A Feminist Nursing Critique of Circumcision

Nurse Kira Antinuk gives a feminist critique and her perspective on circumcision as well as her 13-year long involvement in the movement to promote equal genital autonomy for all children.

 

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INTERNATIONAL NURSES GROUP URGES NURSES TO CONSCIENTIOUSLY OBJECT

11 JUNE 2015

For immediate release

INTERNATIONAL NURSES GROUP CONDEMNS MEDICALLY-UNNECESSARY CIRCUMCISION OF FOUR-YEAR OLD BOY, URGES NURSES TO CONSCIENTIOUSLY OBJECT

 

Nurses for the Rights of the Child supports the genital autonomy rights of Chase Hironimus, a healthy 4.5 year old boy from Florida, USA. Chase’s human rights are in jeopardy following a bitter family court dispute surrounding a parenting agreement which was drawn up after Chase was born. This parenting agreement included the option for a medically unnecessary circumcision desired by the father. The circumcision was not performed during Chase’s infancy. Later, his mother Heather researched circumcision and became aware that it was not medically recommended and that it had risks generally and specifically with regard to her son, who had reacted adversely to anesthetic in the past and who develops keloids. Heather was imprisoned until she agreed to sign a circumcision consent form, which she did while bound in handcuffs and crying. Nurses for the Rights of the Child condemns the actions of Judge Jeffrey Gillen on this matter and notes that this forced consent was done under duress, which is unacceptable and contrary to the principles of informed consent.

We call on nurses who may be asked to assist with the proposed circumcision of Chase to demonstrate moral courage by taking conscientious objector status.

The Association of Women’s Health Obstetric and Neonatal Nursing (AWHONN) supports nurses’ rights to conscientious objection and recommends that every institution have a written policy protecting these rights and making reasonable accommodations for nurses with such objections. It also says that taking a conscientious objector position “…should not jeopardize a nurse’s employment, nor should nurses be subjected to harassment due to such a refusal.”

The Code of Ethics for Registered Nurses in Canada states: “Ethical (or moral) courage is exercised when a nurse stands firm on a point of moral principle or a particular decision about something in the face of overwhelming fear or threat to himself or herself. [… T]he nurse should discuss with supervisors, [or] employers […] what types of care she or he finds contrary to his or her own beliefs and values (e.g., caring for individuals having an abortion, male circumcision, blood transfusion, organ transplantation) and request that his or her objections be accommodated, unless it is an emergency situation”.

According to the American Academy of Pediatrics, “Performing an action that violates one’s conscience undermines one’s sense of integrity and self-respect and produces guilt, remorse, or shame. Integrity is valuable, and harms associated with the loss of self-respect should be avoided.”

If you are a nurse in moral distress about assisting with Chase’s proposed circumcision or any non-therapeutic circumcision, please contact Nurses for the Rights of the Child . We can assist you with resources and support regarding conscientious objection and refer you to legal support if needed.

You are not alone.

____________________________________________________

Nurses for the Rights of the Child is a non-profit organization dedicated to protecting the rights of infants and children to bodily integrity.  As health professionals, we specifically seek to protect non-consenting infants and children from surgical alteration of their healthy genitals.

Nurses for the Rights of the Child was founded in June of 1995 by a group of nurses who had become R.N. Conscientious Objectors to infant circumcision at St. Vincent Hospital in Santa Fe, New Mexico.

Read the story of the courageous nurses of St.Vincent Hospital here.

Our work includes:

  • Empowering, supporting, and advising nurses who want to help stop the genital cutting of infants and children, whether as conscientious objectors or as change agents.
  • Advocating for babies and children by educating the public that the forced amputation of a healthy body part of a non-consenting person – whether in the name of medicine, religion, or social custom – is a human rights violation.
  • Providing information to parents and parents-to-be about circumcision and the intact penis.
  • Educating health professionals about circumcision, the intact penis, and the ethics of neonatal circumcision, and promoting curriculum change in the training of health professionals.
  • Taking leadership in cooperating with others working in this country and abroad to promote the rights of children to bodily integrity.
  • Promoting the human rights principles of the Universal Declaration of Human Rights (1948) and the United Nations Convention on the Rights of the Child (1989).

