Nurses Just Say No

April 2005
Nurses Just Say No
By Angela Starks


There is a surgical procedure performed on more than a million newborn baby boys each year in the U.S. that the American Academy of Pediatrics (AAP) considers to be unnecessary. It’s a procedure that lasts about 15 minutes and involves strapping a newborn boy to a restraining board and amputating his foreskin (literally tearing it from the penis, like a fingernail from a finger), usually without anesthesia. This is routine infant male circumcision, and an increasing number of medical staff are objecting to it.

Today, the U.S. is the only country in the world to circumcise the majority of its newborn males (albeit a shrinking majority), mostly under hygienic pretenses, with more than 90 percent being done for non-religious reasons.

The main concern with circumcision is the pain and suffering inflicted on the baby. The AAP recently confirmed: “infants undergoing circumcision suffer severe trauma and pain.” Moreover, virtually all of the medical arguments for it—including improved hygiene—have been hotly debated and largely discredited. The AAP says that the supposed benefits are not sufficient justification for routine circumcision and the American College of Obstetrics and Gynecology has also expressed concerns. Many eminent doctors and scientists go so far as to declare that it should be completely discontinued.

Mary Conant’s Story
In 1986, four nurses at St. Vincent Hospital in Santa Fe, New Mexico, decided not to participate in infant circumcision, but their supervisors said they had no right to refuse. After several years, these nurses determined that they did not need to seek permission to take a moral stance. Ultimately, 20 of their co-workers joined them, declaring themselves “conscientious objectors to circumcision.” As the hospital became increasingly polarized on the issue, the nurses called for professional mediation. As a result, in 1995, a legally binding document was drawn up called the Memo of Understanding for Circumcision Procedure which relieved conscientious objectors from participating in circumcisions. Consequently, the number of doctors performing circumcisions at St. Vincent’s dropped from about 20 to just six. Some stopped performing the procedure altogether, while others left the hospital.

In June 1995, two of the nurses, Mary Conant and Betty Katz Sperlich, announced the formation of Nurses for the Rights of the Child, a nonprofit organization “dedicated to protecting the rights of infants and children to bodily integrity” that seeks to “protect unconsenting infants and children from surgical alterations of their healthy genitals.” They initially formed this group to take their activism outside of the workplace where it was causing so much antagonism. One of their first objectives as an organization was to campaign for the use of anesthesia during circumcision, believing this would open the doors for debate of all issues surrounding circumcision, eventually leading to its abolition. They also provided information to the public as well as medical staff, including information for Jewish parents interested in alternatives to ritual circumcision.

I spoke with Mary Conant about her experiences at St. Vincent. She had difficulty revisiting the issue, which is a testament to the extent of pain and suffering that she witnessed in the babies. When I asked her what she remembers of a typical circumcision procedure she confessed “this stuff is very emotionally draining. I would like to skip over describing what happens during a circumcision, I just can’t go there right now.” In fact, if you ask Mary what caused her to stop participating in circumcision in the first place, she says simply, “the sheer torture of it.” However, it took her a while to process this reaction at the time, to arrive at a firm conclusion, and to develop a strategy to deal with it. She contrasts this to her colleague Betty Katz Sperlich’s reaction, who she says “seemed to have understood instantly with the first circumcision she witnessed that something was horribly wrong.”

When Mary and her colleagues first wanted to take a stand against circumcision, they began to work within the system, doing things “the proper way” she recalls, describing that period of the campaign as the “Good Girl Phase.” They outlined their objections to their supervisor, which included the medical, legal and ethical cases against it. They voiced concerns about losing their nursing licenses by taking part in what they saw as an “indefensible procedure” that could render them vulnerable to lawsuits in the future, when boys might decide to sue their circumcisers. Moreover, they were “appalled by the shoddiness of the informed consent process that parents were provided prior to agreeing to a circumcision,” because possible complications were barely touched upon and the pain was not properly addressed. Still, the nurses were told by the nursing director to just go ahead and keep on assisting. “I don’t think she heard a word we said,” recalls Mary, “so it was back to the drawing board for us.”

At this point the nurses knew they would have to take a firm stance. They would tell their employers that they would not participate in circumcision, rather than simply asking permission not to. They wrote a letter to their immediate supervisor, and when word got out, about half of the staff wanted to sign it as well. Mary was surprised and inspired by this reaction. “This response was totally unsolicited—we had been perfectly willing to take our chances and get fired if that was what had to happen. We quickly realized that there was no way that 25 or so highly skilled and experienced nurses would be fired. That was very empowering. We knew we were on to something big.”

It wasn’t all plain sailing. Some of their colleagues thought that their actions hurt the image of nurses in general. They were also faced with the hierarchical system of the medical establishment. “Doctors are not accustomed to nurses taking ethical positions on issues,” says Mary, “and there was anger and ridicule around that. I believe that our flaunting of the traditional nurse/doctor hierarchy paradigm was as important a factor in this as the issue of circumcision itself. Some of them tried to get us fired.”

Mary says that she was a natural target for dismissal because she was also a union delegate, always standing up for the oppressed or trying to effect change in the hospital. However, it was Betty who came closest to being fired. “It was just because of a facial expression!” says Mary. “She was changing a diaper one day but had not been told that this baby had been circumcised. When she saw the raw, bloody stump, she was taken aback. The mother reported her, saying that Betty’s facial expression had made her feel guilty. The case went through the official grievance procedure, and the hospital eventually backed down because they knew we would go to the press.”

