Policy statements by medical organizations: Difference between revisions
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== Introduction == | == Introduction == | ||
Medical organizations in the various English speaking nations have found it appropriate to issue policy statements for the information of the medical community and the public. The Circumcision Reference Library has collected these official policy statements, both old and new, from the various English speaking nations. The medical societies of non-English speaking nations do not issue circumcision policy statements because neonatal male circumcision is not a practice of those countries. The older statements may not reflect current policy but are presented for reference purposes. | [[Medical trade association| Medical organizations]] in the various English speaking nations have found it appropriate to issue policy statements for the information of the medical community and the public. The Circumcision Reference Library has collected these official policy statements, both old and new, from the various English speaking nations. The medical societies of non-English speaking nations do not issue circumcision policy statements because neonatal male circumcision is not a practice of those countries. The older statements may not reflect current policy but are presented for reference purposes. | ||
=== Conflict of interest === | === Conflict of interest === | ||
Medical organizations are political associations of doctors that have a duty to represent the interests of their doctor members, of whom some may profit by performing circumcision. The protection of the income and estates of the members may be given high priority. This duty to the members may in some instances prevent complete candor about the effects of non-therapeutic circumcision. Generally, the alleged prophylactic benefits of male circumcision are overstated while the risks, complications, certain injury, and other drawbacks are understated. Human rights, legal, and ethical issues usually glossed over. The content of circumcision policy statements may also be influenced by religious and political considerations. | Medical organizations are political associations of doctors that have a duty to represent the interests of their doctor members, of whom some may profit by performing [[circumcision]]. The protection of the income and estates of the members may be given high priority. This duty to the members may in some instances prevent complete candor about the effects of non-therapeutic circumcision. Generally, the alleged prophylactic benefits of male circumcision are overstated while the risks, [[Complication| complications]], [[Trauma| certain injury]], and other drawbacks are understated. [[Human rights]], legal, and ethical issues are usually glossed over. The content of circumcision policy statements may also be influenced by religious and political considerations. | ||
== Statements == | == Statements == | ||
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==== Canadian Paediatric Society ==== | ==== Canadian Paediatric Society ==== | ||
The '''Canadian Paediatric Society''' issued its first statement on neonatal circumcision in 1975. It issued a supplement in 1982 and again in 1989 in response to the Wiswell claims regarding UTI that appeared in the medical literature. These statements are collected into one file. The CPS issued a completely new policy statement in 1996 which is in its own file. | The '''Canadian Paediatric Society''' issued its first statement on neonatal [[circumcision]] in 1975. It issued a supplement in 1982 and again in 1989 in response to the Wiswell claims regarding [[UTI]] that appeared in the medical literature. These statements are collected into one file. The CPS issued a completely new policy statement in 1996 which is in its own file. | ||
* [https://www.cirp.org/library/statements/cps1975/ Canadian Paediatric Society (1975, 1982, 1989)] | * [https://www.cirp.org/library/statements/cps1975/ Canadian Paediatric Society (1975, 1982, 1989)] | ||
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The following statement by the Canadian Paediatric Society was issued especially to reject the contentions of Thomas E. Wiswell, MD, concerning the value of neonatal circumcision in preventing urinary tract infection. | The following statement by the Canadian Paediatric Society was issued especially to reject the contentions of [[Thomas E. Wiswell]], MD, concerning the value of neonatal [[circumcision]] in preventing [[urinary tract infection]]. | ||
