Male Infant Circumcision? YES or NO

I think it all falls into the category of: "Perhaps I lack judgement in choosing the right forum in which to start a debate." I had no problem when originally choosing this forum to debate the ethics of non-medically indicated circumcision. If a mod feels it is more appropriate in another forum I have no problem with them moving it.



The foreskin and shaft skin is a single piece of continous skin. On a flaccid penis the skin starts behind the coronal sulcus of the glans, goes toward the tip of the glans, folds away from the glans back down over itself and continues to the base of the penis.

When an intact penis is inserted into the vagina, the penis shaft is now free to "glide" within it's own slack skin. This is often referred to as "gliding action". This is a different function than a circumcised penis experiences where all of the shaft skin is sliding in and out of the vagina along with the penis. Circumcision removes much, if not all, of the "slack skin" and depends on more lubrication from the woman.

The anatomy and functions of the foreskin can be seen here (you, of course, have stated that you have no need for the photos but others might need a visual representation):

http://www.noharmm.org/anatomy.htm

The "severity of change in function" is a valuation judgement which, IMO, carries weight when assessing the benefits and risks of circumcision. I see it as a significant change. Just as some guys claim the an intact penis feels better while other guys claim that a circumcised penis feels better, only the individual can determine that for himself. I have made no claims as to which is better for all men.

smt,

That's quite a good link you posted, as I'm sure that most circumsized men and the majority of women don't really know how the uncircumsized penis works - or very much about the foreskin at all.

The images are clear and descriptive. And it was interesting to find out how much skin was actually removed.

Good post.

"Like smt, then, you have one genuine criterion -- medical necessity -- and a number of factors that are, in the end, subsumed under that single criterion."

How is inability to give informed consent subsumed under this criterion?

I do not consider medically unnecessary surgery on adults who have given informed consent unethical. I might have other words for a lot of it - but I do not consider it unethical.

We're not dealing with adults here, we're dealing with infants who are incapable of giving or withholding consent. Thus, when deciding whether or not to authorize a medical procedure on an infant, both you and smt would make your decisions based upon a single criterion: medical necessity. The infant's consent plays no role, since an infant cannot consent even to a life-saving medical procedure. The infant's lack of consent, in other words, is not an issue, it's a given.

Joe has a point here.

oh my god. i just looked at that site . that is just awful. now i am even more set in my beliefs that it shouldnt be done.
> feeling very thankful that i am not a man right now<

Joe wrote:

"dlowan wrote:
The Australian Medical Association position - and more so the Paediatric association DOES differ - in that it actively DIScourages male infant circumcision.

Only for infants younger than six months old. That, as I pointed out, is the only significant difference. Yet that proviso is not significant as a matter of ethics. After all, the infant is in much the same situation at six months as he is at birth: incapable of assenting to a medical procedure but capable of pain. The only difference is that he's six months older."

No, Joe - you are wrong. The Australian paediatric association recommends against it. Not just for infants.


"The Australasian Association of Paediatric Surgeons
Position statement, 1996

Guidelines for circumcision

Preamble

The Australasian Association of Paediatric Surgeons does not support the routine circumcision of male neonates, infants or children in Australia. It is considered to be inappropriate and unnecessary as a routine to remove the prepuce, based on the current evidence available.

Due to religious beliefs, Jewish children are circumcised by the seventh day of life, as a mark of dedication to God. Children born into the Muslim faith will likewise be circumcised for religious reasons, although the timing for the procedure is less clearly defined. There are Christian groups in other parts of the world, who insist on ritual religious circumcision, as well as tribal or cultural customs promoting male circumcision.

We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications and risks which may arise. In particular, we are opposed to male children being subjected to a procedure, which had they been old enough to consider the advantages and disadvantages, may well have opted to reject the operation and retain their prepuce."

Anyhoo - I am out of here.

I am only really arguing it from a mild opposition - which is based on allowing people to choose things for themselves, where risks are clear, and benefits very doubtful, as far as we know at present. Only the weight of religious tradition makes this contentious, I believe.

Yet, in the end, it reaches the same conclusion as the other medical associations: as long as the parents are fully informed and the circumcision is done under anesthesia (and the child is at least six months old), it is ethical for the doctor to perform the procedure.


Cheers.

I add then a quote from The COLLEGE OF PHYSICIANS & SURGEONS OF BRITISH COLUMBIA, courtesy Jer;

"Circumcision removes the prepuce that covers and protects the head or the glans of the penis. The prepuce is composed of an outer skin and an inner mucosa that is rich in specialized sensory nerve endings and erogenous tissue. "

i believe you were seeking a modicum of supportive evidence..........!

