Is “parental choice” the medical ethic or not?

There is no such thing as parental choice. Parents cannot do things that will harm their children in the face of clear evidence. You might think I’m making an argument against circumcision, since I’m the director of the documentary American Circumcision and spent six years following the Intactivist anti-circumcision movement. However, I’m actually repeating the viewpoint of the American Academy of Pediatrics, one of the largest pro-circumcision medical organizations. It just happens to be their view on vaccines.

I have no interest in the vaccines. I have not researched them. The focus of my work has been on circumcision, and I see the two as very separate issues. However, when I heard the phrase “parental choice” enter the vaccine debate, my ears perked up. Parental choice has been the primary argument that medical groups like the American Academy of Pediatrics have made in favor of circumcision. They argue that decision whether or not a child is circumcised should be a parent’s choice. Yet, when I heard this phrase in the vaccine debate, they were arguing that parental choice doesn’t exist and should not be allowed for vaccines. Huh?

The state of California recently passed a mandatory-vaccine law, requiring children be vaccinated, and removing the previous parental choice that existed around vaccination. Pro-vaccine doctors and groups like the American Academy of Pediatrics are pushing for similar laws in other states, like Oregon and New York.

In fact, many doctors and doctors groups do not even believe there should be choice around what information parents consume on the vaccine issue. Members of the AAP celebrated on social media when Amazon removed anti-vaccine books and movies from their listings. Dr. Peter Hotez, a pro-vaccine doctor who has championed this de-platforming, even said anti-vaccine groups should be classified as “hate groups.” On vaccines, the medical establishment is clear: zero-parental choice.

At the same time, parental choice is primary argument advanced by pro-circumcision groups. The 2012 American Academy of Pediatrics policy statement on circumcision says “Parents ultimately should decide whether circumcision is in the best interests of their male child.”A paper published by Andrew Freedman, a member of the 2012 AAP circumcision taskforce, suggests that the American Academy of Pediatrics assessment of risks and benefits in 2012 circumcision policy statement included the non-medical cultural benefits of circumcision.

When I interviewed Freedman for my documentary, Freedman said the same thing: circumcision is not medically recommended, but because some cultures or tribes (tribe was his word choice) want to do it, they should be allowed to. In other words, the last AAP policy statement on circumcision is not a statement on medicine, but culture. On circumcision, the American Academy of Pediatrics weighs parental choice as more important than medical evidence.

How are these two viewpoints compatible? On one issue, the AAP says parental choice does not exist. On another, they say parental choice is the rule. Which is it? What is the universal ethical standard here?

I know what vaccine proponents will say: ‘The evidence on vaccines is so compelling that it should not be a choice. You are causing to your child harm by not vaccinating. If we don’t vaccinate our children, many will die from preventable diseases.’ However the parental choice argument on circumcision suggests that parental choice trumps even the death of children.

Over a 100 babies die a year from routine infant circumcision. Many more have complications and botches. Former president of the Virginia Urological Society James Snyder has said that around ten percent of the boys in his practice have a botch of some kind. So according to what the AAP says on circumcision, parental choice trumps even preventable infant deaths.

In fact, it goes further. In New York, several newborn infants were given herpes during Jewish circumcision ceremonies involving metzitzah b’peh — a Jewish circumcision practice in which the Mohel (Jewish ritual circumciser) puts his mouth on the child’s fresh circumcision wound and sucks blood out. The New York health department struggled to even regulate these practices or require a consent form because the practice was considered religious.

In response to an attempt to ban male infant circumcision in San Francisco, the state of California passed AB-768, protecting male circumcision in law. This law was championed by both Jewish and religious groups and doctors groups. However, California has removed a religious exemption for vaccines. Thanks to the efforts of doctors groups, sucking blood from an infants wounded penis with open herpes sores is a “parental choice” protected by law, but which vaccines your child gets is not.

Again, I will re-iterate — I have no interest in vaccines. Don’t send me any vaccines studies, pro or anti, because according the parental choice ethic pushed in the circumcision debate, they don’t matter. According to circumcision proponents, “parental choice” extends to even choices that could kill your child. The AAP has published papers suggest that pleasing tribal and cultural desires is a form of benefit that out-weighs medical evidence or risks.

I know some medical groups will also say that circumcision and vaccines are such completely different issues that separate and incompatible ethical frameworks are required for each. However, that is not what circumcision proponents have said in the past. Circumcision proponents have referred to circumcision as a surgical vaccine, in news articles, academic research, and on camera in my documentary American Circumcision. Unless medical groups denounce this comparison as strongly as they promoted it, then they need to apply same ethical framework to both circumcision and vaccines. Is that framework “parental choice” or not?

There may also be some who say that because circumcision is a Jewish custom, a ban on circumcision would unfairly affect the Jewish people. However, measles outbreak in Rockland County was mostly in the Orthodox Jewish community. In response, Rockland County made vaccines mandatory with no religious exemption, banned unvaccinated children from public spaces, and threatened to prosecute parents for their religiously motivated parental choice. Medical groups have created a precedent whereby even Jewish families could be prosecuted and jailed for their “parental choice” if that choice is harmful to children.

If anti-vaccine groups want, they could simply cite the AAP’s view on circumcision. The AAP standard on circumcision is that parental choice, culture, and religion trump evidence. By the standard, the anti-vaccine movement does not need to present any medical evidence. They simply need to say that it’s their “parental choice,” or against their culture or religion. Any of the cultural, social, or political tactics used against anti-semites would also be fair game to use on doctors groups who deny their religious rights.

If anti-circumcision groups want, they could simply cite the AAP’s view on vaccines. Parental choice doesn’t exist. The desires of parents do not matter in evidence-based medicine. The AAP needs to say circumcision is bad or good, but they cannot say that it is a parental choice, because parental choice does not exist. If the evidence on circumcision is not compelling enough to fight for it as strongly as medical groups fight for vaccines, then they need to remove it as an option for parents.

If there is evidence circumcision is harmful, or that it causes the death of children, then the AAP ethical standard on vaccines suggests that circumcision proponents should have their religious exemptions removed by law, their books banned and de-platformed, and groups that promote circumcision should be classified as hate groups.

To be clear — I am not suggesting this. My personal opinion on either issue appears nowhere in this article. I am simply saying that the medical establishment viewpoint on vaccines implies these measures when applied to the circumcision debate, and vise versa.

There is a saying that where ever there appears to be a double standard, you can be sure there is one standard being secretly applied. Doctors make money on vaccines, and make an argument for them. Doctors also make money doing circumcisions, and make a completely different and incompatible argument for them. It looks like the golden rule in action — the real golden rule — “he who has the gold makes the rules” — and the rules are usually whatever produces the most gold for the person making them.

The question is — in trying to protect their income stream from circumcision, has the American Academy of Pediatrics created an opening that might cost them their position on vaccines? Or could the political tactics the medical establishment is using in the vaccine debate be used against them by the Intactivist movement?