Circumcision

[Amulek]

45 minutes ago, Scott Lloyd said:

I understand your argument quite well. I’m saying you’re in effect comparing intact earlobes to a birth defect, which I find to be a dumb comparison.  

And I understand why you would want to be dismissive. Because once you admit that you are okay with painful, elective body modification in some cases but not in others, it's then up to you to distinguish between them.

 

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Are you going to condone facial plastic surgery on your infant daughter because her nose is too big to suit you?

I would be fine with my daughter having a rhinoplasty if I thought she really needed it - though I wouldn't have the surgery performed as an infant. I would wait until she was at least 14 or so, when her nose is mostly formed. 

But the question isn't about whether I would be okay with some procedure or another - it's whether I should be able to make these kinds of decisions in the first place. 

And in my view, the answer to that question is, in almost all circumstances, a resounding yes.

If you want to use the power of government to override my decisions as a parent about what is in the best interest of my child, you better have a really compelling reason for doing so.

If you don't want to have your children circumcised...don't have them circumcised! Problem solved. 

If you don't want to have my children circumcised...well, thanks for your concern, but it's really none of your business.

 

[california boy]

4 hours ago, Storm Rider said:

CB, no. I act as if it does not really matter. I accept that it may have a function. However, I also accept that its absence does not reduce the efficacy and functioning of the organ itself. I just don't feel strongly about it either way. On this issue, I have more of a live and let live position. I am glad for those that are proud to be uncircumcised as I am for those that are circumcised. I remain ambivalent. 

I have pretty much the same live and let live attitude towards what other people do and how they want to live their lives.  I also don't have any issue with someone who wants to be circumcised.  But the problem with this issue is the only person who is being affected by that decision does not get a say in it.  He has to live with a decision he did not make just because his parents had this idea the circumcision should be performed on him.  I have run into many guys that were cut at birth and profoundly regret that their parents took it upon themselves to make that decision for them.  Does that seem fair to you?

[california boy]

2 hours ago, Amulek said:

And I understand why you would want to be dismissive. Because once you admit that you are okay with painful, elective body modification in some cases but not in others, it's then up to you to distinguish between them.

 

I would be fine with my daughter having a rhinoplasty if I thought she really needed it - though I wouldn't have the surgery performed as an infant. I would wait until she was at least 14 or so, when her nose is mostly formed. 

But the question isn't about whether I would be okay with some procedure or another - it's whether I should be able to make these kinds of decisions in the first place. 

And in my view, the answer to that question is, in almost all circumstances, a resounding yes.

If you want to use the power of government to override my decisions as a parent about what is in the best interest of my child, you better have a really compelling reason for doing so.

If you don't want to have your children circumcised...don't have them circumcised! Problem solved. 

If you don't want to have my children circumcised...well, thanks for your concern, but it's really none of your business.

 

The really compelling reason is that it is not your decision to make.  It is your sons.  Parents should not be deciding cosmetic surgery on their children without their consent.  Does a parent have the right to demand breast implants on their child without the child's consent even if the parent thinks it is in the best interest of the child?  What if I think my child should have extremely small feet.  Do I as a parent have the right to bind my child's feet at birth?  What if my child wants normal feet?  Do they not get a say in that?  

I am absolutely fine with a person deciding that they want to be circumcised.  I am fine with someone wanting breast implants.  I am fine with any cosmetic surgery.  But it is THEIR decision not their parents.  

[Storm Rider]

2 hours ago, california boy said:

I have pretty much the same live and let live attitude towards what other people do and how they want to live their lives.  I also don't have any issue with someone who wants to be circumcised.  But the problem with this issue is the only person who is being affected by that decision does not get a say in it.  He has to live with a decision he did not make just because his parents had this idea the circumcision should be performed on him.  I have run into many guys that were cut at birth and profoundly regret that their parents took it upon themselves to make that decision for them.  Does that seem fair to you?

This seems to be a point - the fact parents make a choice on behalf of their son - to be harped on as if it has meaning. I don't know a child alive - as in since the beginning of time - that has had parents make decisions on their behalf. The fact that it is harped on does not make it valid; it just means it is harped on. I find it a completely ineffective point.

