Changes

{{Notebox|'''The AAP does not recommend non-therapeutic infant circumcision.''' The AAP is regularly cited with its 2012 circumcision policy as a major US medical organization recommending non-therapeutic infant circumcision. The 2012 policy expired in 2017 and has not been renewed or re-affirmed since.<ref>{{REFjournal |last=AAP Task Force on Circumcision |url=https://publications.aap.org/pediatrics/article/130/3/585/30235/Circumcision-Policy-Statement |title=Circumcision Policy Statement |date=2012-09 |accessdate=2022-11-15 |journal=Pediatrics |volume=130 |issue=3 |pages=585–6 |DOI=10.1542/peds.2012-1989}}</ref>}}  The '''American Academy of Pediatrics''' (AAP) is an American professional a [[medical trade association ]] of American pediatricians, headquartered in Elk Grove Village, Illinois. Almost all U.S. pediatricians are members. The AAP advances the financial and business interests of its members. Hundreds of millions of dollars are paid out by [[Third-party payment| third-parties]] to physicians, including pediatricians, obstetricians, 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 fellows ("members") overrides their duties to children. Preservation of that income stream has always been a fundamental policy of the AAP. The AAP has not recognized the [[human rights]] of children that were granted by the ''International Covenant on Civil and Political Rights'' (1966) and the ''Convention on the Rights of the Child'' (1989), nor has it recognized the legal right of children to [[physical integrity]]. The AAP publishes [https://publications.aap.org/pediatrics/ Pediatrics]. == History of AAP circumcision policy ===== Introduction === 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]] It is thought that the AAP chooses [[circumcised doctors]] who don't have a [[foreskin]] to its various task forces on circumcision, so personal knowledge and understanding of a normal body part has been lacking on its various task forces. Perhaps the AAP believes that such doctors will be [[Bias| biased]] in favor of [[circumcision]]. The AAP apparently hopes to continue to produce statements in favor of [[circumcision]] so that the collection of revenue, usually by [[third-party payment]], 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:{{Citation |Text='''There are no valid medical indications for circumcision in the neonatal period.''' |ref=<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>}} The policy cited the 1970 landmark paper by E. Noel Preston as its authority.<ref name=" Almost preston1970">{{REFjournal |last=Preston |first=E. Noel |init= |author-link= |etal=no |title=Whither the foreskin? |trans-title= |language= |journal=JAMA |location= |date=1970-09 |volume=213 |issue=11 |article= |page= |pages=1853-8 |url=http://www.cirp.org/library/general/preston/ |quote=Routine circumcision of the newborn is an unnecessary procedure. It provides questionable benefits and is associated with a small but definite incidence of complications and hazards. These risks are preventable if the operation is not performed unless truly medically indicated. Circumcision of the newborn is a procedure that should no longer be considered routine. |pubmedID=5468911 |pubmedCID= |DOI=10.1001/jama.213.11.1853 |accessdate=2021-07-23}}</ref> === Second policy (1975) ===The simple 1971 statement that dismissed non-therapeutic 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.<ref name="aap1975">{{REFjournal |last=Thompson |first= |init=HR |author-link= |last2=King |first2= |init2=LR |author2-link= |last3=Knox |first3= |init3=E |author3-link= |etal=yes |title=Report of the ad hoc task force on circumcision |trans-title= |language= |journal=Pediatrics |location= |date=1975-10 |volume=56 |issue=4 |article= |pages=610-1 |url=https://www.cirp.org/library/statements/aap/#a1975 |archived= |quote= |pubmedID=1174384 |pubmedCID= |accessdate=2023-06-13}}</ref> 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 in 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 [[physical integrity| bodily integrity]] and security of the person, 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-unnecessary, non-therapeutic [[circumcision]] could still be performed and doctors could continue to [[Financial incentive| profit thereby]] and anesthesia for surgical [[pain]] 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. It is believed that five of the six members of the task force, or 83 percent, were Jewish and none had an [[intact]] [[foreskin]]. This statement claimed for the first time that "potential" medical benefits exist.