"Forced Genital Cutting," and Jewish circumcision

[Me Myself]

But two can play at that game.I have absolutely zero issue with the fact my parents put shoes on me in fact Im grateful.That is a non issue for me.

I know. Another reason for it being an apt analogy.

I dont have issues with it either.

Our feet are still deformed though.

 

[9-10ths_Penguin]

Jeff, my argument is that parents should have the right to choose what's best for their children. I'm a proponent of educated decision making and feel that the APA provides a plethora of resources to explore.

I have presented evidence provided through sources from the APA, CDC and other sites throughout this thread, which conflict with the claims provided in the OP.

I respect that you would opt for option #1 for your male child.

I find the statements of the APA to be quite reasonable as a parent:



Source: New Evidence Points to Greater Benefits of Infant Circumcision, But Final Say is Still Up to Parents, Says AAP

I think you completely missed my point.

Even if we were to agree that circumcusion is better than no circumcision at all, nothing in that source or any other that you've provided does anything to justify why NEWBORN circumcision is better than circumcision later. Most of the purported benefits you claim deal with things later in life. Meanwhile, even setting aside the human rights of the child, the evidence shows that the risk of complications drops dramatically if circumcision is delayed until after the child is 30 days old.

Immediately after birth is the absolutely worst time to perform a circumcision. The only possible reason to do it then (besides religious doctrine) is the expediency of "killing two birds with one stone" and avoiding another trip to the hospital or clinic later.

Basically, I think you're arguing for the option that cannot be considered the best for their child by any educated person. Even if the parents don't care about the choice of the man their boy will become, delaying circumcision decreases the risks without affecting the supposed benefits.

It's more caring and more reasonable to wait until the prepuce can be expected to have separated from the glans on its own. It's more caring and more reasonsble to wait until the child is toilet trained to the point that there's a decent chance that the wound won't be covered in excrement on a regular basis. And this holds true regardless of the values of the parent: when the outcomes of two options are exactly the same except one has higher risk of complications, there is no rational way to choose the riskier option.

 

[dawny0826]

I think you completely missed my point.

Even if we were to agree that circumcusion is better than no circumcision at all, nothing in that source or any other that you've provided does anything to justify why NEWBORN circumcision is better than circumcision later. Most of the purported benefits you claim deal with things later in life. Meanwhile, even setting aside the human rights of the child, the evidence shows that the risk of complications drops dramatically if circumcision is delayed until after the child is 30 days old.

Immediately after birth is the absolutely worst time to perform a circumcision. The only possible reason to do it then (besides religious doctrine) is the expediency of "killing two birds with one stone" and avoiding another trip to the hospital or clinic later.

Basically, I think you're arguing for the option that cannot be considered the best for their child by any educated person. Even if the parents don't care about the choice of the man their boy will become, delaying circumcision decreases the risks without affecting the supposed benefits.

It's more caring and more reasonable to wait until the prepuce can be expected to have separated from the glans on its own. It's more caring and more reasonsble to wait until the child is toilet trained to the point that there's a decent chance that the wound won't be covered in excrement on a regular basis. And this holds true regardless of the values of the parent: when the outcomes of two options are exactly the same except one has higher risk of complications, there is no rational way to choose the riskier option.

Seriously?

I'm not posting my source again. We should both have this memorized by now, anyway.

The medical benefits alone may not outweigh other considerations for individual families. The medical data show that the procedure is safest and offers the most health benefits if performed during the newborn period. The AAP policy recommends infant circumcision should be performed by trained and competent providers, using sterile techniques and effective pain management.

A baby is typically considered a newborn through 3 months.

So.... Are we done now?

 

[Terrywoodenpic]

men should be circumcised the day of their marriage.
So that they can properly get to know their wives.

 

[9-10ths_Penguin]

I suppose it's contingent upon the individual, Jeff. I'm much more interested in a pediatrician's reputation as a surgeon, than their personal views on circumcision.

I'm direct enough as a person that I wouldn't hesitate to ask personal questions regarding my pediatrician's opinions, if it was important to me, but my greatest concern revolves around her abilility and the ability of those within her practice.

Hmm. Personally, I care about the motivations of people I trust to advise me. Different strokes for different folks, I guess.

