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Tornali C, Migliore M, Polizzi A, Bragazzi NL, Martini M, Ruggieri M, Praticò AD, Vecchio I. Reconstructive Surgery in Children with Down Syndrome: Bioethical Implications. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1709510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractDown Syndrome is a genetic disorder caused by a third copy of chromosome 21. One of the main feature of the syndrome is the facial dysmorphism, characterized by broad, flat face, oblique eyelid rhymes, skin folds at the inner corner of the eyes (epicanthus), receding chin, protrusion of the tongue. These features are often social and functional obstacles, reducible with surgical interventions. The first facial plastic/cosmetic surgery approaches on Down children were performed in 1960 in Germany, Great Britain and the United States, where plastic surgeons began to reshape the Down patients physiognomy through the surgical correction of the face, tongue, eyes, nose, of the nostrils, of the neck. Recent studies have shown that in spite of the tendency to infections and early pulmonary hypertension in children with DS, surgery is not contraindicated, as previously suggested, but can be performed with very good results. This treatment has aesthetic, functional, rehabilitative, social effects, as well as favorable outcome on the familiar behavior. However different issues emerge in cases of patients presenting intellectual disability and unable to understand the consequences or the side effects related to plastic surgery. In this aspect, different Countries have enacted distinct laws directly regulating the consensuses for such intervention, with the goal to reduce the risks for the affected patients and the respect of their willing and social inclusion.
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Affiliation(s)
- Cristina Tornali
- Department of Biomedical and Biotechnological Sciences, Section of Neurology, University of Catania, Catania, Italy
| | - Marcello Migliore
- Department of Surgical Sciences, Section of Thoracic Surgery, University of Catania, Catania, Italy
| | - Agata Polizzi
- Department of Educational Sciences, University of Catania, Catania, Italy
| | | | - Mariano Martini
- Department of Health Sciences, Section of History of Medicine and Ethics, University of Genoa, Genoa, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Andrea D. Praticò
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Ignazio Vecchio
- Department of Clinical and Experimental Medicine, Section of History of Medicine, University of Catania, Catania, Italy
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Michael AI, Jarrett OO. Parental views on plastic surgery for Down syndrome: an African perspective. Pan Afr Med J 2019; 32:207. [PMID: 31312319 PMCID: PMC6620072 DOI: 10.11604/pamj.2019.32.207.18316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Plastic surgery for Down syndrome has not been embraced in sub-Saharan Africa. This study sought to determine the attitudes of some parents from sub-Saharan Africa to plastic surgery for their Down syndrome child. Methods Consenting parents completed a questionnaire survey instrument that obtained demographic characteristics and contained a likert scale on attitudes to plastic surgery. Internal consistency of the scale was determined with Chronbach's alpha and Pearsons chi square analysis was used to analyze relationships between demographic variables and attitudes scores. Values less than 0.05 were considered statistically significant. Results Most (61.9%) of the 42 consenting mothers were above 35 years of age. The most disturbing of the Down syndrome characteristics were the protruding tongue, 18(42.9%), slanting palpebral fissures, 14(33.3%) and the flattened nasal bridge 14(33.3%). Although the mothers had low awareness of plastic surgery most of them had favourable attitudes towards it. A reliability analysis of the mother's attitudes on the likert scale showed good internal consistency. Chronbachs alpha 0.87. Conclusion The parents in this study have favourable attitudes towards plastic surgery for Down syndrome. The prominent tongue was the most disturbing feature.
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Affiliation(s)
- Afieharo Igbibia Michael
- Department of Plastic, Reconstructive and Aesthetic Surgery, University, College Hospital, Ibadan, Oyo State, Nigeria
| | - Olumide Olatokunbo Jarrett
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria
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Carlson L. Intelligence, Disability, and Race: Intersections and Critical Questions. AMERICAN JOURNAL OF LAW & MEDICINE 2017; 43:257-262. [PMID: 29254465 DOI: 10.1177/0098858817723663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Licia Carlson
- Professor of Philosophy, Providence College. University of Toronto, Ph.D., Vassar College, B.A. I am grateful to all of the participants of the symposium, and especially to Terrence Keel, Osagie Obasogie and Khiara Bridges for the invitation to be a part of this rich conversation. Many thanks to those whose questions, comments, and editorial wisdom have helped to shape and clarify my reflections
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Hodges FM, Svoboda JS, Van Howe RS. Prophylactic interventions on children: balancing human rights with public health. JOURNAL OF MEDICAL ETHICS 2002; 28:10-6. [PMID: 11834752 PMCID: PMC1733522 DOI: 10.1136/jme.28.1.10] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Bioethics committees have issued guidelines that medical interventions should be permissible only in cases of clinically verifiable disease, deformity, or injury. Furthermore, once the existence of one or more of these requirements has been proven, the proposed therapeutic procedure must reasonably be expected to result in a net benefit to the patient. As an exception to this rule, some prophylactic interventions might be performed on individuals "in their best interests" or with the aim of averting an urgent and potentially calamitous public health danger. In order to invoke these exceptions, a stringent set of criteria must first be satisfied. Additionally, where the proposed prophylactic intervention is intended for children, who are unlikely to be able to provide a meaningfully informed consent, a heightened scrutiny of any such measures is required. We argue that children should not be subjected to prophylactic interventions "in their best interests" or for public health reasons when there exist effective and conservative alternative interventions, such as behavioural modification, that individuals could employ as competent adolescents or adults to avoid adverse health outcomes. Applying these criteria, we consider the specific examples of prophylactic mastectomy, immunisations, cosmetic ear surgery, and circumcision.
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Affiliation(s)
- F M Hodges
- Department of History, Yale University, New Haven, CT 06520-8324, USA.
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Jones RB. Impairment, disability and handicap--old fashioned concepts? JOURNAL OF MEDICAL ETHICS 2001; 27:377-379. [PMID: 11731599 PMCID: PMC1733473 DOI: 10.1136/jme.27.6.377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The drawbacks of using the concepts of models in discussing the problems of disabled people are discussed. It is suggested that the terms "impairment", "disability", and "handicap" can unify the different models and enhance the position of people with disabilities in society.
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