<ref name="aap1989">{{REFjournal |last=Schoen |first=Edgar J. |init=EJ |author-link=Edgar J. Schoen |last2=Anderson |first2=Glenn |init2=G |author2-link= |last3=Bohon |first3=Constance |init3=C |author3-link= |last4=Hinman |first4=Frank |init4=F |author4-link= |last5=Poland |first5=Ronald |init5=R |author5-link= |last6=Wakeman |first6=E. Maurice |init6=EM |etal=no |title=Report of the Task Force of Circumcision |journal=Pediatrics |location= |date=1989-11 |volume=84 |issue=4 |pages=388-91 |url=http://www.cirp.org/library/statements/aap/#a1989 |pubmedID=2664697 |pubmedCID= |DOI= |accessdate=2020-03-31}}</ref> One should understand that ''potential'' means to be '''[c]apable 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 medical benefits discussed do not actually exist. The use of the 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 of analgesia or anesthesia for foreskin [[amputation]].<ref name="aap1989"/> Based on methodologically flawed studies by circumcision promoter [[Thomas E. 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="aap1989"/> The statement does not recognize baby boys as human beings with rights that should be respected.<ref name="aap1989"/> Although the 1989 statement speaks favorably about non-therapeutic circumcision of infant boys, a careful reading shows that it does not actually recommend [[circumcision]],<ref name="aap1989"/> perhaps for avoidance of legal liability. The statement was not well received. Professor [[Ronald L. Poland]], a member of the task force, published a dissent in the ''New England Journal of Medicine''.<ref name="poland1990">{{REFjournal |last=Poland |first=Ronald L. |init=RL |author-link= |etal=no |title=The question of routine neonatal circumcision |journal=N Eng J Med |location= |date=1990-05-03 |volume=322 |issue= |pages=1312-5 |url=http://www.cirp.org/library/general/poland/ |pubmedID=2183058 |pubmedCID= |DOI=10.1056/NEJM199005033221811 |accessdate=2020-03-31}}</ref> === Statement on medical ethics === The Committee on Bioethics of the AAP issued a statement on bioethics and consent in 1995 that has caused great difficulty for the promoters of male non-therapeutic circumcision of non-consenting infants at the AAP. The statement provides in part:{{Citation |Text=We now realize that the doctrine of "[[informed consent]]" has only limited direct application in pediatrics. Only patients who have appropriate decisional capacity and legal empowerment can give their [[informed consent]] to medical care. In all US pediatricians other situations, parents or other surrogates provide informed permission for diagnosis and treatment of children with the assent of the child whenever appropriate. |ref=<ref>{{REFjournal |last=Kohnman |first=Arthur |init= |author-link= |last2=Clayton |first2=Ellen Wright |init2= |author2-link= |last3=Frader |first3=Joel E. |init3= |author3-link= |etal=yes |title=Informed consent, parental permission, and assent in pediatric practice. |journal=Pediatrics |location= |date=1995-02 |volume=95 |issue=2 |article= |page= |pages=314-7 |url=http://www.cirp.org/library/ethics/AAP/ |pubmedID=7838658 |pubmedCID= |DOI= |accessdate=2021-07-23}}</ref>}} Non-therapeutic circumcision of children is neither diagnosis nor treatment, so the statement means that parents do ''not'' have a right to consent to non-therapeutic circumcision of children. This has caused problems for future advocates of male non-therapeutic circumcision at the AAP, so they have adopted a work-around policy. Future statements regarding male non-therapeutic circumcision resorted to citing a non-germane statement on the medical ethics of sick and dying children.<ref>{{REFjournal |last=Fleischman |first= |init=AL |author-link= |last2=Nolan |first2= |init2=K |author2-link= |last3=Dubler |first3= |init3=NN |author3-link= |etal=yes |title=Caring for gravely ill children |trans-title= |language= |journal=Pediatrics |location= |date=1994-10 |volume=94 |issue= |article= |page= |pages=433-9 |url=https://pediatrics.aappublications.org/content/94/4/433.long |pubmedID=7936849 |pubmedCID= |DOI= |accessdate=2021-07-24}}</ref> Non-therapeutic [[circumcision]] of children, however, is performed only on healthy children who can withstand the [[pain]], [[trauma]], and stress of the [[amputation]]. === Fourth policy (1999) ===The American Academy of Pediatrics had been acutely embarrassed by the faults of [[Edgar J. Schoen| Edgar Schoen]]'s horrific circumcision policy statement, so a new task force was convened under the direction of Carole Marie Lannon, {{MD}}, {{MPH}}, to produce a new, more appropriate, and less embarrassing policy statement on non-therapeutic child circumcision which was published in Pediatrics in September 1999.