From the Anne Arundel Medical Center’s information page on (infant) circumcision, in the “How is circumcision performed?” section:
Circumcision is performed only on healthy babies.
I will never understand how medical service providers can recognize that and still think nothing is wrong with their participation in their imposition of this non-therapeutic surgery on their patient.
This picture is amazing. It captures the inherent contradiction in the way many parents think and behave toward their sons:
I don’t have a source for this. I found it on Twitter but don’t remember from whom. Since it cites The Whole Network, I’m happy to provide a link there. Whoever is responsible for creating this, kudos. It’s excellent.
In an article about an Australian couple arrested for “allegedly organising the illegal circumcision of their one-year-old baby girl in Bali,” this anecdote from Edith Cowan University’s head of medical sciences Moira Sim about patients she has treated is insightful:
She said the women she treated did not see the mutilation of their genitals as an issue because they did not remember having the procedure.
That’s a defense for male circumcision so commonly offered in the United States. Yet, in this anecdote, it’s clear how irrelevant their opinion is as a defense. The violation occurred, and we can easily assume that these women would not feel that way if they hadn’t had their genitals mutilated as children. Ex post facto defenses of non-therapeutic genital cutting offered by the victim, or an assumption that the recipient will develop a specific opinion, can never justify imposing the procedure on a minor.
Adding to my post on ethics, I want to continue with the recommendations from the technical report on non-therapeutic male child circumcision issued by the AAP Task Force:
- Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child.
- …
- Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not.
Notice the past tense in the second point. Parents should be instructed in the care of the penis before they decide to circumcise. My anecdotal experience suggests some number of parents circumcise in part because they don’t understand how to care for a normal penis. However small this number probably is, if parents shouldn’t be ignorant, the AAP should recommend education before the decision, not after. Some parents may leave their son his choice if they’re educated in how simple and non-scary it is to care for a normal, intact penis.
It should also provide factually correct information. From “Care of the Circumcised Versus Uncircumcised (sic) Penis” (Pg. 763):
Parents of newborn boys should be instructed in the care of the penis at the time of discharge from the newborn hospital stay, regardless of whether they choose circumcision or not. The circumcised penis should be washed gently without any aggressive pulling back of the skin.24 The noncircumcised (sic) penis should be washed with soap and water. Most adhesions present at birth spontaneously resolve by age 2 to 4 months, and the foreskin should not be forcibly retracted. When these adhesions disappear physiologically (which occurs at an individual pace), the foreskin can be easily retracted, and the whole penis washed with soap and water.25
No, they should be instructed about care before discharge. Even if we ignore the obvious point that a circumcision would likely already have been performed by that point, are parents not responsible for any care for their son while in the hospital? Unless a hospital is doing it wrong, they don’t just keep the child until parents are discharged and then say “here you go”.
More importantly, that paragraph contains factually incorrect information. The Task Force states that most adhesions present at birth spontaneously resolve by age 2 to 4 months, which is ridiculous. It’s also unsupported by their source. From footnote 25, Caring for the uncircumcised penis: what parents (and you) need to know by Cynthia J. Camille, FNP, CPNP, Ramsay L. Kuo, MD, and John S. Wiener, MD:
Penile growth, along with intermittent erection, aids in the process that eventually completely separates the prepuce from the glans to form the preputial space (Figure 1). This process begins late in gestation and proceeds at varying rates during childhood; therefore, the age when the prepuce is completely retractable also varies.2,3 Complete retraction past the corona is possible in at least 90% of boys by 5 years of age. In contrast, some boys will not have complete separation of the prepuce circumferentially beyond the corona until accelerated penile growth occurs at puberty.
Even if “90% by age 5” is correct (some evidence at this link suggests it might be an overestimate), that differs significantly from “by age 2 to 4 months”. This is a recipe for incorrect diagnoses of phimosis and forced retraction, leading to unnecessary circumcision for non-existent medical necessity.
If we look at source 24, the AAP’s Caring For Your Son’s Penis, it states:
The Uncircumcised Penis
In the first few months, you should simply clean and bathe your baby’s uncircumcised penis with soap and water, like the rest of the diaper area. Initially, the foreskin is connected by tissue to the glans, or head, of the penis, so you shouldn’t try to retract it. No cleansing of the penis with cotton swabs or antiseptics is necessary, but you should watch your baby urinate occasionally to make sure that the hole in the foreskin is large enough to permit a normal stream. If the stream consistently is no more than a trickle, or if your baby seems to have some discomfort while urinating, consult your pediatrician.