[bluebell]

2 hours ago, california boy said:

I am absolutely fine with a person deciding that they want to be circumcised.  I am fine with someone wanting breast implants.  I am fine with any cosmetic surgery.  But it is THEIR decision not their parents.  

Part of the problem is that a lot of people don’t agree that circumcision is cosmetic. I have three sons who are circumcised and none of them went through the procedure because I or their father cared what their penises looked like. 

[3DOP]

2 hours ago, Storm Rider said:

This seems to be a point - the fact parents make a choice on behalf of their son - to be harped on as if it has meaning. I don't know a child alive - as in since the beginning of time - that has had parents make decisions on their behalf. The fact that it is harped on does not make it valid; it just means it is harped on. I find it a completely ineffective point.

Hi Storm Rider.

By the way, you meant to say that you don't know a child alive..."that hasn't had parents make decisions on their behalf." Who should make the decision to do countless things for a child until it is competent to make its own decisions? Parents can make bad decisions. But societies have naturally acknowledged parents are the most likely of all qualified candidates to make decisions for children. Why? Because even some of the worst people want their own children cared for. Very few parents deliberately make decisions for their children that they think will be harmful. Whatever their race or religion, nation or tribe, parents ordinarily try to help their children and that is why I will always fight for the rights of parents to make harmful decisions for their children. This is also a principle which informs Catholics that even though a child in their temporary custody might seem to benefit, if they should be secretly baptized, that it is forbidden without parental consent. 

No parent is perfect. But unless I thought they did it because they hated me, I could never begrudge them for any of the mistakes mine might have made, including decisions about my male anatomy.        

Edited January 12, 2019 by 3DOP

[Scott Lloyd]

5 hours ago, bluebell said:

Part of the problem is that a lot of people don’t agree that circumcision is cosmetic. I have three sons who are circumcised and none of them went through the procedure because I or their father cared what their penises looked like. 

There have been a lot of misguided reasons over the years for favoring circumcision. Cosmetic preference is not the only one. 

[Scott Lloyd]

On 1/12/2019 at 8:25 AM, Amulek said:

And I understand why you would want to be dismissive. Because once you admit that you are okay with painful, elective body modification in some cases but not in others, it's then up to you to distinguish between them.

 

 

It's the difference between correcting a birth defect (as per your example) and ordering elective cosmetic surgery (pierced ears) on a helpless infant to gratify a fashion preference.  I'm amazed that you don't see the obvious difference.

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I would be fine with my daughter having a rhinoplasty if I thought she really needed it - though I wouldn't have the surgery performed as an infant. I would wait until she was at least 14 or so, when her nose is mostly formed. 

But the question was not about waiting until she was 14 and capable of giving informed consent. The question was about doing it in her I infancy, a time when she would be incapable of giving such consent.

 

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But the question isn't about whether I would be okay with some procedure or another - it's whether I should be able to make these kinds of decisions in the first place. 

And in my view, the answer to that question is, in almost all circumstances, a resounding yes.

 

 

 

Again, in cases of elective cosmetic surgery and the absence of informed consent, I find that ethically problematic.

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If you want to use the power of government to override my decisions as a parent about what is in the best interest of my child, you better have a really compelling reason for doing so.

Who said anything about using "the power of government"? Not I. If you're going to argue with me, please make it about something I said, not what I didn't say.

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If you don't want to have your children circumcised...don't have them circumcised! Problem solved. 

If you don't want to have my children circumcised...well, thanks for your concern, but it's really none of your business.

 

In the abstract, grappling with issues of ethics -- especially medical ethics -- is everybody's business.

Edited August 15, 2019 by Scott Lloyd

[bluebell]

12 hours ago, Scott Lloyd said:

There have been a lot of misguided reasons over the years for favoring circumcision. Cosmetic preference is not the only one. 

And I believe some misguided reasons for disregarding it.  

[california boy]

2 hours ago, bluebell said:

And I believe some misguided reasons for disregarding it.  