<ref name="aap1999">{{REFjournal |last=Lannon |first=Carole Marie |init=CM |last2=Bailey |first2=Ann Geryl Doll |init2=AGD |last3=Fleishman |first3=Alan R. |init3=AR |last4=Kaplan |first4=George W. |init4=GW |author4-link=George W. Kaplan |last5=Shoemaker |first5=Craig T. |init5=CT |last6=Swanson |first6=Jack T. |init6=JT |last7=Coustan |first7=Donald |init7=D |etal=no |title=Circumcision Policy Statement |journal=Pediatrics |date=1999-09 |volume=103 |issue=3 |pages=686-93 |url=http://www.cirp.org/library/statements/aap1999/ |pubmedID=22926180 |DOI=10.1542/peds.2012-1989 |accessdate=2021-10-10}}</ref> 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 |init=AL |last2=Nolan |init2=K |last3=Dubler |init3=NN |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. The pain of circumcision is very stressful, so it is performed only on babies who are stable and healthy. 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 would follow that inability to do so means that proceeding with an intervention that could be harmlessly deferred constitutes needless violation of patient 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) ======= Genesis ====Several state Medicaid organizations had delisted medically-unnecessary, non-therapeutic male circumcision as a covered procedure, which caused alarm at the AAP. The corrupt [[World Health Organization]] (WHO), in a very poor and misguided decision in 2007, falsely claimed that male [[circumcision]] would reduce [[infection]] with human immunodeficiency virus ([[HIV]]).<ref name="who2007">{{REFweb |quote= |url=http://www.who.int/hiv/topics/malecircumcision/en/ |title=Male circumcision for HIV prevention |last= |first= |publisher=World Health Organization |work= |date=2007 |accessdate=2020-04-16}}</ref> The AAP saw this as an opportunity to protect third-party payment for non-therapeutic circumcision.<ref name="jones2022">{{REFweb |url=https://www.circumcisionisafraud.com/foia-request-sheds-new-light-on-aaps-motivations |title=FOIA request sheds new light on AAP's motivations |last=Jones |first=Ryan |init= |author-link=Ryan Jones |website=Circumcision is a Fraud |date=2022-02-07 |accessdate=2022-08-27}}</ref>  The AAP allied itself with the [[American College of Obstetricians and Gynecologists]] (ACOG) and the [[American Academy of Family Physicians]] (AAFP) to produce a new [[circumcision]] policy that would claim a medical benefit. A new task force was named with [[Susan Blank]], a Jewish doctor with pro-[[circumcision]] credentials, as chairwoman. The task force was an unusually large eight-member task force with an unusual constitution. It included: * Ellen Buerk, {{MD}}, representing the board of directors of the AAP. * [[Michael Brady]], {{MD}}, an [[HIV]] specialist with pro-circumcision views.* Waldemar Carlo, {{MD}}, a specialist in the care of the newborn.* [[Andrew Freedman]], a Jewish urologist from Los Angeles who [[circumcised]] his own son on the kitchen table.* [[Douglas Diekema]], a pediatric medical ethicist.* Lynne Maxwell, {{MD}}, a [[pain]] control specialist.* Steven Wegner, {{MD}}, {{JD}}, a medical insurance specialist, who evidently was appointed to the task force to preserve and protect [[third-party payment]]. The addition of a member to represent the board of directors and an insurance specialist was most unusual and illustrates the importance that the administration of the AAP placed on preservation and protection of [[third-party payment]]. The task force also included representatives from other pro-circumcision organizations: * Charles LeBaron, {{MD}}, representing the [[Centers for Disease Control and Prevention]], where [[Bias| biased]] doctors had been working to produce a pro-circumcision policy since 2008* Sabrina Craigo, {{MD}}, representing the [[American College of Obstetricians and Gynecologists]], whose fellows make extra money by performing non-therapeutic [[circumcision]] on newborn baby boys, although males are outside of their practice area.* Lesley Atwood, {{MD}}, representing the [[American Academy of Family Physicians]]. whose fellows also make extra money by performing non-therapeutic circumcision. ==== Discussion ==== 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 |url=https://www.doctorsopposingcircumcision.org/wp-content/uploads/2016/08/commentary-on-american-academy-of-pediatrics-2012-circumcision-policy-statement.pdf |title=Commentary on American Academy of Pediatrics 2012 Circumcision Policy Statement |trans-title= |language= |last= |first= |author-link= |publisher=[[Doctors Opposing Circumcision (D.O.C.)]] |website= |date=2013-04 |accessdate=2020-02-15 |format=PDF |quote=}}</ref> {{Box|Boxtext=<big><b>'''The AAP policy regarding its statements is to give each statement a five-year life, after which the statement expires unless it is reaffirmed. The 2012 Circumcision Policy Statement has not been reaffirmed, so it expired in 2017. As of 2023, the AAP has had ''no'' official circumcision policy for six years, although it misleadingly continues to publish its long expired policy on its website.'''</b></big>}} Although the patients of the fellows of the AAP are memberschildren, the AAP consistently has failed to acknowledge the [[human rights]] of its child patients.<ref name="doc2013" />