Find NRC Online

Find NRC on Facebook

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GENITAL AUTONOMY 2014

The 13th International Symposium on Genital Autonomy and Children’s Rights
“Whole Bodies, Whole Selves: Activating Social Change”
University of Colorado – Boulder, CO
July 24-26, 2014
To register please go to our website at: http://www.genitalautonomy2014.com/
Detailed program information coming soon!
Please also visit our Facebook Event Page: https://www.facebook.com/events/400707260032181/

 

From international experts, you will learn about:
 
  • Laws protecting the rights of infants and children
  • The complications and consequences of human genital mutilations
  • The psychological sequela of genital cutting
  • The importance of protecting all children–male, female, and intersex–from non-therapeutic genital cutting
  • Cultural practices and cultural changes
  • Global efforts to promote genital autonomy for all infants and children
 And, you will see these films:
 
  • Intersexion
  • The Hidden Trauma: Circumcision in America (in production)
  • American Secret: The Circumcision Agenda (in production)
 Upon completion of this program, you will understand:
 
  • How laws protecting children’s rights are applied to genital cutting
  • How to provide expectant and new parents with accurate information
  • Ways in which to offer help to survivors of genital cutting
  • Global activities with regard to protecting genital autonomy rights of infants and children
  • The importance of raising awareness to include the rights of infants and children to their own bodies
 Continuing Education Credit
 
  • Provider approved by the California Board of Registered Nursing, Provider Number CEP 10870 for 22 contact hours.
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Canadian student nurse Kira Antinuk wins ethics award

Kira Antinuk discusses events that prompted her to research circumcision and then pursue a nursing career. Antinuk’s essay, “Forced genital cutting in North America: Feminist theory and nursing considerations” was published in the September issue (20: 723-728) of Nursing Ethics. She was the winner of the Paul Wainwright Nursing Ethics Student Essay Prize 2013!

Kira is Nursing Director for the Children’s Health & Human Rights Partnership:

http://chhrp.org

and CHHRP’s YouTube channel:
https://www.youtube.com/user/CHHRP

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Genital Autonomy being recognized in Europe

In recent weeks, several major events acknowledging a child’s right to genital autonomy occurred in Europe. Nurses for the Rights of the Child applauds these efforts to protect the fundamental human rights of children and extend our gratitude to the growing number of individuals around the world who are working to end forced genital cutting.

On September 30, 2013, a prominent group of Nordic ombudsmen, pediatricians, and pediatric surgeons met in Oslo to sign a resolution urging their national governments to protect boys from non-therapeutic circumcision.

“As ombudsmen for children and experts in children’s health we consider circumcision of underage boys without a medical indication to be in conflict with the UN Convention of the Rights of the Child, article 12, about children’s right to express their views about their own matters, and article 24, pt. 3, which says that children must be protected against traditional rituals that may be harmful to their health. … We consider it central that parental rights in this matter do not have precedence over children’s right to bodily integrity.”

http://www.arclaw.org/news/exciting-news-norway-five-nordic-childrens-ombudsmen-pass-resolution-work-ban-non-therapeutic-c

On October 1, 2013, the Parliamentary Assembly of the Council of Europe adopted a resolution by an overwhelming majority which categorized non-therapeutic circumcision as a “violation of the physical integrity of children.” It called on its forty-seven member states to take educational, legislative, and policy measures toward protecting the best interests of the child in regard to male, female, and intersex genital cutting practices.

http://www.arclaw.org/announcements/more-good-news-europe-council-europe-condemns-male-circumcision

On October 10, 2013, the Nordic Association for Clinical Sexology endorsed the above two resolutions. Expressing their concern about the human rights aspects associated with the practice of non-therapeutic circumcision of young boys, they conclude,

“unless there are compelling medical reasons to operate before a boy reaches an age and a level of maturity at which he is capable of providing informed consent, the decision to alter the appearance, sensitivity, and functionality of the penis should be left to its owner, thus upholding his fundamental rights to protection and bodily integrity.”

http://www.arclaw.org/news/more-good-news-nordic-sexology-association-upholds-childrens-right-bodily-integrity

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Genital autonomy and human rights at the Victoria Pride Festival

Nursing students Breanna de Groot, Emily Gage and Kira Antinuk bring the discussion of genital autonomy and human rights to visitors of the Victoria Pride Festival.