* [https://www.cirp.org/library/statements/cps3/ Canadian Paediatric Society (1989)] | * [https://www.cirp.org/library/statements/cps3/ Canadian Paediatric Society (1989)] | ||
This is the | This is the very good 1996 CPS policy statement by lead author Dr. Eugene Outerbridge: | ||
* {{REFjournal | * {{REFjournal | ||
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|issue=6 | |issue=6 | ||
|pages=769-80 | |pages=769-80 | ||
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1487803/ | |||
}} (link to CPS website) | }} (link to CPS website) | ||
The CPS | The CPS recommended that "Circumcision of newborns should not be routinely (i.e.,in the absence of medical indication) performed." Since there are no medical indications for circumcision in the newborn period, in effect, the CPS is saying that newborn circumcisions should not be performed. | ||
The CPS updated its current circumcision statement in 2015. Sadly, it appears to have been influenced by the now discredited and expired 2012 AAP statement. | |||
* {{REFjournal | |||
|last=Sorokin | |||
|first=S. Todd | |||
|init=ST | |||
|author-link= | |||
|last2=Finlay | |||
|init2=JC | |||
|author2-link= | |||
|last3=Jeffries | |||
|init3=AL | |||
|author3-link= | |||
|etal=yes | |||
|title=Newborn male circumcision | |||
|journal=Paediatr Child Health | |||
|location= | |||
|date=2015-08 | |||
|volume=20 | |||
|issue=6 | |||
|pages=311-20 | |||
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578472/ | |||
|quote= | |||
|pubmedID=26435672 | |||
|pubmedCID=4578472 | |||
|DOI=10.1093/pch/20.6.311 | |||
|accessdate=2023-05-31 | |||
}} | |||
==== College of Physicians and Surgeons of British Columbia ==== | ==== College of Physicians and Surgeons of British Columbia ==== | ||
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==== American Academy of Pediatrics ==== | ==== American Academy of Pediatrics ==== | ||
The '''American Academy of Pediatrics''' (AAP) issued a brief statement within its 1971 hospital care manual. An ad hoc committee issued a longer statement in 1975. More information was contained in the 1978 hospital care manual. A supplement to the 1975 statement was issued in 1989 by a task force assembled for that purpose. This 1989 supplement recognized the pain of neonatal circumcision for the first time. The 1989 statement reaffirmed the previous position that there is no medical indication for neonatal circumcision and reported new information on the role of the HPV virus in cervical cancer. The 1997 statement emphasized the elective nature of child circumcision. The Circumcision Reference Library has combined these statements into one file. The AAP statements dated prior to 1999 have been superseded by the 1999 policy statement. The 1999 policy statement has its own file. | The '''American Academy of Pediatrics''' (AAP) issued a brief statement within its 1971 hospital care manual. An ad hoc committee issued a longer statement in 1975. More information was contained in the 1978 hospital care manual. A supplement to the 1975 statement was issued in 1989 by a task force assembled for that purpose. This 1989 supplement recognized the [[pain]] of neonatal circumcision for the first time. The 1989 statement reaffirmed the previous position that there is no medical indication for neonatal circumcision and reported new information on the role of the HPV virus in cervical cancer. The 1997 statement emphasized the elective nature of child circumcision. The Circumcision Reference Library has combined these statements into one file. The AAP statements dated prior to 1999 have been superseded by the 1999 policy statement. The 1999 policy statement has its own file. | ||
* [https://www.cirp.org/library/statements/aap/ American Academy of Pediatrics (1971, 1975, 1977, 1989, 1997)] | * [https://www.cirp.org/library/statements/aap/ American Academy of Pediatrics (1971, 1975, 1977, 1989, 1997)] | ||
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}} | }} | ||
The AAP has also issued several other statements relevant to the consideration of male circumcision. The first is its statement on neonatal anesthesia which was issued in 1987. This statement anticipates the new AAP position that pain control is required for circumcision pain. | The AAP has also issued several other statements relevant to the consideration of male circumcision. The first is its statement on neonatal anesthesia which was issued in 1987. This statement anticipates the new AAP position that pain control is required for [[Pain| circumcision pain]]. | ||
