This blog discusses the benefits, risks and harms of circumcision and the ethical challenges of this ancient practice in our modern days
Saturday, August 25, 2012
My quick opinion on the new 2012 AAP policy on routine circumcision of infants
I found troubling this: “The majority of severe or even catastrophic injuries are so infrequent as to be reported as case reports (and were therefore excluded from this
literature review). These rare complications include glans or penile amputation,
198–206 transmission of herpes simplex after mouth-to-penis contact by a mohel (Jewish ritual circumcisers) after circumcision,207–209 methicillinresistant
Staphylococcus aureus infection, 210 urethral cutaneous fistula,211 glans ischemia,212 and death.213″
They absolutely IGNORED any information on the more severe complications of circumcision because they are just “case reports”. Hmm, how many cases of impurity is needed in a medication before it’s recalled, how many incidents are needed with any product that can affect a child before it’s recalled. But to deny analyzing this issue just because it’s reduced to case studies…
When they refer to the African studies linking HIV and “lack of circumcision”, of course at the same time they ignore any study that did not match that result, like the one from Puerto Rico that found more prevalence of HIV among circumcised males, or the one from the NAVY that found no correlation between circumcision and HIV among people in the NAVY, or any analysis of the difference with Europe. Perhaps the methodology is different as those were not experiments.
One question that they never seem to ask is: are there benefits to not being circumcised? Because, when weighing the potential benefits and the possible risks, what are the benefits of not performing the intervention? This question alone would completely change the balance of the ethic dilemma in my opinion.
And what follows from there is the lack of analysis as to why some (or so many) men are unhappy about being circumcised. Those men are the children that the AAP should have protected 20 and 30 and 40 years ago. Today, thanks to the internet, they are speaking out and stating that they wish this had not been done to them. Isn’t that information essential to debate the future of the procedure? Or do they reduce the foreskin to a price tag and completely dismiss the person who had it?
The policy also states that “parents are granted wide latitude in terms of the decisions they make on behalf of their children, and the law has respected those decisions except where they are clearly contrary to the best interests of the child or place the child’s health, well-being, or life at significant risk of serious harm” Well, what if circumcision does place the child’s health, well-being and life at significant risk of serious harm? How do they define “significant”? Because the severe risks were ignored because they were case studies, so they must be insignificant, right?
It also says that If the US is a “pluralistic society of the United States, where parents
are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare”, but why is it that the only healthy tissue that can be legally removed for non-therapeutic reasons, whether by a doctor or religious practicioner is the foreskin? Why is the foreskin not granted the same protection as, say, the tip of the nose, the lips, the skin of the fingers, the clitoral hood? Is it really just a matter of having a health benefit to justify it when the individual does not have the ability to consent? Or is this “pluralistic” adjective a hint to come back in a couple of years an recommend the ritual nick on infant girls as an alternative to female genital mutilation, like they did in 2010?
What they never discuss is if an imposed circumcision can the violate human rights of the baby, and I think that was the most important question. In lack of that answer, potential health benefits and minimized risks are just a distraction. Candy coating the issue. It will give us something to talk about. We can discuss benefits and risks all day long, and in doing it we forget that we are talking about a human rights issue, about an unneeded and irreversible amputation performed on a vulnerable individual who is incapable to voice his consent or lack of. Which is evidenced in this malicious statement: “Newborn males who are not circumcised at birth are much less likely to elect circumcision in adolescence or early adulthood.” Not only that states that most men would not elect to get circumcised if given the chance, but they use it to leverage it against the baby by pressing the parents: “do it to him now while you have the chance because he won’t want it done later”.
Oh and on this: “The Task Force advises against the practice of mouth-to-penis contact during circumcision” – They make it sound like they don’t recommend it JUST during circumcision, which is to say that at any other time it would be just fine right? Or do we just need to type a big “duh” after the statement. Or should they extend it to say “during circumcision – and at any other time”.
The point of this new AAP Policy on circumcision is to rub in our noses the 3 African studies (while ignoring anything that doesn't match them - or why the conditions are different in the U.S.), to further pressure parents into circumcising their babies before they grow up and have the right to decline, to press Medicaid into restoring funding for circumcisions in those states where they have dropped it (as an unnecessary intervention), and of course to open the door for institutions like Johns Hopkins Medicine for further solicitation of funds from the likes of Bill and Melinda Gates for additional self-serving studies.