What do  you think the most misguided reason for not circumcising a baby is?

[bluebell]

3 hours ago, california boy said:

What do  you think the most misguided reason for not circumcising a baby is?

I don't know that I want to say because what i think about other people's decision to circumcise or not is irrelevant to anyone but me.

[Tacenda]

4 hours ago, california boy said:

What do  you think the most misguided reason for not circumcising a baby is?

I'm not bluebell, but I think the cleanliness aspect might be on people's minds. ETA: oops, I thought it was "circumcising". I guess a misguided reason for not circumcising, might would be a big ? mark for me.

I discussed with my daughter the other day how glad I was that she didn't have her son's circumcised. She told me it was because they didn't have insurance. And if they had insurance, she probably would have. But now with what she knows, she wouldn't. So it all worked out in the end.

Edited January 13, 2019 by Tacenda

[pogi]

On 1/11/2019 at 3:42 PM, Amulek said:

I don't believe so. The ethical grounds you provided for opposing circumcision (and ear piercings) what that, "for purely cosmetic reasons, it amounts to the infliction of pain,  discomfort and bodily alteration on one incapable of giving informed consent."

So, I'm questioning how do those ethics hold up in other situations. 

When a child, like my friend's daughter, is born with an additional joint on her pinkie finger, is it ethical to remove the extra digit? According to your statement above, my understanding is that your answer would be no. There is no medical reason why the extra digit needs to be removed; it's purely a cosmetic procedure - one which clearly involves the infliction of pain, discomfort, and bodily alteration on one who is incapable of giving informed consent, so parents should not be allowed to have that surgery performed. Right? She must wait until she is 18 and can consent to the procedure herself. If not, why not?

 

Hi Amulek,  I would say that the ethics and moral obligation that we hold as a society to "reduce unnecessary pain and suffering" is unquestionable.  The only time it can be justified ethically is when the benefits outweigh any associated pain.  I would also state that permanent bodily alteration on one incapable of giving informed consent would need to be justified on the basis of 1) medical necessity or at least highly beneficial for the patient, and 2) is reasonably assumed that the patient would consent if they could make the decision for themselves.  These ethics are well outlined in the medical literature.  So, I would argue that yes, these ethics do hold up under peer review and generally accepted ethical practice.  In terms of informed consent, most states adopt what is called "reasonable patient standard".

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Reasonable patient standard: what would the average patient need to know in order to be an informed participant in the decision? This standard focuses on considering what a typical patient would need to know in order to understand the decision at hand.

In regards to polydacty, there are justifiable reasons why surgery would be ethically acceptable.  For one, it is not purely a cosmetic surgery and there are absolutely medical reason to remove the extra digit.  These digits often get caught on clothing and are easily irritated, injured, and many times they are actual torn off accidentally.  It also can inhibit regular use of the hands in some situations.  It becomes impractical in many situations where gloves might be required.  Winter gloves, gardening and work gloves, medical and food handling gloves, dish cleaning gloves etc. etc.  It can severely inhibit a person from performing everyday tasks.  But also, it is a congenital deformity - it is reasonable to assume that the child would consent if they were able to, as it is reasonable to assume that most adults would undergo surgery to correct the limiting deformity.   It is also a procedure where parents are able to obtain informed consent.  So, it is reasonable to state that surgery for polydatcy could be perceived as highly beneficial for the well-being of the patient, and is ethical

When it comes to circumcision on the other hand, informed consent under reasonable patient standard is not happening - for reasons I have already gone over.   That in and of itself makes it a medically unethical practice.  The only thing that is obtained in regards to circumcision is consent - the "informed" part seems to be neglected.  Now, we have to ask ourselves if it is medically necessary or at least beneficial enough to where the associated pain and risks are justifiable.  We also have to suggest that it is reasonable that the child would consent for themselves if they could (more unlikely than likely).  The only reason circumcision continues to be popularly practiced outside of religious reasons is because we perform it on babies who are unable to consent instead of adult men. 

