Douglas Diekema

Colleagues & Benefactors:

Susan Blank Andrew Freedman

Member of:

AAP Circumcision Task Force 2012

Associates with:

American Academy of Pediatrics

Douglas Diekema is a paediatric bioethicist serving on AAP's Task Force on Circumcision.

Douglas S. Diekema, MD, MPH, is attending physician and director of education for the Treuman Katz Center for Pediatric Bioethics at Seattle Children’s Hospital and professor in the Department of Pediatrics at the University of Washington School of Medicine. He received his MD from the University of North Carolina School of Medicine and his MPH from the University of Washington School of Public Health.

He caused controversy by advocating a ritual nick of the clitoris of young girls.

The Ashley Treatment

Douglas Diekema also caused controversy with his participation as chair of the Children's Hospital institutional review board that handled the Ashley case. The Ashley Treatment refers to a controversial set of medical procedures undergone by a Seattle child, “Ashley X”. Ashley, born in 1997, has severe developmental disabilities due to static encephalopathy of unknown etiology; she is, and will remain, at an infant level mentally and physically. The treatment included growth attenuation via estrogen therapy; hysterectomy (to prevent menstruation and possibility of pregnancy), bilateral breast bud removal (to prevent the development of large breasts), and appendectomy (to prevent appendicitis). The principal purpose of the treatment was to improve Ashley’s quality of life by limiting her growth in size, eliminating menstrual cramps and bleeding, and preventing discomfort from large breasts. The combination of the surgery and the estrogen therapy attracted much public comment and ethical analysis in early 2007, both supportive and condemning. The hospital later admitted that the surgery was illegal and should only have been performed after a court order, a position that is disagreed upon by the attorney of Ashley’s family.

Dr. Diekema and Dr. Gunther wrote an article in 2006 defending the case. Dr. Diekema also defended his position on media interviews.

Dr. Daniel F. Gunther, the doctor who performed the hysterectomy on the six year old, committed suicide for unclear reasons.

Read also Pillow Angel Ethics.

Quotes

“	Female genital cutting [It] would remove no tissue, would not touch any significant organ but, rather [it] would be a small nick of the clitoral hood which is the equivalent of the male foreskin - nothing that would scar, nothing that would do damage, [...] (The Sydney Morning Herald)

“	Ritual Nick is less extensive than male circumcision We’re talking about something far less extensive than the removal of foreskin in a male

“

Circumcision death [I will say that there are not 117 deaths in the United States that are directly the result of circumcision... ...for example, there's at least one of these cases that gets trotted out that involved a very sick baby that was likely to die anyway and his parents wanted him circumcised before his death. And to attribute that to a circumcision is silly. (KQED Radio)

“

The Benefits (Explaining why the AAP didn't recommend circumcision outright) Even when something in medical practice may benefit a patient, the level of benefit may not be so overwhelming that it would lead to a universal recommendation. Other factors may come into play in those situations, like the cost of the procedure, the parents’ values, or other nonmedical factors. In the case of circumcision, the likelihood that the benefits would accrue to an individual child are relatively small, and it seems reasonable that a child’s parents should be weighing the risks and benefits of the procedure in consultation with their physician. (The Washington Post)

“

Disregard for Self Determination [Circumcision] does carry some risk and does involve the loss of the foreskin, which some men are angry about. But it does have medical benefit. Not everyone would trade that foreskin for that medical benefit. Parents ought to be the decisionmakers here. They should be fully informed. (Broward Palm Beach New Times)

“

Circumcision and Sexual Pleasure What you really want to know -- , it's fine and dandy to say circumcision removes all kinds of nerve cells, but more nerves doesn't necessarily equate to more pleasure -- so what you really want to know but can't look under a microscope and get the answer is: How has the sexual experience changed?" Ultimately, we don't have any good data. Circumcised men may experience sex differently than uncircumcised men -- intuitively that makes sense -- but it's simply not the case that we have an epidemic of uncircumcised men that don't get pleasure or can't function sexually. (Broward Palm Beach New Times)

“	The Task Force [...] a moderate group -- not pro, not anti. We're trying to uncover what's real here.

“

Attitude Towards Intactivists For individuals who have decided that circumcision is wrong, no amount or quality of data will put these questions to rest. It is always possible to find potential weaknesses in any study. What the AAP report does is provide a critical assessment of all of the studies that have been done to date. There are clearly many studies of good quality that demonstrate that circumcision has potential medical benefits. (The Washington Post)

Job posting

Douglas Diekema posted a job opening for a Clinical Bioethics Fellowship at the website of the The Society of Jewish Ethics File:Societyofjewishethics.org-node-52.pdf

Religious influence

“

Where my religious beliefs take me is rarely different from where a standard bioethics analysis might take me One of the challenges of being a Christian who does ethics in a secular medical setting is struggling with how to integrate your own personal beliefs in a setting where overt religious and theological considerations really aren’t considered appropriate, unless they are the patient’s or family’s religious beliefs. What I’ve discovered is that where my religious beliefs take me is rarely different from where a standard bioethics analysis might take me. And, I think one of the skills I’ve had to learn is that if I do arrive at a decision about what I think is the right thing to do and my reasons for believing that are related to my religious beliefs, I have to be able to craft secular arguments to support that view. The real art of bioethics is convincing other people why something is right or something is wrong and why something shouldn’t be done or should be done. Many people aren’t going to pay attention to you if that argument is crafted purely in religious language. One of the things that I’ve had to do is craft arguments in the language of the world, which I have not found to be particularly difficult. The reality is that medical ethics has its roots largely in theological ethics, so the basic principles that many people who are not religious subscribe to actually have very strong roots in the Bible and in religious belief. (The Spark Online)

CircWatch

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