Kira Antinuk is one of the founders of The Children’s Health & Human Rights Partnership (CHHRP), Canada’s first dedicated not-for-profit partnership of medical, legal, and ethics professionals working alongside concerned citizens towards ending forced non-therapeutic genital cutting of children in Canada.

http://chhrp.org

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Registered nurse Robbie T, RN (Rob Tsvetkov, RN) speaks out against circumcision

While training to be a registered nurse Robbie T, RN (Rob Tsvetkov, RN) witnessed a baby boy’s healthy penis being cut (circumcised). So disgusted by what he saw he has since worked to educate parents on the functions of the foreskin, and the harm of circumcision.

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THE 2012 HELSINKI DECLARATION OF THE RIGHT OF GENITAL AUTONOMY

Nurses for the Rights of the Child endorses the 2012 Helsinki Declaration of the Right of Genital Autonomy:

THE 2012 HELSINKI DECLARATION OF THE RIGHT OF GENITAL AUTONOMY

Whereas it is the fundamental and inherent right of each human being to security of the person without regard to age, sex, gender, ethnicity or religion as articulated in the Universal Declaration of Human Rights, the International Covenant on Civil and Political Rights and the Convention on the Rights of the Child.

Now we declare the existence of a fundamental right of each human being a Right of Genital Autonomy, that is the right to:

* personal control of their own genital and reproductive organs; and
* protection from medically unnecessary genital modification and other irreversible
reproductive interventions.

We declare that consistent with the Right of Genital Autonomy the only person who may consent to medically unnecessary genital modification and other irreversible reproductive interventions is:

* in the case of a person who is competent to give free and informed consent, being fully informed about the nature, the risks and benefits of the intervention – the person undergoing the intervention; and
* in the case of an incompetent person including a young child – only a properly constituted public authority or tribunal appointed to balance the human rights and the best interests of the person after considering the views of family members, professionals and an independent advocate for the person.

We recognise the fundamental right of parents and guardians to freedom of thought, conscience and religion. Those rights of parents and guardians are not absolute, they are limited by the same fundamental human rights of others, in particular their children.

We declare that healthy genital and reproductive organs are natural, normal, functional parts of the human body. Governments and healthcare providers have a duty to educate parents and children about non-invasive hygiene, care of genital and reproductive organs, and to explain their anatomical and physiological development and function.

We encourage and support further research into the adverse consequences of such interventions.

We oppose research and experimentation that involves the performance of medically unnecessary modification and other irreversible medical interventions affecting genital and reproductive organs upon non-consenting children and adults.

We call on all governments to acknowledge the Right of Genital Autonomy for every child and adult, that is the right to:

* personal control of their own genital and reproductive organs; and
* protection from unnecessary genital modification and other irreversible                  reproductive interventions.

We call on all States members to the Convention on the Rights of the Child to honour their commitments under that instrument in particular Articles 2, 12, 14, 19, and 24.

Done at Helsinki, Wednesday 3 October 2012

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Revised male infant circumcision policy: A disservice to Americans

September 22, 2012

Dr. Christopher L. Guest, Co-Founder of the Children’s Health and Human Rights Partnership replies to the American Academy of Pediatrics (AAP) revised statement on male infant circumcision calling itA disservice to Americans”. His reply was published to the AAP’s on-line journal. View journal posting here.

Revised male infant circumcision policy: A disservice to Americans

The American Academy of Pediatrics (AAP) revised statement on male infant circumcision claims “the benefits of circumcision may exceed the risk of complications” but the AAP fails to recognize the sensory and mechanical function of the human foreskin. The foreskin is richly innervated, erogenous tissue which enhances sexual pleasure and it also provides a unique, linear gliding mechanism during sexual intercourse. In 2009, the College of Physicians and Surgeons of British Columbia stated “the foreskin is rich in specialized sensory nerve endings.” In 2010, the Royal Australian College of Physicians stated “the foreskin is a primary sensory part of the penis, containing some of the most sensitive areas of the penis” and in the same year, the Royal Dutch Medical Association concluded “the foreskin is a complex erotogenic structure that plays an important role in the mechanical function of the penis during sexual acts.” The AAP statement fails to consider the obstinate relationship between structure and function as it pertains to the foreskin; circumcision alters the structure of the penis which inevitably alters function. The long term harm and sexual side effects of circumcision have not been adequately studied.

