There’s been some mystery about why the AAP has taken so long to issue its revised statement on routine infant circumcision. It was expected years ago but still hasn’t been released. I won’t speculate on why this delay continues. Instead, we must look at the only new piece of information, a bit of insider speculation revealed this week. Deirdra Funcheon interviewed task force member Dr. Doug Diekema for the Broward Palm Beach New Times.
“Your frustration is shared by many,” Diekema said. He said that it had been hard to coordinate schedules of the busy task force members but that they had finally completed an exhaustive review of all relevant studies, and now “our work is 95 percent done. To my knowledge, the [new] statement and technical report have been drafted and are being reviewed by other members of the task force. We expect that this will be released sometime this spring.” Said Diekema: “Our starting point was the existing policy statement from 1995, which took a fairly neutral stance — it said there were modest medical benefits and some risks. Since then, data has been generated that might alter that recommendation. It’s fair to say that there are much more clear medical benefits than there were at the time of the last report, although no radical change in the data regarding risk. I expect that the academy will come out with a somewhat stronger statement.”
I don’t think “somewhat stronger” suggests a statement that will say anything close to “everyone should circumcise their sons”. That’s a guess, but if the task force was determined to say that because they feared parents leaving their sons intact was any real danger to the boys, they’d work harder to coordinate their schedules. They didn’t. Still, any inching toward a more positive statement would be indefensible, because the statement should be stampeding to the ethical position, the one which removes the choice from parents and leaves the choice with its proper owner, the (healthy) child. But I suspect Dr. Diekema’s statement is less than we fear. As always we should respond to this with logic and respect. The facts are on our side.
For example:
He went on to say, “If you talk to reasonable people about what the data shows… it’s real. …
I’m interrupting his thought here to point out that “reasonable people” is a framing device intended to show that he’s serious, unlike others who reject the data. It’s pointless. Reasonable people can disagree on the data, the methodology, and the application without being insincere or propagandists.
On that point, the data also shows that almost every male has healthy genitalia at birth. No surgery is indicated. The pursuit of some possible future benefit is speculative because the child is healthy. This is as true for the normal foreskin as it is for every other body part on boys and every body part on girls. This is the ethical question improperly ignored when advocates ask us to focus on “what the data shows”. A healthy body is also science.
… [Circumcision] does carry some risk and does involve the loss of the foreskin, which some men are angry about. But it does have medical benefit. Not everyone would trade that foreskin for that medical benefit. Parents ought to be the decisionmakers here. They should be fully informed.
There’s the ethical question improperly ignored. Dr. Diekema understands that not all males would trade that foreskin for the medical benefit. The condition he set can’t be met. Parents can’t know if their healthy son will be one of those males. They can never be fully informed. This is the beginning and end of the discussion.
Dr. Diekema is a pediatric bioethicist. If he is to adhere to the ethics his position requires, he would immediately and completely oppose any AAP statement other than a complete rejection of non-therapeutic male child circumcision. Non-therapeutic genital cutting on a non-consenting individual who may not want the surgical alteration is ethically wrong.
Consider the AAP’s policy on the ethics of female genital mutilation (while remembering the comparison is non-therapeutic genital cutting on a non-consenting individual):
The physical burdens and potential psychological harms associated with FGM violate the principle of nonmaleficence, a commitment to avoid doing harm, and disrupt the accepted norms inherent in the patient-physician relationship, such as trust and the promotion of good health. More recently, FGM has been characterized as a practice that violates the right of infants and children to good health and well-being, part of a universal standard of basic human rights.
Which parts of the emphasized sections have an exemption based on gender? It’s certainly not the pursuit of benefits that he stressed in the linked interview. Those are subjective and speculative. He has indirectly testified to this standard in court. Participating in the revision of a statement to encourage parents and physicians to behave unethically doesn’t make sense.
The trend of opinion on routine male circumcision is so overwhelmingly negative in industrialized nations that it would be quite surprising were male circumcision to be recommended in the United States. No respected U.S. based medical board recommends circumcision for U.S. 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.
If the AAP were to “recommend” the circumcision of infants, it would be to taking an unfounded position against the best medical authorities of the West, within and outside of the United States.
Readers, consider this: There is not enough evidence for any major medical organization to come to any reasonable conclusion regarding the circumcision of infants. And yet, Diekema expects parents, most of whom never went to med-school, to take the very same evidence and somehow do better.
I don’t think there is a greater example of professional irresponsibility.
In reference to the AAP’s policy on Female Genital Cutting:
Diekema is the same ethicist who suggested the ritual knicking of girls to appease parents who wanted them circumcised – a position he still stands by. So, quoting the AAP policy on FGM to him probably won’t convince him much. At least in that respect, he is consistent.
If he were to read this, I don’t think the AAP policy on FGM would convince him. For now the best that we have is to point out the inconsistencies and make them twist themselves into weird denials and blather. It’s not much, but all we have is the tedious work of a long-term effort to end the cognitive dissonance.