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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Children’s Health & Human Rights Partnership condemns new AAP policy statement

Posted on August 27, 2012 by admin

27 August 2012 – For immediate release
Contact: Christopher Guest, M.D.
info@chhrp.org

AAP CIRCUMCISION POLICY ‘SERIOUSLY FLAWED’, CONDEMNED BY CANADIAN CHILDREN’S RIGHTS GROUP

CHHRP co-founder Christopher Guest, M.D. said the new policy makes claims that international paediatric associations reject and he encouraged the Canadian Paediatric Society (CPS) to maintain its policy of deterrence with regard to circumcising otherwise normal, healthy boys.

Citing a continued failure of the AAP to recognize the unique sensory functions of the male foreskin, Guest asserted that “A growing number of medical associations now recognize that an intact penis with a foreskin enhances sexual pleasure for the male and his partner.” According to Guest, in 2010 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.”

“Circumcision alters the structure of the penis, which inevitably alters function. Long term harm to men from infant circumcision has never been studied” Guest said. He referred to a growing body of anecdotal evidence collected by the Canadian-based Global Survey of Circumcision Harm. Guest said that in the past 12 months over 900 men have answered the online survey to document their harm.

Guest also faults the AAP for relying on methodologically weak African trials claiming HIV is lower in circumcised men. He says the studies also contradict global HIV trends, citing the United States, with a high circumcision rate, yet a significantly higher rate of HIV infection than Sweden and Japan where circumcision is rare. “Even if the African trials are scientifically valid, they cannot be used to justify infant circumcision in North America where the incidence of heterosexual HIV transmission is low.”

Guest cautioned that infant circumcision could never be justified based on the ethical principle of proportionality, because there are more effective and less destructive methods to improve hygiene and prevent or treat disease that don’t involve removing healthy genital tissue. “Soap and water and safer sex practices, including condoms, can prevent disease. New vaccines against penile and cervical cancer can prevent human papillomavirus (HPV) infection.”

Guest harshly criticized the AAP’s failure to note the conflict between contemporary medical ethics and infant circumcision, which he says violates the fundamental ethical principles of autonomy, beneficence and primum non nocere (First, Do No Harm). According to Guest “Medical associations in the Netherlands, Finland, Sweden, Norway, Denmark, Germany and other countries confirm there’s no justification for circumcising infants in the absence of medical urgency. Those medical associations are urging an end to the practice due to ethical and human rights concerns.”

He notes that the College of Physicians and Surgeons of British Columbia stated in 2009 that “…routine removal of normal tissue in a healthy infant, is not recommended…[P]roxy consent by parents is now being questioned. …Under the Canadian Charter of Rights and Freedoms and the United Nations Universal Declaration of Human Rights, an infant has rights that include security of person, life, freedom and bodily integrity. Routine male circumcision is an unnecessary and irreversible procedure. Therefore many consider it to be ‘unwarranted mutilating surgery’.”

According to Guest, the AAP has exercised poor judgment in the past. In 1989, the AAP Task Force on Circumcision declared circumcision was “necessary”, but in 1999 reversed its position to declare “There is no valid medical indication for circumcision.” In 2010, the AAP released a statement defending female genital nicking for cultural reasons, only to retract it under pressure from children’s rights groups opposed to circumcision of girls and boys.

“Preservation of bodily integrity is a basic and universal human right that the AAP doesn’t seem to value when it comes to male children” he said. “In spite of the new U.S. policy, we Canadians, as well as our institutions and government, have an obligation to preserve that right for all of our citizens, regardless of gender or age.”

The Children’s Health & Human Rights Partnership was established in 2012 as a partnership of professionals in the fields of medicine, ethics and law, and concerned citizens, to further public education and social advocacy to end non-therapeutic genital surgery on Canadian children.


 

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Intact America Condemns Anticipated Circumcision Statement from American Academy of Pediatrics

Group opposed to the non-therapeutic genital cutting of all children calls AAP “Shockingly biased and out of touch with medical ethics and children’s rights.”

“It is clear that the AAP is blind to the mounting worldwide movement against the genital cutting of boys.”