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The ultimate popularity of circumcision depended not on convincing normal men to undergo the ordeal of surgery, but on targeting a group of patients who could not object. 
—David Gollaher 

 

Edited January 14, 2019 by pogi

[Tacenda]

2 hours ago, pogi said:

Hi Amulek,  I would say that the ethics and moral obligation that we hold as a society to "reduce unnecessary pain and discomfort" is unquestionable.  The only time it can be justified ethically is when the benefits outweigh any associated pain.  I would also state that permanent bodily alteration on one incapable of giving informed consent would need to be justified on the basis of 1) medical necessity or at least highly beneficial for the patient, and 2) is reasonably assumed that the patient would consent if they could make the decision for themselves.  These ethics are well outlined in the medical literature.  So, I would argue that yes, these ethics do hold up under peer review and generally accepted ethical practice.  In terms of informed consent, most states adopt what is called "reasonable patient standard".

In regards to polydacty, there are justifiable reasons why surgery would be ethically acceptable.  For one, it is not purely a cosmetic surgery and there are absolutely medical reason to remove the extra digit.  These digits often get caught on clothing and are easily irritated, injured, and many times they are actual torn off accidentally.  It also can inhibit regular use of the hands in some situations.  It becomes impractical in many situations where gloves might be required.  Winter gloves, gardening and work gloves, medical and food handling gloves, dish cleaning gloves etc. etc.  It can severely inhibit a person from performing everyday tasks.  But also, it is a congenital deformity - it is reasonable to assume that the child would consent if they were able to, as it is reasonable to assume that most adults would undergo surgery to correct the limiting deformity.   It is also a procedure where parents are able to obtain informed consent.  So, it is reasonable to state that surgery for polydatcy could be perceived as highly beneficial for the well-being of the patient, and is ethical

When it comes to circumcision on the other hand, informed consent under reasonable patient standard is not happening - for reasons I have already gone over.   That in and of itself makes it a medically unethical practice.  The only thing that is obtained in regards to circumcision is consent - the "informed" part seems to be neglected.  Now, we have to ask ourselves if it is medically necessary or at least beneficial enough to where the associated pain and risks are justifiable.  We also have to suggest that it is reasonable that the child would consent for themselves if they could (more unlikely than likely).  The only reason circumcision continues to be popularly practiced outside of religious reasons is because we perform it on babies who are unable to consent instead of adult men. 

 

Thank you, thank you, thank you!!

[Amulek]

On 1/13/2019 at 5:52 AM, Scott Lloyd said:

It's the difference between correcting a birth defect (as per your example) and ordering elective cosmetic surgery (pierced ears) on a helpless infant to gratify a fashion preference.  I'm amazed that you don't see the difference.

I don't think most people would consider pierced ears to be "cosmetic surgery." That's why I think it's strange that, according to your ethic, you are okay with subjecting an infant to actual surgery with all the potential complications involved (up to and including the risk of death) for cosmetic purposes in some cases, but cannot tolerate ear piercings at all - a procedure which is not nearly as painful, risky, permanent, etc. But, hey, it's not my ethic, so I'm not the one who has to make sense of it.

 

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But the question was not about waiting until she was 14 and capable of giving informed consent. The question was about doing it in her I nfancy, a time when she would be incapable of giving such consent.

Well, technically, a fourteen year old is incapable of giving informed consent as well. There may be rare exceptions for emancipated minors, but in general you can't have any kind of cosmetic surgery without your parent's consent.

But, back to your question, which I believe I already addressed but would be happy to state again: If I believe that having a surgery (cosmetic or otherwise) is in the best interest of my infant child, then yes, I would move forward with the procedure. 

 

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Again, in cases of elective cosmetic surgery and the absence of informed consent, I find that ethically problematic.

I think it depends on the situation. 

 

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Who said anything about using "the power of government"? Not I. If you're going to argue with me, please make it about something I said, not what I didn't say.

So, just to be clear, you do not believe that government should prevent circumcisions. And that medical regulators / state licensing boards should not change their requirements in any way that would prevent the practice of circumcision from taking place. Correct?

