"Forced Genital Cutting," and Jewish circumcision

[Falvlun]

And in general, that's my position - don't ban it outright, but:

- don't cover circumcision with health insurance
- don't include it as part of a "standard" package for newborn care
- support doctors' right to refuse to do it
- discourage the practice through education

All of that sounds reasonable to me.

 

[Me Myself]

And in general, that's my position - don't ban it outright, but:

- don't cover circumcision with health insurance
- don't include it as part of a "standard" package for newborn care
- support doctors' right to refuse to do it
- discourage the practice through education

I personally dont have problems with that.

Dnt think its immoral at all, but dont have problem with those anyways.

 

[dawny0826]

I'm talking more about the sort of critical thinking that a person normally employs when the used car salesman insists that the perfect car for you just happens to be one of the cars on his lot. A reasonable person takes note of the fact that he only gets paid if someone buys a car from him and weighs his advice accordingly.

I'm a United States citizen and I can honestly say that this has never been my train of thought and I think I can attribute this to having amazing health care professionals in my life. My eye care professionals are awesome. I've never purchased anything that I didn't fully understand and feel comfortable with. My pediatrician was amazing. I have a wonderful relationship with my neurologist and primary care practioner and my pcp, in particular, is not at all pushy. She listens. presents options and makes it clear that my choice is what matters.

My pediatrician was always so encouraging of my choices as a parent, particularly when I was a young, first time mother. She would leave the room, when she provided me literature on immunizations. NEVER did I feel pressured or coerced. But, when I had questions, she answered them - concisely and in a friendly manner, which never made me feel like my intelligence was insulted or that she was bull ******** me in any way.

The one time I was given a "frivoluos" medical exam was by my neurologist and he told me beforehand that my insurance was probably not going to cover it as it was an entirely elective MRI.

I can't really relate to what you're saying here, because when I've experienced physicians that haven't provided me the feedback or results that I've expected - I've moved on and found anther health care provider.

My OBGYN would have given me print outs of information from the APA and told me that it was up to me. He was an arrogant jerk, but, an AMAZING surgeon. My C-section scars are hardly visible and he had a track record for being an amazing surgeon, which is why I chose him and trusted him. His bed side manner was lacking, but, his skill made up for it.

Speak for yourself. I certainly don't.

I don't really believe this, myself. I think that self-respecting people remain true to their core values, in whatever station they are in. And regardless as to the concept of separation of state, honest people, can't truly detangle from their core values. They can still exercise their job duties with honesty and integrity.

Why is it hard for you to realize that virtually every professional code of ethics includes a prohibition on conflict of interest, and that they're in there for a reason?

It's not that I have a hard time understanding the concept of conflict of interest, Jeff and appropriate prohibition. Is this measurable in a way that has the type of significace that you're insisting? And you didn't answer my question.

Can a medical professional not have a strong personal opinion, influenced by their own experiences and leanings, but still provide an unbiased presentation of information to their patients? I think it's quite possible.

So you wouldn't necessarily be against circumcision yourself even if, on the basis of the body of research at the time, the APA recommended against it in the future?

Entirely contingent upon WHY the APA recommends against it.

And as it stands now, routine circumcision meets none of the three prongs I gave.

As it stands now, routine circumcision isn't at all being endorsed. So, I fail to see why you continue to come back to this. Routine circumcision wasn't recommended before by the APA and it isn't recommended now.

Then I can only assume that you're not in a profession that's covered by a code of ethics.

To the contrary. I am bound by a Code of Conduct and a specific set of principles - with neutrality being one. I understand quite well the concept of working neutrally to accomplish a task whilst holding my own strong opinions and bias.

I feel as if you can't see a middle ground here. While yes, I acknowledge that there are medical professionals who must do what they do for the "wrong" reasons - being motivated by greed and to push their own agendas - I still acknowledge that it's possible for someone to separate their personal motivations from business.

I have to do this in my own line of work. I can't allow personal opinion or politics into my daily activities as it's a direct violation of our principles. I still have personal opinions and leanings which influence the person that I am - but - I can still deliver services in the manner that I'm supposed to.

No, they're real. When a group develops recommendations that are supposed to be in the public interest, but members of the group have a personal interest that would be affected by the recommendations, there is a conflict of interest.

A personal interest in what? Making tons of money off of of infant, male circumcisions? Is this REALLY what you think is happening?