Tarrytown, NY (PRWEB) August 22, 2012

Intact America, an organization founded in 2008 to ensure that all children are protected from permanent bodily alteration inflicted on them without their consent, is criticizing the anticipated August 27 release by the American Academy of Pediatrics (AAP) of its new “Circumcision Policy Statement.” Based on comments to the press made by members of the AAP’s Task Force on Circumcision, which authored the document, Intact America deplores the Statement’s focus on selective evidence supporting medical benefits of removing normal foreskins from baby boys.

Georganne Chapin, Executive Director of Intact America, stated today, “From the AAP Circumcision Task Force’s pre-publication comments, it is clear that the group has chosen to feature only literature (almost exclusively focused on adult men in Africa) that supports its predisposition toward circumcising boys; the Task Force has failed to consider the large body of evidence from the developed world that shows no medical benefits for the practice, and has given short shrift, if not dismissed out of hand, the serious ethical problems inherent in doctors removing healthy body parts from children who cannot consent.”

In 2010, Intact America responded similarly when the AAP issued a new Policy Statement on Ritual Genital Cutting of Female Minors; this statement called for doctors to be allowed to inflict a “ritual nick” on infant girls’ genitalia for “cultural” reasons, in contravention of Federal law prohibiting any such cutting. The AAP’s policy statement also acknowledged that, “Some forms of FGC [performed in African cultures] are less extensive than the newborn male circumcision commonly performed in the West.” Pressure from Intact America and other groups opposing Female Genital Mutilation resulted in the quick retraction of the AAP’s call for tolerance of and doctors’ participation in the ritual cutting of baby girls, and in the issuance of a revised policy condemning “all types of female genital cutting that pose risks of physical or psychological harm.”

Intact America maintains that any alteration or cutting performed on the normal, healthy genitalia of minors is an unethical act that ignores the well-established right of all individuals to bodily integrity.

“It is clear,” said Ms. Chapin, “that the AAP is blind to the mounting worldwide movement against the genital cutting of boys. This American physician organization is disregarding the risks and harms of the procedure. It also is ignoring the fact that circumcision is rare in Europe, with no negative health consequences, and that European politicians and physician groups – in increasing numbers – are calling for doctors to refuse to perform the procedure, on the basis that it is harmful and violates children’s rights and bodies. In its selective blindness, the AAP has failed to put the well-being of the infants and children it is supposed to protect ahead of that organization’s cultural bias and interest in perpetrating a medically unnecessary, harmful, and unethical practice.”

Intact America was formed in 2008 to change the way America thinks about neonatal male circumcision. Intact America believes that painful and medically unnecessary surgery to remove healthy genital tissue from non-consenting baby boys violates medical ethics and human rights.

http://www.prweb.com/releases/2012/8/prweb9826314.htm

 

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Attorneys for the Rights of the Child Condemns American Academy of Pediatrics for Hiding the Truth, Putting Doctors Ahead of Patients in its Circumcision Statement

The human rights group Attorneys for the Rights of the Child has condemned the American Academy of Pediatrics for its upcoming circumcision policy statement, which ignores and minimizes the truth about male circumcision and places doctors’ interests ahead of patients’ needs.

“The AAP has no business promoting a harmful and discredited cultural relic masquerading as a medical procedure.”

Berkeley, CA (PRWEB) August 22, 2012

The human rights group Attorneys for the Rights of the Child (ARC) (http://www.arclaw.org) has condemned the American Academy of Pediatrics (AAP) for its upcoming “Circumcision Policy Statement,” due out on August 27, 2012, which ignores and minimizes the truth about male circumcision and places doctors’ interests ahead of patients’ needs. J. Steven Svoboda, ARC’s Executive Director, commented today, “Based on comments that have appeared in the media attributed to members of the task force preparing the statement, the AAP appears to endorse a disproven procedure that violates the infant patient’s rights and removes functional tissue without providing any proven benefit.”

The AAP position statement ignores the wealth of medical evidence that shows that painfully amputating functional tissue from newborns is a dangerous and outmoded practice.

