The American Academy of Pediatrics recently released a policy statement and technical report on circumcision, in both of which the organisation suggests that the health benefits conferred by the surgical removal of the foreskin in infancy definitively outweigh the risks and complications associated with the procedure. While these new documents do not positively recommend neonatal circumcision, they do paradoxically conclude that its purported benefits ‘justify access to this procedure for families who choose it,’ claiming that whenever and for whatever reason (...) it is performed, it should be covered by government health insurance. The policy statement and technical report suffer from several troubling deficiencies, ultimately undermining their credibility. These deficiencies include the exclusion of important topics and discussions, an incomplete and apparently partisan excursion through the medical literature, improper analysis of the available information, poorly documented and often inaccurate presentation of relevant findings, and conclusions that are not supported by the evidence given. (shrink)

The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision—the removal of this structure—is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.Circumcision is usually performed for religious, cultural and personal reasons. Early claims about (...) its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.Circumcision violates the cardinal principles of medical ethics, to respect autonomy, to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics' position, also risk liability for misleading parents about circumcision. (shrink)

Every infant has a right to bodily integrity. Removing healthy tissue from an infant is only permissible if there is an immediate medical indication. In the case of infant male circumcision there is no evidence of an immediate need to perform the procedure. As a German court recently held, any benefit to circumcision can be obtained by delaying the procedure until the male is old enough to give his own fully informed consent. With the option of delaying circumcision providing all (...) of the purported benefits, circumcising an infant is an unnecessary violation of his bodily integrity as well as an ethically invalid form of medical violence. Parental proxy ‘consent’ for newborn circumcision is invalid. Male circumcision also violates four core human rights documents—the Universal Declaration of Human Rights, the Convention on the Rights of the Child, the International Covenant on Civil and Political Rights, and the Convention Against Torture. Social norm theory predicts that once the circumcision rate falls below a critical value, the social norms that currently distort our perception of the practice will dissolve and rates will quickly fall. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:When the Political Becomes Personal:Circumcision as a Cause and as a Parental DecisionJ. Steven SvobodaAs I prepared for the arrival of my first child, a son, a central activity that I previously saw as political suddenly also became very personal. I had founded a non-profit organization in 1997 devoted to educating the world that genital cutting of a child, regardless of a child's gender, is unnecessary and harmful. This (...) includes male circumcision. In 2001, as part of my non-profit work I led a team that went to the United Nations in Geneva and for the first time, put the issue of male circumcision as a human rights violation in the United Nations record. At the time, my then wife was pregnant with our first child, a son. (I had the ultrasound photo of my son-to-be on my nightstand while in Geneva.) Now the circumcision question would be posed to me!A few months after the Geneva trip, when it came time in early 2002 for my son's birth on the US territory of Guam, I naturally was never going to agree to the procedure. Nevertheless, I was trying not to inject my own beliefs into the arrival of my first child. My children's mother, while Jewish, is a pediatrician who always had some doubts about the wisdom of circumcision and easily agreed with my desire to keep our son intact. No one in either of our families had any serious problems with our decision.The nurse at the hospital in Guam where my wife worked and gave birth asked me a total of five separate times if I wanted my son to be circumcised. Each time, I answered, "No," without saying more, until the fifth time, when I politely added, "You do know that there is no medical reason for this to be done, right?" The nurse replied in a chirpy voice, "I know." I then asked, "Why do you ask parents about it then?" She replied, "Because they want it sometimes." Well, the odd thing about that is there is no other medically unnecessary procedure on their children for which parents are repeatedly solicited. And if I had agreed even one time, I am sure that my child would have been circumcised [End Page 73] without any follow-up questions to make sure I really wanted this done. Besides, at least in the absence of any medical condition making it necessary (which is essentially never the case), it should not be my decision to make, nor his mother's, but rather the child's whose body it is.The oddest aspect of this whole chain of events may be that I was not given a single shred of information explaining why I should support my son being cut. My son had zero issues after being left intact, and how could it be otherwise? My advice, naturally, to parents expecting boys (or girls, or intersex children, for that matter) is to educate yourself. You will learn, the more you look into these issues, that there are thousands of people around the world, including countless physicians and other experts, who believe childhood circumcision is as outmoded, useless, and as harmful a practice as footbinding. Why not leave the choice for the child to make about their own body? No asserted medical reason withstands the most minimal scrutiny. And religious claims must stop at the boundaries of another person's body, even if the person is your child. Parents: you have the right to teach your children your beliefs, but your children may not follow your beliefs, and they have the right to make their own decisions, so please consider refraining from marking their bodies with your religion. Two months to the day after his birth, I was holding my son in Washington, DC, having just traveled halfway around the world from Guam. (I was in DC to receive the National Organization of Circumcision Information Resource Center's (NOCIRC) Human Rights Award, which I was presented with for my founding of the non-profit.)My own experience with circumcision strongly influenced my decision. For a decade, I felt that no other single... (shrink)

In 2017 Ploug and Holm argued that anonymizing individuals in the Danish circumcision registry was insufficient to protect these individuals from what they regard as the potential harms of being in the registry. We argue that Ploug and Holm’s fears in each of the areas are misguided, not supported by the evidence, and could interfere with the gathering of accurate data. The extent of the risks and harms associated with ritual circumcision is not well known. The anonymized personal health data (...) supplemented with the circumcision registry will enable more precise research into the medical consequences of ritual circumcision, and allow parents to make more fully informed decisions about circumcision with minimal, if any, adverse consequences. (shrink)

The Helsinki Declaration is the universally accepted standard for ethical behavior in research involving human subjects. The Declaration calls for research studies to compare new therapies to the best current therapies. Despite this standard, multiple studies of pain relief interventions in newborns have recruited placebo controls instead of active controls using the best current therapy. These studies are evaluated using the standards required by the Helsinki Declaration, and the reasons for the ethical shortcomings of these studies are explored.

The Helsinki Declaration, first published in 1964, is the universally accepted standard for ethical behavior in research involving human subjects. The Declaration was formulated in response to the abuses of human subjects by the scientists in Nazi Germany and to update the Nuremberg Code. Amended in 1975, 1983, 1989, 1996, and 2000, the Declaration provides the foundation for the United States federal regulations for research involving human subjects.To conform to standards developed in the Declaration, a researcher must fulfill the following: (...) respect the autonomy of the individual; promote and safeguard the individual’s health; provide informed consent without coercion; take special measures with vulnerable populations; compare new therapies to the best current therapies; have a thorough scientific knowledge of the subject; assess risk versus benefit of the intervention; perform studies that will ultimately benefit the population involved in the research; accurately report their findings; and fully disclose ethical concerns in their research protocols. (shrink)