 

[pogi]

3 hours ago, Amulek said:

Well, technically, a fourteen year old is incapable of giving informed consent as well. There may be rare exceptions for emancipated minors, but in general you can't have any kind of cosmetic surgery without your parent's consent.

For good reason too.

While the child may not be able to give informed consent, an information and  consent form needs to be signed by the legal guardians, and an information and assent form needs to be signed by the minor who is 7 or older.  Nothing can be performed without their personal assent.  Their voice matters. 

Edited January 14, 2019 by pogi

[Amulek]

18 hours ago, pogi said:

I would also state that permanent bodily alteration on one incapable of giving informed consent would need to be justified on the basis of 1) medical necessity or at least highly beneficial for the patient, and 2) is reasonably assumed that the patient would consent if they could make the decision for themselves.

When it comes to determining what is "highly beneficial" for a patient, we don't have to limit ourselves to medical benefits though. I believe it is ethical for one to consider social, cultural, religious, etc. benefits as well as any potential medical benefits. 

And according to the AAP (which I know you take issue with), "Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it." 

 

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In regards to polydacty, there are justifiable reasons why surgery would be ethically acceptable.  For one, it is not purely a cosmetic surgery and there are absolutely medical reason to remove the extra digit.

Sure. Sometimes. But not always - as was the case for my friend's daughter - it was purely cosmetic. 

 

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But also, it is a congenital deformity - it is reasonable to assume that the child would consent if they were able to, as it is reasonable to assume that most adults would undergo surgery to correct the limiting deformity.

Why? Because we live in a society that doesn't value body diversity and sees such variance as "other." What if you lived in a society where it wasn't considered a deformity and was instead, revered?

 

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It is also a procedure where parents are able to obtain informed consent.

From whom? The child?

 

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So, it is reasonable to state that surgery for polydatcy could be perceived as highly beneficial for the well-being of the patient, and is ethical.

How about webbed feet then? And let's stick to a simple example, not an extreme case. Say for example that a child is born with their second and third toes on each foot conjoined below the middle joint of the toe.

There is absolutely no medical reason for why the toes would need to be separated other than for cosmetic reasons. It is ethical for a parent of such a child to have this surgically corrected while they are still small and will be able to recover quickly? Or must they wait until they are an adult and are capable of making the decision themselves?

 

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When it comes to circumcision on the other hand, informed consent under reasonable patient standard is not happening - for reasons I have already gone over. [...] The only thing that is obtained in regards to circumcision is consent - the "informed" part seems to be neglected.

I think different people can look at the same data and come to different conclusions about what is in the best interest of their children. 

 

[pogi]

14 minutes ago, Amulek said:

[1] When it comes to determining what is "highly beneficial" for a patient, we don't have to limit ourselves to medical benefits though. I believe it is ethical for one to consider social, cultural, religious, etc. benefits as well as any potential medical benefits. 

[2] And according to the AAP (which I know you take issue with), "Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it." 

 

[3]Sure. Sometimes. But not always - as was the case for my friend's daughter - it was purely cosmetic. 

 

[4]Why? Because we live in a society that doesn't value body diversity and sees such variance as "other." What if you lived in a society where it wasn't considered a deformity and was instead, revered?

 

[5]From whom? The child?

 

[6]How about webbed feet then? And let's stick to a simple example, not an extreme case. Say for example that a child is born with their second and third toes on each foot conjoined below the middle joint of the toe.

There is absolutely no medical reason for why the toes would need to be separated other than for cosmetic reasons. It is ethical for a parent of such a child to have this surgically corrected while they are still small and will be able to recover quickly? Or must they wait until they are an adult and are capable of making the decision themselves?

 

[7]I think different people can look at the same data and come to different conclusions about what is in the best interest of their children. 

 

[1] I agree that psycho/social/religious benefits need to be considered.  

[2] Yes, based on the AAP evaluation, health benefits outweigh the risks.  I would simply ask based on what evidence?  The risks are poorly understood as adverse events with circumcision are not required to be reported like other procedures are.  We have no idea what the real risks are, so their evaluation is based on guessing and potentially misleading. Making true informed consent impossible.  Also, 99% of the benefits they claim can be obtained through non-surgical methods (condoms).  The advice of medical professionals is to always seek the least invasive measure first - first do no harm. 