Not a single study has ever proven that circumcision has actually decreased any disease in the United States. Svoboda observed, “Rather than objectively evaluating all available evidence, the AAP selectively quotes and references highly contested and controversial studies to attempt to justify an entrenched yet outmoded cultural—not medical—practice. Over a hundred boys die each year from this needless procedure, yet the AAP quotes an absurdly low overall complication rate overall and fails to mention the deaths stemming from the practice.”

The AAP released a policy statement in Pediatrics in 2010 defending certain forms of female circumcision if performed for “cultural” reasons. Physicians who had followed the AAP’s suggestion at that time would have thereby violated federal law protecting females from such procedures. After ARC and other organizations opposing genital cutting pointed out the errors, the AAP quickly retracted its statement and replaced it with anew statement calling for the elimination of all forms of female genital cutting. Svoboda commented, “Boys deserve no less protection from the AAP than girls received. If circumcision is so great, why have no European countries adopted it, and why do their males enjoy better average health than Americans?”

The AAP statement demonstrates its ignorance of the fact that European men don’t circumcise and yet enjoy better health outcomes including the areas the statement cites as improved after circumcision. Moreover, medical organizations and politicians in Finland, Sweden, Norway, the Netherlands, Germany, Switzerland, Austria, and other countries are calling for the practice to stop. Even in the US, the American Medical Association (AMA) agrees that there is insufficient justification for performing the procedure on newborns absent specific medical indications.

Svoboda noted that studies of adult males in Africa have numerous methodological flaws and that even if valid, given vast differences in health conditions and modes of transmission between the US and Africa, the results can hardly be applied to justify infant male circumcision in the United States. “Babies don’t get HIV and AIDS from sexual contact,” Svoboda added.

“Male circumcision,” Svoboda said, “is a disfigurement that carries risks without providing benefits. It violates a child’s right to bodily integrity, not to mention numerous civil and criminal laws.” Malpractice awards are mounting up including a recent $700,000 settlement reported in the Massachusetts Lawyers Weekly. Svoboda noted, “Although the AAP’s statement regarding male circumcision is presumably influenced by its desire to protect its members who perform the outmoded procedure, the AAP has no business promoting a harmful and discredited cultural relic masquerading as a medical procedure. In these days of rising medical costs and scarce resources, we simply cannot afford to continue to carry out such a harmful and outmoded practice.”

Americans are getting the message, as according to the Centers for Disease Control and Prevention (CDC), rates have dropped substantially in recent years.

Attorneys for the Rights of the Child is a non-profit organization founded in 1997 to protect children from unnecessary medical procedures to which they do not consent.

http://www.prweb.com/releases/2012/8/prweb9828887.htm

 

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“AAP’s circumcision policy fails to show benefits” – doctors

FOR IMMEDIATE RELEASE

“AAP’s circumcision policy fails to show benefits” – doctors

The American Academy of Pediatrics’ new policy on infant circumcision fails to show that benefits exceed the risks, a doctors’ group claims.

Doctors Opposing Circumcision (DOC), an international organization based in Seattle, says the policy, to be made public August 27, makes a poor case for the procedure, which has been declining in the USA. A little over half of all boy babies are circumcised in hospitals –as few as 20% in western states like California, Oregon, and Washington.

John Geisheker, Executive Director of DOC, asks, “Why is the AAP championing this unnecessary surgery during a crisis of necessary care for our children?”

Geisheker notes that all other English-speaking countries have nearly abandoned circumcision as unnecessary. In England and New Zealand, Geisheker notes, the circumcision rates have been effectively zero for decades, “with no detectable loss in child health.”

Regarding the AAP claim that circumcision is an HIV preventative, Geisheker adds, “Children do not spread sexually transmitted diseases. Non-circumcising countries have lower rates of sexually transmitted diseases like HIV than the U.S. We have so many other health needs for children which are more critical. Circumcision is a huge waste of medical resources which could be better employed elsewhere. Using public funds for circumcision would be utterly wasteful.”

The new AAP policy leaves the decision to parents, but urges parents to choose to have their son’s foreskin amputated, and encourages the public to pay for it. Dr. George Denniston, President of DOC, says this does the boys, and the men they grow up to be, a disservice.

