Position statements on infant circumcision: Difference between revisions

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Perhaps the most shocking fact is that circumcision continues to be practiced in the United States even though no official western medical organization in the world recommends it. The Royal Dutch Medical Society, The British Medical Association, the Canadian Pediatric Society, and the Royal Australian College of Physicians have all made official policy statements against circumcision.  
Perhaps the most shocking fact is that circumcision continues to be practiced in the [[United States]] even though no official western medical organization in the world recommends it. The Royal Dutch Medical Society, The British Medical Association, the Canadian Pediatric Society, and the Royal Australian College of Physicians have all made official policy statements against circumcision.  


The American Academy of Pediatrics, the American Medical Association, the American Academy of Family Physicians, and the American Urological Association all do not recommend circumcision, but deceptively claim "potential" benefits. (The word ''potential'' means to exist in possibility, but ''not'' in actuality,<ref>{{REFweb
The American Academy of Pediatrics, the American Medical Association, the American Academy of Family Physicians, and the [[American Urological Association]] all do not recommend circumcision, but deceptively claim "potential" benefits. (The word ''potential'' means to exist in possibility, but ''not'' in actuality,<ref>{{REFweb
  |url=https://medical-dictionary.thefreedictionary.com/potential
  |url=https://medical-dictionary.thefreedictionary.com/potential
|archived=
  |title=Potential
  |title=Potential
|trans-title=
|language=English
|last=
|first=
|author-link=
  |publisher=The Free Dictionary by Farlex.
  |publisher=The Free Dictionary by Farlex.
  |website=https://medical-dictionary
  |website=https://medical-dictionary
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}}</ref> so a "''potential'' benefit" is an imaginary benefit.)  
}}</ref> so a "''potential'' benefit" is an imaginary benefit.)  


The trend of opinion on non-therapeutic male circumcision is overwhelmingly negative in industrialized nations. No respected medical board in the world recommends circumcision for infants, not even in the name of HIV prevention. They must all point to the risks, and they must all state that there is no convincing evidence that the benefits outweigh these risks. To do otherwise would be to take an unfounded position against the best medical authorities of the West.
The trend of opinion on non-therapeutic male circumcision is overwhelmingly negative in industrialized nations. No respected medical board in the world recommends circumcision for infants, not even in the name of [[HIV]] prevention. They must all point to the risks, and they must all state that there is no convincing evidence that the benefits outweigh these risks. To do otherwise would be to take an unfounded position against the best medical authorities of the West.


== United States of America ==
== United States of America ==
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===The trade associations pact===
===The trade associations pact===


The circumcision policies of American medical trade associations are currently in chaos.
The circumcision policies of American [[medical trade association| medical trade associations]] are currently in chaos.


The three trade associations, whose member profit by carrying out non-therapeutic circumcision of boys formed a pact in 2007 to create a circumcision statement that would protect [[third-party payment]] for non-therapeutic circumcision. The three trade associations are:
The three trade associations, whose member profit by carrying out non-therapeutic circumcision of boys formed a pact in 2007 to create a circumcision statement that would protect [[third-party payment]] for non-therapeutic circumcision. The three trade associations are:


American College of Obstetricians and Gynecologists (ACOG)
* [[American Congress of Obstetricians and Gynecologists| American College of Obstetricians and Gynecologist]]s (ACOG)
 
* [[American Academy of Family Physicians]] (AAFP)
[[American Academy of Family Physicians]] (AAFP)
* [[American Academy of Pediatrics]] (AAP)
 
[[American Academy of Pediatrics]]. (AAP)


===American Academy of Pediatrics===
===American Academy of Pediatrics===
The American Academy of Pediatrics (AAP) would take the lead and create a task force to draft a new statement. It would have representatives from AAFP and ACOG. The monetary intent of the AAP, ACOG, and AAFP is made clear by the appointment of  medical insurance specialist Steven Wegner, MD, JD, representing the AAP Committee on Child Health Financing, to the task force.
The American Academy of Pediatrics (AAP) would take the lead and create a task force to draft a new statement. It would have representatives from AAFP and ACOG. The monetary intent of the AAP, ACOG, and AAFP is made clear by the appointment of  medical insurance specialist Steven Wegner, {{MD}}, {{JD}}, representing the AAP Committee on Child Health Financing, to the task force.


