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Response to
American Academy of Pediatrics (AAP) Circumcision Policy
Statement
SIGNS OF PROGRESS
- The statement takes a position of not
recommending circumcision. Consistent with all previous AAP
reports, no proven, actual benefits for circumcision are found.
The claims of potential medical benefits are discussed in
more detail that the last report (1989) and shown to be
insignificant.
- The report recognizes the extreme pain and
trauma caused by circumcision as evidenced by large increases in
heart rate, blood pressure, and stress hormone levels during
circumcision. The AAP notes that according to a recent study,
circumcised infants exhibit a stronger pain response to
vaccination at six months than uncircumcised infants,
demonstrating that the effects of circumcision are not
short-lived. By calling for pain medication, in the form of
injection into the infant’s penis, the AAP acknowledges that this
extreme pain and trauma of circumcision are serious.
- The AAP statement acknowledges that the
foreskin contains "a concentration of specialized sensory cells"
and reports that "penile sensation and sexual satisfaction are
decreased for circumcised males."
- The statement references a report that
circumcised men are more likely to engage in various sexual
practices such as masturbation and heterosexual oral sex. This
finding suggests that without a foreskin to contribute to sexual
pleasure, circumcised men seek alternative forms of stimulation to
compensate for their loss.
- The report identifies 20 different possible
circumcision complications. The 1989 report only mentioned
bleeding, infection, and death as possible complications.
- It warns physicians that parents should not
be coerced by medical professionals to choose circumcision,
suggesting that some medical professionals have coerced
parents to choose circumcision. In fact, some infants have been
circumcised even though parents explicitly requested no
circumcision.
- As in previous reports, hygiene is not an
issue. According to the report, "there is little evidence to
affirm the association between circumcision status and optimal
penile hygiene."
DEFICIENCIES
- The evidence calls for a stronger statement
than "the procedure is not essential to the child’s … well-being."
See Position
Statements of Other Medical Societies
- The statement lacks balance. It uses about 10
times more space discussing potential benefits as compared to
potential harm, specifically sexual and psychological harm. See
Recent Medical
Studies.
- It fails to acknowledge that there is much
about circumcision that we do not know. For example, it does not
answer or even ask about the potential connection between
circumcision and impotence. This connection has been noted in the
medical literature.
- According to the statement, pain medication
is "safe and effective in reducing the procedural pain associated
with circumcision." For any other elective surgery, "reducing the
pain" is unacceptable. In any case, there is no enforcement
mechanism for this recommendation. Infants will continue to be
circumcised with no pain medication.
- Various studies have found that short-term
effects of circumcision include changed sleep patterns, activity
level, and mother-infant interaction, more irritability, and
disruptions in feeding and bonding. Long-term behavior changes are
not known. This information is not included in the report.
- The AAP attempts to shift responsibility for
circumcisions to the parents, but physicians are the ones doing
the cutting. This is the only instance where laypeople make the
decision about whether or not to operate.
- The report notes that informed consent
"obligates the physician to explain any procedure or treatment and
to enumerate the risks, benefits, and alternatives." A physician
cannot do this if the physician is not aware of this information.
Some physicians describe circumcision as not painful, just causing
"discomfort." Few physicians know the functions of the foreskin
and are aware of the sexual and psychological effects of
circumcision.
- The AAP does not instruct physicians on the
proper care of the natural penis, which is to leave the foreskin
alone. Some misinformed physicians forcefully retract the foreskin
of a young boy and cause extreme pain and tissue damage.
- Cutting off an important, healthy, and
irreplaceable part of a child's body without medical justification
raises serious ethical questions.
- The AAP Committee on Bioethics report
states, "Pediatric health care providers … have legal and
ethical duties to their child patients to render competent
medical care based on what the patient needs, not what someone
else expresses… .[T]he pediatrician’s responsibilities to his or
her patient exist independent of parental desires or proxy
consent." For these reasons, some physicians and nurses refuse
to circumcise for ethical reasons. Yet the AAP Circumcision
Policy Statement concluded that it is "legitimate" to circumcise
if the parent requests it for nonmedical reasons. These two
reports of the AAP are in conflict. This office wrote to a
member of the AAP Committee on Bioethics requesting comment on
this conflict. No response was received.
- Circumcision violates the Golden Rule.
Adults would not consent to having a healthy genital part cut
off, with or without pain medication. Yet adults put a helpless,
vulnerable, sensitive newborn child through this painful ordeal.
- According to an article in the medical
literature, circumcision violates all seven principles of
Medical Ethics. (Denniston, G., "Circumcision and the Code of
Ethics," Humane Health Care International 12 (1996):
72-74)
Ethics Questions for AAP
Committee on Bioethics
AAP Policy Statement
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