MEDICAL FRAUD and the criminal assault of boys
A Short Guide to Male Circumcision
A publication from Doctors Opposing Circumcision,
George C. Denniston, MD, MPH, President;
Mark D. Reiss, MD, Vice-President;
George Hill, Executive Secretary
There are no medical indications for circumcision of newborn infants.
1 2 The Council on Scientific Affairs of the American Medical Association classifies neonatal male circumcision as a non-therapeutic procedure.3 No disease is present in newborn male infants, so no therapeutic action is required. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, in a joint publication, Guidelines for Perinatal Care, have reclassified neonatal circumcision as an "elective procedure."4 5 This re-classification removes any suggestion that newborn circumcision is a normal part of hospital routine or a medically recommended procedure. Non-therapeutic infant circumcision, therefore, is not presently the American standard of care.A few doctors have expressed the
opinion that there are medical or prophylactic benefits from circumcision. The medical evidence, however, does not support these claims. Recent evidence-based statements from the American Academy of Pediatrics,6 the American Medical Association,7 the American Academy of Family Physicians,8 and the American College of Obstetricians and Gynecologists9 firmly establish that circumcision is not medically necessary.All decline to recommend the procedure. All emphasize that circumcision is an elective procedure.Medical societies worldwide find that the
alleged benefits do not exceed the known risks.10 11 They counsel that circumcision should not be routinely performed, meaning that circumcision should not be performed without a specific medical indication.10 11Risks and disadvantages
The principal risks of circumcision are hemorrhage, infection, and surgical accident leading to mutilation.
12 Death may occur from loss of blood13 or from systemic infection.14
1 Foetus and Newborn Committee. FN 75-01 Circumcision in the Newborn Period.
Canadian Paediatric Society News Bulletin Supplement 1975;8(2):1-2.2 Committee on Fetus and Newborn:
Standards and Recommendations for Hospital Care of Newborn Infants. Sixth Edition. American Academy of Pediatrics; Evanston, IL, 1977: 66-7.3 Council on Scientific Affairs, American Medical Association. Report 10: Neonatal circumcision. Chicago: American Medical Association, 1999. Available at URL: http://www.ama-assn.org/ama/pub/article/2036-2511.html
4 American Academy of Pediatrics & American College of Obstetricians and Gynecologists.
Guidelines for Perinatal Care, Fourth Edition, 1997.5 American Academy of Pediatrics & American College of Obstetricians and Gynecologists.
Guidelines for Perinatal Care, Fifth Edition, 2002.6 American Academy of Pediatrics Task Force on Circumcision. Circumcision Policy Statement,
Pediatrics 1999;103(3):686-93. URL: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/3/6867
Council on Scientific Affairs, American Medical Association. Report 10: Neonatal circumcision.Chicago: American M
edical Association, 1999. Available at URL: http://www.ama-assn.org/ama/pub/article/2036- 2511.html8 Commission on Clinical Policies and Research.
Position Paper on Neonatal Circumcision. Leawood, KS. American Academy of Family Physicians, 2002. URL: http://www.aafp.org/policy/camp/4.html9 ACOG Committee Opinion Number 260: Circumcision.
Obstetrics & Gynecology 2001; 98(4):707-8.10 Fetus and Newborn Committee, Canadian Paediatric Society. Neonatal circumcision revisited. (CPS)
Can Med AssocJ
1996; 154(6): 769-780. URL: http://www.cps.ca/english/statements/FN/fn96-01.htm11 Beasley S, Darlow B, Craig J,
et al. Position statement on circumcision. Sydney: Royal Australasian College ofPhysicians,
2002. URL: http://www.racp.edu.au/hpu/paed/circumcision/
Interference with the conjugal relationship
Circumcision has been shown to increase the difficulty of penetration,
15 16 to cause erectile dysfunction,16 17 and to cause symptoms of sexual arousal disorder in the spouse.18 The overall effect on marital happiness and the frequency of divorce has not been studied.Bioethics
The practice of non-therapeutic circumcision of children fails the five tests of beneficence, non-maleficence, proportionality, autonomy, and justice.
