Medical Aspect/Circumcision and Patient

As can be seen, the reasons for the practice of circumcision vary from one person to another in the same society, but whether the circumcision is necessary and how the arrangements and pra-ctices related to the subject should be done is a common and important social debate for almost all societies today. While societies where circumcision has not traditionally been practiced go for legal regulations for this purpose, the process is different in the societies where circumcision is traditionally accepted. Legislation in our country is also very new and in this sense debates are just beginning to arise. In addition, although it does not seem to be performed for religious reasons in our country, it can be said with a general evaluation that circumcision is a tradition, a ritual which people accept without question, in a sense, as indicated by Bourdieu entering into out lives as “habitus” [48]. In this sense, the practice of circumcision in our country may be regarded as a

“social necessity” applied for different reasons even if it is not legally necessary. As can be seen, it is clear that the treatment of non-therapeutic male circumcision regimens and practices may lead to controversy and problems naturally leading to similar arrangements and practices that may be applicable to all communities and societies, even if the universal principles rise over the principles of social differences.

inter-ventions, taking into account the risks of circumcision. In this sense, it is possible that circumcisi-on practices that have never been changed by religious beliefs are more vulnerable to risks. It is also important and necessary to create the most suitable environments for reducing the fear and anxiety of children psychologically in the period of comprehending what they are going through and to take all the measures to reduce the child’s pains. For this reason, it is necessary to ensure that the physician or those who are able to perform circumcision procedure on this process with ethi-cal concerns about how and under what circumstance circumcision is to be carried out and that circumcision should not be regarded as an illness and such authority should not be misused. In today’s world, where the simplest interventions are defined as serious illnesses and new diseases are created every day, it is necessary to implement and regulate to reveal how important this is.

Just like in other Muslim countries, as it is common for circumcision to be performed not for medi-cal reasons but on religious and traditional grounds, surgimedi-cal intervention is also usually performed in a traditional way. Although circumcision is increasingly performed for medical reasons, it is still quite commonly performed on traditional and religious reasons. Since circumcision is performed for medical reasons in developed countries, the ratio of the performance of circumcision by physi-cians is low in our country while in developed countries; the procedure is performed by urologists, family physicians, obstetricians and pediatric surgeons. The increase in the adoption of circum-cision procedures in hospitals is a little more prevalent in urban areas. Due to the reason that circumcision in Turkey is performed by “circumciser” who are not health professionals or who lack having the required technical equipment, it is alleged that early or late period complications are encountered at a high level regarding the circumcision procedure [24]. Circumcision is practiced by

“circumcisers” especially in rural areas and regions where cities are poor and traditions are more prevalent. Therefore, it is important for the persons performing the circumcision to have the neces-sary technical equipment even if they are not physicians, in order to overcome the probability of the possible risks that will arise after circumcision. In terms circumcision procedure, according to the results of the study by Söylemez and Burgu the utilization rate of hospitals for circumcision in Turkey is 7.2%, whereas this rate is determined in the Southeastern Anatolia Region as the lowest (3.75%). [24] The rate of performance of circumcision at home is 40.38%. It has been detected that 3 out of 10 persons in Turkey undergo circumcision procedure at ceremonies and that the person performing the procedure differs from one region to another. In general, the rate of performance of circumcision by physicians has been observed as 11.5% in our country, whereas the lowest ratio is observed in the Mediterranean (7.30%) and in Southeastern Anatolia (7.81%).

According to the results based on the face-to-face interviews by Şahin and Aktürk with parents of boys younger than 16 years of age who applied to Gazi University child healthcare clinic and to 10 healthcare centers in Ankara, the average age for circumcision has been determined to be 6 [33]. The ratio of children circumcised before one year of age is only 1%. According to the in-terviews, the main reasons for circumcision were determined as religious and traditional values rather than medical (84.8%). The ratio of emphasizing the health benefits of the procedure is 15.2. Although religious and traditional values are considered as high rationale, only 13.3% of children being circumcised by traditional means attracts attention. This data proves that althou-gh circumcision is adopted in the traditional way, the change in its practice is in question and that this change differs from one city to another. This is because the ratio of the performance of circumcision in hospitals in Turkey is low compared to the results of this study conducted in

An-kara. According to the results of a study on students in Giresun Province conducted by Üstüner et al., the ratio of circumcision performed for those who are under 3 years of age was found to be 13.5% for students, 42,2% for 3-6 years and 44,3% for over six years [34]. This data also indica-tes that the age of circumcision is higher in Turkey compared to the countries where circumcision is common for treatment purposes.

People’s attitudes and behaviors may not always coincide with each other. Behind this non-o-verlap lies social and cultural factors. From this point of view, the attitudes of the mothers and fathers on circumcision are not consistent with their behavior. For example, when the data of the study done by Çataklı is examined, it can be seen that all mothers consider circumcision to be performed by a doctor in hospital as appropriate, non-reflection of this attitude towards the behavior reveals the importance of social and cultural factors related to the practice of circumci-sion. [23] When the mothers who participated in the study were asked regarding the unfavorable situations that may be experienced during circumcision, the answers related to their concerns were observed to be, bleeding, with the highest ratio of (56.5%), infection (23.3%) and inaccu-rate cut (10.6%) and 9.7% stated that hey had no idea. In this sense, considering the low inaccu-rate of circumcision performed by a doctor, the prevalence of traditional circumcision is remarkable in showing the power of tradition.

In short, whatever the meaning is attributed to circumcision, regardless of whether it is religious or traditional, circumcision is not an illness, but its procedure is a surgical intervention and it is important that this intervention is done under the best conditions and at the lowest risk, whether performed on an infant, adolescent or adult. However, there are also objections and debates over whether the best decision will be given by the physicians, especially if it is seen as a medical lem or illness. If this is a social phenomenon, the decision of the physicians is considered prob-lematic [19]. It will of course be probprob-lematic to leave this decision to physicians, especially when the definition of illness is more clearly commercialized than before and physicians are thought to be influenced by this process [51]. Also, as Savelescu points out, the paternalist/hierarchical view stating that doctors take the best decision for the patient is not as valid for the present as it was before [19]. Today, the patient-doctor relationship has become more complex and the “framing effects” have become more involved in the decision-making process. The relationship between the patient and the physician is seen as a relationship that is taken into account and the process is de-fined as ‘shared decision making’. In this sense, the requirement to take into account the approval of the patient or his different treatment process choice in all kinds of procedures to be applied is adopted more extensively. However, social differences can also be of importance in this acceptan-ce. In addition, it is also possible that practices and applications that the physicians perform while practicing their profession can provide serious benefits to others as well as harm them. For this reason, doctors have to keep an eye on all aspects of the procedure in their decisions for procedure and have to review their decisions taking into account the values of the patient at all times. In addi-tion, doctors’ making decisions about patients are related to the system of values [31]. The doctors making the right decision for the patient is not an individual issue but a social one. That is to say, although the doctors have a different opinion of what is good, they can take a decision otherwise in application. For that reason, it is important to develop policies taking into account all relevant factors in ensuring that doctors choose the “best” for the patient.