The doctor will tell you when the foreskin has separated and can be retracted safely. This will not be for several months or years, and should never be forced; if you were to force the foreskin to retract before it is ready, you could cause painful bleeding and tears in the skin. After this separation occurs, retract the foreskin occasionally to gently cleanse the end of the penis underneath.
The Task Force provided no obvious evidence to support its “by age 2 to 4 months” claim. Either they didn’t correctly source the claim they made, or they’ve allowed at least one mistake to enter the document. Neither generates much confidence in the overall process.
Much has already been said on the flaws in the AAP’s revised policy statement on non-therapeutic male child circumcision. (Here’s an additional plug for the exceptional rebuttal by Brian D. Earp.) I want to comment directly on its recommendations and the ethical issues addressed – or unaddressed – in the technical report. First, from page 757:
The Task Force made the following recommendations:
- Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it.
- …
- Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.
These two statements conflict. Stating that the benefits outweigh the risks is a judgment call based on subjective valuations of the various inputs. The task force recognizes this when acknowledging that some parents would value other considerations more than the AAP’s evaluation of the net effect. That same possible difference of opinion applies to the cost-benefit analysis itself, which should include actual costs (i.e. the foreskin) rather than just risks.
The AAP is stating that it’s possible to disagree with the task force, but only to an extent because it reviewed the data and drew a conclusion. That’s wrong because the evaluation requires subjective weightings rather than objective criteria. It’s one thing to question the possible benefits altogether, as some do. It’s also possible to accept the potential benefits while not valuing them more than the costs involved. All individual tastes and preferences are unique. AAP Circumcision Task Force member Dr. Douglas Diekema said as much prior to the release of the revised policy statement. Why is that not reflected here in place of this incorrect statement that the benefits definitively outweigh the risks (and the unmentioned costs/harms)?
Further discrediting its recommendation on this, the ethics section (Pg. 759) states:
… Reasonable people may disagree, however, as to what is in the best interest of any individual patient or how the potential medical benefits and potential medical harms of circumcision should be weighed against each other. …
The highlighted statement is the ethical argument. This accurate statement contradicts the conclusion the AAP presents that the potential benefits definitively outweigh the risks it considered. It is more relevant in the context of what the individual being circumcised might value. How will he – rather than his parents – want the benefits, risks, and costs weighed against each other for his normal, healthy foreskin? That’s the ethical core that the AAP Task Force sidestepped. Its recommendation for proxy consent for non-therapeutic circumcision is indefensible.
Moving on to the Ethical Issues section (pp. 758-760):
As a general rule, minors in the United States are not considered competent to provide legally binding consent regarding their health care, and parents or guardians are empowered to make health care decisions on their behalf.9 In most situations, parents are granted wide latitude in terms of the decisions they make on behalf of their children, and the law has respected those decisions except where they are clearly contrary to the best interests of the child or place the child’s health, well-being, or life at significant risk of serious harm.10
Sure. But that doesn’t support non-therapeutic male child circumcision. Proxy consent for permanent, amputative surgery must require something approaching objective need. Legally, we already require this for non-therapeutic genital cutting on female minors, including that which is analogous to or less harmful than a typical male circumcision. The comparison to be made for non-therapeutic male circumcision is whether or not parents are given this same non-therapeutic, cultural latitude in cutting the genitals of their daughters. They are not, which demonstrates that it shouldn’t be about the parents but about the child.
(a) Except as provided in subsection (b), whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years …
Subsection (b) establishes that only therapeutic genital cutting is legal for female minors. Subsection (c) rejects all parental preferences, whether cultural or religious, for non-therapeutic genital cutting on their daughters. It’s improper for the AAP Task Force to treat non-therapeutic male child circumcision as if it’s just a health care decision. It’s unlike any other decision we allow. If nothing else, circumcision guarantees (i.e. “significant risk”) the child’s normal, healthy foreskin will be removed forever (i.e. “serious harm”). Do male minors ever become reasonable people who may disagree about the weighting of the benefits and risks?
