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Doctors Opposing Circumcision
Genital Integrity Policy Statement

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Chapter One: Introduction

Doctors Opposing Circumcision (DOC) is a non-governmental, non-profit, educational organization, organized by medical doctors who support genital integrity and who oppose non-therapeutic genital cutting of infants and children. Female circumcision already is recognized generally as a harmful operation and a violation of human rights. Laws have been passed to protect girls, but boys have not been protected. This statement, therefore, will concentrate on the protection of the genital integrity of male infants and children.

Several medical societies in English-speaking nations have issued position statements regarding the circumcision of male children. These societies are composed of members, many of whom perform circumcision. The first duty of medical societies appears to be to protect and advance the financial and legal interests of their members. (The practice of non-therapeutic child circumcision generates about $1.2 billion annually for the American medical community.1) Under these circumstances, there is a conflict of interest that hampers honest discussion of the issues.

Goldman argues that medical society circumcision policy statements are biased in favor of circumcision for a variety of emotional and social-political factors.2 Emotional factors include the avoidance of the emotional discomfort of questioning one's own circumcision by circumcised doctors, and the protection of self-esteem by those who have performed hundreds or thousands of circumcisions.2 Social-political factors include a division of opinion and a desire to avoid an appearance of religious intolerance.2 Goldman observes that discussions of sexual, psychological, human rights, ethical, and legal issues frequently are excluded from medical society circumcision policy statements.2

DOC agrees that medical society position statements often are incomplete, inadequate, and tend to ignore discussion of the structures, functions, development, and care of the normal penis and, instead, tend to over-state the so-called “potential benefits,” while minimizing the inherent injury, risks, complications, and disadvantages of circumcision. In some position statements, medical science is tainted with religious/cultural bias. Such bias perpetuates the practice of male circumcision for the benefit of the society members, some of who profit personally from the performance of child circumcision. The discussion of the bioethics of circumcision is often superficial and inadequate. In some cases, the statements appear to have been drafted by lawyers, not medical doctors, so as to protect medical practitioners from liability. These statements fail to meet the needs of the public for accurate information and are a disservice to the infant boys who need protection.* (See Chapter Six.)

DOC has no such conflict of interest and, therefore, has determined to issue its own statement regarding the circumcision of male children. This statement will consider the anatomy, histology, and physiology of the prepuce; the alleged advantages of circumcision, the complications, harms, and disadvantages of circumcision; the inherent injury to the penis and its proper physiological function; the psychological sequellae of circumcision, and their social consequences. This statement will also review the position of the circumcision of male children under international human rights law, domestic law, and contemporary bioethics. Genital integrity is most likely to provide the highest state of health and well-being,3 so this statement will propose actions to support and defend the genital integrity of America's children.


*The American Academy of Pediatrics (AAP) is a case-in-point. The media generally regard the AAP as the nation’s authority on what is best for the health and well-being of children. The Academy usually does, in fact, give sound advice on child health and well-being. In the matter of male circumcision and genital integrity, however, a quite different situation prevails.

The practice of male circumcision creates two kinds of men – those who enjoy genital integrity and those who do not. Some of those men who do not enjoy genital integrity have various emotional issues relating to their deprivation of a whole penis by a traumatic operation.1,4 Many circumcised doctors have an emotional need to defend their culture of origin and to rationalize their personal deprivation by the creation of medical literature asserting prophylactic benefits of circumcision.4 On the other hand, it appears that most non-circumcised doctors and some circumcised doctors oppose circumcision. The AAP has both kinds of doctors within its membership. Consequently, there is an ongoing tug-of-war between the two opposing forces who seek to dominate the AAP’s circumcision policy.2 The medical literature relating to male circumcision is polarized by the 130-year-old debate between the circumcised doctors and the others;1 the AAP may be equally polarized with respect to non-therapeutic male circumcision because of the presence of so many circumcised doctors within its fellowship.2 Furthermore, Goldman (2004) observes that doctors who have performed circumcisions in their medical practice have an emotional need to defend the practice,2 so they may "deny some of the evidence against circumcision."2

The AAP claims that its circumcision policies (all four of them) are evidence-based. The reality, however, is quite different. Thompson (1983) reported great controversy within the ad hoc commitee that produced the 1975 Report of the Ad Hoc Task Force on Circumcision and a necessity to compromise the evidence.5 The dissension in the task force that produced the 1989 AAP Report of the Task Force on Circumcision erupted into open warfare in the pages of the May 3, 1990 issue of the New England Journal of Medicine, with Edgar J. Schoen, MD, FAAP, representing the circumcision party6 and Ronald L. Poland, MD, representing the genital integrity advocates.7

Goldman (2004) reports the Task Force that produced the 1999 AAP Circumcision Policy Statement also was filled with controversy and dissension.2 George C. Denniston, MD, MPH, the president of Doctors Opposing Circumcision, compared the 1999 AAP Circumcision Policy Statement produced by that task force with other AAP statements of good medical practice and the American Medical Association's Principles of Medical Ethics.8 In a letter to the then-president of the AAP, Louis Z. Cooper, M.D., FAAP, et al., he pointed out numerous variances from good medical practice and ethics as reported in other statements by the AAP and AMA.8 Apparently, these variances were necessary to satisfy the male doctors who represented the circumcision party.

Gollaher (2000), discussing the 1999 statement, writes:

“As in the past, the new policy was a compromise meant to reconcile the AAP’s hawks and doves.”9

AAP circumcision policy statements are compromises that have scant relationship to the real evidence. Even after being informed of the variances by Denniston,8 the AAP took no action to bring its Circumcision Policy Statement into conformity with good medical practice and ethics. The need to provide a compromise acceptable to the circumcised male doctors who appear to dominate AAP circumcision policy, therefore, takes precedence over the health, well-being, human rights, best interests, and genital integrity of America's children.

References

  1. Hill G. The case against circumcision. J Mens Health Gend 2007;4(3):318–23. [Full Text]
  2. Goldman R. Circumcision policy: a psychosocial perpective. Paediatr Child Health 2004;9(9):630–3. [Full Text]
  3. Van Howe RS. A cost-utility analysis of neonatal circumcision. Med Decis Making 2004;24:584–601. [Full Text]
  4. Goldman R. The psychological impact of circumcision. BJU Int 1999;83 Suppl. 1:93–103. [Full Text]
  5. Thompson HC. The value of neonatal circumcision. An unanswered and perhaps unanswerable question. Am J Dis Child 1983;137: 939–40. [Full Text]
  6. Schoen EJ. The status of circumcision of newborns. New Engl J Med 1990;322(18):1308–12.
  7. Poland RL. The question of routine neonatal circumcision. N Eng J Med 1990;322(18):1312–5. [Full Text]
  8. Denniston GC. Letter to Louis V. Cooper, M.D. et al., October 15, 2002. [Full Text]
  9. Gollaher DL. Circumcision: A History of the World's Most Controversial Surgery. New York: Basic Books, 2000: p. 173.

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