What if the CPA does revisit their policy again and make revisions - changing their stance to more of a neutral stance? Will your thoughts remain the same if the CPA adopts a more comparable policy to that of the APA?

Would you change your position if the APA changed their position to be more in line with that of the CPS (and numerous other medical associations)?

For me to think that routine circumcision of infants was a good idea, a few things would need to be shown:

- that the benefits of circumcision significantly outweigh its associated risks and harm
- that these benefits can't be achieved by other less invasive means
- that there's a compelling reason not to wait until the boy is old enough to consent

Okay. Fair enough. I suppose I cannot argue with you, here, however, what I intended to convey there, was that they are not pushing a particular agenda in terms of - "yes, do this" or "no, do not do this".

They're absolutely pushing an agenda: that both positions on the issue are reasonable and defensible.

I think this depends solely upon the individual medical professional, Jeff. While yes, I agree that there must be some who would allow financial incentive to sway their decisions, a good doctor will provide unbiased information. I do believe that there are good doctors out there.

So you don't deny that a conflict of interest is present; you just trust that doctors are virtuous enough to do the right thing.

And regardless as to our personal opinions on this subject matter, we cannot possibly know the personal motivations of our doctors outside the auspices of what we see through their works. They do take oaths not to do harm and again, when you establish a trusted relationship with your doctor, which I've been fortunate to do with both my girls' former pediatrician and with my present PCP, you assume as a patient, that unless your medical professional gives you reason to doubt, you're being given credible information and guidance.

Doctors also take oaths to follow their medical associations' codes of ethics, and a prohibition against conflicts of interest is a standard item in these codes.

I get your point, Jeff. But, you need to take this down to the couple who is making decisions for their child. Again, if they are proactive in contemplating a decision before giving birth, they approach this multi-faceted decision and provide themselves ample opportunity to weigh risks and benefit.

Ultimately, it's not going to matter what their doctor chose for his/her child. It's going to matter what they choose for their child. More importantly, if they choose incorrectly for their child.

They aren't meeting with the entire populace of physicians. They are meeting with perhaps the 1-2 pediatricians within their own chosen pediatric practice.

And either the pediatricians advising those parents or the parents themselves will be informed by the extant body of research on circumcison. It's ridiculous to argue that the quality of the studies that make up this body of research doesn't matter.

Many of my decisions and opinions were formed while pregnant with my first baby, before I knew of the APA website. I did however, keep my nose buried in pregnancy and parenting books, which contained a lot of great information on infant circumcision. Additionally, I come from a family of medical professionals, and I can freely bounce questions off of them. My ex-husband's situation was rather unique. He was circumcised at 16 and resented his parents for not having him circumcised as a baby. He did not regret his circumcision and true story, said he preferred the feel of it after the procedure, but, he did regret the pain and embarassment of having it done in his teens.

That article I quoted earlier spoke to the issue you're raising here:

Some adult males may squirm at the very thought of routinely offering circumcision to peripubertal males, possibly because of perceived pain and discomfort. But infant circumcision also causes pain and discomfort.2,4 Indeed it’s curious that a painful elective procedure of no major benefit to the infant until years later would ever be deemed more acceptable than the same procedure for a peripubertal boy.

Male circumcision: get the timing right

Dear God, man, you are relentless.

By your logic, the very same can be said about ANY organization that is participating in study regarding circumcision. I'm sure there's bias and persuasive power within the CPA and NHS too. Don't front as if the APA doesn't contain solid information to rely upon. In fact, there are a plethora of resources to pull from which would support a person staunchly against the procedure as well as someone more neutral.

Actually, I'd say that the APA is unique in two important respects:

- none of the organizations that recommend against circumcision make money off this recommendation.

- if the organizations that recommend against circumcision took the opposite position, it wouldn't expose their members to lawsuits.

We don't know for sure what conflicts of interest may have influenced the policy statement.

Thank you. I'm glad you acknowledged this.

But again, the policy statement hasn't really changed in a ground breaking enough way to make that much of a difference.

But should it have? That's the question.

Okay, I agree with you on one point - pediatric groups (APA included) are pushing for insurance companies to cover circumcision. But, the procedure is not deemed medically necessary to where it's offered routinely at birth.

