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Their slogan is==History of AAP circumcision policy==The AAP evidently has an apparent long standing policy of appointing members of its various circumcision task forces who are believed by reason of published statements and/or ethnicity to be [[Bias| biased]] in favor of non-therapeutic male circumcision. Some such members are: * [[Susan Blank]]* [[Michael Brady]]* [[Douglas Diekema]]* [[Andrew Freedman]]* [[Edgar J. Schoen]] The AAP apparently hopes to continue to produce statements in favor of circumcision so that the collection of revenue from circumcision can continue. ===First policy (1971)===The first policy was a one-sentence statement in a book on care of the newborn that stated:<blockquote>There are no valid medical indications for circumcision in the neonatal period.<ref name="aap1971">{{REFweb |url=http: //www.cirp.org/library/statements/aap/#a1971 |title=Standards and Recommendation for Hospital Care of Newborn infants. 5th ed. |last= |first= |date=1971 |accessdate=2020-03-31}}</ref></blockquote>===Second policy (1975)===The simple 1971 statement that dismissed circumcision as a medical procedure did not sit well with the AAP, so efforts were made to walk back that statement. An "ad hoc" task force of four male physicians was formed to develop a new statement that was released in 1975. The new statement attempted to shift responsibility and legal liability from the physician to the parents. The statement claimed that "traditional, cultural, and religious factors" could be considered it making a decision to perform non-therapeutic circumcision upon a boy. The statement did not recognize the boy as a person with human and legal rights to bodily integrity, nor did it consider pain control. There was no mention of the numerous [[Foreskin#Physiological_functions| functions of the foreskin]] or of [[Risks and complications| risks and complications]] of circumcision. The statement contained not a single reference. The result was that medically-unecessary, non-therapeutic circumcision could still be performed and doctors could continue to profit thereby and anesthesia for surgery was not required. ===Third policy (1989)===The 1975 policy was considered outmoded so a new "task force on circumcision" with circumcision promoter [[Edgar J. Schoen]] as chairman was formed. This statement claimed for the first time that "potential medical benefits exist.<ref name="aap1999"Dedicated >{{REFjournal |last=Schoen |first=Edgar |author-link=Edgar J. Schoen |last2=Anderson |first2=Glenn |author2-link= |last3=Bohon |first3=Constance |author3-link= |last4=Hinman |first4=Frank |author4-link= |last5=Poland |first5=Ronald |author5-link= |last6=Wakeman |first6=E. Maurice |author6-link= |etal=no |title= Report of the Task Force of Circumcision. |trans-title= |language= |journal=Pediatrics |location= |date=1989-11 |volume=84 |issue=4 |pages=388-91 |url=http://www.cirp.org/library/statements/aap/#a1989 |archived= |quote= |pubmedID=2664697 |pubmedCID= |DOI= |accessdate=2020-03-31}}</ref> One should understand that ''potential'' means to '''Capable of being but not yet in existence; latent or undeveloped''',<ref>{{REFweb |url=https://www.thefreedictionary.com/potential |title=Potential |last= |first= |accessdate=2020-03-31}}</ref> therefore the use of the word ''potential' means the Health medical benefits discussed do not actually exist. The use of All Childrenthe word ''potential'' may be misleading to parents. This statement acknowledged that infants feel pain but minimized the effects of pain and declined to recommend the use on analgesia or anesthesia for foreskin amputation.<ref name="aap1999" /> Based on methodologically flawed studies by circumcision promoted [[Thomas J. Wiswell]],the statement falsely claimed a reduction in the incidence of urinary tract infection (UTI) could be obtained by non-therapeutic infant circumcision.<ref name="aap1999" however /> The statement does not recognize baby boys as human beings with rights that should be respected.<ref name="aap1999" /> Although the protection 1989 statement speaks favorably about non-therapeutic circumcision of infant boys, a careful reading shows that it does not actually recommend circumcision,<ref name="aap1999" /> perhaps for avoidance of legal liability. The statement was not well received. Professor Ronald Poland, a member of the income task force published a dissent in the ''New England Journal of Medicine''.<ref name="poland1990">{{REFjournal |last=Poland |first=Ronald L |author-link= |etal=no |title=The question of routine neonatal circumcision |trans-title= |language= |journal=N Eng J Med |location= |date=1990-05-03 |volume=322 |issue= |pages=1312-5 |url=http://www.cirp.org/library/general/poland/ |archived= |quote= |pubmedID=2183058 |pubmedCID= |DOI=10.1056/NEJM199005033221811 |accessdate=2020-03-31}}</ref> ===Fourth policy (1999)=== The AAP asserted in their 1999 Circumcision Policy Statement that parents have a right to decide to circumcise their children based on cultural or religious factors (although they removed any mention of esthetics as a possible parental motivation, despite previous inclusion in their 1989 statement). No further substantiation of this right was offered. Whether or not a medical benefit was required for parents to make this choice was also not addressed. <br>:The following statement appeared in its members <b>1999 Policy Statement:</b> {{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)}} :The above sentence cited <u>Caring for Gravely Ill Children</u><ref name="fellowsFleischmann 1994">{{REFjournal |last=Fleischman |first=A.L. |last2=Nolan |first2=K. |last3=Dubler |first3=N..N. |etal=yes |date=1994 |title=Caring for gravely ill children |journal=Pediatrics |volume= |issue= |pages=7 |url=http://pediatrics.aappublications.org/content/94/4/433 |quote= |accessdate=2011-10-09}}</ref> as its source. The Fleishman article addresses the ethics of caring for gravely ill and dying children. It is totally irrelevant to the care and non-therapeutic circumcision of well-babies. <!