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Doctors Opposing Circumcision
Genital Integrity Policy Statement

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Chapter Twelve: Conclusion

We have set forth in this statement the reasons why non-therapeutic circumcision of male children should not be performed.

Summary

We have discussed in Chapter One the impediments that preclude medical societies from producing an accurate and useful statement, and why it is necessary for Doctors Opposing Circumcision to produce this statement.

We have shown in Chapter Two that the prepuce has various physiological functions throughout life, including:

The excision of the prepuce exposes the newborn to meatal disease and leaves the patient permanently diminished, with impaired and degraded functions.

We have shown in Chapter Three that there is no medical indication for circumcision of the newborn and that the alleged benefits relate to the possible but unproved prevention of future disease. We now know that these alleged benefits are fear-based, confer potential protection at best, and are often overstated and advanced in part by circumcised doctors who are compelled to justify and reenact their own circumcision.1,2

We have shown in Chapter Four that the immediate complications of non-therapeutic male circumcision primarily include:

We have shown in Chapter Five that the post-operative complications of circumcision include:

We have shown in Chapter Six that long-term complications of circumcision include:

We have shown in Chapter Seven that conservative non-invasive or minimally invasive treatment usually is superior to therapeutic circumcision for the treatment of foreskin conditions.

We have shown in Chapter Eight that the United States has a low incidence of genital integrity as compared with other English-speaking nations.

We have shown in Chapter Nine that the non-therapeutic circumcision of male children violates numerous general human rights and children’s rights.

We have shown in Chapter Ten that non-therapeutic circumcision of children is more likely to be unlawful than lawful.

We have shown in Chapter Eleven that non-therapeutic circumcision of male children fails nine ethical tests and is an unethical surgical intervention.

Discussion

We have shown that the genital cutting of male children is unnecessary, harmful, injurious, a threat to good health, and a violation of the child's human rights. The child's best interests include the protection of his legal right to bodily integrity. Boys whose genital integrity is protected suffer none of the harms and insults described above. They enter life with body, mind, and spirit intact. Genital integrity, therefore, is most likely to provide the highest state of health and well-being.

The United States infant morbidity and mortality rates are much higher than they should be in a developed nation. The high incidence of child circumcision has not purchased good infant health. The United States needs a dramatic overhaul of U.S. medical policy and a change in the medical culture with regard to non-therapeutic circumcision of male children and the protection of their genital integrity.

The male is the weaker and more fragile of the two genders,3 with higher rates of disease, infection,3,4 and death.3 The male, therefore, has greater need of protection. America has it backward, protecting females from circumcision, but not males. This needs to be rectified. Children of both genders deserve our protection.

Ending circumcision is safe and cost-free. Prior to 1971, Australia had an incidence of neonatal circumcision of more than 65 percent.5 In that year, the Australian Paediatric Association recommended that neonatal circumcision should not be performed.6 The incidence of neonatal circumcision in Australia then declined precipitously7 and settled at about 13 percent. Concurrently, with the decline in circumcision, infant mortality showed a marked improvement and the gap in male and female death rates was narrowed.8 It is clear, therefore, that non-therapeutic male circumcision can be discontinued safely and is likely to result in an improvement in child health.

Twisselmann (2008) writes:

The foreskin has a role in male sexual health, and circumcision is more than merely another disagreeable experience like vaccination that infants are subjected to. Were circumcision a new procedure, ethics approval, scientific support, cooperation from colleagues, trial participants, and government or charity funding would not be forthcoming.9

America needs and is ready for a new policy of genital integrity for its children.

Recommendations

We recommend that the genital integrity of boys be preserved. Parental request for non-therapeutic circumcision of a son appears to exceed the powers granted to parents by law. We further recommend that doctors refuse to perform non-therapeutic circumcision at parental request.

We call on medical schools to stop requiring medical students to perform non-therapeutic circumcisions.

We call on medical societies to repudiate the practice of non-therapeutic child circumcision and to adopt genital integrity policies.

We call on hospitals to prohibit the practice of non-therapeutic circumcision of children in their facilities.

We call on the American Hospital Association to adopt a uniform genital integrity policy for its members.

We call on the United States Conference of Catholic Bishops to apply paragraph 2297 of the Catechism of the Catholic Church and Directives 1, 6, 9, 23, 29, and 33 of the Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition,10 to non-therapeutic circumcision of children.

We call on public and private health insurance providers to support efficient use of health-care resources by ending subsidies for non-therapeutic male circumcision and by promoting genital integrity.

We call on medical doctors everywhere to refuse to perform non-therapeutic circumcision of children.

We call on healthcare professionals everywhere to make clear to the public that non-therapeutic circumcision of children is unhealthy and injurious to children and should not be performed.

We call on state medical boards to establish legal and ethical guidelines for the regulation of male circumcision.

We call on courts to recognize and apply human rights law in cases involving children.

We call on all segments of the medical community and of society to work together to create an environment in which newborn and immature human beings receive the respect for human dignity and the special protection they so richly deserve.11-13

References

  1. Goldman R. The psychological impact of circumcision. BJU Int 1999;83 Suppl. 1:93–103. [Full Text]
  2. Hill G. The case against circumcision. J Mens Health Gend 2007; 4(3):318–23. [Full Text]
  3. Kraemer S. The fragile male. BMJ 2000;321:1609–12. [Full Text]
  4. Thompson DJ, Gezon HM, Rogers KD, et al. Excess risk of staphylococcus infection and disease in newborn males. Am J Epidemiol 1965;84(2):314–28.
  5. Richters J, Smith AMA, de Visser RO, et al. Circumcision in Australia: prevalence and effects on sexual health. Int J STD AIDS 2006;17:547–54. [Full Text]
  6. Belmaine SP. Circumcision. Med J Aust 1971;1:1148. [Full Text]
  7. Wirth JL. Current circumcision practices in Australia: a discussion of medical insurance statistics for circumcisions in Australia, state by state. Med J Aust 1982;1:177–80.
  8. Part II, Section 3: Mortality. A picture of Australia's children. Canberra: Australian Institute for Health and Welfare, 2005. [Full Text]
  9. Twisselmann B. Circumcision: right or wrong. summary of responses. BMJ 2008;336(7635):60. doi:10.1136/bmj.39451.714606.BE [Full Text]
  10. Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition, Washington, DC: U.S. Conference of Catholic Bishops, 2001. [Full Text]
  11. International Covenant on Civil and Political Rights. Adopted and opened for signature, ratification and accession by General Assembly resolution 2200A (XXI) of 16 December 1966 entry into force 23 March 1976, in accordance with Article 49. [Full Text]
  12. Bioethics Committee, Canadian Paediatric Society. Treatment decisions regarding infants, children and adolescents. Paediatr Child Health 2004;9(2):99–103. [Full Text]
  13. Intergovernmental Bioethics Committee. Universal Declaration on Bioethics and Human Rights. Adopted by the General Conference of the United Nations Educational, Scientific and Cultural Organization on 19 October 2005. [Full Text]

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