I'm glad you acknowledge that circumcision is unnecessary. Along with conflict of interest, the AMA Code of Medical Ethics covers this issue:

Opinion 2.19 - Unnecessary Medical Services

Physicians should not provide, prescribe, or seek compensation for medical services that they know are unnecessary.

AMA's Code of Medical Ethics

The risks of the procedure are still clearly outlined and it's a very much a choice, not much unlike some immunizations. This just happens to yield much greater risk and requires much greater contemplation.

At the end of the day - individual people are held accountable for their decisions, though. That doesn't change.

Exactly how are parents who choose to circumcise their baby sons "held accountable for their decisions"?

 

[Me Myself]

Again, making babies wear shoes is unnecesary at early ages. It deforms the feet and it makes the more prone to several foot conditions and make the muscles of their feet be considerably less flexible healthy and strong.

Should this deformation be punished by law?

 

[DallasApple]

old enough for the person being circumcised to freely consent to the circumcision (i.e. adulthood).

This seems not only reasonable but logical.

 

[DallasApple]

Again, making babies wear shoes is unnecesary at early ages. It deforms the feet and it makes the more prone to several foot conditions and make the muscles of their feet be considerably less flexible healthy and strong.

Should this deformation be punished by law?

You need to go sue your parents..Obvioulsy they messed up your feet putting shoes on you for decoration..My parents didn't.My parents put shoes on me to protect my feet and overall health...My feet are fine..Only damage to my feet is choosing at about 11 to go on toe. (ballet) and later to wear pointed toed high heals.

 

[DallasApple]

Again, making babies wear shoes is unnecesary at early ages. It deforms the feet and it makes the more prone to several foot conditions and make the muscles of their feet be considerably less flexible healthy and strong.

Should this deformation be punished by law?

I have 3 sons..All three of them I put shoes on them for appropriate reasons..their feet are not even close to deformed..Their penises are.(from circumcision)

 

[Me Myself]

I have 3 sons..All three of them I put shoes on them for appropriate reasons..their feet are not even close to deformed..Their penises are.(from circumcision)

Do their feet look like everybody else's ? With their toes going in? Or do the toes spread like they normally do in their natural state? Not that it is the only measure, but is one of the most visible ones.

In reality a foot that wore shoes on early stages will never be as healthy as those who did not.

 

[Me Myself]

You need to go sue your parents..Obvioulsy they messed up your feet putting shoes on you for decoration..My parents didn't.My parents put shoes on me to protect my feet and overall health...My feet are fine..Only damage to my feet is choosing at about 11 to go on toe. (ballet) and later to wear pointed toed high heals.

Why would I? I dont care about my deformity , it is even more common than e mutilation of circumsicion.

My circumsised penis is great, I am really happy about it. No damage to it whatsoever.

 

[dawny0826]

Hmm. Personally, I care about the motivations of people I trust to advise me. Different strokes for different folks, I guess.

So, you have in-depth conversations with all of your medical providers as to their personal code of ethics? They're already bound by a professional code and are subsequently held to those standards and the quality of care they provide you evidences whether or not they are serious about the oaths and codes they're bound to.

Do you take it a step further and dig into their personal lives to ensure that the dentist doing your root canal is doing it for the right reasons? Or the physician checking your prostate doesn't have a personal fetish for prostates?

Trust is built primarily upon the level of care provided and the patient/physician relationship established.

Yes, you should be able to trust your physician and trust is usually established through the cultivation of a relationship. Honest communication is vital and I believe I've reiterated the importance of this.

If I'm contemplating surgery for my child - any surgical procedure - the skill and performance record of the physician and their presence and feedback, mean more to me vs. their personal opinions on the procedure.

We expect our politicians to separate their religious views from their political office. Why is it harder for a medical professional to put their personal views aside and do their job?

Would you change your position if the APA changed their position to be more in line with that of the CPS (and numerous other medical associations)?

The APA isn't the sole driver in my decision making. I had an opinion on infant circumcision before visiting the APA's site. Absolutely, if the APA changed it's position, I think it important to understand why.

