounds, but most of the
world's religions support donation as a charitable act of great benefit to the community. Issues surrounding patient
autonomy, living wills, and guardianship make it nearly impossible for involuntary organ donation to occur.
 From a philosophical standpoint, the primary issues surrounding the morality of organ donation are semantical in
nature. The debate over the definitions of life, death, human, and body is ongoing. For example, whether or not
a brain-dead patient ought to be kept artificially animate in order to preserve organs for procurement is an
ongoing problem in clinical bioethics.
 Further, the use of cloning to produce organs with an identical genotype to the recipient has issues all its own.
Cloning is still a controversial topic, especially considering the possibility for an entire person to be brought into
being with the express purpose of being destroyed for organ procurement. While the benefit of such a cloned
organ would be a zero-percent chance of transplant rejection, the ethical issues involved with creating and killing a
clone may outweigh these benefits. However, it may be possible in the future to use cloned stem-cells to grow a
new organ without creating a new human being.
 A relatively new field of transplantation has reinvigorated the debate. Xenotransplantation, or the transfer of
animal (usually pig) organs into human bodies, promises to eliminate many of the ethical issues, while creating
many of its own. While xenotransplantation promises to increase the supply of organs considerably, the threat of
organ transplant rejection and the risk of xenozoonosis, coupled with general anathema to the idea, decreases the
functionality of the technique. Some animal rights groups oppose the sacrifice of an animal for organ donation and
have launched campaigns to ban them.

52.  Theleological issues
 On teleological or utilitarian grounds, the moral status of "black market organ donation" relies
upon the ends, rather than the means. In so far as those who donate organs are often
impoverished and those who can afford black market organs are typically well-off, it would appear
that there is an imbalance in the trade. In many cases, those in need of organs are put on waiting
lists for legal organs for indeterminate lengths of time — many die while still on a waiting list.
 A consequence of the black market for organs has been a number of cases and suspected cases
of organ theft including murder for the purposes of organ theft. Proponents of a legal market for
organs say that the black-market nature of the current trade allows such tragedies and that
regulation of the market could prevent them. Opponents say that such a market would encourage
criminals by making it easier for them to claim that their stolen organs were legal.
 Legalization of the organ trade carries with it its own sense of justice as well. Continuing black-
market trade creates further disparity on the demand side: only the rich can afford such organs.
Legalization of the international organ trade could lead to increased supply, lowering prices so
that persons outside the wealthiest segments could afford such organs as well.
 Exploitation arguments generally come from two main areas:
 Physical exploitation suggests that the operations in question are quite risky, and, taking place in
third-world hospitals or "back-alleys," even more risky. Yet, if the operations in question can be
made safe, there is little threat to the donor.
 Financial exploitation suggests that the donor (especially in the Indian subcontinent and Africa)
are not paid enough. Commonly, accounts from persons who have sold organs in both legal and
black market circumstances put the prices at between $150 and $5,000, depending on the local
laws, supply of ready donors and scope of the transplant operation. In Chennai, India where one of
the largest black markets for organs is known to exist, studies have placed the average sale price
at little over $1,000. Many accounts also exist of donors being postoperatively denied their
promised pay.[17]
 The New Cannibalism is a phrase coined by anthropologist Nancy Scheper-Hughes in 1998 for an
article written for The New Internationalist. Her argument was that the actual exploitation is an
ethical failing, a human exploitation; a perception of the poor as organ sources which may be used
to extend the lives of the wealthy.

53. POLITICAL ISSUES
 There are also controversial issues regarding how organs are
allocated between patients. For example, some believe that
livers should not be given to alcoholics in danger of
reversion, while others view alcoholism as a medical condition
like diabetes.
 Faith in the medical system is important to the success of organ
donation. Brazil switched to an opt-out system and ultimately
had to withdraw it because it further alienated patients who
already distrusted the country's medical system.
 Allowing or forbidding payment for organs affects the availability
of organs. Generally, where organs can not be bought or
sold, quality and safety are high, but supply is not adequate to
the demand. Where organs can be purchased, the supply
increase somewhat, but safety declines, as families and living
donors have an incentive to conceal unfavorable information.