I note that i have made a premature ej... er, post; as further information concurring with my comment has been posted (smt)



However the above claims are ridiculous, as neither has the capacity to 'compare', thus the functional difference must be attributed to medical, and scientific description, rather than experience.
It must however be very apparent that removing tissue "rich in specialized sensory nerve endings and erogenous tissue", will result in a less intense experience, regardless of any unwarranted claims.

I do want to respond to Joe's last post to me, but I'd like to quickly suggest that there are people who get circumcised as adults and can make a comparison of "before and after". There are also men that go through various ways of "foreskin restoration" and although they cannot recover lost nerves, they can regain much of the "gliding action" and claim increased sensitivity of the glans.

<patiently waiting>

good point smt; when i go cavalierly throwing the word 'ridiculous' about, i should expect evidence to surface that will negate it's application
but i would suggest that those who as adults chose to have the procedure done, must have reasons that have nothing to do with sensory gratification!

So a man returns home to his wife, doubled over in pain after day surgery on his nether regions. "Ooooh, Jesus, this friggin' hurts...ahhhhh, uuuurrrgggh....something's wrong, honey....get me an ice pack and some valium."

The wife says, "Gee, I don't know what could have gone wrong. It was a simple circumcision."

Hubby looks shocked. "Circumcision?? I thought you said castration!!"

The humour of such an error, just might escape the average male!

But then, i have always wondered (without the courage to engage in the 'experiment') if life as a eunuch, without the constant interference of sexual preoccupation, would be a life more fulfilling, in so many other ways?

Only one way to find out....

Re: Male Infant Circumcision? YES or NO


False dilema. (sp?)

my answer would be: up to the parents.

08Joe, I apologize for the delay in responding to your last post.


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.


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.


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



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. 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.

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.

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.
2) Violates the AAP's Workgroup on Breastfeeding recommendation that "Procedures that may interfere with breastfeeding or traumatize the infant should be avoided or minimized". There is no medical indication for RIC which is a traumatic surgery.
3) Violates the AAP's joint statement from the Committee on Fetus and Newborn, Committee on Drugs, Section on Anesthesiology, Section on Surgery Prevention and Management of Pain and Stress in the Neonate that painful procedures should be avoided. There is no medical indication for RIC which is a painful procedure, even with anesthesia.
4) Violates the AAP's Committee on Bioethics statement that "Every child should have the opportunity to grow and develop free of preventable illness or injury" and violates the AMA's First Principle of Medical Ethics, that the doctor must respect the human dignity and the rights of the patient. RIC injures healthy, functional, tissue without medical cause and violates the inherent right to to be free of physical injury.
5) Violates the AAP's Committee on Bioethics statement that the doctor's first priority is to the child's needs and not the guardian's wishes. This also violates the AMA's Principle 3 that the doctor's legal responsibility is to the patient. As stated above, guardians only have an ethical right to give proxy consent for therapeutic or diagnostic procedures. The AAP's policy on circumcision violates there policy on bioethics by giving discretion to parents for invasive, non-therapeutic, procedures.
6) Violates the AAP's Section on Urology that states that genital surgery should be avoided during the first six weeks of life when it can interfere with bonding. Virtually all RIC is performed within the first 8 days of birth and most within the first 48 hours. Since there is no medical indication for RIC it should be avoided.
7) Violates the AMA's Council on Ethical and Judicial Affairs Principle 8, that doctors regard their responsibility to the patient as paramount. When non-medically indicated circumcision is done at the request of the parent, the parent's desires are put above the doctor's relationship to the child-patient. A US Supreme Court opinion expresses this as: "Parents may be free to become martyrs themselves. But it does not follow that they are free to, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves."
8) Violates the AAP's Committee on Bioethics' provision for accurate and unbiased information("informed consent") and violates the AMA Principle 2 that doctors deal honestly with patients. The AAP policy on circumcision and informational handouts do not address the ethical issues, adverse sexual and psychological effects of circumcision, and the benefits and risks or alternative treatments. While at the same time they emphasize benefits that are so minimal that they cannot possibly justify an invasive routine procedure.


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.

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.

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

dude it is healthyer and not as pleasureable so ummmm I guess it should be up to the parents

I am circumsied or whatever and I don't mind it I wish sicko's at the YMCA would just wear some clothes you know.

gosh, it's healthier? i never even thought to consider the medical issues... so screw the ethicsl!