<blockquote><p>"In a 2012 position statement, the academy Academy stated that a systematic evaluation of the medical literature shows that the "preventive health benefits of elective [[circumcision]] of male newborns outweigh the risks of the procedure" and that the health benefits "are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns," but "are not great enough to recommend routine circumcision for all male newborns". The academy Academy takes the position that parents should make the final decision about circumcision, after appropriate information is gathered about the risks and benefits of the procedure. By doing this, the AAP attempts to shift the liability for the certain injury of child non-therapeutic circumcision from the doctor to the parents. </blockquote> The 2012 statement is a shift in the academyAcademy's position from its [https://www.cirp.org/library/statements/aap1999/ 1999 statement ] in that the academy Academy now says the health benefits of the procedure outweigh the risks, and supports having the procedure covered by insurance. The 2012 position statement is an obvious effort to preserve [[third-party payment]] to physicians, without which most non-therapeutic circumcisions would not be done.</p> ==== Criticism ====After the release of the position statement, there was a substantial immediate critical comment by Brian Earp.

<p>After the release of the position statement, a debate appeared in the journal ''Pediatrics'' and the ''Journal of Medical Ethics'' between the AAP and an ad* {{REFjournal |last=Earp |first=Brian D. |init=BD |author-hoc group of Western doctors, ethicists and lawyers, who questioned the evidence and ethics of the AAP position statement, and accused the AAP of "cultural bias"link=Brian D. Earp |etal=no |title=The AAP received further criticism from activist groups that oppose [[report on circumcision]]."<ref>: bad science + bad ethics = bad medicine |journal=Practical Ethics |location= |date=2012 |volume= |issue= |article= |page= |pages= |url=https://enwww.wikipediaacademia.orgedu/wiki15617255/American_Academy_of_Pediatrics</ref></p></blockquote>The_AAP_report_on_circumcision_bad_science_bad_ethics_bad_medicine |accessdate=2020-12-25}}

== International protests ==In 2013, international physicians protest against American Academy of Pediatrics’ policy on infant male circumcision. This protest was organized by [[Morten Frisch]] Shorty thereafter a debate appeared in the journal ''Pediatrics'' and led to an article in the ''Pediatics todayJournal of Medical Ethics''<ref>[http://knmg.artsennet.nl/web/file?uuid=62e174e8between the AAP and an ad-613e-4d79-910f-747708dbf27a&owner=a8a9ce0e-f42b-47a5-960e-be08025b7b04&contentid=129611 Cultural Bias in hoc group of Western doctors, ethicists and lawyers, who questioned the AAP’s 2012 Technical Report evidence and Policy Statement on Male Circumcision. Pediatrics 2013 131 (4) (PDF)]</ref>ethics of the AAP position statement, signed by an international group and accused the AAP of 38 physicians from 16 European countries"cultural bias".