The revised statement also claims “circumcision may decrease the risk of heterosexual HIV transmission” and is supported with selective evidence from randomized control trials from Kenya, Uganda and South Africa. These trials reveal a number of methodological weaknesses and they contradict larger demographic trends in global HIV prevalence. For instance, the United States has a high prevalence of circumcision, yet has a significantly higher rate of HIV infection compared with countries like Sweden and Japan where the prevalence of circumcision is very low. Behavioural factors greatly overshadow any potential protective effect of circumcision and should be the focus of effective and ethical prevention strategies. Even if the African trials were scientifically valid, the evidence can not be applied to justify infant circumcision in North America where the incidence of heterosexual HIV transmission is low.

The revised statement also claims “circumcision may decrease the risk of urinary tract infections” yet the AAP ignores the wealth of international medical evidence to the contrary. Even if circumcision provided complete protection against urinary tract infections, this practice could never be justified based on the ethical principle of proportionality – there are effective and less destructive therapies available for preventing and treating urinary tract infections which do not involve the prophylactic removal of healthy genital tissue.

The AAP’s revised statement ignores the inherent conflict of circumcision with contemporary medical ethics. Infant circumcision violates the fundamental ethical principles of autonomy, beneficence and primum non nocere. Medical associations in the Netherlands, Finland, Sweden, Norway, Denmark, Germany and other countries have stated that there is no justification for performing the procedure without medical urgency. Medical associations in these countries are calling for the practice to stop due to ethical and human rights concerns. The AAP’s new position statement does a disservice to American parents and children.

Respectfully, Christopher L. Guest M.D., F.R.C.P.C.

Conflict of Interest:

None declared

 

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My Letter to the American Academy of Pediatrics

AUGUST 31, 2012

On August 29, Intact America launched an email campaign, inviting our followers to tell the American Academy of Pediatrics what they think about the new Circumcision Task Force’s Technical Report onCircumcision. The Report, which concedes that the purported health benefits of infant circumcision are not great enough to justify recommending it, and that the risks of circumcision have not been adequately documented, somehow concludes that the “benefits” outweigh the risks. The Report also states that the decision to circumcise baby boys, who cannot consent to have this unethical, medically unnecessary surgery performed on their bodies, should be left to the parents, and, that parents’ non-medical decision to have their child’s genitals unjustifiably altered should be abetted by having Medicaid and private insurance companies pay doctors to do the cutting.

Here’s my letter:

Dear AAP Leadership,

What were you thinking?

How can you approve a report that extols the benefits of removing the foreskin, a normal body part, without one single word devoted to the function of that body part, or why it’s there in the first place? How credible is such a report, which neglects to mention that the vast majority of the world’s men are intact (or as the report says, “uncircumcised”), and that these men do just fine?

What were you thinking when you deputized as co-author of the report a doctor who has openly boasted about circumcising his own son? The American Medical Association’s code of ethics (AMA E8.19) states: “Physicians generally should not treat themselves or members of their immediate families” … “In particular, minor children will generally not feel free to refuse care from their parents.” In 2009, the AAP’s own Committee on Bioethics clearly stated that pediatricians who treat their own children “violate a fundamental professional obligation.”* How can we trust the neutrality or the ethics of a Task Force member who so flagrantly violated his own organization’s bioethical principles?

What were you thinking when you named a specialist in adult sexually transmitted diseases to chair a Task Force to examine infant circumcision? Babies and children don’t have sex, and thus they are not at risk of contracting an STD. It seems to me, by selecting this individual as chair, the Task Force already knew what it was looking to conclude.