The AAP released its two-part statement<ref name="2012policy">{{REFjournal
The AAP released its two-part statement<ref name="2012policy">{{REFjournal
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  |etal=no
  |etal=no
  |title=Circumcision Policy Statement
  |title=Circumcision Policy Statement
|trans-title=
|language=English
  |journal=Pediatrics
  |journal=Pediatrics
  |location=
  |location=
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  |pages=585-6
  |pages=585-6
  |url=http://www.cirp.org/library/statements/
  |url=http://www.cirp.org/library/statements/
|archived=
|quote=
  |pubmedID=22926180
  |pubmedID=22926180
  |pubmedCID=
  |pubmedCID=
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  |etal=no
  |etal=no
  |title=Male circumcision
  |title=Male circumcision
|trans-title=
|language=English
  |journal=Pediatrics
  |journal=Pediatrics
  |location=
  |location=
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  |pages=e756-e785
  |pages=e756-e785
  |url=https://pediatrics.aappublications.org/content/pediatrics/130/3/e756.full.pdf
  |url=https://pediatrics.aappublications.org/content/pediatrics/130/3/e756.full.pdf
|archived=
|quote=
  |pubmedID=22926175
  |pubmedID=22926175
  |pubmedCID=
  |pubmedCID=
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The statement immediately received scathing, withering critical comment from many sources,<ref>{{REFweb
The statement immediately received scathing, withering critical comment from many sources,<ref>{{REFweb
  |url=http://www.circumstitions.com/news/news48.html#aap12
  |url=http://www.circumstitions.com/news/news48.html#aap12
|archived=
  |title=Intactivism News
  |title=Intactivism News
|trans-title=
|language=English
  |last=Young
  |last=Young
  |first=Hugh
  |first=Hugh
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  |format=
  |format=
  |quote=
  |quote=
}}</ref> including [[Doctors Opposing Circumcision]],<ref>{{REFweb
}}</ref> including [[Doctors Opposing Circumcision (D.O.C.)]],<ref>{{REFweb
  |url=https://www.doctorsopposingcircumcision.org/for-professionals/medical-organization-statements/
  |url=https://www.doctorsopposingcircumcision.org/wp-content/uploads/2016/08/commentary-on-american-academy-of-pediatrics-2012-circumcision-policy-statement.pdf
|archived=
  |title=Commentary on American Academy of Pediatrics2012 Circumcision Policy Statement
  |title=Medical Organization Statements
  |publisher=[[Doctors Opposing Circumcision (D.O.C.)]]
|trans-title=
|language=English
|last=
|first=
|author-link=
  |publisher=Doctors Opposing Circumcision
  |website=www.doctorsopposingcircumcision.org
  |website=www.doctorsopposingcircumcision.org
  |date=2016-03
  |date=2013-04
  |accessdate=2020-06-26
  |accessdate=2020-06-28
  |format=
  |format=
  |quote=By contrast, U.S. medical associations – especially the American Academy of Pediatrics, the lead broker of this cultural practice for decades – have been strategically deferential to parental choice and tradition. The AAP has been equivocal on the medical evidence since declaring circumcision “unnecessary” in 1971 – then walking that disavowal back ever since. The AAP has consistently dangled the specter of unpleasant, even dangerous (but highly unlikely) outcomes for intact boys, while disingenuously leaving it up to frightened young parents to make an immediate ‘decision.’ The rare mention by the AAP of the [[human rights]] of the child to an intact body has been, at best, parenthetical, and at worst, disdainful and dismissive.