[3] Could your friend's daughter reasonably wear gloves?

[4] Partly yes.  Cats with polydacty are usually passed over for normal looking cats - no one wants their child to be subject to the same social rejection.

[5] No.  What I am saying is that informed consent is impossible to obtain when it comes to circumcision because we can't compare risk vs. benefit.  Until we have that data, the patient cannot be properly "informed" as to the risks.  

[6] My purpose is simply to outline medical ethic and show that circumcision does not fit that ethic.   If you would like to do the same for other procedures, feel free.  I  wouldn't be surprised to see ethical violations in other areas as well.

[7] I agree.  But when the information is unavailable to look at, and people are therefore making uninformed decisions, then we have an ethical problem. 

 

[Amulek]

3 hours ago, pogi said:

[1] I agree that psycho/social/religious benefits need to be considered.  

Likewise. 

 

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[2] Yes, based on the AAP evaluation, health benefits outweigh the risks.  I would simply ask based on what evidence? 

You can read the results from their task force online, here: http://pediatrics.aappublications.org/content/130/3/e756

 

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We have no idea what the real risks are, so their evaluation is based on guessing and potentially misleading. Making true informed consent impossible.

I disagree. We may not have perfect information regarding potential risks, but that doesn't mean we're just playing guessing games here.

According to the AAP, "[t]wo large US hospital-based studies with good evidence estimate the risk of significant acute circumcision complications in the United States to be between 0.19% and 0.22%. Bleeding was the most common complication (0.08% to 0.18%), followed by infection (0.06%) and penile injury (0.04%). For comparison, an audit of 33 921 tonsillectomies found an incidence of hemorrhage of 1.9% among children aged 0 to 4 years."

The chance of something going wrong with a circumcision performed by a trained medical professional here in the United States is remarkably small. And those numbers comport with my own experience. I've never in my entire life had a friend or family member who has had a problem due to circumcision. 

 

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 Also, 99% of the benefits they claim can be obtained through non-surgical methods (condoms).  The advice of medical professionals is to always seek the least invasive measure first - first do no harm. 

If doctors could ensure that young men and women always used prophylactics, well...that would solve a whole host of problems. Last I checked, that isn't happening though.

 

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[3] Could your friend's daughter reasonably wear gloves?

Yes. She typically wore either gloves or mittens so as to not draw attention to it. 

 

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[5] No.  What I am saying is that informed consent is impossible to obtain when it comes to circumcision because we can't compare risk vs. benefit.  Until we have that data, the patient cannot be properly "informed" as to the risks.  

[...]

[7] I agree.  But when the information is unavailable to look at, and people are therefore making uninformed decisions, then we have an ethical problem. 

Well, I think there is a difference between having imperfect / incomplete information and having no information whatsoever. 

One can make an "informed" decision based on the best information available - even if that information is technically incomplete. This is something we do all the time. 

There seems to be pretty good evidence that there are some positive health benefits associated with circumcision. And the risks associated with the procedure (at least in our country) - while not so rare as to fall into case study territory - are really, really small. Small enough for one to conclude that the health benefits outweigh the risks and therefore justify access to this procedure. 

 

[Hamba Tuhan]

7 hours ago, pogi said:

Yes, based on the AAP evaluation, health benefits outweigh the risks.  I would simply ask based on what evidence?

Considering that a very recent study concluded 'that 37–39% of men globally are circumcised', that means that 61–63 per cent of males have complete genitals. That's an enormous 'control group'. Can you or anyone else point me to the robust data that show that, at a population level, intact males experience statistically significant negative health outcomes in comparison to their surgically altered peers? It should be pretty easy to establish, I would think. Non-Muslim Europe and South America, for example, should have solid, reliable data available. Japan and China too.

If men in Saudi Arabia (97.1 per cent cut) enjoy greater genitourinary health than men in the Czech Republic (0.14 per cent cut), for example, it should be obvious from the medical evidence.