54. PRISON INMATES
In the United States, prisoners are not discriminated against as
organ recipients and are equally eligible for organ
transplants along with the general population. A 1976 U.S.
Supreme Court case ruled that withholding health care
from prisoners constituted “cruel and unusual
punishment.” United Network for Organ Sharing, the
organization that coordinates available organs with
recipients, does not factor a patient’s prison status when
determining suitability for a transplant. An organ transplant
and followup care can cost the prison system up to one
million dollars. If a prisoner qualifies, a state will allow
compassionate early release to avoid high costs associated
with organ transplants.

55. Religious viewpoints
All major religions accept organ donation in at least some form on either
utilitarian grounds (i.e., because of its life-saving capabilities) or
deontological grounds (e.g., the right of an individual believer to make
his or her own decision). Most religions, among them the Roman
Catholic Church, support organ donation on the grounds that it
constitutes an act of charity and provides a means of saving a
life, although certain bodies, such as the popes', are not to be
used. Some religions impose certain restrictions on the types of organs
that may be donated and/or on the means by which organs may be
harvested and/or transplanted. For example, Jehovah's
Witnesses require that organs be drained of any blood due to their
interpretation of the Hebrew Bible/Christian Old Testament as
prohibiting blood transfusion, and Muslims require that the donor have
provided written consent in advance. Orthodox Judaism considers organ
donation obligatory if it will save a life, as long as the donor is considered
dead as defined by Jewish law. A few groups disfavor organ
transplantation or donation; notably, these include Shinto and those
who follow the folk customs of the Gypsies.

56. THEOLOGICAL VIEWS
 Question: "What does the Bible say about organ donation?"
 Answer: The Bible does not specifically address the issue of organ transplantation.
Obviously, organ transplants would have been unknown in Bible times. However, there are verses
that illustrate broad principles that may apply. One of the most compelling arguments for organ
donation is the love and compassion such an act demonstrates toward others. The mandate to
"love your neighbor" was stated by Jesus (Matthew 5:43), Paul (Romans 13:9), and James (James
2:8), but it can actually be traced all the way back to Leviticus 19:18. From the earliest days in the
Old Testament, God's people were commanded to demonstrate a love for God as well as for their
neighbors. Being willing to donate an organ from our own bodies would seem to be an extreme
example of selfless sacrifice for another.
Paul, in writing to the Corinthians, provided some insight as to the difference between the
physical body at death (which may be disposed of in a variety of ways), and the spiritual body of
the resurrection (1 Corinthians 15:35-49). He used the analogy of the difference between a seed
and the product of that seed to illustrate the difference between the earthly body and the
resurrected body. He then went on to comment: "It is sown a natural body; it is raised a spiritual
body. There is a natural body, and there is a spiritual body" (v. 44). If we believe that the bodies
raised at the resurrection represented simply a "reoccupation" of our earthly bodies, then we
possess a false concept of our resurrection as presented in the Bible. We are told that the earthly
body "that of flesh and blood" will not enter into the heavenly inheritance (1 Corinthians 15:50).
Based on these facts, Christians should not fear or reject organ donation merely in an attempt to
keep the physical body intact for the resurrection.

57. Additional thoughts on organ
donation and organ
harvesting

58. The legitimate argument against organ donation arises from the
process of organ harvesting. There is nothing ethically wrong
in recovering organs from the dead, but most successful
organ transplants require that any prospective organs be kept
alive with blood and oxygen flowing through them until they
are removed from the body. This dilemma is
troublesome, because we cannot, and must not, support the
termination of life in favor of organ donation. The medical
profession has traditionally used cessation of heart and lung
activity to mark the point of death. Medical technology had
progressed to a point where it is possible to sustain (via a
respirator) heart and lung activity for days or even weeks
after a patient had irreversibly lost all brain function. There
has been a push in some medical circles to harvest organs
when the patient has lost higher brain functions but is still
alive. In 1994, the Council on Ethical and Judicial Affairs of the
American Medical Association (AMA) issued its updated
opinion that it is "ethically permissible" to use babies born
without higher brain functions as organ donors.

59. As Christians, we can support organ donation only in
those cases in which death has been determined by
every criterion "including complete loss of brain
function" rather than just by one or two criteria.
God forbids intentional killing (James 2:10-11); thus
we must carefully determine, in light of the
teachings found within God"s Word, whether a
respirator is simply oxygenating a corpse or
sustaining a living human being. Then we must act
accordingly. Since most transplants come from
donors who have been declared neurologically
dead, it is important that we fully understand the
criteria the medical profession is using to define
brain death. Only when a patient is determined to
be irreversibly and completely brain dead should he
or she be considered a candidate for organ
donation.