Could it not be, Jeff, that statistics genuinely suggest about an equal "wash" in terms of benefits and risk and that pediatricians actually give a damn about those who might choose the procedure for non-medical reasons too? The APA has already said - hey - this isn't medically necessary - but - we're okay with the health benefits and in fact have determined that the scale might tip in the favor of there being more health benefits over risks.

The APA is, afterall encouraging parents to make these decisions within the context of their cultural and religious situations.

Perhaps, the "conflict of interest" here is that pediatricians are parents too. So, what are you going to do - fire all the parents? Fire all the pediatricians who give a damn about personal freedom?

Unless you can provide statistics and something measurable to show me how these conficts of interests tangibly are impacting this subject - I don't know what we have to argue about.

I acknowledge that conflicts of interest exist. I believe in accountability.

The way to deal with a conflict of interest ethically is to assume that any conflict of interest is severe enough to affect the results until it has been confirmed by a qualified third party (e.g. an institution's review committee) that it does not affect the results.

Then start appealing for change, Jeff. What the hell do you want me to say?

Again, I can only assume that you're not in a profession that's governed by a code of ethics.

Oh no. Quite the contrary.

So... you think that being anti-circumcision would be a sign that a doctor is inappropriately biased, but if they personally gain financially from circumcision, that's A-OK?

I think that doctors are entitled to bias. I think that they should be financially gaining from the procedures that they lawfully perform as per the nature of their position. If their bias negately impacts their ability to perform their job and provide UNBIASED counsel to their patients, then we have a problem.

The normal approach - and I would argue the ethical approach - is to assume that a conflict of interest has poisoned the results until it can be confirmed otherwise. If the conflict of interest can't be measured, then it can't be determined to be unimportant.

First, Jeff, you have the burden of proving that there's a conflict of interest. Then, you have to prove that Mom and Dad are incapable in some way of deciphering fact from fiction. Good luck.

I thought it was clear enough. You're painting an unrealistic picture of the decision-making process for parents on this issue. The recommendations of organizations like the APA have influence.

Sure. And just how experienced are YOU as a parent making such decisions, any type decisions for that matter regarding circumcision or ANYTHING that involves consultation over the health of your child? Circumcision is only ONE of of MANY decisions made with health care providers and one of many topics that can be researched via the APA website.

No... should it have been changed to recommend against the procedure?

No.

Yes, I do insist that an agenda is being pushed. Physicians have a duty to the well-being of their patients. Putting forward a recommendation that allows for circumcision implies that circumcision is in keeping with the well-being of the boys being circumcised.

But, that's not WHAT you read, if you take five ten - minutes to read the FULL policy statement of the APA. Make sure you're getting all your facts straight, Jeff. The APA provides a very balanced approach to the risks and medical benefits of the procedure. It doesn't sugar coat anything. If you've read it, you're not going to be left with a picture of gee..if I have this done, my son will be the picture of health. You'll be left with more questions.

I'm not sure whether this is special pleading on your part or just innumeracy. Are you also now going to argue that low risks of things like penile cancer or HIV are irrelevant? After all, circumcised men can be affected by these things, too.

Neither.

The risks of the procedure are relatively low too. What means more to parents? Risk or possible benefit?

 

[dawny0826]

Dawn, I'm curious about something: why do you think that all those other medical associations are opposed to circumcision?

It's not a matter of being privy to different facts; they all have access to the same body of research. You assure us that doctors are above reproach and don't let their personal interests and biases sway their actions... so what is it? Why do you think that these doctors would be against the procedure?

I've already explained why American doctors might be reluctant to recommend against circumcision. Why would a European doctor with no "skin in the game" (no pun intended) br motivated to recommend against circumcision if it's as beneficial as you claim?

I'm not convinced that I'm reading the same thing that you are. I didn't read that the CPS in example, is "opposed" to infant circumcision. I read that they do not recommend the procedure as routine practice.

Not recommending something as routine is not the same thing as opposing it.

In fact, the CPS calls the benefits and risks of the procedure to be "even". Even the CPS acknowledges that ultimately parents may make the decision based upon cultral and religious reasons.