  |quote=The 2012 Circumcision Policy Statement was created by a team put together for the specific purpose of protecting the goose that lays golden eggs for the American medical industry. None of the members had any specific expertise in circumcision and their document suggests they knew little or nothing about the anatomy and utility of the human foreskin. They claimed to have studied voluminous literature, but ignored older and more useful studies, and cherry-picked the medical oeuvre.
}}</ref> an association of European doctors,<ref>{{REFjournal
}}</ref> an association of European doctors,<ref>{{REFjournal
  |last=Frisch
  |last=Frisch
  |first=M
  |init=M
  |author-link=Morten Frisch
  |author-link=Morten Frisch
  |last2=Aigrain
  |last2=Aigrain
  |first2=Yves
  |first2=Yves
|init2=Y
  |author2-link=
  |author2-link=
  |last3=Barauskas
  |last3=Barauskas
  |first3=Vidmantas
  |first3=Vidmantas
|init3=V
  |author3-link=
  |author3-link=
  |last4=Bjarnason,
  |last4=Bjarnason
  |first4=Ragnar
  |first4=Ragnar
|init4=R
  |author4-link=
  |author4-link=
  |last5=Boddy
  |last5=Boddy
  |first5=Su-Anna
  |first5=Su-Anna
|init5=SA
  |author5-link=
  |author5-link=
  |last6=Czauderna
  |last6=Czauderna
  |first6=Piotr
  |first6=Piotr
|init6=P
  |author6-link=
  |author6-link=
  |last7=de Gier
  |last7=de Gier
  |first7=Robert
  |first7=Robert
|init7=R
  |author7-link=
  |author7-link=
  |last8=de Jong
  |last8=de Jong
  |first8=Tom
  |first8=Tom
|init8=T
  |author8-link=
  |author8-link=
  |last9=Günter
  |last9=Günter
  |first9=Faschig
  |first9=Faschig
|init9=F
  |author9-link=
  |author9-link=
  |etal=yes
  |etal=yes
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  |pages=796-800
  |pages=796-800
  |url=https://pediatrics.aappublications.org/content/131/4/796
  |url=https://pediatrics.aappublications.org/content/131/4/796
|archived=
|quote=
  |pubmedID=23509170
  |pubmedID=23509170
  |pubmedCID=
  |pubmedCID=
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}}</ref>  and others.<ref>{{REFjournal
}}</ref>  and others.<ref>{{REFjournal
  |last=Steven
  |last=Steven
  |first=JS
  |init=JS
  |author-link=J. Steven Svoboda
  |author-link=J. Steven Svoboda
  |last2=Van Howe  
  |last2=Van Howe  
  |first2=RS
  |init2=RS
  |author2-link=Robert S. Van Howe
  |author2-link=Robert S. Van Howe
  |etal=no
  |etal=no
  |title=Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision
  |title=Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision
|trans-title=
|language=
  |journal=J Med Ethics
  |journal=J Med Ethics
  |location=
  |location=
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  |pages=434-41
  |pages=434-41
  |url=https://www.arclaw.org/wp-content/uploads/Svoboda-Van-Howe-Out-of-Step-Fatal-Flaws-in-AAP...-JME-2013.pdf
  |url=https://www.arclaw.org/wp-content/uploads/Svoboda-Van-Howe-Out-of-Step-Fatal-Flaws-in-AAP...-JME-2013.pdf
|archived=
|quote=
  |pubmedID=23508208
  |pubmedID=23508208
  |pubmedCID=
  |pubmedCID=
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  |last=Van Howe
  |last=Van Howe
  |first=Robert S.
  |first=Robert S.
|init=RS
  |author-link=Robert S. Van Howe
  |author-link=Robert S. Van Howe
  |etal=no
  |etal=no
  |title=Response to Vogelstein: How the 2012 AAP Task Force on circumcision went wrong
  |title=Response to Vogelstein: How the 2012 AAP Task Force on circumcision went wrong
|trans-title=
|language=English
  |journal=Wiley Bioethics
  |journal=Wiley Bioethics
  |location=
  |location=
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  |pages=77-80
  |pages=77-80
  |url=https://d1wqtxts1xzle7.cloudfront.net/56031979/Van_Howe_2018.pdf?
  |url=https://d1wqtxts1xzle7.cloudfront.net/56031979/Van_Howe_2018.pdf?
|archived=
|quote=
  |pubmedID=28691236
  |pubmedID=28691236
  |pubmedCID=
  |pubmedCID=
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===American College of Obstetricians and Gynecologists===
===American College of Obstetricians and Gynecologists===


