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Male Infant Circumcision? YES or NO

 
 
joefromchicago
 
  1  
Reply Sun 18 Jul, 2004 08:04 pm
smt wrote:
08Joe, I apologize for the delay in responding to your last post.

No problem.

smt wrote:
The medical community does addresses ethical issues. In the case of routine infant circumcision (RIC), it appears that the AAP is ignoring some of those issues. I will expand on this below.

Well, let's be clear on this point: the medical community addresses ethical issues only as they pertain to physicians and other medical professionals. I have, throughout this discussion, assumed that you were not referring to them when you said that it was "unethical" to authorize this procedure. Is that assumption correct?

smt wrote:
Purely cosmetic procedures are non-therapeutic when performed on a non-consenting individual. The criteria for performing cosmetic surgery is for the individual to gain a psychological benefit that outweighs the risks. Only the individual can give consent for, and benefit from, a strictly cosmetic procedure. If the individual's thoughts and feelings cannot be part of the decision then the psychological component of a cosmetic procedure cannot be determined.

This is rather confused. You previously based your objection on the ground that circumcision is not "medically necessary." Now you're saying that circumcision is a cosmetic procedure, which, presumably, in some cases might actually be necessary -- if not medically then at least psychologically. If that's the case, then you've brought the issue of consent back into the picture.

Let's see if we can determine exactly where this leads us. One type of birth defect is polydactyly -- in laymen's terms, extra fingers or toes. Now, in some cases this is one aspect of a serious congenital defect, but in other cases it's simply an extra digit or two. The bonus finger or toe may be functional, or it may simply be rudimentary. Typically, such extra digits are surgically removed (the procedure may be as simple as tying a string around it and waiting for it to fall off).

Now, in cases where the sixth finger or toe doesn't really affect the infant's health or long-term medical prospects, one could certainly argue that any operation to remove the extra digit is purely cosmetic, much as operating to remove a third nipple would be cosmetic. Indeed, apart from the difficulties involved in buying gloves, one could expect to lead a full and satisfying life with eleven or twelve fingers. So, in those cases, would you argue that it is unethical to operate on the infant to remove that digit?

smt wrote:
It's not that the consent changes the risks or benefits. The benefits and risks change the criteria for proxy consent based on whether or not a procedure is therapeutic (or diagnostic). In the case of RIC (an invasive, non-diagnostic, non-therapeutic procedure), a guardian is not given the right to proxy consent.

Says who?

smt wrote:
"We now realize that the doctrine of "informed consent" has only limited direct application in pediatrics. Only patients who have appropriate decisional capacity and legal empowerment can give their informed consent to medical care. In all other situations, parents or other surrogates provide informed permission for diagnosis and treatment of children with the assent of the child whenever appropriate" -AAP Committee on Bioethics - Informed Consent, Parental Permission, and Assent in Pediatric Practice

That certainly does not support your point that parents and guardians do not have the right to authorize circumcision on male infants. Indeed, it would be surprising if the AAP guidelines you cite would stand for that proposition, given that the AAP guidelines on circumcision specifically permit parents/guardians to authorize the procedure.

smt wrote:
The key being 'diagnosis and treatment(therapeutic) of children'. There is no right given for prophylactic(non-therapeutic) medical procedures.

In the case of male infant circumcision, you are most definitely wrong.

smt wrote:
Medical organizations ARE in the ethics business. The AAP's policy on circumcision is out of sync with the medical community at large and even other policies within the AAP itself. What we have is no major medical organization in the world that recommends RIC (or ever has, to my knowledge) and some that recommend against it. Just the fact that a medical procedure is not discouraged by some medical organizations does not mean it meets the requirements of a therapeutic procedure.

It's getting very hard to figure out what forms the basis for your charge that circumcision is unethical. Initially, you argued that a parent could not ethically authorize circumcision because the procedure was not "medically necessary." As you stated: "The whole gist of my premise is that routine infant circumcision is unethical because it is not a medically indicated procedure." When asked to provide the basis for this claim that circumcision was "medically unnecessary," you have cited some of the very same organizations that you simultaneously criticize for being inconsistent.

Of course, it's not difficult to figure out why you're having these problems. The same organizations that say that circumcision is unnecessary are the same organizations that say its OK for doctors to perform the procedure. So at the same time you rely on them for medical support you reject them when it comes to ethical grounds.

smt wrote:
In fact, according to the AAP, RIC is a non-recommended, non-therapeutic, elective surgery with no proven net benefit. The Council on Scientific Affairs of the AMA has recognized RIC as a non-therapeutic, elective procedure. The AAP and ACOG both have stated "There are no medical indications for routine neonatal circumcision". The Agency for Healthcare Research and Quality's "U.S. Preventive Services Task Force" has not recognized circumcision as a preventive procedure. The American Cancer Society and the American Urological Association do not recommend RIC as a preventative procedure.