Neonatal circumcision revisited | Position statements and practice points | Canadian Paediatric Society

 

[dawny0826]

And in general, that's my position - don't ban it outright, but:

- don't cover circumcision with health insurance
- don't include it as part of a "standard" package for newborn care
- support doctors' right to refuse to do it
- discourage the practice through education

I can agree with everything here, except not covering the procedure with health insurance. I'm paying out of my booty for my health care and expect "preventive" expenses to be covered and the APA considers this preventive - elective - but preventive.

 

[9-10ths_Penguin]

I'm not convinced that I'm reading the same thing that you are.

I'm reading this:

Recommendation: Circumcision of newborns should not be routinely performed.

What are you reading?

 

[9-10ths_Penguin]

I can agree with everything here, except not covering the procedure with health insurance. I'm paying out of my booty for my health care and expect "preventive" expenses to be covered and the APA considers this preventive - elective - but preventive.

It's cosmetic. Should my tattoo have been covered by insurance, too?

 

[Terrywoodenpic]

And in general, that's my position - don't ban it outright, but:

- don't cover circumcision with health insurance
- don't include it as part of a "standard" package for newborn care
- support doctors' right to refuse to do it
- discourage the practice through education

That is very much the UK position
Our National Insurance to the health service does not cover it unless there is a medical problem that requires it.
It is in no standard package.
It is mostly outside the competence of doctors to do it. (they are mostly untrained in the procedure)
It is not actively discouraged as there is little call for it. Though no one would be encouraged to have it done.

 

[dawny0826]

I'm reading this:



What are you reading?

The recommendation of the CPS is that the procedure not be performed ROUTINELY for infants. They acknowledge risk, benefit and those areas for which additional study is required and in fact reference risk and benefit as being evenly balanced.

I'm not reading an attitude of opposition to anything other than routine infant circumcision.

Parents obviously, can make a choice, even if, in your country, finding a doctor to perform the procedure is more challenging. I'm sure that fewer parents in Canada will opt for circumcision for their children and that the CPS can be partly attributed to that. But, the CPS clearly isn't attempting to block the choices of parents who might choose otherwise, as they acknowledge that parents may choose otherwise, for personal, cultural or religious reasons. They do not share any sort of "beef" with that.

It appears that they, like the APA, encourage educated decision making and though they don't claim a netural stance. Their stance along with that of the APA appear, in my opinion to be rather neutral. A presention of risks, benefits and ultimately allowing parents the ability to make decisions, without recommending the practice as routine.

Even I don't believe that this should be routine practice, Jeff. Please, understand that. My position is that parents should always have choice. In fact, I oppose the concept of a routine procedure, as it could inhibit educated decision making.

My concern is when someone with an opposing view on the procedure confesses desire to stifle parental rights and freeoms, because they have an objection to it. I think in truth we're all a bit hypocritical when it comes to issues concerning morality and ethics. We're quite verbal and passionate about those issues that mean a lot to us. Even if I wasn't comfortable with male, infant circumcision, I would still want for other parents to have the right to make such decision for their child within the auspice of their religious or cultural persuasion or for those benefits that they deem worthy for their child.

We undertook this literature review to consider whether the CPS should change its position on routine neonatal circumcision from that stated in 1982. The review led us to conclude the following.

• There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1% to 2%.
• The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2% to 2%. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision.
• Evaluation of alternative methods of preventing UTI in infancy is required.
• More information on the effect of simple hygienic interventions is needed.
• Information is required on the incidence of circumcision that is truly needed in later childhood.
• There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases.
• When circumcision is performed, appropriate attention needs to be paid to pain relief.
• The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed.
• When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. Their decision may ultimately be based on personal, religious or cultural factors.

 

[dawny0826]

It's cosmetic. Should my tattoo have been covered by insurance, too?

Where has your country's CPS deemed the procedure cosmetic? The CPS acknowledges about an even split between risk and health benefit.

 

[9-10ths_Penguin]

Not recommending the procedure as routine does not translate to absolute opposition, as the CPS contains medical professions who, like the medical professionals within the APA, also acknowledge health benefit and would have no problem performing the procedure.

The recommendation of the CPS is that the procedure not be performed ROUTINELY. They acknowledge risk, benefit and those areas for which additional study and evidence is needed.

I'm not reading an attitude of opposition not in the vein that you're coming from. Parents obviously, still, can make a choice and the CPS isn't attempting to block those choices, outside the auspices of education. And it appears that they, like the APA, encourage educated decision making.