For me to think that routine circumcision of infants was a good idea, a few things would need to be shown:

- that the benefits of circumcision significantly outweigh its associated risks and harm
- that these benefits can't be achieved by other less invasive means
- that there's a compelling reason not to wait until the boy is old enough to consent

Completely rational.

They're absolutely pushing an agenda: that both positions on the issue are reasonable and defensible.

Both positions are reasonable and defensible.

So you don't deny that a conflict of interest is present; you just trust that doctors are virtuous enough to do the right thing.

I acknowledge that you can hold very staunch opinions and biases and still do your job appropriately. I do it everyday.

Doctors also take oaths to follow their medical associations' codes of ethics, and a prohibition against conflicts of interest is a standard item in these codes.

This should be as challenging for you to debate as it is for me, as we can't measure these conflicts of interest. They are assumed. The "severity" of them are also assumed. Again, I think it's quite reasonable for someone to hold a strong opinion about something but separate their personal views from their job responsibilities. I have to do it all the time in my line of work.

There's a difference between having personal objections to or being overtly gung-ho over a procedure due to personal interpretation and experience vs. serving on anti-circumcision boards or "campaigning" in either direction of the controversy.

Any way you slice it, we can't measure this. So, we have to use common sense and advocate for ourselves.

And either the pediatricians advising those parents or the parents themselves will be informed by the extant body of research on circumcison. It's ridiculous to argue that the quality of the studies that make up this body of research doesn't matter.

There are comparable stats that you'll find from the "for" and "against" sides. I don't really understand what you're fishing for here. I think a couple has access to enough information to make an informed choice, personally.

And if you disagree, we're at a stalemate. I have nothing more to comment in this regard.

But should it have? That's the question.

Should it have what? Changed to a statement that you would have found more favorable? I'm quite pleased with their stance, as it leaves the decision making in the court of parents, neither recommending the procedure or swaying parents to foego. You argue that this isn't what the policy statement achieves. You insist that there's an agenda being pushed. Either "side" can find what they need to justify their decisions.

I'm glad you acknowledge that circumcision is unnecessary. Along with conflict of interest, the AMA Code of Medical Ethics covers this issue:


AMA's Code of Medical Ethics


Exactly how are parents who choose to circumcise their baby sons "held accountable for their decisions"?

You're funny. I love it when you misrepresent my meaning.

It's not a medically necessary procedure, but, unlike earlobe piercing, there is statistical data to support medical benefit.

As a Mom, if I make a poor decision for my child, accountability is immediate. The majority of side effects/complications that are no-dispute, linked to cirumcision are going to manifest shortly after the procedure. Your grown son's failure to get an erection and lessened sensitivity may or may not be attributed to his circumcision as his uncircumsised friends could have the same issues.

 

[9-10ths_Penguin]

So, you have in-depth conversations with all of your medical providers as to their personal code of ethics?

I'm talking more about the sort of critical thinking that a person normally employs when the used car salesman insists that the perfect car for you just happens to be one of the cars on his lot. A reasonable person takes note of the fact that he only gets paid if someone buys a car from him and weighs his advice accordingly.

We expect our politicians to separate their religious views from their political office.

Speak for yourself. I certainly don't.

Why is it harder for a medical professional to put their personal views aside and do their job?

Why is it hard for you to realize that virtually every professional code of ethics includes a prohibition on conflict of interest, and that they're in there for a reason?

The APA isn't the sole driver in my decision making. I had an opinion on infant circumcision before visiting the APA's site. Absolutely, if the APA changed it's position, I think it important to understand why.

So you wouldn't necessarily be against circumcision yourself even if, on the basis of the body of research at the time, the APA recommended against it in the future?

Completely rational.

And as it stands now, routine circumcision meets none of the three prongs I gave.

I acknowledge that you can hold very staunch opinions and biases and still do your job appropriately. I do it everyday.

Then I can only assume that you're not in a profession that's covered by a code of ethics.

This should be as challenging for you to debate as it is for me, as we can't measure these conflicts of interest. They are assumed.

No, they're real. When a group develops recommendations that are supposed to be in the public interest, but members of the group have a personal interest that would be affected by the recommendations, there is a conflict of interest.

The "severity" of them are also assumed.