Edited January 15, 2019 by Hamba Tuhan

[sheilauk]

Or compare the UK and the USA.  We have similar cultures but circumcision is very low - 6 - 9 % and mainly for religious reasons.   I've never heard it discussed as a possibility for a newborn boy.  Rates of ill health are often the same or similar (eg obesity, cancer) so comparison of genital health may be enlightening.  Interestingly, it used to be around 35% in the UK in the 1930s but fell rapidly after the war, probably because the government said it wasn't necessary and refused to do it for free.

[Hamba Tuhan]

6 minutes ago, sheilauk said:

Or compare the UK and the USA.

No doubt Britain is awash in penile pathologies, and you all just don't realise it. I'm sure that's what the data must show. Perhaps the government is hiding this reality from everyone just to save money?

[Scott Lloyd]

10 hours ago, sheilauk said:

Or compare the UK and the USA.  We have similar cultures but circumcision is very low - 6 - 9 % and mainly for religious reasons.   I've never heard it discussed as a possibility for a newborn boy.  Rates of ill health are often the same or similar (eg obesity, cancer) so comparison of genital health may be enlightening.  Interestingly, it used to be around 35% in the UK in the 1930s but fell rapidly after the war, probably because the government said it wasn't necessary and refused to do it for free.

WithIn the United States, frequency of neonatal circumcision has fallen dramatically within the last generation or two, though not to what it is in your country. It used to be well above 90 percent; now it’s down to around 60 percent or less. If there has been a corresponding detriment to health attributable to that drop in frequency, I’m unaware of it. 

Edited January 15, 2019 by Scott Lloyd

[pogi]

18 hours ago, Amulek said:

Likewise. 

 

You can read the results from their task force online, here: http://pediatrics.aappublications.org/content/130/3/e756

 

I disagree. We may not have perfect information regarding potential risks, but that doesn't mean we're just playing guessing games here.

According to the AAP, "[t]wo large US hospital-based studies with good evidence estimate the risk of significant acute circumcision complications in the United States to be between 0.19% and 0.22%. Bleeding was the most common complication (0.08% to 0.18%), followed by infection (0.06%) and penile injury (0.04%). For comparison, an audit of 33 921 tonsillectomies found an incidence of hemorrhage of 1.9% among children aged 0 to 4 years."

The chance of something going wrong with a circumcision performed by a trained medical professional here in the United States is remarkably small. And those numbers comport with my own experience. I've never in my entire life had a friend or family member who has had a problem due to circumcision. 

 

If doctors could ensure that young men and women always used prophylactics, well...that would solve a whole host of problems. Last I checked, that isn't happening though.

 

Yes. She typically wore either gloves or mittens so as to not draw attention to it. 

 

Well, I think there is a difference between having imperfect / incomplete information and having no information whatsoever. 

One can make an "informed" decision based on the best information available - even if that information is technically incomplete. This is something we do all the time. 

There seems to be pretty good evidence that there are some positive health benefits associated with circumcision. And the risks associated with the procedure (at least in our country) - while not so rare as to fall into case study territory - are really, really small. Small enough for one to conclude that the health benefits outweigh the risks and therefore justify access to this procedure. 

 

Actually, we are just playing guessing games and the AAP admits it in their report.  It is not the information is imperfect/incomplete, it is that it is entirely inadequate and impossible to .

Quote

The AAP makes the key claim, repeated numerous times, that “the benefits of newborn male circumcision outweigh the risks,” without ever quantitatively comparing them. Indeed, it admits multiple times that the true rate and impact of circumcision complications is unknown, but still illogically makes this claim.
“The true incidence of complications after newborn circumcision is unknown.” p. e772
“It is unknown how often these late complications require surgical repair; this area requires further study.” p. e772
“Based on the data reviewed, it is difficult, if not impossible to adequately assess the total impact of complications.” p. e775
“Financial costs of care [after complications], emotional tolls, or the need for future corrective surgery are unknown.” p. e775

A guiding principle of medicine, however, suggests that a procedure should not be recommended until its complications, losses, and harms are fully understood.

https://www.doctorsopposingcircumcision.org/for-professionals/medical-organization-statements/

If the medical benefits of circumcision were so beneficial, why would it not be indicated for all male children?  From the AAP:

Quote

Although health benefits are not great enough to recommend routine circumcision for all male newborns...