I think you're misreading their statement. "Routine circumcision" is the sort of circumcision you're arguing for: circumcision performed on a healthy boy with no particular indications for the procedure. The term "routine" is meant to differentiate this practice from cases where circumcision is used as a treatment for a specific medical condition (e.g. certain cases of phimosis).

IOW, when they recommend against "routine circumcision", they're recommending against precisely the sort of circumcision we've been discussing.

 

[Juhurka]

"Yesterday, during a meeting in Oslo, Nordic ombudsmen for children, Nordic paediatricians, and paediatric surgeons agreed a resolution urging their national governments to work for a ban on non-therapeutic circumcision of underage boys.

Dr Antony Lempert, a GP and spokesperson for the UK Secular Medical Forum (SMF) applauded this historic resolution and urged the UK and devolved Governments to work towards protecting all UK children at risk of forced genital cutting.

Dr Lempert argued that, "with an increasing awareness of serious irreversible harm caused to boys and girls from forced genital cutting it is time for the genitals of all children to be protected from people with knives and strong religious or cultural beliefs. There can be no justification for healthy children to be forcibly cut. All children deserve society's protection from serious harm."
source
​

And

"The world should learn from the Nordic countries how to ban non-therapeutic, nonsense circumcision of underage boys. Children’s rights must be protected. We adults do not have the right to impose our superstitions, religious belief and madness on our children and abuse, or mutilate them. It is a nasty crime against children

The human right to bodily integrity is more important than the human right to freedom of religion. Religious tradition is a poor excuse to subject a baby to circumcision. People started practicing circumcision long before the birth of monotheistic religions. The risks of circumcision are many, infection, necrosis, gangrene, BXO, urinary tract infection, urinary retention, meatal ulceration or stenosis, urethral fistula, hypospadias or epispadias, lymphedema etc. Circumcision also affects sexual function and desensitizes the penis. Seriously, how many diseases do we need to ban circumcision?
source

​

As a kid I, and almost every guy I knew, was circumcised early on, so anyone who was not was looked upon as rather odd---this was apparent in the changing area at the local pool. Asking my mother about the difference I can remember being told that circumcision was done to facilitate cleanliness---not in those words of course. It's something I never came to regret, but can now see why it's not only unnecessary, but possibly harmful.

Back to my childhood; I learned that two of my cousins who were Jewish---I was not---were also circumcised, but for religious reasons. Told that because of their religion they were required to be circumcised brought a whole other dimension to the practice. I remember thinking that it was quite curious that a religion required some of the skin on the penis be sniped off. How utterly strange---what significance could penis skin have to a religion? In any case, at least my cousins could more easily keep their tools clean.

Then I found out that this Jewish practice wasn't a religious requirement at all, but simply a social custom that could be ignored. Looking it up for this thread, I came across the following.

"Like the American cultural practice of circumcision, Jewish circumcision (bris or brit milah) is dependent on the acceptance of cultural myths. Of all the myths that Jews believe about circumcision, the one that is paramount is the belief that all Jews circumcise. With this belief, we put ourselves under tremendous pressure to conform.

Bound by this burden to comply with social expectations, most Jewish parents do not recognize that circumcision is a choice. Since open communication about circumcision is discouraged, there is virtually no awareness of others who feel similar conflicts and doubts around circumcision. Moreover, if a Jewish parent does decide not to circumcise a male child, it is not generally known to the rest of the community. As a result, many parents submit to the pressure and then discover only too late, perhaps after witnessing the circumcision of their son, that they wish they had chosen differently. Some parents report that if they could take back one decision, it would be their son's circumcision.
source
​

How about you, what are your thoughts?

Some more liberal BS.

 

[dawny0826]

I think you're misreading their statement. "Routine circumcision" is the sort of circumcision you're arguing for: circumcision performed on a healthy boy with no particular indications for the procedure. The term "routine" is meant to differentiate this practice from cases where circumcision is used as a treatment for a specific medical condition (e.g. certain cases of phimosis).

IOW, when they recommend against "routine circumcision", they're recommending against precisely the sort of circumcision we've been discussing.

Or maybe there's more than one interpretation of their policy statement.

Again, I'm not arguing for circumcision. I agree with the policy statement of the APA. I recognize benefits and risks. And if I have a son of my own, I want to have the opportunity to consider those risks and benefits and make an educated choice as to whether or not circumcision is the right choice for my child.