* {{REFjournal |last=Svoboda |first=J. Steven |init=JS |author-link=J. Steven Svoboda |last2=Van Howe |first2=Robert S. |init2=RS |author2-link=Robert S. Van Howe |etal=no |title=Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision |journal=J Med Eth |location=Published online first |date=2013-03-13 |volume=39 |issue=7 |pages=434-41 |url=https://arclaw.org.customers.tigertech.net/wp-content/uploads/Svoboda-Van-Howe-Out-of-Step-Fatal-Flaws-in-AAP...-JME-2013.pdf |pubmedID=23508208 |pubmedCID= |DOI=10.1136/medethics-2013-101346 |accessdate=2020-04-16}}  * {{REFdocument |title=Commentary on American Academy of Pediatrics 2012 Circumcision Policy Statemeni |url=https://www.doctorsopposingcircumcision.org/wp-content/uploads/2016/08/commentary-on-american-academy-of-pediatrics-2012-circumcision-policy-statement.pdf |contribution= |last=Hill |first=George |author-link=George Hill |publisher= From [[IntactWikiDoctors Opposing Circumcision (D.O.C.)]] |format=PDF |date=2013-04-01 |accessdate=2020-04-16}} * In 2013, international physicians protested against American Academy of Pediatrics’ policy on infant male circumcision. This protest was organized by [[Morten Frisch]] and led to an article in ''Pediatics''<ref name="frisch2013">{{FromIntactWikiREFjournal |last=Frisch |first=Morten |init=M | URL author-link= httpMorten Frisch |last2=Aigrain |first2=Yves |init2=Y |author2-link= |last3=Barauskas |first3=Vidmontas |init3=V |author3-link= |etal=yes |title=Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision |journal=Pediatrics |location= |date=2013-04-01 |volume=131 |issue=4 |pages= |url=https://intactwikipediatrics.aappublications.org/wikicontent/131/4/796.long |quote= |pubmedID=23509170 |pubmedCID= |DOI=10.1542/American_Academy_of_Pediatricspeds.2012-2896 | Title accessdate= 2020-04-04}}</ref>, signed by an international group of 38 physicians from 16 European countries. The AAP received further criticism from activist groups that oppose [[circumcision]]."<ref>{{URLwikipedia|American_Academy_of_Pediatrics|American Academy of Pediatrics|2020-03-31}}</ref></p> * {{REFjournal |last=Darby |first=Robert |init=R |author-link=Robert Darby |etal=no |title=Risks, Benefits, Complications and Harms: Neglected Factors in the Current Debate on Non-Therapeutic Circumcision |journal=Kennedy Institute of Ethics Journal |location= |date=2015-04 |volume=25 |issue=1 |pages=1-34 |url=https://kiej.georgetown.edu/wordpress/wp-content/uploads/2015/03/03_25.1darby.pdf |pubmedID=25843118 |pubmedCID= |DOI=10.1353/ken.2015.0004 |accessdate=2020-04-16

== From [[IntactWiki]] ==<blockquote>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= | date=2011-03/-23/2011 | title=Where We Stand: Circumcision | url=http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/pages/Where-We-Stand-Circumcision.aspx | publisher=AAP Official Website | accessdate=

| 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

| 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

| 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

| 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

| last=MacReady | first=Norra | coauthorsinit=N | pubyeardate=2010-07-03 | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=The authors suggested that a “ritual nick,” in which the clitoral [[skin ]] is pricked or incised, might satisfy these symbolic requirements, and “is no more of an alteration than ear piercing”. | accessdateDOI=2011-09-27 | id = {{doi | 10.1016/S0140-6736(10)61042-2}} |accessdate=2011-09-27

| last=MacReady | first=Norra | coauthorsinit=N | pubyeardate=2010-07-03 | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=...female circumcision had symbolic or ceremonial aspects. | accessdateDOI=2011-09-27 | id = {{doi | 10.1016/S0140-6736(10)61042-2}} |accessdate=2011-09-27

| 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

| 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 | first=Norra | coauthorsinit=N | pubyeardate=2010-07-03 | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=...the AAP revised a much more forceful statement published in 1998, which unequivocally condemned [[FGC ]] in any form. | accessdate=2011-09-27 | id DOI= {{doi | 10.1016/S0140-6736(10)61042-2}} |accessdate=2011-09-27

| 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

| 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

| 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

| last=MacReady | first=Norra | coauthorsinit=N | pubyeardate=2010-07-03 | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=The American Academy of Pediatrics (AAP) sparked a backlash... | accessdateDOI=2011-09-27 | id = {{doi | 10.1016/S0140-6736(10)61042-2}} |accessdate=2011-09-27

| last=MacReady | first=Norra | coauthorsinit=N | pubyeardate=2010-07-03 | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=...was interpreted by many as a tacit endorsement of the ritual nick... | accessdateDOI=2011-09-27 | id = {{doi | 10.1016/S0140-6736(10)61042-2}} |accessdate=2011-09-27