So the AAP can't say specifically who it would be and would not be medically indicated for and throws this burden on lay parents - that's weak!  It doesn't seem to be clear at all that the benefits are greater than the risks or else it would be indicated for all male children. Consider that all other developed nations have access to the same information and have come to vastly different conclusions.  Makes it seem like the methods of the AAP are highly questionable. 

Quote

 

Canadian Paediatric Society (CPS) (2015)
The CPS does not recommend the routine circumcision of every newborn male. It further states that when “medical necessity is not established, …interventions should be deferred until the individual concerned is able to make their own choices.”

Royal Dutch Medical Association (KNMG) (2010)
The KNMG states “there is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene.” It regards the non-therapeutic circumcision of male minors as a violation of physical integrity, and argues that boys should be able to make their own decisions about circumcision.

The Royal Australasian College of Physicians (RACP) (2010)
The RACP states that routine infant circumcision is not warranted in Australia and New Zealand. It argues that, since cutting children involves physical risks which are undertaken for the sake of merely psychosocial benefits or debatable medical benefits, it is ethically questionable whether parents ought to be able to make such a decision for a child.

British Medical Association (BMA) (2006)
The BMA considers that the evidence concerning health benefits from non-therapeutic circumcision is insufficient as a justification for doing it. It suggests that it is “unethical and inappropriate” to circumcise for therapeutic reasons when effective and less invasive alternatives exist.

Expert statement from the German Association of Pediatricians (BVKJ) (2012)
In testimony to the German legislature, the President of the BVKJ has stated, “there is no reason from a medical point of view to remove an intact foreskin from …boys unable to give their consent.” It asserts that boys have the same right to physical integrity as girls in German law, and, regarding non-therapeutic circumcision, that parents’ right to freedom of religion ends at the point where the child’s right to physical integrity is infringed upon.

In addition, medical organizations and children’s ombudsmen from a number of other countries, including Belgium, Finland, Norway, Slovenia, South Africa, Denmark, and Sweden, have gone on record in opposition to non-therapeutic circumcision of boys.

https://www.doctorsopposingcircumcision.org/for-professionals/medical-organization-statements/

Of course, I have already shared this all before, so it makes me question whether or not you are taking it seriously.  Either way you haven’t yet addressed it.
 

Edited January 15, 2019 by pogi

[pogi]

18 hours ago, Amulek said:

If doctors could ensure that young men and women always used prophylactics, well...that would solve a whole host of problems. Last I checked, that isn't happening though.

Do you really think it is ethical to cut up a person's genitals because they may not be responsible when they get older?  Also, evidence suggests that male to male sex does not increase risk in uncircumcised people.  So, not only are you betting that your child will be irresponsible, but you are betting that they will be straight. How is that ethical and fair to all the responsible children and gay children who do use condoms or who only have sex with men?  In their cases, there is absolutely no indicated medical reason for circumcision.

Is it ethical to remove healthy organs as a prophylaxis for potential future cancer or infection?  Do we routinely remove woman's breasts because they may get breast cancer in the future (WAY higher risk than penile cancer I might add)?  What about infection?  Do we routinely remove the appendix (a relatively simple procedure) as prophylaxis against appendicitis (a much more serious infection than UTI)? Nope.  Removing healthy genital tissue as a prophylaxis from potential irresponsible promiscuity and heterosexuality is not justifiable. 

The fact is, if someone is sleeping around and not using condoms then being circumcised probably isn't enough to protect them from HIV/HPV, etc anyway.  It is highly invasive and not very  effective measure of prophylaxis at all.  Not to mention there is an extremely effective vaccine for HPV now, so we shouldn't need to cut someones genitals as a prophylactic measure for that one anymore. 

Edited January 15, 2019 by pogi