I can also argue that the term "routine" is being used here to mean a practice that is being offered habitually, without variance, on a regular basis. Or maybe "routine" in this context refers to both understandings.

 

[9-10ths_Penguin]

Or maybe there's more than one interpretation of their policy statement.

Again, I'm not arguing for circumcision. I agree with the policy statement of the APA. I recognize benefits and risks. And if I have a son of my own, I want to have the opportunity to consider those risks and benefits and make an educated choice as to whether or not circumcision is the right choice for my child.

I can also argue that the term "routine" is being used here to mean a practice that is being offered habitually, without variance, on a regular basis. Or maybe "routine" in this context refers to both understandings.

No, I don't think it does, because it would make no sense. "Don't circumcise unless there's a specific reason to do it" is consistent. "Circumcise some kids but don't make a habit of it" is not.

 

[dawny0826]

No, I don't think it does, because it would make no sense. "Don't circumcise unless there's a specific reason to do it" is consistent. "Circumcise some kids but don't make a habit of it" is not.

It reads to me like this...

We cannot justify recommending this as a routine procedure, as it's not medically necessary. However, studies have shown that the procedure can yield benefits. There are also risks that need to be considered. The CPS considers them even. The APA considers the benefits to exceed the risks.

During circumcisions, pain management and sterile technique is imperative. Those skilled in circumcision should perform the procedure.

Though the procedure is not recommended as routine - the CPS acknowledges that parents may make decisions within the auspices of their personal, cultural and religious influence. The APA acknowledges the same and encourages parents to make educated decisions. Again - both recommend educated decision making.

This is paraphrase from the policy statements of both organzations.

If you read this differently than I do - it's asinine for either of us to go back and forth with childish - you're wrong! antics.

You have presented points that I have appreciated. And I feel that I've benefited as a parent, from taking the time to learn more about different points of view and even learning more about the CPS and commonalities and differences between Canadian Pediatric practice and American Pediatric practice.

I do agree with you on more than one point that you've made.

 

[Curious George]

It reads to me like this...

We cannot justify recommending this as a routine procedure, as it's not medically necessary. However, studies have shown that the procedure can yield benefits. There are also risks that need to be considered. The CPS considers them even. The APA considers the benefits to exceed the risks.

During circumcisions, pain management and sterile technique is imperative. Those skilled in circumcision should perform the procedure.

Though the procedure is not recommended as routine - the CPS acknowledges that parents may make decisions within the auspices of their personal, cultural and religious influence. The APA acknowledges the same and encourages parents to make educated decisions. Again - both recommend educated decision making.

This is paraphrase from the policy statements of both organzations.

If you read this differently than I do - it's asinine for either of us to go back and forth with childish - you're wrong! antics.

You have presented points that I have appreciated. And I feel that I've benefited as a parent, from taking the time to learn more about different points of view and even learning more about the CPS and commonalities and differences between Canadian Pediatric practice and American Pediatric practice.

I do agree with you on more than one point that you've made.

I read it this way as well. A non routine procedure is one which is opt-in. A procedure which is only available for medical purposes would more clearly state this. Moreover, given the amount of circumcisions claimed to be performed by the Canadian specialists, I think that a reading of routine as "medically necessary" does not hold under scrutiny, unless a whole lot of people must need circumcision. Moreover the Canadian medical authority and the u.s. had very similar statements prior to the U.S. change. And I know for certain that dawny's reading is representative of that policy.

 

[DallasApple]

Dawn, I'm curious about something: why do you think that all those other medical associations are opposed to circumcision?

I"m curious too.

 

[DallasApple]

Some more liberal BS.

You mean more logical BS?

 

[Juhurka]

You mean more logical BS?

More liberal BS. Liberals love to shove their agenda down peoples troats. They couldn't care less about a new born child but they will use that to pursue their goals.

First they gave us the Oslo accords and now this and all of that is comming from people who until recently kepts kids who were born from German soldiers in psychiatric hosiptals.
http://http://en.wikipedia.org/wiki/War_children

Hypocrites.

 

[DallasApple]

More liberal BS. Liberals love to shove their agenda down peoples troats. They couldn't care less about a new born child but they will use that to pursue their goals.

First they gave us the Oslo accords and now this and all of that is comming from people who until recently kepts kids who were born from German soldiers in psychiatric hosiptals.
http://http://en.wikipedia.org/wiki/War_children

Hypocrites.

Your link goes know where.