This may all very well be true (although it is customary to provide links when citing these sorts of authoritative statements), but then do any of these organizations forbid their members from performing male infant circumcisions?

smt wrote:
There is a real ethical dilemma when presenting an invasive, preventive, procedure where the benefits do not outweigh the risks. This is compounded when there are less invasive options available to gain similar benefits while virtually eliminating all of the risks of the circumcision procedure itself. Because RIC is non-therapeutic it has been dropped from a number of state medicaid programs, some private insurance, and from the British and Canadian national health services. The burden of proof for performing RIC rests on the ones promoting the procedure. They have failed to make their case.

Clearly, you've mixed up two very different things: medically necessary and medically acceptable procedures. At the point where you were arguing that medical necessity was the key factor, I suppose you could get away with this mix-up. Now, however, you've drifted off into an argument based on consent, so you must explain how the "medical necessity" issue comes back into the picture.

To make things easy for you, let me ask specifically:

1. Are you contending that the only procedures that can ethically be performed on an infant are those that are "medically necessary?"

2. If the answer to the previous question is "yes," is that because you are relying upon a "presumed consent" standard, whereby you presume that an infant, if it had the ability to grant consent, would only give consent to those procedures that are "medically necessary?"

3. If you answered the first question "yes," then what are the criteria that determine "medical necessity?"

smt wrote:
RIC is an ethical violation based on the following:

1) Violates the primary tenet of medicine: "First do no harm" and the AMA's Code of Ethics Principle 4 (rights of patient). RIC is an invasive, prophylactic, procedure with no recognized medical net benefit, that violates the inherent bodily integrity, security of the person and freedom from unnecessary medical procedures.

Well, even if we were to accept this point, it would only restrict physicians. It would, on the other hand, not constitute an ethical constraint on parents, guardians, mohels, witch doctors, enthusiastic amateurs, or anyone else who either authorizes or performs these procedures.

smt wrote:
2) Violates the AAP's Workgroup on Breastfeeding recommendation...

Your points 2 through 8 merely cite purported inconsistencies within the AAP's position. But, of course, the AAP dictates neither the ethics for the entire medical profession nor for non-professionals in any respect. Furthermore, such inconsistencies are a little difficult to square with the AAP's specific statement regarding circumcision. If the AAP is being inconsistent, we should be just as entitled to claim that its other working groups are wrong as we would be to claim that the circumcision guidelines are in error.

smt wrote:
Where there is a conflict between legal procedures and ethical concerns, the ethical concerns rise above the legal principles: "Ethical values and legal principles are usually closely related, but ethical obligations typically exceed legal duties." AMA Medical code E-1.02 The Relation of Law and Ethics.

So what?

smt wrote:
Physicians have an obligation to to not perform unnecessary procedures: "Physicians should not provide, prescribe, or seek compensation for services that they know are unnecessary." AMA Medical code E-2.19 Unnecessary Services.

There is no provision for providing invasive prophylactic treatment where there is no medical indication. E-8.20 Invalid Medical Treatment.

Yet, again, the AMA adopts the AAP guidelines regarding circumcision. If the AMA has issued inconsistent rulings, we are just as entitled to state that its circumcision guidelines are correct as we are to assert that they are in error.

smt wrote:
A lot of clarity can be seen in the most recent statement on circumcision from a major medical organization:
"Infant male circumcision was once considered a preventive health measure and was therefore adopted extensively in Western countries. Current understanding of the benefits, risks and potential harm of this procedure, however, no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention." COLLEGE OF PHYSICIANS & SURGEONS OF BRITISH COLUMBIA - Infant Male Circumcision

And yet this group also permits its members to perform male infant circumcisions (you didn't provide the link, so I will: CPSBC Policy Manual).
0 Replies
 
au1929
 
  1  
Reply Mon 19 Jul, 2004 07:19 am
I believe it is high time that this post be circumcised. Laughing Laughing
0 Replies
 
joefromchicago
 
  1  
Reply Tue 27 Jul, 2004 08:45 am
Well, I must say that I am somewhat surprised. Usually, single-issue posters like smt show much more tenacity in debate. Yet it seems that smt, who has apparently discussed this issue on numerous boards and has, up to now, been disappointed with the level of debate, has abandoned this board just as the thread was getting interesting. Surely, it couldn't be that smt was intimidated by the vigorous discourse -- that, after all, was what s/he liked about A2K. And it's not that smt hasn't been around since his/her last post -- I've seen him/her lurking around here in the past week.