Revisiting “reasonable people may disagree”:
Parents and physicians each have an ethical duty to the child to attempt to secure the child’s best interest and well-being.11 Reasonable people may disagree, however, as to what is in the best interest of any individual patient or how the potential medical benefits and potential medical harms of circumcision should be weighed against each other. This situation is further complicated by the fact that there are social, cultural, religious, and familial benefits and harms to be considered as well.12 It is reasonable to take these nonmedical benefits and harms for an individual into consideration when making a decision about circumcision.13
It is not reasonable. The individual who must live with the permanent consequences of the decision, if the decision is to circumcise, is not the person taking these non-medical benefits and harms into consideration. (Here, based on my earlier excerpt from this paragraph, benefits such as a reduced risk of heterosexually-acquired HIV should be evaluated as non-medical because they are a non-therapeutic justification for surgical intervention via proxy consent. Or remedy my rebuttal to “these medical benefits, non-medical benefits, and harms” if my precision focused on the lack of need irritates.)
In footnote 13, which is Diekema’s “ethics” perspective on Boldt v. Boldt, he concludes:
(3) Absent a significant medical indication, circumcision should not be performed on older children and adolescents in the face of dissent or less than enthusiastic assent.
This is important. Infants can’t consent, of course, but there is no reason that an inability to consent should be construed as a “yes” in favor of his parents’ preferences. Not even benefits that reasonable people may determine do not outweigh the risks (and costs). From the Ethical Issues section of the policy statement technical report:
Parents may wish to consider whether the benefits of the procedure can be attained in equal measure if the procedure is delayed until the child is of sufficient age to provide his own informed consent. These interests include the medical benefits; the cultural and religious implications of being circumcised; and the fact that the procedure has the least surgical risk and the greatest accumulated health benefits if performed during the newborn period. Newborn males who are not circumcised at birth are much less likely to elect circumcision in adolescence or early adulthood. Parents who are considering deferring circumcision should be explicitly informed that circumcision performed later in life has increased risks and costs. Furthermore, deferral of the procedure also requires longer healing time than if performed during the newborn period and requires sexual abstinence during healing. Those who are already sexually active by the time they have the procedure lose some opportunities for the protective benefit against sexually transmitted infection (STI) acquisition, including HIV; moreover, there is the risk of acquiring an STI if the individual is sexually active during the healing process. (See the section entitled Sexually Transmitted Diseases, Including HIV.)
First, note that it references a section on STDs, including HIV. Condoms are a cheaper, ethical way of achieving the same benefits and in greater than equal measure. They’re also still necessary after circumcision to prevent STDs, including heterosexually-acquired HIV. Yet, the word condom appears¹ zero times in the body of the technical report. Why?
The same applies to the other benefits, or there are safe, effective, non-invasive treatments available. It’s also reasonable to infer that, since people may disagree based on their preferences for whether the benefits outweigh the risks, people may also differ on whether the cited gains from infant circumcision rather than voluntary, adult circumcision are worth the trade-offs of their foreskin and their choice. The “greatest accumulated health benefits” isn’t enough to justify circumcising the individual who will not want to be circumcised.
The most crucial sentence in that excerpt is the third. Males left with their normal genitals are less likely to elect (or need) circumcision. This is too often portrayed as something akin to weakness or cowardice in the autonomous male, for which parents can be the brave, responsible decision-maker. (e.g. Brian Morris et al.) That’s a bad framing device. Instead, this unwillingness (i.e. less likely) is the most powerful indicator that males left with their foreskin value something more than being circumcised. Even if that is merely a desire to avoid the (perceived) pain of the surgery, it is proof of their preference against being circumcised. It is not better to guarantee that pain by forcing it on them in infancy. The typical defense is that they won’t remember it, which is so ridiculous that it could justify any intervention. As AAP Task Force member and bioethicist Douglas Diekema said, “Not everyone would trade that foreskin for that medical benefit.” If the AAP had reflected that view in its recommendations, the revised policy statement could’ve been ethical.
For the remaining sentences, parents who are considering deferring circumcision should be explicitly informed that circumcision performed later in life has a very low likelihood of being necessary. Why leave this point out to focus only on one side of the equation if parents should be fully informed? It shouldn’t be included as an abused throwaway in a technical report most parents will never know exists.