“We simply do not know the long-term effects of circumcision on males,” says Dr. Denniston. “This lucrative practice is completely unregulated. The only studies have been of immediate post-birth discharge where the hospital has legal motives to be optimistic. In outpatient settings we do not even know that much. In any case, the unavoidable complications of the procedure far outweigh any prophylaxis. For instance, the epidemic rise of ‘super bugs’ like MRSA in hospital nurseries makes cutting healthy children unwise.”

Denniston says the AAP has failed to consider the protective and sexual benefits of keeping the foreskin, or the long-term risks and harm of having it removed. He adds, “they contradict their own bioethics policy statement warning that parental wishes are not sufficient to justify unnecessary surgery.”

The AAP’s policy has shifted towards circumcision as a result of studies of adult volunteers for circumcision in Africa. But Denniston says these have no bearing on the health status of baby boys in the U.S. “These are the same people who recommended genital cutting of African-American immigrant girls in both 1996 and 2010, and were forced to back down.”

“The U.S. is the only country where an unnecessary surgery is imposed on boys, but the actual medical care they need is often unavailable.”

“We need to remember that the AAP is a lobbying organization whose purpose is to protect the interests of its members. If the AAP were a judge in our judicial system, it would be obliged to recuse itself since it has a huge vested interest in the procedure. At the moment, the AAP is the only medical organization in the world to recommend infant circumcision.”

Adds Denniston, “The AAP has now gone on record supporting one of the largest scams in American medical history – the introduction of circumcision allegedly to prevent sexually transmitted diseases. Everyone knows that America has the highest rate of circumcision and the highest rate of STD’s in the industrialized world. How could circumcision possibly be thought to prevent STD’S in the U.S. in 2012?”

The physicians’ public statement on the new AAP guidelines may be seen at:

http://www.doctorsopposingcircumcision.org/pdf/2012-08-22_PublicNotice.pdf

For attribution:

John V. Geisheker, J.D., LL.M.
Executive Director, General Counsel,
Doctors Opposing Circumcision
DoctorsOpposingCircumcision.org
2040 Westlake Ave. N., Suite #420 Seattle, WA 98109
tel +1. 206. 465. 6636

Dr. George C Denniston, M.D, M.P.H.
(Telephone # on request to John V. Geisheker, above)

 

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Doctors Opposing Circumcision reaffirms its Genital Integrity Policy

Public Notice

AAP Announces Intent to Release its Sixth Major Circumcision Policy

Doctors Opposing Circumcision reaffirms its Genital Integrity Policy

The American Academy of Pediatrics (AAP) revealed that it intends to publish its sixth major circumcision policy on Monday, August 27, 2012 and in the September 2012 issue of Pediatrics, its house journal. This will be its sixth position statement on male circumcision, as it has previously published position statements in 1971, 1975, 1983, 1989, and 1999.

The new AAP policy has been five years in the making. The intent to publish a new statement was announced in 2007, however internal disagreement on its content has prevented publication. The new statement likely will be a compromise between positions.

The AAP, despite its high-sounding academic name, actually is a trade association of pediatric doctors. Its primary duty is to advance the business and professional interests of its 60,000 members who are called “fellows”. The interests of its child-patients are a distant second to their primary interest.

There is a severe and intractable conflict of interest between the financial interests of its fellows and the best interests of the child-patient. Most of its fellows perform non- therapeutic circumcisions on children and profit thereby. These members do not want anything to interfere or disrupt their steady income stream. The AAP will not publish a statement that would harm that income stream. The AAP ensures the outcome of its circumcision statements by appointing doctors who are known to have a pro-circumcision position. The current task force, like previous task forces on circumcision, is stuffed with pro-circumcision doctors, including its chairwoman. Obstetricians and family doctors also profit by doing unnecessary circumcisions. The presence on the task force of a representative from the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Family Doctors (AAFP), as well as Dr. Stephen Wegner, MD, JD, representing the AAP Health Care Financing Committee, highlight the business and financial nature of the forthcoming circumcision policy statement. We anticipate a very self-serving statement that protects doctors’ incomes.