--While this document focuses primarily on sick children and not infants, it does go into much detail on the ethics surrounding autonomy and consent, particularly with respect to patient-centered vs. parent-centered medicine.--> That document says the following, which the AAP's "hands-off" position on circumcision might contradict: {{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 also 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 important considerationintervention 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)}} ===Fifth policy (2012)===
== The AAP's 1999 Circumcision Policy Statement <small>(and its apparent contradictions with other AAP positions on bioethics)</small> ==
The AAP asserted in their 1999 Circumcision Policy Statement that parents have a right to decide to circumcise their children based on cultural or religious factors (although they removed any mention of esthetics as a possible parental motivation, despite previous inclusion in their 1989 statement). No further substantiation of this right was offered. Whether or not a medical benefit was required for parents to make this choice was also not addressed. <br>
:The following statement appeared in its <b>1999 Policy Statement:</b>
{{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)
}}
:The above sentence cited <u>Caring for Gravely Ill Children</u><ref name="Fleischmann 1994">{{REFjournal
|last=Fleischman
|first=A.L.
|last2=Nolan
|first2=K.
|last3=Dubler
|first3=N..N.
|etal=yes
|date=1994
|title=Caring for gravely ill children
|journal=Pediatrics
|volume=
|issue=
|pages=7
|url=http://pediatrics.aappublications.org/content/94/4/433
|quote=
|accessdate=2011-10-09
}}</ref> as its source. The Fleishman article addresses the ethics of caring for gravely ill and dying children. It is totally irrelevant to the care and non-therapeutic circumcision of well-babies. <!--While this document focuses primarily on sick children and not infants, it does go into much detail on the ethics surrounding autonomy and consent, particularly with respect to patient-centered vs. parent-centered medicine.--> That document says the following, which the AAP's "hands-off" position on circumcision might contradict:
{{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)
}}
----
Revise and add text.
[[Image:Aap.jpg|right|thumb|Emblem of the American Academy of Pediatrics]]
The '''American Academy of Pediatrics''' (AAP) is an American trade association of pediatricians, headquartered in Elk Grove Village, Illinois. The AAP advances the financial and business interests of its members. Almost all US pediatricians are members. Hundreds of millions of dollars are paid out to physicians, including pediatricians, obstetrician, and family physicians to provide medically, unnecessary non-therapeutic [[circumcision]] of minor boys. Their slogan is: "Dedicated to the Health of All Children," however the protection of the income of its members ("fellows") is also an important consideration.
The AAP, in association with [[ACOG]] and [[AAFP]], issued a circumcision policy statement in 2012. That statement was heavily criticized by many due to its obvious bias toward obtaining and preserving [[third-party payment]] for non-therapeutic child circumcision.<ref name="doc2013">{{REFweb
}}
The American Academy of Pediatrics (AAP) currently advises parents on its "Healthy Children" website that "The existing scientific evidence is not sufficient to recommend routine (non-therapeutic) circumcision.<ref>{{REFweb
|last=
|first=
In other words, they were using the fact that MGM is accepted as an argument in favor of "milder" FGM.
== AAP‘s pamphlet on intact care ==
<blockquote>The function of the foreskin and the glans at birth is delicate and easily irritated by urine and feces. The foreskin shields the glans. With circumcision this protection is lost. In such cases, the glans and especially the urinary opening (meatus) may become irritated or infected, causing ulcers, meatitis (inflammation of the meatus) and meatal stenosis (a narrowing of the urinary opening.) Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life.</blockquote>
*1990 - The AAP removed the above with no explanation.
==Comment==
The AAP's difficulties with a child circumcision policy is largely of its own doing. The AAP puts its members financial well-being ahead of the [[human rights]] and well-being of its child patients, which it does by omission of significant information and distortion of the medical facts from its numerous circumcision policy statements. Medical societies outside of the United States are in near total disagreement with regard to non-therapeutic child circumcision.
{{SEEALSO}}