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American Academy of Pediatrics

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On April 26, 2010, the AAP changed its long-held stance against female genital cutting.
<ref>{{REFnews
| last=Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | date=2010-05-11 | publisher=Time | quote=On April 26, the organization changed its long-held stance on female genital cutting... | accessdate=2011-09-27
}}</ref> In their report, chiefly authored by Dena Davis, a professor at Cleveland-Marshall College of Law at Cleveland State University,<ref>{{REFnews
| last=Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | date=2010-05-11 | publisher=Time | quote=...the report's lead author, Dena Davis, a professor at Cleveland-Marshall College of Law at Cleveland State University... | accessdate=2011-09-27
}}</ref> the AAP advised doctors to inform families that the procedure is medically unnecessary and even dangerous.<ref>{{REFnews
| last=Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | date=2010-05-11 | publisher=Time | quote=In its new report, the AAP advises doctors to inform families... | accessdate=2011-09-27
}}</ref> The AAP raised the idea of legalizing a less-severe ritual cutting, which they compared to an ear piercing,<ref>{{REFnews
| last=Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | date=2010-05-11 | publisher=Time | quote=...the AAP raises the idea of legalizing a less-severe ritual cutting... | accessdate=2011-09-27
}}</ref><ref>{{REFjournal
|last=MacReady
|accessdate=2011-09-27
}}</ref> and offering a "ritual nick" might dissuade parents that were resolute, from sending their daughters to their home countries,<ref>{{REFnews
| last=Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | date=2010-05-11 | publisher=Time | quote=...to dissuade parents from sending their daughters to be circumcised in their home country... | accessdate=2011-09-27
}}</ref> thereby avoiding greater harm.<ref>{{REFnews
| last=Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | date=2010-05-11 | publisher=Time | quote=...a ritual nick as a possible compromise to avoid greater harm... | accessdate=2011-09-27
}}</ref> The AAP had deviated from a much more forceful statement published in 1998, which unequivocally condemned FGC in any form.<ref>{{REFjournal
|last=MacReady
The Girls Protection Act, which would make it illegal to take a minor outside the U.S. to seek female circumcision, was introduced in Congress on the same day the AAP published its new recommendation.
<ref>{{REFnews
| last=Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | date=2010-05-11 | publisher=Time | quote=On the same day the AAP published its new recommendation... | accessdate=2011-09-27
}}</ref> New York Representative Joseph Crowley, one of the bill's sponsors, condemned the AAP's move as "the wrong step forward on how best to protect young women and girls" by creating confusion about the acceptability of FGM in any form.<ref>{{REFnews
| last=Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | date=2010-05-11 | publisher=Time | quote=I am sure the academy had only good intentions... | accessdate=2011-09-27
}}</ref> Davis of the AAP countered that such a law would be difficult to enforce.<ref>{{REFnews
| last=Luscombe | first=Belinda | coauthors= | url=http://www.time.com/time/health/article/0,8599,1988434,00.html | title=Has a U.S. Pediatrics Group Condoned Genital Cutting? | date=2010-05-11 | publisher=Time | quote=Davis counters that such a law would be extremely difficult to enforce. | accessdate=2011-09-27
}}</ref>
The AAP wrote the following in their 2010 FGC Policy:
{{Citation
| Text=The American Academy of Pediatrics policy statement on newborn male circumcision expresses respect for parental decision-making and acknowledges the legitimacy of including cultural, religious, and ethnic traditions when making the choice of whether to surgically alter a male infant's genitals.<small>(119)</small> | Author=Committee on Bioethics | Source=AAP Policy Statement on Ritual Genital Cutting of Female Minors (April, 2010).
}}
This was a segue into the following sentence:
{{Citation
| Text=But parental rights have limits -- FGC is damaging so it should be disallowed. But maybe we should change the law for the mild alterations.<small>(119)</small> | Author=Committee on Bioethics | Source=AAP Policy Statement on Ritual Genital Cutting of Female Minors (April, 2010).
}}
{{Citation
| Text=In the pluralistic society of the United States in which parents are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare, it is legitimate for the parents to take into account cultural, religious, and ethnic traditions, in addition to medical factors, when making this choice.<small>(119)</small> | Author=Committee on Bioethics | Source=1999 AAP Circumcision Policy Statement (re-affirmed 2005)
}}
{{Citation
| Text=This patient-centered "best interest" standard, which has been accepted by a broad spectrum of groups and commentators, [n9,n10] emphasizes that children ought to be valued as individuals and protects children in situations involving conflict between what is best for the child and what is best for the family or society. | Author= | Source=Caring for Gravely Ill Children (1994)
}}
:The AAP <b>1999 Policy Statement</b> also includes this statement on informed consent:
{{Citation
| Text=The process of informed consent obligates the physician to explain any procedure or treatment and to enumerate the risks, benefits, and alternatives for the patient to make an informed choice. For infants and young children who lack the capacity to decide for themselves, a surrogate, generally a parent must make such choice.<small>(118)</small> | Author= | Source=1999 AAP Circumcision Policy Statement (re-affirmed 2005)
}}
:The above sentences cited <u>Informed Consent, Parental Permission, and Assent in Pediatric Practice</u>, a policy guide by AAP's Bio-ethics Committee.<ref>{{REFweb
| last=Committee on Bioethics | first= | date=1995-02 | title=Informed Consent, Parental Permission, and Assent in Pediatric Practice | url=http://www.cirp.org/library/ethics/AAP/ | publisher=Pediatrics | accessdate=2011-10-09
}}</ref> However, those sentences appear to contradict the document they cited, which says:
{{Citation
| Text=Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. [...] the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent. | Author= | Source=AAP Committee on Bioethics - Informed Consent, Parental Permission, and Assent in Pediatric Practice
}}
: That document also says:
{{Citation
| Text=A patient's reluctance or refusal to assent should also carry considerable weight when the proposed intervention is not essential to his or her welfare and/or can be deferred without substantial risk. | Author= | Source=AAP Committee on Bioethics - Informed Consent, Parental Permission, and Assent in Pediatric Practice
}}
The AAP has no official position on whether a baby can refuse a procedure, nor does it specify if crying in pain counts as reluctance or refusal. However, they do write that a patient's discomfort should be taken into account, and that children should have the necessity of a procedure communicated to them.<ref name="Fleischmann 1994"/> (It might follow that inability to do so means that proceeding with an intervention that could be harmlessly deferred constitutes needless violation of autonomy, or inadequate consent):
{{Citation
| Text=Although very young children may be unable to envision the future benefits of treatment that may justify its associated burdens (eg, pain, discomfort, and hospitalization), their perceptions of those burdens should not be ignored. [...] Regardless of the child's level of participation in planning care, he or she should be given as much control over the actual treatment as possible. | Author= | Source=Caring for Gravely Ill Children (1994)
}}
{{REF}}
 
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