| last=MacReady | first=Norra | coauthorsinit=N | pubyeardate=2010-07-03 | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=On May 1, Judith Palfrey, President of the AAP, released a statement... | accessdateDOI=2011-09-27 | id = {{doi | 10.1016/S0140-6736(10)61042-2}} |accessdate=2011-09-27}}</ref> Palfrey reiterated this stance in an interview with ''The Lancet'', saying “we want to make it clear to the international community we are opposed to any form of female genital cutting, and that includes the ritual nick.”<ref>{{REFjournal | last=MacReady | first=Norra | coauthorsinit=N | pubyeardate=2010-07-03 | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=we want to make it clear to the international community we are opposed to any form of female genital cutting, and that includes the ritual nick. | accessdateDOI=2011-09-27 | id = {{doi | 10.1016/S0140-6736(10)61042-2}} |accessdate=2011-09-27

| last=MacReady | first=Norra | coauthorsinit=N | pubyeardate=2010-07-03 | title=AAP retracts statement on controversial procedure | journal=The Lancet | volume=376 | issue=9734 | pages=15 | url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61042-2/fulltext | quote=The AAP has since withdrawn the committee's report and has rewritten it completely. | accessdateDOI=2011-09-27 | id = {{doi | 10.1016/S0140-6736(10)61042-2}} |accessdate=2011-09-27

The AAP wrote the following in their 2010 [[FGC ]] Policy:

| 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).

| 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).

== It is now self-evident that many, perhaps most, of America's child care doctors, including pediatricians and family doctors, do not know how to care of a boy's intact penis. The AAPforeskin an an infant boy is non-retractable by design. An attempt to forcibly retract a non-retractable foreskin of a boy can only lead to a painful injury to the boy. There are frequent reports of attempts by ignorant physicians to retract a boy's 1999 Circumcision Policy Statement non-retractile foreskin.<smallref>(and its apparent contradictions with other AAP positions on bioethics){{REFjournal |last=Geisheker |first=John V. |init=JV |author-link=John V. Geisheker |url=https://www.psychologytoday.com/us/blog/moral-landscapes/201110/doctor-ignorance-male-anatomy-harms-boys |title=Doctor ignorance of male anatomy harms boys: What you can do to protect boys from medical interference |journal=Psychology Today |date=2011-10-20 |accessdate=2021-07-18}}</smallref> ==

The AAP asserted in their 1999 Circumcision Policy Statement that parents have a right is the nation's leading child care organization, but it has taken no action to decide to circumcise their children based educate its pediatrician members and other doctors on cultural or religious factors (although they removed any mention the [https://en.intactiwiki.org/wiki/Foreskin_Care_for_Boys proper care of esthetics the infant foreskin], so as a possible parental motivation, despite previous inclusion in their 1989 statement). No further substantiation to avoid [[iatrogenic]] injury of this right was offered. Whether or not a medical benefit was required for parents to make this choice was also not addressedboys. <br>:The following statement appeared in its <b>1999 Policy Statement:</b>

== American Academy of Pediatrics Lawsuit ==A major lawsuit<ref name="delaney2021">{{CitationREFweb | Texturl=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 choicehttps://www.circumcisionisafraud.<small>(119)<com/small>docket-mer-l-000272-21 | Authortitle=Committee on BioethicsAmerican Academy of Pediatrics Lawsuit | Sourcewebsite=1999 AAP Circumcision Policy Statement (reis a Fraud |date=2021-affirmed 2005)02-05 |accessdate=2021-05-01}}</ref> was filed on February 5th, 2021 against the American Academy of Pediatrics and Princeton Medical Group alleging constructive and intentional fraud around a botched circumcision.

:* The above sentence cited <u>Caring for Gravely Ill Children</u><ref>{{REFjournal | last=Fleischman ALAAP had a number of undisclosed biases, Nolan Kincluding a financial bias, Dubler NN, et aland made false claims in their 1989 Report of the Task Force on Circumcision Guidance. | first= | coauthors= | pubyear=1994 | title=Caring * This Guidance induced the Plaintiffs to provide consent for gravely ill children | journal=Pediatrics | volume= | issue= | pages=7 | url=http://pediatrics.aappublicationscircumcisions without all of the necessary medical facts and information to make an informed decision, which the AAP has a fiduciary obligation to provide.org/content/94/4/433 | quote= | accessdate=2011-10-09}}</ref> as its source. While this document focuses primarily on sick children and not infants* The AAP owes a duty to the general public, it does go into much detail on including the ethics surrounding autonomy and consentPlaintiffs, particularly with respect to patient-centered vs. parent-centered medicine. That document says tell the followingtruth, which the AAP's "hands-off" position on circumcision might contradict:whole truth and nothing but the truth when issuing reports, policy statements, and guidelines for medical care and procedures.