Obstetricians are doctors for female patients. They deliver babies so they get the first opportunity to profit from doing circumcision of a baby boy. Although males are outside of the scope of practice of Ob-Gyn, Although its embarrassingly bad statement regarding non-therapeutic infant male circumcision now has been deleted from its website, ACOG still prints and sells promotional pamphlets to its member physicians.
Obstetricians are doctors for female patients. They deliver babies so they get the first opportunity to profit from doing circumcision of a baby boy. Although males are outside of the scope of practice of {{OBGYN}}, although its embarrassingly bad statement regarding non-therapeutic infant male circumcision now has been deleted from its website, ACOG still prints and sells promotional pamphlets to its member physicians.


* {{REFweb |url=https://www.acog.org/store/products/patient-education/pamphlets/labor-delivery-and-postpartum-care/newborn-male-circumcision |title=Newborn Male Circumcision |last |first= |accessdate=2020-06-26}}
* {{REFweb |url=https://www.acog.org/store/products/patient-education/pamphlets/labor-delivery-and-postpartum-care/newborn-male-circumcision |title=Newborn Male Circumcision |last |first= |accessdate=2020-06-26}}
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===Canadian Paediatric Society===
===Canadian Paediatric Society===
The [[Canadian Paediatric Society]] has issued three statements on non-therapeutic neonatal circumcision.  Not one supports the practice.
====1975====
The Canadian Paediatric Society (CPS) took a position against non-therapeutic circumcision of boys in 1975, declaring it to have "no [[medical indication]]" and to be an "obsolete operation".<ref name="cps1975">{{REFjournal
|last=Swyer
|init=PR
|author-link=
|last2=Boston
|init2=RW
|author2-link=
|last3=Murdock
|init3=A
|author3-link=
|last4=Paré
|init4=C
|author4-link=
|last5=Rees
|init5=E
|author5-link=
|last6=Segal
|init6=S
|author6-link=
|last7=Sinclair
|init7=JC
|author7-link=
|etal=no
|title=FN 75 Circumcision in the newborn period
|journal=CPS News Bull Suppl
|location=
|date=1975
|volume=8
|issue=2
|pages=1-2
|url=http://www.cirp.org/library/statements/cps1975/
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|accessdate=2020-06-27
}}</ref>
====1996====


The [https://www.cps.ca/ Canadian Paediatric Society] (1996) stated:
The [https://www.cps.ca/ Canadian Paediatric Society] (1996) stated:
<blockquote>
<blockquote>
[We] do not support recommending circumcision as a routine procedure for newborns. Circumcision of newborns should not be routinely performed.<ref>{{REFjournal
[We] do not support recommending circumcision as a routine procedure for newborns. Circumcision of newborns should not be routinely performed.<ref>{{REFjournal
  |last=Eugene
  |last=Outerbridge
  |first=Outerbridge
|first=Eugene
  |title=Neonatal circumcision revisited.
  |init=E
  |title=Neonatal circumcision revisited
  |journal=CMAJ
  |journal=CMAJ
  |volume=154
  |volume=154
Line 268: Line 286:
}}</ref></blockquote>
}}</ref></blockquote>


===Canadian Urological Association===
====2015====


The [http://www.cua.org/en Canadian Urological Association] issued its statement on circumcision in February 2018.
The CPS again considered non-therapeutic infant circumcision in 2015. The CPS stated:
<blockquote>While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male.<ref name="cps2015">{{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=2020-06-27
}}</ref>
</blockquote>
 
=== Canadian Urological Association ===
 
The [[Canadian Urological Association]] issued its statement on circumcision in February 2018.


{{Citation
{{Citation
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  |last=Dave
  |last=Dave
  |first=Sumit
  |first=Sumit
|init=S
  |author-link=
  |author-link=
  |etal=yes
  |etal=yes
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  |Text=The BMA considers that the evidence concerning health benefits from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it.
  |Text=The BMA considers that the evidence concerning health benefits from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it.
  |Author=The British Medical Association<ref>{{REFdocument
  |Author=The British Medical Association<ref>{{REFdocument
  |title=Non-therapeutic male circumcision (NTMC) of children practical guidance for doctors
  |title=Non-therapeutic male circumcision (NTMC) of children practical guidance for doctors
  |trans-title=
  |trans-title=
  |language=English
  |language=English
  |url=https://www.bma.org.uk/media/1847/bma-non-therapeutic-male-circumcision-of-children-guidance-2019.pdf
  |url=https://www.bma.org.uk/media/1847/bma-non-therapeutic-male-circumcision-of-children-guidance-2019.pdf
|archived=
|contribution=
  |quote=Doctors can refuse to perform NTMC if they do not believe it is in the overall best interests of a child.  Doctors are under no obligation to comply with a request to circumcise a child. In these circumstances, doctors should explain this to the child and his parents, and, if appropriate, explain their right to seek a second opinion.  
  |quote=Doctors can refuse to perform NTMC if they do not believe it is in the overall best interests of a child.  Doctors are under no obligation to comply with a request to circumcise a child. In these circumstances, doctors should explain this to the child and his parents, and, if appropriate, explain their right to seek a second opinion.  
  |trans-quote=
  |trans-quote=
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}}
}}


The National Health Service performs circumcision only for medical reasons.  It does not do non-therapeutic circumcision.
The [https://www.nhs.uk/ National Health Service] performs circumcision only for medical reasons.  It does not offer non-therapeutic circumcision.<ref name="nhs2018">{{REFweb
|url=https://www.nhs.uk/conditions/circumcision-in-boys/
|title=Circumcision in Boys
|publisher=National Health Service
|website=
|date=2018-11-20
|accessdate=2020-06-27
|format=
|quote=
}}</ref>
 
The [https://www.gmc-uk.org/ General Medical Council] has disciplined several medical doctors who performed male circumcision unethically or improperly.
 
See [[United Kingdom]].


