Showing posts with label adolescents. Show all posts
Showing posts with label adolescents. Show all posts

Tuesday, January 29, 2008

Religion of the Father?

AP reports that the Oregon Supreme Court has ruled that a 12 year old boy's preferences on whether or not to be circumcized should guide the decision in the dispute between his parents.

Excerpt:

The father, James Boldt, converted to Judaism in 2004 and wants the boy to be circumcised as part of the faith. The mother, Lia Boldt, appealed to the high court, saying the operation could harm her son physically and psychologically.

The state Supreme Court ruled that earlier court decisions failed to determine whether the boy wanted the circumcision, as his father contended, or opposed it, as his mother alleged.

The Supreme Court sent the case back to the trial court to answer that question.

If the trial court finds the child agrees to be circumcised, the Supreme Court said, it should deny the mother's requests. But if the trial court finds the child opposes the circumcision, the court has to determine if it will affect the father's ability to care for the child.

The custody dispute began when the child was 4 and the circumcision issue began three years ago when he was 9.

We have several interesting issues impacting this case. First: informed consent of the patient. Is a 12 year old mature and competent enough to make a decision about this permanent operation? There is a precedent in our society that denies non-medically indicated permanent procedures. For reference, most physicians deny elective sterilization operations to women even if they are of legal, consenting age (depending on the state, 25 is often used as a "no questions approval" cutoff).

Second, what is the nature of the circumcision procedure? Ought it be considered a ritual fully protected by free exercise of religion, or an elective permanent surgical procedure for non-health related reasons, thus violating the non-maleficence clause of the Hippocratic Oath? Note the sliding scale of the perceived magnitude of circumcision - from something akin to a piercing to mutilation of one's body and bodily function.

Third, the dispute between the parents should be considered carefully, and both parties' motives must be separated from what is in the best interest of the teenager. However, the "father's ability to care for the child" should not be used as a factor, as it should be categorically seen as a sign of unfit parenting to abuse or neglect one's child for not conforming to religious practice.

In my opinion, a case would be made for supporting such a procedure on someone not legally competent only if 1) there were a medical indication or 2) there were a time-sensitive factor to the procedure in terms of reducing side effects or discomfort. Thus, there is potential for supporting circumcision of infants over children or teenagers because some believe less pain is felt at that time (I do not endorse this position, I simply present it for argument) than would be felt later on. And there are rare cases where a circumcision is medically indicated in a child or a teenager due to developmental or other impairments.

However, this situation does not fulfill either criterion - a 12 year old does not have time-sensitive reasons for seeking a circumcision, there is no medical indication, and even the religious argument falls short due to the father's recent conversion. I do not see a reduction in suffering that would result from the operation occuring now or occuring six years from now, but the difference legally, cognitively, and ethically would be significant. Therefore, while I applaud the court's intent to look to the teenager's wishes, I do not feel that he is able to ethically consent to such a procedure at this time, and there should not be a circumcision until he comes of legal age of consent.

Addendum: Upon further reflection, I suspect that this is an attempt by the court to foist responsibility for the act (or non-act) onto the teenager so they do not have to risk appearing to be anti-religion. If so, that is an irresponsible course of action.

Monday, January 14, 2008

Better Schooling Through Biology

Nancy Kalish, in a NYT Op-Ed advocates using biological research to provide guidance in reforming our education system in light of data that show adolescents would benefit from a high school schedule that started later.

Excerpt:
Research shows that teenagers’ body clocks are set to a schedule that is different from that of younger children or adults. This prevents adolescents from dropping off until around 11 p.m., when they produce the sleep-inducing hormone melatonin, and waking up much before 8 a.m. when their bodies stop producing melatonin. The result is that the first class of the morning is often a waste, with as many as 28 percent of students falling asleep, according to a National Sleep Foundation poll. Some are so sleepy they don’t even show up, contributing to failure and dropout rates.

Moving the start time of high school back by one hour showed significant benefits, both specific to education and in peripheral gains, like student safety:

In 2002, high schools in Jessamine County in Kentucky pushed back the first bell to 8:40 a.m., from 7:30 a.m. Attendance immediately went up, as did scores on standardized tests, which have continued to rise each year. Districts in Virginia and Connecticut have achieved similar success. In Minneapolis and Edina, Minn., which instituted high school start times of 8:40 a.m. and 8:30 a.m. respectively in 1997, students’ grades rose slightly and lateness, behavioral problems and dropout rates decreased.

Later is also safer. When high schools in Fayette County in Kentucky delayed their start times to 8:30 a.m., the number of teenagers involved in car crashes dropped, even as they rose in the state.

This is but one example of how science can constructively inform policy and provide a directed goal to which we can strive as we reform conventional methods that were influenced not by anticipated benefits, but from mere logistical necessity. With the significant shifts in lifestyle following the departure from an agrarian industry base and the advent of the Internet and other telecommunications technologies, there is no reason why we cannot come up with a system that is not just feasible, but beneficial to groups said policy seeks to benefit.