I can only conclude that, for smt, the issue is no longer of interest. And given that smt was only interested in this topic (never having posted on any other thread), I would surmise that s/he is no longer interested in anything else. Tant pis.
0 Replies
 
Setanta
 
  1  
Reply Tue 27 Jul, 2004 08:52 am
I would prefer that you do not speak of my Aunt urinating, Joe . . .


tant mieux
0 Replies
 
littlek
 
  1  
Reply Tue 27 Jul, 2004 09:02 am
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Cole says, above, that he's sure glad his mommy and daddy didn't curcumsize him.
0 Replies
 
Bella Dea
 
  1  
Reply Tue 27 Jul, 2004 09:38 am
owie. Has anyone actually seen a circumcision? Those babies scream for a reason. It HURTS! Shocked

And besides, I've been with a man who was not circumcised and honestly there was no difference. And it wasn't yucky or gross. Just wore a turtleneck. Very Happy

I think it is up to parents. If done for religious reasons it is totally understandable but most people do it because, well, it just is that way.
0 Replies
 
smt
 
  1  
Reply Wed 28 Jul, 2004 11:07 am
joefromchicago wrote:
I can only conclude that, for smt, the issue is no longer of interest.


I apologize Joe, my stepfather has been very sick with cancer and died on Thursday. I do intend to get back to this thread but have had to give my attention to other, more important, areas the last few weeks. I have kept this window open so I don't forget about it. I would like to continue the debate but have not had the time or energy to give a proper reply.

smt
0 Replies
 
joefromchicago
 
  1  
Reply Wed 28 Jul, 2004 11:25 am
smt: Please accept my sympathies on the passing of your step-father. I'll be around whenever you decide to return.
0 Replies
 
joefromchicago
 
  1  
Reply Thu 7 Apr, 2005 08:19 am
A recent addition to the infant male circumcision debate:

A Proposed Bill to Ban Male Circumcision: The Clash of Gender, Religion, and the Protection of Children
0 Replies
 
material girl
 
  1  
Reply Thu 7 Apr, 2005 08:30 am
Wasnt there a story of twin boys being circumcised in a hospital in the USA and one went wrong and his penis was burnt off.They then tried to bring the boy up as a girl which led to absolute disaster.
Both twins killed themselves bcause of everything that happened because of it.
A good reason against circumcision.
0 Replies
 
au1929
 
  1  
Reply Thu 7 Apr, 2005 08:49 am
Millions of people here and around the world adhere to the practice for religious reasons. Just as I believe religion has no place in government I believe government has no place in religion. The only exception would be if it was a dangerous medical practice. Which it is not.
0 Replies
 
BlindBandit
 
  0  
Reply Thu 13 Sep, 2012 03:55 pm
@smt,
The American Academy of Pediatrics now acknowledges that circumcision has real advantages.
http://www.circinfo.net/pdfs/GFParents-EN(US)2012.pdf

So a lot of people against circumcision got hit hard by A.A.P.'s reversal of their stance and are getting a real taste of reality for the first time since they have been operating and recruiting new soldiers to help spread their lies and deception.

You can go ahead and leave the boy unprotected until he is approaching a responsible age when he might start practicing safe sex and leave him until he has missed most of the medical benefits particularly at ages when he is most vulnerable then offer him a procedure with at least ten times the complication rate, less likelihood of a good cosmetic outcome, and six to eight times the recovery period when stitching, uncomfortable mobility, disruption of school or work, and sexual abstinence are factors. While you are at it don't let him know that circumcision improves sexual pleasure and tell him to ignore authoritative information like the AAP so that he can make an 'informed' choice.

0 Replies
 
joefromchicago
 
  1  
Reply Fri 14 Sep, 2012 10:28 am
It's refreshing to see someone who is as fanatically pro-circumcision as all of those who are anti-circumcision.
0 Replies
 
north
 
  1  
Reply Fri 14 Sep, 2012 03:45 pm

NO
0 Replies
 
hawkeye10
 
  1  
Reply Thu 26 Dec, 2013 01:10 am
yes, because there is conclusive proof that in helps keep men from HIV infection. It also reduces sensitivity some to help men go longer before orgasm, which is good for women. It also looks better. It also us easier to keep clean.

there is no downside actually.
0 Replies
 
kerridragon
 
  1  
Reply Mon 13 Nov, 2017 12:46 am
@doglover,
hi is it up to the mom if boy gets circomesized and should mom tell you what is going to hapen before
0 Replies
 
 

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