* [https://www.cirp.org/library/pain/aap/ Neonatal Anesthesia (1987)] | * [https://www.cirp.org/library/pain/aap/ Neonatal Anesthesia (1987)] | ||
The '''AAP''' statement on breastfeeding which was issued in 1997 is relevant because it recommends breastfeeding as a preventive measure against urinary tract infection. Previously, the AAP recommended circumcision as a preventive measure against urinary tract infection. This is an important policy change. | The '''AAP''' statement on breastfeeding which was issued in 1997 is relevant because it recommends [[breastfeeding]] as a preventive measure against [[urinary tract infection]]. Previously, the AAP recommended circumcision as a preventive measure against urinary tract infection. This is an important policy change. | ||
* [http://www.aap.org/policy/re9729.html Breastfeeding and the Use of Human Milk (1997)] | * [http://www.aap.org/policy/re9729.html Breastfeeding and the Use of Human Milk (1997)] | ||
Furthermore, the '''AAP''' statement on breastfeeding contains an implicit advice against circumcision: It states that "procedures that may interfere with breastfeeding or traumatize the infant should be avoided or minimized." Neonatal circumcision is the most common traumatic procedure carried out on newborns. | Furthermore, the '''AAP''' statement on breastfeeding contains an implicit advice against circumcision: It states that "procedures that may interfere with breastfeeding or traumatize the infant should be avoided or minimized." Neonatal circumcision is the most common [[trauma| traumatic procedure]] carried out on newborns. | ||
The 1999 '''AAP''' Circumcision Policy Statement's position on the medical ethics of circumcision is inconsistent with major AAP Committee on Bioethics policy statements. The AAP completely revised its policy on informed consent in 1995 to bring their policy into conformity with the provisions of the [https://www.cirp.org/library/ethics/UN-convention/ UN Convention on the Rights of the Child (1989)]. The 1995 statement of the Committee on Bioethics says that parents may only grant permission for diagnosis and treatment. This would exclude consent for non-therapeutic neonatal circumcision which is neither diagnosis nor treatment. The statement also calls for the delay on non-essential procedures until the child is developmentally capable of granting consent. | The 1999 '''AAP''' Circumcision Policy Statement's position on the medical ethics of circumcision is inconsistent with major AAP Committee on Bioethics policy statements. The AAP completely revised its policy on informed consent in 1995 to bring their policy into conformity with the provisions of the [https://www.cirp.org/library/ethics/UN-convention/ UN Convention on the Rights of the Child (1989)]. The 1995 statement of the Committee on Bioethics says that parents may only grant permission for diagnosis and treatment. This would exclude consent for non-therapeutic neonatal circumcision which is neither diagnosis nor treatment. The statement also calls for the delay on non-essential procedures until the child is developmentally capable of granting consent. | ||
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|last=AAP Task Force on Circumcision | |last=AAP Task Force on Circumcision | ||
|title=Circumcision policy statement | |title=Circumcision policy statement | ||
|url= | |url=https://publications.aap.org/pediatrics/article/130/3/585/30235/Circumcision-Policy-Statement?autologincheck=redirected | ||
|journal=Pediatrics | |journal=Pediatrics | ||
|date=2012 | |date=2012 | ||
|volume=130 | |volume=130 | ||
|pages=585-6 | |pages=585-6 | ||
| | |DOI=10.1542/peds.2012-1989 | ||
}} | }} | ||
* {{REFjournal | * {{REFjournal | ||
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|volume=130 | |volume=130 | ||
|pages=e756-85 | |pages=e756-85 | ||
| | |DOI=10.1542/peds.2012-1990 | ||
|format=PDF | |format=PDF | ||
}} | }} | ||
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|volume=00 | |volume=00 | ||
|pages=1–8 | |pages=1–8 | ||
| | |DOI=10.1136/medethics-2013-101346 | ||
|note=Published on line ahead of print | |note=Published on line ahead of print | ||
}} | }} | ||
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|issue=4 | |issue=4 | ||
|pages=1-5 | |pages=1-5 | ||
| | |DOI=10.1542/peds.2012-2896 | ||
|note=Published on line ahead of print | |note=Published on line ahead of print | ||
}} | }} | ||