The Ethical Dilemma of Circumcision

In recent years, protesters have gathered outside the American Academy of Pediatrics’ (AAP) annual convention, and this year was no exception.

From October 22 to 25, a protest led by several “intactivist” groups rallied against the AAP’s stance on male circumcision at the Moscone Center in San Francisco.

“The AAP needs to realize that it is lagging behind the growing public opinion that circumcision is wrong,” said Georganne Chapin, executive director of Intact America. “Pediatricians should be told to stop pushing new parents to inflict needless and harmful pain on tiny baby boys.”

The AAP’s most recently revised policy statement on circumcision in 2012 states, “Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it.”

In the 1970s, the AAP had stated, “there are no valid medical indications for circumcision in the neonatal period.” The recent change was due to studies that found a reduction in urinary tract infections (UTI), penile cancer, and AIDS transmission in circumcised males.

But protestors argued that there is no inherent parental right to authorize genital surgery on a healthy baby, girl or boy, and that the risks of circumcision are often downplayed while the benefits exaggerated. Activists say the only person who should choose such surgery is the person who will receive it, since some men experience pain and other adverse effects into adulthood.

Male circumcision rates in the US for newborns have fallen from 64.5 percent in 1979 to 58.3 percent in 2010, according to a report by the Centers for Disease Control and Prevention. Yet male circumcision is still the most common surgical procedure performed in the United States. It is usually performed for religious or cultural reasons.

However, female circumcision, also known as female genital mutilation, was declared as a federal criminal offense by the US Congress in 1996 when performed on a minor, unless necessary to protect the young person’s health.

A report published July 2016 by the Journal of Law, Medicine and Ethics by members of the organization Attorneys for the Rights of the Child concluded that circumcision is unethical, unlawful, and a “non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death.”

“The AAP acknowledges that circumcision is not a medical necessity, so it cannot recommend it,” said Chapin. “But that’s not what people think, and it is not what doctors say to parents. More than 3,300 baby boys are circumcised every day.”

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Chapin announced at a press conference on Oct. 22 that the group gathered 10,000 signatures asking the AAP to stop routine circumcision of baby boys. The group will deliver the petition to the AAP office in Elk Grove Village, Illinois, since AAP representatives declined to meet with activists during the five-day convention in San Francisco.

A 2010 research paper, titled “Complications of circumcision in male neonates, infants and children: a systematic review,” found that “there have been no systematic reviews of the published literature on complications associated with” circumcision in children. But at least two studies found a severe adverse event frequency of 2 percent. Although rare, children have died from complications.

At Massachusetts General Hospital, 7.4 percent of all visits over a five-year period to a pediatric urologist were for circumcision complications.

“Circumcision generates $2 billion a year for doctors and hospitals,” said Chapin. “I believe the AAP has discounted the risks of circumcision to justify its call for insurers and Medicaid to pay doctors to carry out the procedure.”

Protesters called for the AAP to look again at the risks of circumcision, especially the physical and emotional pain experienced by the child.