In cases such as the decision to perform a circumcision in the newborn period (where there is reasonable disagreement about the balance between medical benefits and harms, where there are nonmedical benefits and harms that can result from a decision on whether to perform the procedure, and where the procedure is not essential to the child’s immediate well-being), the parents should determine what is in the best interest of the child. In the pluralistic society of the United States, where 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 their own cultural, religious, and ethnic traditions, in addition to medical factors, when making this choice.11
It is not legitimate. The Task Force’s own words demonstrate that it’s possible for the individual male to not value circumcision. He is in his parents’ care for 18 years. (Per Diekema’s recommendation, his parents may be able to choose non-therapeutic circumcision for only a few of those years.) He will then be an autonomous adult for what will likely be another 40 to 80 years. What will he believe is in his best interest about his normal body for that time period? If his parents circumcise him, he will never be autonomous on this question. (As his sister(s) will be by law, contra the absurd idea that parents should be afforded wide authority to determine what constitutes his best interest forever.)
This decision involves informed proxy consent, not informed consent. For this, non-therapeutic circumcision, there is no reasonable disagreement about the lack of need. What is in the child’s best interest is to not undergo unnecessary surgery for reasons he may not value. He can choose it later, or his parents can choose it should genuine medical need arise while he remains their responsibility. He can’t unchoose it once it’s imposed.
The technical report does not support the AAP’s recommendations because it contains omissions and contradictions. Both the technical report and the condensed versions are irresponsible documentd that will perpetuate the violation of the bodies and rights of newborn males. They should be retracted.
¹ It appears once in a footnote as part of the title of a source.
Catarina Dutilh Novaes has an excellent post on the comparison between male and female genital cutting.
A heated discussion ensued from my post on circumcision last week, which in turn was essentially a plug to a thought-provoking post by Brian D. Earp at the Oxford Practical Ethics blog. The controversial point was whether circumcision is or is not to be compared to female genital cutting.
I’ve learned a lot from the different perspectives presented during the discussion; among other things, I’ve learned the terms ‘genital alteration’ and ‘genital cutting’, which now seem to me to be more adequate than either ‘circumcision’ or ‘genital mutilation’ to formulate the issue in a non-question-begging way (as argued here). And yet, I am now even more convinced that the analogy between male genital alteration and female genital alteration is a legitimate one – which (and let me say this again!) does not mean that there are no crucial differences to be kept in mind. That’s what an analogy is, after all.
I agree with this, and the bulk of the post. I recommend it with only a minor quibble and an additional piece of modern evidence.
My quibble:
It is well known that female genital cutting is practiced with different levels of severity, going from pricking and piercing to infibulation. …
I do not believe this is well known beyond academic knowledge. In my experience the average person hearing this comparison believes that female genital cutting is always a) the most severe form, b) performed to eliminate all sexual pleasure, and c) imposed at the insistence of males. Facts rarely correct that misunderstanding when presented. Most often the avoidance rests on imagined parental intent, as if that alone can dictate the outcome.
Modern evidence:
– Female genital cutting is embedded in a long history of oppression of female sexuality, and has as its main goal to diminish women’s sexual enjoyment. Male genital cutting in the form of circumcision has no such goal.
She is citing an objection from the comments of her original post rather than her opinion. She supports the challenge to the claim with the 19th century history of male circumcision in America. That is relevant, but there’s modern evidence that circumcision seeks to control male sexuality. Last year Rabbi Mark Glickman wrote (my post):
… Unlike female genital mutilation, Jewish circumcision is not a way to limit or control the child, and it does not destroy sexual desire.
Many find the practice troubling, I believe, because it so dramatically distinguishes religious values from commonly accepted modern American ones. America idealizes nature; Judaism and other religions try to control it and improve it. …
There are other examples. Religion still seeks to control the child and his sexuality through circumcision. A lack of ill intent does not negate the control from circumcision or its intentionality.
In a cultural rather than ritual context, circumcision is still about control. Parents circumcise so the boy will “look like his father”, regardless of what the child wants. Parents circumcise so that his sexual partners will not be repulsed. (This is an indirect form of control of his future sexual partners.) Parents circumcise to avoid STDs, even though condoms are still necessary. All of this controls the child and his sexuality. The control of males through non-therapeutic genital cutting is rarely as extreme as it is for females, but it is real and occurs now. There is no need to rely on history. The analogy holds up here.