Previous AAP circumcision statements have exaggerated the alleged, but unproved prophylactic benefits of non-therapeutic circumcision while minimizing the risks, complications, drawbacks, permanent irreversible physical, sexual, and emotional injury of male circumcision. We expect that this one will use prevention of HIV sexual transmission as a reason to circumcise boys, even though the African studies that indicate circumcision prevents HIV infection in adult males have been shown to be trash and,1 2 in any event, not applicable to infant boys in North America.

In recent years, 46 percent of boys born in the United States have left the birth facility with intact foreskins. There is not a shred of evidence that these boys are less healthy than the 54 percent of boys who were circumcised.

Doctors who perform circumcisions have had their income stream curtailed by the decision of eighteen state Medicaid agencies to terminate payments for medically unnecessary non-therapeutic circumcision of children. The AAP is expected to call for restoration of those taxpayer-funded Government payments to doctors, so as to restore the income of their fellows.

The AAP, thus far, has consistently refused to recognize that children are human beings, who have legal rights to bodily integrity and the security of their person under both American law and international human rights law, which are trampled by the unnecessary amputation of the functional body part called the foreskin. The AAP has consistently misapplied legal rules regarding surrogate consent for therapeutic operations on children to non-therapeutic circumcision. By so doing, it has tried to protect the alleged parental right to cut body parts from boys at will for religious/cultural reasons or no reason at all.

As noted above, the AAP is simply a trade association, which advances the perceived interests of its fellows. Its position statements are not legal or medical imperatives and do not have the force of law or public policy. This statement on circumcision is going to be all about money, not about child health or welfare.

The Royal Dutch Medical Association has called male circumcision a human rights violation and an unethical practice. The AAP’s forthcoming pro-circumcision policy is not supported by foreign medical associations.

A court in Cologne, Germany says parents may not grant consent for unnecessary circumcision. We will see shortly whether the AAP will reform its abusive practices. We are not hopeful.

Doctors Opposing Circumcision believes that circumcision of children violates numerous legal rights of the child and is highly unethical, if not unlawful. We believe that genital integrity provides the highest level of health and well- being for the child. We do not know what the AAP is going to say in their new statement, but we are circumcision experts and we are convinced that non-circumcision is best for children. We reaffirm ourGenital Integrity Policy Statement of 2008, which advocates genital integrity for boys.

We urge parents to ignore this latest statement from the AAP and to continue to protect their sons’ whole and complete bodies.

George C. Denniston, MD, MPH                    John V. Geisheker, JD, LLM
President                                                            Executive Director & General Counsel

Wednesday, August 22, 2012.

1 Van Howe, Storms MS. How the circumcision solution in Africa will increase HIV infections. Journal of Public Health in Africa 2011; 2:e4 doi:10.4081/jphia.2011.e4.
2 Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. J Law Med (Melbourne) 2011;19:316-34.

http://www.doctorsopposingcircumcision.org

 

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Amnesty International: Nurses and Human Rights

AI Index: ACT 75/02/97. June 1997

Amnesty International USA 322 Eighth Avenue, New York, NY 10001 $4.00

“Nursing shares with other health professions a commitment to the well-being of the patient and to a professional practice based on codes of ethics. Over the past two decades, national and and international nurses associations have refined their principles to reflect an increasing commitment to human rights and the protection of the patient. However, because of their frontline work…there are persistent risks of nurses being victimised as a result of their witnessing abuses …On the other hand they may risk being pressured to collaborate in, or remain silent about, abuses occurring in their presence or with their knowledge.”

The Nurse’s role in Safeguarding Human Rights…”nurses have individual responsibility but they can often be more effective if they approach human rights issues as a group”.

The Nurse’s Role in the Care of Detainees and Prisoners, first adopted in 1975, reaffirms ICN support for the Geneva Conventions endorses the Universal Declaration of Human Rights..”nurses having knowledge of physical or mental ill-treatment of detainees and prisoners must take appropriate action including reporting the matter to appropriate national and/or international bodies”.

Nurses and Torture. “This statement, adopted in 1989, notes that nurses may be called on to carry out a number of functions which assist torturers. It …prohibits the nurse from assisting in any way in torture and urges national nurses associations to provide a mechanism to support nurses in difficult situations.”

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