19Circumcision of the newborn fails the test of beneficence because of lack of medical benefit.
Circumcision of the newborn fails the test of non-maleficence because of serious risks, complications, and injuries.
Circumcision of the newborn fails the test of proportionality because the risks and complications exceed any conceivable benefit.
Circumcision of children fails the test of autonomy because the permission must be given by a surrogate.
Circumcision fails the test of justice because it excises healthy functional tissue from the body and thereby violates the patient’s right to bodily integrity.
Circumcision has been found to fail all tests for surgical interventions on children.
20Moreover circumcision also violates human rights to security of the person, freedom from cruel and degrading treatment,
21 and the right to protection from traditional procedures prejudicial to the health of children.22 Medical codes of ethics require respect for the human rights of the patient.23
12 Williams N, Kapila L. Complications of circumcision.
Brit J Surg 1993;80:1231-6.13 Newell TEC. Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan. Burnaby, B.C.: B.C. Coroner's Service, Monday, 19 January 2004.
14 Scurlock JM, Pemberton PJ. Neonatal meningitis and circumcision.
Med J Aust 1977;1(10):332-4.15
Taves D. The intromission function of the foreskin. Med Hypotheses 2002;59(2):180.16 Shen Z, Chen S, Zhu C,
et al. [Erectile function evaluation after adult circumcision]. Zhonghua Nan Ke Xue 2004;10(1):18-9.17
Fink KS, Carson CC, DeVellis RF. Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction. J Urol 2002;167(5):2113-6.18
Bensley GA, Boyle GJ. Effects of male circumcision on female arousal and orgasm. N Z Med J 2003;116(1181):595-6.19 Hill G. Can anyone authorize the non-therapeutic permanent alteration of a child’s body.
Am J Bioeth 2003;3(2):1c- 3c.20 Hodges FM, Svoboda JS, Van Howe RS. Prophylactic interventions on children: balancing human rights with public health.
J Med Ethics 2002;28(1):10-16.21 United Nations General Assembly. Universal Declaration of Human Rights (1948).
22 United Nations General Assembly. Convention on the Rights of the Child (1989).
23 Council on Ethical and Judicial Affairs.
Principles of Medical Ethics. Chicago: American Medical Association(2001).
Parental powers are limited. Decisions for children must be made only in the child’s best interests.24 23 Doctors must respect the child-patient’ s rights; parental authority is restricted to the granting of surrogate permission for the diagnosis and treatment of disease.25
Conclusion
Medical societies in Australia, Canada, New Zealand, and the United States counsel that circumcision should
not be performed unless there is a specific medical indication. No medical indication is present in the newborn. Non-therapeutic circumcision of the newborn is almost unknown outside of the English-speaking nations and is almost never done in advanced nations such as Argentina, Austria, Chile, China, Denmark, Finland, Italy, Japan, Spain, Sweden, Finland, France, Norway, Poland, and Russia. Circumcision of the newborn is completely nontherapeutic in nature. Parents elect circumcision of the newborn for various reasons, such as the father being circumcised or because the neighbors had a child circumcised,26 27 but not for medical reasons because, as stated above, there are no medical reasons for circumcision of the newborn. Circumcision cannot reasonably be regarded as being in the best interests of the child and should be discouraged at every opportunity.Prepared by:
George Hill,
Executive Secretary,At the direction of
George C. Denniston, M.D, MPH
, PresidentDoctors Opposing Circumcision
Suite 42, 2442 NW Market Street
Seattle, Washington 98107
Website: http://faculty.washington.edu/gcd/DOC/
March 2004.
24 Bioethics Committee Reference B86-01:
Treatment Decisions for Infants and Children. Ottawa: Canadian Paediatric Society, March 2000.25 American Academy of Pediatrics Committee on Bioethics. Informed consent, parental permission, and assent in pediatric practice.
Pediatrics 1995;95(2):314-7.26
Brown MS, Brown CA. Circumcision decision: prominence of social concerns. Pediatrics 1987;80:215-9.27
Tiemstra JD. Factors affecting the circumcision decision. J Am Board Fam Pract 1999;12:16-20.