{{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 ==Removal 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.| AuthorFederal Court==| Source=Caring for Gravely Ill Children (1994)}}

This lawsuit by the Lavine family, which alleges fraud, has been removed from the New Jersey state court to the United States District for New Jersey based on "diversity of citizenship". The case number is 3:21-CV-17099. The AAP <b>1999 Policy Statementpresiding judge is [https://en.wikipedia.org/wiki/Zahid_Quraishi Zahid N. Quraishi].</bref> also includes this statement on informed consent:{{CitationREFweb | Texturl=The process https://unicourt.com/case/pc-db5-lavine-et-al-v-american-academy-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-pediatrics-et-al-1022393 |title=Lavine et al. v. For infants and young children who lack the capacity to decide for themselves, a surrogate, generally a parent must make such choiceAmerican Academy of Pediatrics et al.<small>(118)</small> |last= |first= | Authordate=2021-11-29 | Sourceaccessdate=1999 AAP Circumcision Policy Statement (re2021-affirmed 2005)12-01}}</ref>

: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= | dateComment=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:Giannetti (2000) argues that scientific misconduct in the American Academy of Pediatrics circumcision policy statements should expose the AAP to trade association liability.<ref name="giannetti2000">{{CitationREFjournal | Textlast=A patient's reluctance or refusal to assent should also carry considerable weight when Giannetti |first=Matthew |init=M |author-link= |title=Circumcision and the proposed intervention is not essential to his or her welfare and/or can be deferred without substantial risk.American Academy of Pediatrics: Should Scientific Misconduct Result in Trade Association Liability |journal=Iowa Law Rev |date=2000 |volume=85 |issue=4 | Authorpages=1507-68 | Sourceurl=https://www.doctorsopposingcircumcision.org/wp-content/uploads/2018/01/Gianetti-AAP Committee on Bioethics - Informed Consent, Parental Permission, and Assent in Pediatric PracticeMisconduct-Trade-Assn-Iowa-Law-Rev-2000.pdf |accessdate=2020-05-09}}</ref>

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 difficulties with a child circumcision policy are largely of a procedure communicated its own doing. The AAP continues to them.<ref>{{REFjournal | last=Fleischman AL, Nolan K, Dubler NN, et al. | first= | coauthors= | pubyear=1994 | title=Caring for gravely ill children | journal=Pediatrics | volume= | issue= | pages=7 | url=http://pediatrics.aappublications.org/content/94/4/433 | quote= | accessdate=2011put its members' financial well-10-09}}</ref> (It might follow that inability to do so means that proceeding with an intervention that could be harmlessly deferred constitutes needless violation being ahead of autonomy, or inadequate consent):{{Citation| Text=Although very young children may be unable to envision the future benefits [[human rights]] and well-being of treatment that may justify its associated burdens (eg, pain, discomfortchild patients, which it does by omission of significant information and hospitalization), their perceptions distortion of those burdens should not be ignoredthe medical facts in its numerous circumcision policy statements. Medical societies outside of the [...[United States]] Regardless of are in near total disagreement with the [[AAP]] and its American allies with regard to non-therapeutic child's level of participation in planning care, he or she should be given as much control over the actual treatment as possible[[circumcision]].| Author=| Source=Caring for Gravely Ill Children (1994)}}

Although the AAP speaks very highly of non----therapeutic circumcision, a close reading indicates that it has never made an actual overt recommendation for [[circumcision]], probably because its lawyers forbid it. Nevertheless, a suit has been filed against the [[AAP]] that alleges fraud in its circumcision statements.<ref name="delaney2021" />

 [[Category:PhysicianParental information]][[Category:Physicians]][[Category:Medical society]][[Category:Organization]][[Category:Promoter]][[Category:American Academy of Pediatrics]][[Category:Lawsuit]] 

[[Category:Organizations]][[Category:From CircLeaks]][[Category:American Academy of Pediatrics]]

[[de:American Academy of Pediatrics{{FULLPAGENAME}}]]