Rabbi Shmuley Boteach has an opinion piece in The Wall Street Journal titled, “Germany’s Circumcision Police”. It starts off well.
There was a head-spinning moment in Germany last week: News emerged that a rabbi had been criminally charged for performing his religious duties. Rabbi David Goldberg of northern Bavaria, who shepherds a 400-member community, is the first person to run afoul of a ruling by a Cologne judge earlier this year that criminalized circumcision, a basic religious rite.
There is some precedent outside of Germany for such a ruling. …
Even though we disagree on policy, agreeing on basic facts is always good. But his essay slowly falls off the path.
… In the United States, a San Francisco ballot initiative tried last year to make circumcision an offense punishable by a $1,000 fine and up to a year in prison; it failed to get enough votes. …
That’s not an accurate summary of what happened last year. A court ruled that the local ballot initiative conflicted with an existing state law and struck it from the ballot. It had nothing to do with getting enough votes.
… But the circumcision ban deserves universal scorn.
…Does the German government really want to get into a public battle over whether they are better guardians of the health and welfare of Jewish (and Muslim) children than their parents?
As long as parents continue to circumcise their healthy sons, I hope so. Obvious physical harm for subjective non-therapeutic benefits is unacceptable without the individual’s consent. Protecting the rights of all citizens is a legitimate role of the state.
The Los Angeles Times recently cited a study predicting that as the number of circumcisions goes down in the U.S., the cost of health care will steadily climb. Eryn Brown reported that “If circumcision rates were to fall to 10% . . . lifetime health costs for all the babies born in a year would go up by $505 million. That works out to $313 in added costs for every circumcision that doesn’t happen.”
I’m not impressed by Rabbit Boteach endorsing the idea that a child’s normal body – and by extension, his rights – has a price beyond which we’ll justify non-therapeutic intervention to remove parts of it. But, more importantly, the key in that is not $313. It’s predicting. Aaron Tobian and his co-authors used a data model to make a guess. There are many factors involved. They are not constant. Cost, availability, and need could be quite different in two decades. For the potential benefits against sexually transmitted infections, circumcision can be chosen later. That would match the ethics of the studies that used adult volunteers. This study seeks to “prove” that a specific, non-urgent solution should be applied now, regardless of ethics.
Why? Because circumcision has been proven to be the second most effective means—after a condom—for stopping the transmission of HIV-AIDS, with the British Medical Journal reporting that circumcised men are eight times less likely to contract the infection.
He gets credit for mentioning condoms, which puts him ahead of the AAP. Still, condoms provide greater protection than circumcision, and remain necessary after circumcision. So, cost-wise, it’s condoms or condoms and circumcision. The former is cheaper and ethical. Infant circumcision is not ethical, including when potential benefits against STDs are cited.
While the Germans decry the barbarity of circumcision for men, they also overlook the benefit to women who are the men’s partners. Male circumcision reduces the risk of cervical cancer—caused by the human papillomavirus, which thrives under and on the foreskin—by at least 20%, according to an April 2002 article in the British Medical Journal.
They overlook the potential benefit to women? Do they? They can agree that (voluntary, adult) circumcision may confer reduced risk to female partners while also finding it unacceptable to impose circumcision on infant males (i.e. not “men”). Rabbi Boteach ignores the ethical foundation for the court’s ruling.
While some attempt to equate male circumcision with female clitoridectomy, the comparison is absurd. Female circumcision involves removing a woman’s ability to have pleasure during sexual relations. …
Not necessarily. Yet, in spite of that, it remains unethical. At some point, the human rights principle(s) involved must factor. Equal protection is a human rights principle.
… It is a barbarous act of mutilation that has no corollary to its male counterpart. …
This is also not true. Within what he wrote, it is, because he limited himself to clitoridectomy. The scope of illegal female genital cutting/mutilation is much broader than that, including any cutting that is anatomically analogous to (or less harmful than) male circumcision. That’s relevant.
… Judaism has always celebrated the sexual bond between husband and wife. Attempts to malign circumcision as a method of denying a man’s sexual pleasure are ignorant. …
Male circumcision controls male sexuality, with a long history as an attempt to limit sexual pleasure. It is still used to reduce pleasure for males.