Would it not have been relevant for the Task Force to mention the limitations of its recommendations? Specifically, even if circumcision were to confer some protection from HIV for adult heterosexual men, as claimed by the studies cited, it was found to confer none for women, or for men having sex with men, or for intravenous drug users. And, again, it confers no protection for babies and children. Furthermore, shouldn’t the Report have mentioned that if or when an adolescent or adult becomes at risk, there are other nonsurgical ways of avoiding sexually transmitted diseases? Shouldn’t the words “safe sex” or “condom” or “abstinence” have appeared at least once in the Report?

Given the Task Force’s unequivocal conclusion that the “health benefits of newborn male circumcision outweigh the risks,” are you not concerned by the Report’s utter failure to address the risks? Specifically, how do you justify the contradictions and doublespeak in the following statements?

The true incidence of complications after newborn circumcision is unknown, in part due to differing definitions of “complication” and differing standards for determining the timing of when a complication has occurred (i.e., early or late). Adding to the confusion is the comingling of “early” complications, such as bleeding or infection, with late complications such as adhesions and meatal stenosis…. (p. 772)

Based on the data reviewed, it is difficult, if not impossible, to adequately assess the total impact of complications, because the data are scant and inconsistent regarding the severity of complications. (p. 775)

The majority of severe or even catastrophic injuries [such as] glans or penile amputation, … methicillin-resistant Staphylococcus aureus infection, urethral cutaneous fistula, glans ischemia, and death are so infrequent as to be reported as case reports (and were therefore excluded from this literature review). (p. 774)

Did you not notice any potential liability problems for the AAP and for pediatricians who circumcise that might arise as a result of the Report? For example, while discussing the Mogen clamp in its review of complications from particular circumcision techniques and tools, the Report says:

There were no specific studies of complications … because complications are rare; thus, one can only rely on available case reports of amputation. (p. 775)

No note is made of the fact that the manufacturer of the Mogen is bankrupt, due to lawsuits resulting from these “rare” complications and amputations, and that any doctor sued for an adverse outcome from a Mogen will be on his own (unless, of course, he can implicate the AAP for failing to inform him of the facts).  Also, the review of techniques and tools neglects to cross-reference a mention elsewhere of “devastating burns” that can occur when electrocautery is used in conjunction with the metal Gomco clamp. Sloppy, at best.

Did anybody think to ask why no data has ever been found in the developed world showing a correlation between circumcision and disease? Since when is sub-Saharan Africa, with high rates of poverty, illiteracy, and disease, the gold-standard comparison population for American pediatrics? Did anybody wonder how it can be that Europe, where very few men have been circumcised, has lower rates of STDs and HIV than the U.S. and better overall health status, along with lower per capita health expenditures?

Has the leadership of the AAP, knowing that a Task Force was preparing recommendations about infant circumcision, noticed that medical associations in European countries are increasingly calling for doctors to refuse to perform this surgery, on the basis that it is risky, medically unnecessary, and a violation of the child’s rights? How can you completely ignore the principles and actions of your learned colleagues in other countries?

Did anybody ask the Task Force to make sure its Report was consistent with other AAP policies, including the statement by the AAP’s own Committee on Bioethics on “Informed Consent, Parental Permission, and Assent in Pediatric Practice”? The policy, still in effect, states in part:

Proxy consent poses serious problems for pediatric health care providers. Such 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… [The] pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent. (p. 315)

In placing the burden of deciding whether to circumcise their sons squarely on the shoulders of parents (who are not medical professionals), is the Task Force Report on Circumcision contradicting this statement on Informed Consent? By referencing religion and culture as valid elements in parental decision-making (p. 759), is the Report attempting to give doctors a free pass? Religion and culture (in the American context) generally lead to circumcisions, but human rights, medical ethics and the mandate to doctors to do no harm clearly lead to leaving a boy intact.

Most important, have you not noticed the growing outcry among parents, complaining that they were duped by doctors into agreeing to allow harmful surgery to be performed on their baby boys? Are you ignoring the growing body of complaints from adult men protesting that they were robbed of an important part of their sexual anatomy, without their consent?

Are any of these considerations not relevant to the pediatrician who would strap down a helpless, screaming baby and cut off part of his penis?

I look forward to your response.

Sincerely,

Georganne Chapin, MPhil, JD
Executive Director
Intact America

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