The way to deal with a conflict of interest ethically is to assume that any conflict of interest is severe enough to affect the results until it has been confirmed by a qualified third party (e.g. an institution's review committee) that it does not affect the results.

Again, I think it's quite reasonable for someone to hold a strong opinion about something but separate their personal views from their job responsibilities. I have to do it all the time in my line of work.

Again, I can only assume that you're not in a profession that's governed by a code of ethics.

There's a difference between having personal objections to or being overtly gung-ho over a procedure due to personal interpretation and experience vs. serving on anti-circumcision boards or "campaigning" in either direction of the controversy.

So... you think that being anti-circumcision would be a sign that a doctor is inappropriately biased, but if they personally gain financially from circumcision, that's A-OK?

Any way you slice it, we can't measure this. So, we have to use common sense and advocate for ourselves.

The normal approach - and I would argue the ethical approach - is to assume that a conflict of interest has poisoned the results until it can be confirmed otherwise. If the conflict of interest can't be measured, then it can't be determined to be unimportant.

There are comparable stats that you'll find from the "for" and "against" sides. I don't really understand what you're fishing for here.

I thought it was clear enough. You're painting an unrealistic picture of the decision-making process for parents on this issue. The recommendations of organizations like the APA have influence.

I think a couple has access to enough information to make an informed choice, personally.

And if you disagree, we're at a stalemate. I have nothing more to comment in this regard.

I agree with you, actually. Not only do we have enough research for parents to make an informed choice, we have enough for medical associations to make sound recommendations. And the vast majority of those medical associations recommend against circumcision. In some cases (e.g. the Royal Dutch Medical Association), they argue that it's a harmful practice that would normally warrant being made illegal, but they step back from this on the grounds that "back-alley" circumcision would still continue and be more harmful than allowing it.

Should it have what? Changed to a statement that you would have found more favorable?

No... should it have been changed to recommend against the procedure?

I'm quite pleased with their stance, as it leaves the decision making in the court of parents, neither recommending the procedure or swaying parents to foego. You argue that this isn't what the policy statement achieves. You insist that there's an agenda being pushed. Either "side" can find what they need to justify their decisions.

Yes, I do insist that an agenda is being pushed. Physicians have a duty to the well-being of their patients. Putting forward a recommendation that allows for circumcision implies that circumcision is in keeping with the well-being of the boys being circumcised.

You're funny. I love it when you misrepresent my meaning.

I can only infer your meaning from what you said. If you meant something other than "not medically necessary", maybe you shouldn't have said "not medically necessary."

It's not a medically necessary procedure, but, unlike earlobe piercing, there is statistical data to support medical benefit.

There's also statistical data to support medical harm... so much that most medical associations recommend against the procedure.

As a Mom, if I make a poor decision for my child, accountability is immediate. The majority of side effects/complications that are no-dispute, linked to cirumcision are going to manifest shortly after the procedure. Your grown son's failure to get an erection and lessened sensitivity may or may not be attributed to his circumcision as his uncircumsised friends could have the same issues.

I'm not sure whether this is special pleading on your part or just innumeracy. Are you also now going to argue that low risks of things like penile cancer or HIV are irrelevant? After all, circumcised men can be affected by these things, too.

 

[9-10ths_Penguin]

Dawn, I'm curious about something: why do you think that all those other medical associations are opposed to circumcision?

It's not a matter of being privy to different facts; they all have access to the same body of research. You assure us that doctors are above reproach and don't let their personal interests and biases sway their actions... so what is it? Why do you think that these doctors would be against the procedure?

I've already explained why American doctors might be reluctant to recommend against circumcision. Why would a European doctor with no "skin in the game" (no pun intended) br motivated to recommend against circumcision if it's as beneficial as you claim?

 

[Curious George]

Dawn, I'm curious about something: why do you think that all those other medical associations are opposed to circumcision?

It's not a matter of being privy to different facts; they all have access to the same body of research. You assure us that doctors are above reproach and don't let their personal interests and biases sway their actions... so what is it? Why do you think that these doctors would be against the procedure?

I've already explained why American doctors might be reluctant to recommend against circumcision. Why would a European doctor with no "skin in the game" (no pun intended) br motivated to recommend against circumcision if it's as beneficial as you claim?