== Australia ==
== Australia ==
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We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications and risks which may arise. In particular, we are opposed to male children being subjected to a procedure, which had they been old enough to consider the advantages and disadvantages, may well have opted to reject the operation and retain their prepuce.
We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications and risks which may arise. In particular, we are opposed to male children being subjected to a procedure, which had they been old enough to consider the advantages and disadvantages, may well have opted to reject the operation and retain their prepuce.


Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anaesthesia to remove a normal functional and protective prepuce. At birth, the prepuce has not separated from the underlying glans and must be forcibly torn apart to deliver the glans, prior to removal of the prepuce distal to the coronal groove.
Neonatal male circumcision has no [[medical indication]]. It is a traumatic procedure performed without anaesthesia to remove a normal functional and protective prepuce. At birth, the prepuce has not separated from the underlying glans and must be forcibly torn apart to deliver the glans, prior to removal of the prepuce distal to the coronal groove.
  |Author=J. Fred Leditshke
  |Author=J. Fred Leditshke
  |Source=
  |Source=
Line 347: Line 408:
  |publisher=Australasian Association of Paediatric Surgeons
  |publisher=Australasian Association of Paediatric Surgeons
  |date=1996
  |date=1996
  |location=Herston, QLD
  |location=Herston, {{AUSC|QLD}}
  |accessdate=2020-06-25
  |accessdate=2020-06-25
}}</ref>
}}</ref>
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===Royal Dutch Medical Association===
===Royal Dutch Medical Association===


In the Netherlands, the [https://www.knmg.nl/over-knmg/about-knmg/about-knmg.htm Royal Dutch Medical Association] (KNMG) issued a statement in 2010 stating that "The official viewpoint of KNMG and other related medical/scientific organizations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity." Circumcision can cause complications, including infection and bleeding, and are asking doctors to insistently inform parents that the procedure lacks medical benefits and has a danger of complications. In addition to there not being any convincing evidence that circumcision is necessary or useful for hygiene or prevention, circumcision is not justifiable and is reasonable to put off until an age where any risk is relevant, and the boy can decide himself about possible intervention, or opt for available alternatives. They went on to say "There are good reasons for a legal prohibition of non-therapeutic circumcision of male minors, as exists for female genital mutilation."<ref>{{REFweb
In the Netherlands, the [https://www.knmg.nl/over-knmg/about-knmg/about-knmg.htm Royal Dutch Medical Association] (KNMG) issued a statement in 2010 stating that "The official viewpoint of KNMG and other related medical/scientific organizations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity." Circumcision can cause complications, including infection and [[bleeding]], and are asking doctors to insistently inform parents that the procedure lacks medical benefits and has a danger of complications. In addition to there not being any convincing evidence that circumcision is necessary or useful for hygiene or prevention, circumcision is not justifiable and is reasonable to put off until an age where any risk is relevant, and the boy can decide himself about possible intervention, or opt for available alternatives. They went on to say "There are good reasons for a legal prohibition of non-therapeutic circumcision of male minors, as exists for female genital mutilation."<ref>{{REFweb
  |quote=The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity.
  |quote=The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity.
  |url=https://www.doctorsopposingcircumcision.org/wp-content/uploads/2016/09/knmg-non-therapeutic-circumcision-of-male-minors-27-05-2010.pdf
  |url=https://www.doctorsopposingcircumcision.org/wp-content/uploads/2016/09/knmg-non-therapeutic-circumcision-of-male-minors-27-05-2010.pdf
Line 381: Line 442:
  |accessdate=2020-06-25
  |accessdate=2020-06-25
}}</ref>
}}</ref>
See [[Netherlands]]
{{SEEALSO}}
* [[Circumcision study flaws]]
* [[Financial incentive]]


{{LINKS}}
{{LINKS}}
* {{REFweb
* {{REFweb
  |url=https://www.doctorsopposingcircumcision.org/for-professionals/medical-organization-statements/
  |url=https://www.doctorsopposingcircumcision.org/for-professionals/medical-organization-statements/
|archived=
  |title=Medical Organization Statements
  |title=Medical Organization Statements
|trans-title=
  |publisher=[[Doctors Opposing Circumcision (D.O.C.)]]
|language=English
|last=
|first=
|author-link=
  |publisher=Doctors Opposing Circumcision
  |website=www.doctorsopposingcircumcision.org
  |website=www.doctorsopposingcircumcision.org
  |date=2016-03
  |date=2016-03
Line 401: Line 461:
}}
}}


{{ABBR}}
{{REF}}
{{REF}}