The September/October 2003 (28[5]) issue of MCN presented an article titled "Newborn behavioral and physiological responses to circumcision" (T. Johnson et al.). I praise the researchers for calling nurses to advocacy and involvement in policy change through research, but I must say that their own lack of advocacy was disconcerting. By citing "customary policy" as support for denying pain control to one group of infants, they provided a very poor role model for other nurses faced with the dilemma of fighting for advocacy in a world of policy driven action. The researchers were clearly aware of standards set by JCAHO that pain should be assessed and treated in all patients, as this was cited in their article. They also cited the American Academy of Pediatrics' (AAP) statement that all infants should receive analgesia to reduce pain associated with circumcision, yet, as with many physicians and hospital policies, they ignored these statements to conduct their study, which they admitted was not even large enough to provide statistical differences between groups (1999).

I am also concerned about the information given the parents to obtain consent for not only the study but also the procedure. The researchers do not make clear what information was given to parents before obtaining consent for the procedure. Did parents verbally consent to their sons experiencing the procedure without any form of pain control? In general, physicians only educate parents about three general complications of the surgery: pain, infection, and hemorrhage, and this is only done about fifty percent of the time (Fletcher, 1999). According to a different study printed in MCN about family teaching before circumcision, while the provider of care is legally responsible for providing information regarding the procedure, it is often the nurse who must obtain the signed informed consent form (Kaufman, Clark, & Castro, 2001). Since Johnson et al. didn't tell us who provided pre-op teaching, it is unclear if the consent was based on full disclosure. They perpetuated antiquated policies on infant pain control, and they knowingly placed 27 infants through unnecessary trauma, which could result in long-term emotional damage. The research supporting pain control is already available, and effective techniques have been established, so why do we continue to turn a blind eye to suffering? How long will we allow the status quo because it is easier than change or suits our research needs? These patients need our voice, not just our research.

Tiffany Reese, BSN, RN, FNP-S

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