Manual for Male Circumcision under Local Anaesthesia
Manual for Male Circumcision under Local Anaesthesia Manual for Male Circumcision under Local Anaesthesia
Male circumcision under local anaesthesia Version 3.1 (Dec09) helps clients see the whole picture and understand the situation better. Example: Counsellor: “We have discussed several ways in which you can reduce your risk of getting infected with an STI or HIV. For example, you seem comfortable with starting to use condoms during sex and drinking less alcohol when you go out with friends. You have many choices and we will develop a specific plan later. First, let’s talk about HIV testing because your plan could change depending on your test result.” INFORMED CONSENT FOR SURGERY General Clients (or parents, in the case of a child) must give informed consent before a circumcision is performed. Health care providers should give clients all the information they need to make a fully informed decision. The following elements should be included. • Provide information. Clients (or parents) should be given an explanation, in plain language, of male circumcision and the nature of the surgery. They should be informed about the risks and benefits of the procedure and of other ways to reduce the risk of HIV infection. They should know that they can choose not to be circumcised. • Assess whether the client understands the information provided. • Assess the capacity of the client to make the necessary decisions. • Assure the client that he is free to choose whether or not to be circumcised. If there is any suggestion that the client is not ready to provide consent, advise him to reflect on it for a few days. • Ask clients who decide to undergo circumcision to sign a consent document. The goal of this consent process is to ensure that the clients (or parents) understand the surgical procedure. At the same time, they should be given the opportunity to make use of other sexual and reproductive health services. Only clients who have appropriate decision-making capacity and legal status can give their informed consent to medical care. Where a child (usually defined as a person under the age of majority in national law) lacks the legal status required to provide independent, informed consent, or lacks the capacity to appreciate the risks and benefits associated with the procedure, written consent based on full information must be obtained from the parent or legal guardian. The parent or legal guardian should make the decision according to the best interests of the child. Children nevertheless have a right to participate in decisions affecting their health, according to their evolving capacities. Even where the law Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-10
Male circumcision under local anaesthesia Version 3.1 (Dec09) does not allow a child to give his own consent, providers of circumcision should explain the risks and benefits to the child in a way appropriate to his capacity. If the child has sufficient capacity, he should be given the opportunity to give or withhold assent to the procedure. Adolescent boys: consent and confidentiality Male circumcision is often performed during adolescence or early adulthood. It is important that health care workers know how to respond to an adolescent boy’s request for circumcision in a way that respects confidentiality, but does not put the health care worker in conflict with the law. Health care workers need to know what the law says about consent for minors. They need to know at what age and in what circumstances minors can legally make an independent decision to seek clinical or medical services without the agreement of their parents or guardian. The age at which an adolescent is allowed to give his own consent may differ for different procedures. For example, in some countries, an adolescent may be able to consent to be tested for HIV or receive condoms at a younger age than that at which he can consent to circumcision. The Ministry of Health and the National Medical or Nursing Associations should be able to provide information on national rules and regulations. Adolescent boys who are mature enough to appreciate the risks and benefits associated with a medical procedure, such as circumcision or HIV testing, should not be subjected to the procedure without their informed consent, whether or not parental consent is required by law. All health services provided to adolescents should be confidential. Where the law allows minors to provide independent informed consent, providers must ensure that information is not disclosed to the parents without the child’s consent. “Children are more likely to use services that are friendly and supportive, provide a wide range of services and information, are geared to their needs, give them the opportunity to participate in decisions affecting their health, are accessible, affordable, confidential and non-judgemental, do not require parental consent and are not discriminatory.” Committee on the Rights of the Child. General Comment No. 3: HIV/AIDS and the rights of the child. Thirty-second session, January 2003 (UN Document CRC/GC/2003/3) para. 20. Health care workers should be guided in their response to adolescents by human rights principles: all adolescents have a right to use health services. Health care workers should act in the best interest of the adolescent with an understanding of his evolving capacities and ability Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-11
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<strong>Male</strong> circumcision <strong>under</strong> local anaesthesia<br />
Version 3.1 (Dec09)<br />
does not allow a child to give his own consent, providers of<br />
circumcision should explain the risks and benefits to the child in a way<br />
appropriate to his capacity. If the child has sufficient capacity, he<br />
should be given the opportunity to give or withhold assent to the<br />
procedure.<br />
Adolescent boys: consent and confidentiality<br />
<strong>Male</strong> circumcision is often per<strong>for</strong>med during adolescence or early<br />
adulthood. It is important that health care workers know how to<br />
respond to an adolescent boy’s request <strong>for</strong> circumcision in a way that<br />
respects confidentiality, but does not put the health care worker in<br />
conflict with the law.<br />
Health care workers need to know what the law says about consent<br />
<strong>for</strong> minors. They need to know at what age and in what circumstances<br />
minors can legally make an independent decision to seek clinical or<br />
medical services without the agreement of their parents or guardian.<br />
The age at which an adolescent is allowed to give his own consent<br />
may differ <strong>for</strong> different procedures. For example, in some countries, an<br />
adolescent may be able to consent to be tested <strong>for</strong> HIV or receive<br />
condoms at a younger age than that at which he can consent to<br />
circumcision. The Ministry of Health and the National Medical or<br />
Nursing Associations should be able to provide in<strong>for</strong>mation on national<br />
rules and regulations.<br />
Adolescent boys who are mature enough to appreciate the risks and<br />
benefits associated with a medical procedure, such as circumcision or<br />
HIV testing, should not be subjected to the procedure without their<br />
in<strong>for</strong>med consent, whether or not parental consent is required by law.<br />
All health services provided to adolescents should be confidential.<br />
Where the law allows minors to provide independent in<strong>for</strong>med<br />
consent, providers must ensure that in<strong>for</strong>mation is not disclosed to the<br />
parents without the child’s consent.<br />
“Children are more likely to use services that are<br />
friendly and supportive, provide a wide range of<br />
services and in<strong>for</strong>mation, are geared to their needs,<br />
give them the opportunity to participate in decisions<br />
affecting their health, are accessible, af<strong>for</strong>dable,<br />
confidential and non-judgemental, do not require<br />
parental consent and are not discriminatory.”<br />
Committee on the Rights of the Child. General<br />
Comment No. 3: HIV/AIDS and the rights of the child.<br />
Thirty-second session, January 2003 (UN Document<br />
CRC/GC/2003/3) para. 20.<br />
Health care workers should be guided in their response to adolescents<br />
by human rights principles: all adolescents have a right to use health<br />
services. Health care workers should act in the best interest of the<br />
adolescent with an <strong>under</strong>standing of his evolving capacities and ability<br />
Educating and Counselling Clients and Obtaining In<strong>for</strong>med Consent Chapter 3-11