A case report of complete penoscrotal transposition with hypospadias and imperforates anus. An ethical dilemma

Abstract The ethical aspects of decision-making regarding children are ambiguous, with many controversial statements within literature and practice. In every country, these decisions are affected by culture, local laws, and religion. Here we present a case of a complete form of Penoscrotal transposition (PST), a condition in which the scrotum is seen superior to the penis as if the scrotum's position and the penis have been reversed, which has two forms, complete and incomplete, based on the position of the penis, in a newborn with concomitant renal and ureteral abnormalities, that if left untreated, would result in the child's death; however, a proper surgical approach would be life-saving. Nonetheless, due to his father not giving his consent for the operation, the child passed away nine days after birth. As in our case, granting the authority to the non-expert parents may slowly propel the parents to choose perfect infants and deny the right of living from their other infants with specific and curable yet life-threatening conditions if they remained untreated. In children with older age, who can communicate, the principle of autonomy should be taken into account and the patient's needs should be addressed. In this case report, we cover the condition itself and the ethical aspects of this case to aid co-workers in managing complex cases, discuss the mental aspects, possible coping methods, and share our experience through this case.