… Judaism insists that sex be accompanied by exhilaration and enjoyment as a bonding experience that leads to sustained emotional connection.
If we ignore explicit statements in favor of circumcision as a way to diminish male sexual pleasure, Rabbi Boteach’s claim here is not mutually exclusive from reduced sexual pleasure. Intent does not guarantee outcome.
We Jews must be doing something right in the bedroom given the fact that, alone among the ancient peoples of the world, we are still here, despite countless attempts to make us a historical footnote.
This is evidence that male circumcision does not eliminate male reproductive ability. No one has claimed it does. His statement is a non-sequitor. The ability to reproduce is not proof that circumcision is acceptable or that it does not affect sexual pleasure or inflict harm.
Related: From the Cut Podcast, a debate between Rabbi Shmuley Boteach and Cut director Eliyahu Ungar-Sargon.
This video, via The WHOLE Network, is excellent. Every picture is compelling and nearly every picture fits within the approach I advocated. I endorse this.
We’re going to win back this right for all children. With so much quality participation, it could be sooner than we imagine.
I don’t think much of the “Why I decided to circumcise my sons” side in CNN’s point-counterpoint approach to parental choice for circumcision. (“Why I decided not to circumcise my sons” is here. Both were originally published at Parenting.com.) Heather Aimee O’Neill discusses how she and her partner Abbie decided to circumcise their two sons. It’s fairly predictable, with the answer essentially being HIV, a cited benefit that has no significant applicability to her sons in the United States.
My takeaway is from something else:
My other sister, Meredith, an amazing mother of three boys who were all circumcised, agreed. “It’s unsanitary,” she said. “I can barely get my kids to brush their teeth at night. And imagine him in the locker room when he’s a teenager.”
Apart from the hygiene analysis being offensive, compare:
I don’t expect everyone to understand or agree with the choice that Abbie and I made for our sons. When Tommy and Teo are naked at the beach with friends, often they are in the minority because they are circumcised.
People believe many things about the social risks of having a foreskin that are simply not true.
A lot has already been said about the AAP’s revised policy statement on non-therapeutic circumcision on non-consenting male children.
More will be said today and beyond. Much of it will be uncritical regurgitations of the AAP’s revision by news organizations. There will also be analysis from those who recognize and highlight the glaring deficincies and oversights in the policy. I expect to contribute my own thoughts. For now, I’ll highlight one key aspect from my initial read-through before going into what I think is a more important consideration to this apparent-but-not-really temporary setback.
The short version of the statement ends with this (emphasis added):
Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for individual families.
That’s so close to the ethical stance. Remove families and focus on the individual and it would be ethical¹.
The way the promoted portion of the new “finding” within the revised statement differs from this conclusion is the key takeaway to challenge the supposed change from the AAP, which is really more-or-less just an exercise in urging politicians to permit circumcision on Medicaid. Here, the AAP demonstrates that its evaluation of the net benefit, that possible benefits outweigh the risks, is subjective and determined only by individuals. This directly contradicts the supposed proof based on their review of research that the potential benefits outweigh the risks (and the costs – the direct harm in every case – that they ignore). We should repeatedly emphasize that as often as necessary.
My concern is that we’ll get stuck in this low-level, short-term portion of the larger debate. It’s clear from European medical associations and courts that the eventual destination is public policy against non-therapeutic circumcision. The AAP and American society, in general, are (inexcusably) behind. But both will get there. Activists for the rights of children can make that happen sooner than it otherwise might happen.
The key is that we must give people the opportunity to save face, to avoid digging in to protect their egos. The problem is their stance, not necessarily their character. It should be obvious to them that their stance is incorrect. It isn’t. To address that, do we want to express an irrelevant, limited sense of superiority or convince others that we’re correct because facts and ethics demonstrate the case we’re making? If we impugn their motives and/or character by choosing the former, we may extend the period during which this policy statement stands or encourage people who can be influenced either way to choose the inferior stance of the AAP.
Edit note: I changed “it’s” to “their stance” to avoid possible confusion.
¹ The existing societal view treats certain basic human rights – for boys only – as a buffet from which parents may pick and choose for their own reasons. This is the problem merely expressed within the AAP’s policy statement.