Gaining Ground
Interestingly, it was the debate over whether or not to give babies pain relief for circumcision that at last provided the nurses with a tolerated, official channel for voicing their concerns. Babies are rarely given pain relief for circumcision because of concerns about its safety and effectiveness, but while many activists believe that administering anesthesia might slow the progress towards a total ban on circumcision, the nurses of St. Vincent saw it as progress. Mary explains, “We were able to give a presentation about circumcision to our hospital’s bioethics committee that was ostensibly about anesthesia, but we included all aspects of the argument against circumcision, and this won us an ally or two in the process.” The committee produced a recommendation that anesthesia be used with all circumcisions. Mary sees this as a victory primarily because “we led them to the conclusion that newborns do feel pain—duh!—and that it should be dealt with. In making this case to the bioethics committee, we were able to show them we were thoughtful, conscientious, well-informed professionals. This won us some respect and credibility.”

As Mary points out, there is both a financial and a safety element to the anesthesia debate. She says, “An anesthetist friend of mine says that the only adequate anesthesia for circumcision would be a regional block (epidural or spinal) or a general. Both of these are insanely risky for infants. You’d only use them for a lifesaving procedure. And of course, this would also jack up the cost and time needed to an outrageous level. People would be less willing to pay for circumcisions. For now we have the myth that topical creams, sugar water, Tylenol, and local injections are enough.”

Beyond the initial—and post operative—pain of the procedure, there is also a litany of possible and probable complications which run the gamut, from disfiguring scar tissue to brain damage from systemic infections. While death from excessive bleeding is rare, it does occur, and local infections that lead to urinary complications occur in about half of all circumcised babies.

Even in the absence of obvious side effects from the surgery, the fact remains that boys are having a useful—some would say essential—part of their anatomy removed. The foreskin has a number of functions. It produces cleansing antibodies (contrary to the myth that a foreskin is ‘dirty’); protects the sensitive glans from external abrasion and germs; maintains the glans as an internal sensitive organ thus heightening sexual pleasure; and makes sexual intercourse much smoother because it acts as a gliding sheath over the penis as it moves within the vagina. The foreskin itself is the most sensitive erogenous zone on the male body.

It is understandable, therefore, that many boys arrive at maturity with the realization that their circumcision resulted in a loss of function, as well as learning that it was a painful assault imposed upon them without their consent. Some boys are now suing their circumcisers, which is what Mary says she “predicted and prayed for.” Why is this so important to her? “Because Betty and I have always felt that lawsuits would be the catalyst that does this thing in. And now it’s happening. The obstacles for attorneys and plaintiffs have been tremendous, but the wall is being torn down—brick by brick. You have to always remember we are a circumcising culture. This is as natural to us as breathing oxygen. Deconstructing circumcision to judges and juries is a tedious process, because all of them—all of us—have been complicit in some way. Their minds wander or shut down because it is very unpleasant news. But there have been some lovely victories.”

Examples of victories include the case of William Stowell, who settled with the doctor and the Long Island hospital where he was circumcised at birth. He waited until he was 18 and then sued. “This is a historic case,” says Mary, “because he was the first person we are aware of to sue his circumcisers after he reached the age of maturity. There are other young men who are planning to do the same.” Boys in other countries are suing too, such as Shane Peterson in Australia, who was awarded $360,000 for a circumcision that was botched.

The lawsuits are certainly encouragement to activists who believe that circumcision should be completely banned, although Mary thinks that other forces will conspire to end circumcision before it is made illegal. She says “I hope hospitals will see the wisdom in ceasing to offer genital mutilation services after a few lawsuits occur, after reimbursement dries up, and when the public figures out this is not a good thing to do to a baby.”

What about circumcisions that are performed for religious reasons, whether in a hospital setting or not? This can be a sensitive issue, yet many nurses who have joined Nurses for the Rights of the Child are themselves Jewish. This gives Mary hope that one day all circumcisions—religious as well as so-called medical ones—may come to be seen as unnecessary and cruel. In the meantime, she expects to encounter some hostility from religious communities. She tells me that her colleague Betty, who is Jewish, has been accused of anti-Semitism even by non-Jews.

It’s easy to see why the battle against infant male circumcision can sometimes feel like an uphill struggle. Mary acknowledges that “the deconstruction of cultural ‘givens’ on circumcision is slow and requires great patience and an ability to constantly examine, reflect, and reinvent.” She continues to educate others about the issue, but is somewhat relieved to no longer be working in obstetrics. She is now a hospice nurse, working with dying patients and their families, and while this can have its emotional challenges as well, she is happier that she is removed from what she calls “the trenches” and “having my everyday reality consumed with newborn infants, circumcisers, and parents who are condemning their beautiful babies to the knife. I was reliving it at night, worrying about what I did or did not do. I am no longer only a few feet away from the bloodcurdling screams.”

Mary Conant’s experience enables her to offer support to other nurses who are suffering in their roles as circumcision assistants. “At Nurses for the Rights of the Child, we suggest strategies and offer advice. I think I have scared a lot of nurses away, because I always encourage them to do a lot of soul searching about what they are trying to accomplish and try to impress upon them the potential for repercussions in the workplace. I don’t want to be responsible for someone cavalierly getting into a volatile situation without a clear-eyed notion of what might happen. We were willing to accept the prospect of getting fired. Other nurses must be willing to do the same. But they can also learn from our mistakes and some reactions that took us by surprise can now be anticipated.”

Mary called me several days after our interview with something she wanted to add. She said “I’ve just visited the web site of your magazine and it made me so happy to see that we are on the same path. There is such a connection between all the issues that relate to human rights and global justice, including animal rights. And you know, healing the earth has to include compassion for the individuals who populate it. It was my circumcision activism that led me to become a vegan. I saw that cruelty to animals, like cruelty to babies, is an abuse of power.” To quote a phrase that is familiar to Satya readers, she describes this as “connecting the dots.”