While I disagree with the greedy doctor conspiracy, I would suggest that the doctors are divided because the risk and benefit is about even. Which is why most, if not all, countries allow for parental choice. Though some doctors do indeed push to change the laws, Britain, Canada, and the U.S. all agree that it should be left to the parents.

I think that some doctors feel patient consent must be acquired when dealing with medical procedures that are not necessary, while the majority of medical associations feel parental consent is valid.

 

[9-10ths_Penguin]

While I disagree with the greedy doctor conspiracy, I would suggest that the doctors are divided because the risk and benefit is about even. Which is why most, if not all, countries allow for parental choice. Though some doctors do indeed push to change the laws, Britain, Canada, and the U.S. all agree that it should be left to the parents.

Kinda sorta.

I think the reality is that most recognize that while the medical concerns outweigh any medical benefits, many people circumcise their sons for religious and cultural reasons, not medical ones. The medical associations tend to only weigh in in the medical issues and don't try to rule on whether those non-medical reasons are legitimate.

That being said, in at least one case I know of (the Netherlands), the medical association's position is that the harm of circumcision is enough to justify banning it altogether, except the additional harm that would be caused by untrained people doing "underground" circumcision in unideal conditions would make the outcome of a ban even worse.

I think that some doctors feel patient consent must be acquired when dealing with medical procedures that are not necessary, while the majority of medical associations feel parental consent is valid.

Again, I think it's more that they realize that the question of what sort of consent should be required for a religious ritual is not a medical issue.

 

[Curious George]

Kinda sorta.

I think the reality is that most recognize that while the medical concerns outweigh any medical benefits, many people circumcise their sons for religious and cultural reasons, not medical ones. The medical associations tend to only weigh in in the medical issues and don't try to rule on whether those non-medical reasons are legitimate.

That being said, in at least one case I know of (the Netherlands), the medical association's position is that the harm of circumcision is enough to justify banning it altogether, except the additional harm that would be caused by untrained people doing "underground" circumcision in unideal conditions would make the outcome of a ban even worse.


Again, I think it's more that they realize that the question of what sort of consent should be required for a religious ritual is not a medical issue.

But surely they do not take such a stance on fgm. So, there exists examples of rituals which clearly demonstrate how doctors do not allow potential cultural concerns to effect their medical standing.

As I acknowledged their are some medical professionals who have challenged the legality, but we should also wonder why so few associations, even the ones who acknowledge the risk slightly outweighs the benefit, have joined the cause.

Your answer is cultural respect, but I don't think your answer stands up to scrutiny. I think that it is much more likely that the risk/benefit ratio does not provide grounds for such a position.

 

[9-10ths_Penguin]

But surely they do not take such a stance on fgm. So, there exists examples of rituals which clearly demonstrate how doctors do not allow potential cultural concerns to effect their medical standing.

Can you give me an example of a country where the medical association is calling for a ban on FGM but it isn't already illegal?

As I acknowledged their are some medical professionals who have challenged the legality, but we should also wonder why so few associations, even the ones who acknowledge the risk slightly outweighs the benefit, have joined the cause.

Your answer is cultural respect, but I don't think your answer stands up to scrutiny. I think that it is much more likely that the risk/benefit ratio does not provide grounds for such a position.

Let me put things in perspective: how many medical associations have called for a ban on alcohol or tobacco? You'll probably find that the situation on those issues is a lot like the one for circumcision: most medical associations recommend against it, but only a few of them call for outright bans. Do you think this implies that medical associations think that for alcohol or tobacco, the risks are balanced by health benefits?

 

[Falvlun]

Do you think this implies that medical associations think that for alcohol or tobacco, the risks are balanced by health benefits?

No, but it does imply that they believe such a ban unnecessary. Meaning, that even if the risks outweigh the benefits, the risks are not risky enough to support draconian measures against it.

 

[9-10ths_Penguin]

No, but it does imply that they believe such a ban unnecessary. Meaning, that even if the risks outweigh the benefits, the risks are not risky enough to support draconian measures against it.

And in general, that's my position - don't ban it outright, but:

- don't cover circumcision with health insurance
- don't include it as part of a "standard" package for newborn care
- support doctors' right to refuse to do it
- discourage the practice through education