Joint Response from
Georganne Chapin, MPhil, JD
Executive Director, Intact America
Marilyn Fayre Milos, RN
Executive Director, National Organization of Circumcision Information Resource Centers
The Canadian Paediatric Society’s 2015 Position Statement
on Newborn Male Circumcision1
Tarrytown, NY—October 2, 2015
On September 8, 2015, the Canadian Paediatric Society (CPS) released its new statement on Newborn Male Circumcision. Appearing three years following the American Academy of Pediatrics’ report on the same subject, and two years after announcing it was forthcoming, the statement’s expressed goal is to give “guidance to health care providers and up-to-date information for the parents of newborn boys, to enable them to make informed decisions regarding circumcision.”
On a positive note (and because to do otherwise would be unconscionable), we admire the CPS for acknowledging that routine circumcision of male infants and children is not medically necessary. The statement’s authors also acknowledge the protective and sensory function of the foreskin, and recognize that it is normal (i.e., not pathological) for the foreskin to be nonretractile in a male infant or child. Further, the CPS states that applicable law and bioethical principles require that medically unnecessary surgery be deferred until a person is old enough to choose for him- or herself. If only the CPS had stopped there.
However, in an obvious effort to appease those Canadian physicians and others who continue to advocate for (and carry out) the routine removal of boys’ genital tissue, the statement’s authors confuse the issue, contradict themselves, and put forth a hodgepodge of irrelevant and even fraudulent citations in the course of their obfuscation. The net effect reveals (1) the extraordinary dilemma in which North American physicians find themselves at a time when many of their European colleagues are calling for an outright ban on the circumcision of children, and (2) the CPS’s lack of a game plan (and courage) to end the practice.
This response, jointly prepared by Intact America (IA) and the National Organization of Circumcision Information Resource Centers (NOCIRC), highlights serious methodological and ethical problems in the CPS 2015 statement, and calls for that organization publicly acknowledge the errors, misleading information and outright dishonesty therein; to revoke, correct and reissue the document; and to follow the facts to their logical conclusion – a call for doctors to cease removing functional, protective genital tissue from children who cannot consent.
Full text available upon request.
INTACT AMERICA SENT LETTERS TO ALL FLORIDA UROLOGISTS
IN RESPONSE TO A RECENT CASE INVOLVING A BOY WHO
MIGHT BE CIRCUMCISED AGAINST HIS MOTHER’S WISHES.
Tarrytown, NY—January 15, 2015
Intact America, an organization that opposes the forced genital cutting of babies and children, sent letters this week to nearly one thousand urologist offices in the state of Florida. Cosigned by the executive directors of California-based Attorneys for the Rights of the Child and Seattle-based Doctors Opposing Circumcision, the letter requested that the urologists not circumcise the four-year-old boy.
The boy was caught in the middle of a dispute between his parents – the father who wants him to be circumcised, and the mother, of Boynton Beach, who opposes the circumcision on the grounds that her son is normal and healthy, and that the circumcision will put him at risk. According to court documents, the 4th District Court of Appeal (Case No. 4D14-1744) ruled against the mother, and allowed the father to pursue circumcision for his son, despite the fact that a pediatric urologist testified in court that the child is healthy and that the circumcision is not medically necessary.
On January 7, Intact America sent a certified letter to Dr. Charles E. Flack, the urologist who testified on behalf of the father, warning him to not circumcise the child. Similar letters were mailed this week in response to this court case to urologists licensed to practice in Florida cautioning them from carrying out this medically unnecessary surgery since the mother has gone on record as opposing the elective surgery.
Georganne Chapin, Executive Director of Intact America, stated: “In the absence of medical necessity, no one has the right to carry out permanently disfiguring medical procedures on a child. There is a groundswell of men protesting the fact that they were forcibly circumcised as children. Parents and doctors should take heed, and keep boys safe from risky surgery that removes healthy, normal sexual tissue and permanently damages their genitals.”
About Intact America:
Intact America is the leading organization dedicated to ending infant and child circumcision. With its membership of over 60,000 intactivists, Intact America works toward creating a world in which all people of all ages are protected from circumcision or any other permanent genital alteration inflicted on them without their informed consent. Its mission is to educate parents, doctors, nurses, and the American public that the foreskin is a normal, natural part of the human body, designed by nature to provide protection and pleasure.
Intact America is based in Tarrytown, N.Y. Visit Intact America at www.intactamerica.org, on Facebook, and on Twitter.
The American Congress of Obstetricians and Gynecologists (ACOG)
draws protesters to New Orleans convention.
Intact America calls circumcision “an unnecessary, inherently risky surgery that
violates boys’ human rights.” Press conference highlights ethical issues surrounding
nation’s most common pediatric surgery.
May 2, 2013
TARRYTOWN, NY—Intactivists are gathering in New Orleans this weekend to call upon members of the American Congress of Obstetricians and Gynecologists (ACOG) to join the global medical community’s movement away from neonatal male circumcision.
Intact America, the organization leading the demonstration and an 11 AM press conference on Saturday, May 4, placed an advertisement in the New Orleans Times-Picayune and hired a mobile billboard, urging those who see it to “Tell America’s Obstetricians – No More Circumcision.” The sign includes the message “His Body, His Rights” to underscore the organization’s human rights concerns. Approximately 70 Intactivists are expected to participate in the demonstration, displaying banners, carrying placards, and handing out literature.
Georganne Chapin, founding executive director of Intact America, the country’s leading voice against neonatal male circumcision, said, “The leaders of ACOG apparently do not think their members – who, according to estimates, perform at least half of the one million circumcisions in the United States on unconsenting baby boys each year – should hear the arguments that have led medical authorities across the developed world to reject the surgery as unnecessary, inherently risky, and a violation of baby boys’ right to an intact body.”
Chapin commented that ACOG rejected her group’s request to rent space for an educational booth in the convention’s exhibition hall. ACOG’s rejection came in an email in which the group said male circumcision “is only indirectly related to women’s health and of only casual interest to members of ACOG.” Consequently, Intact America decided to communicate with ACOG using protesters.
“It is both sad and disingenuous that ACOG claims circumcision is of no interest to the very doctors who perform the surgery hundreds of thousands of times each year,” Chapin said. “It is also not surprising they have embraced the widely-discredited Circumcision Policy Statementissued August 27, 2012 by the American Academy of Pediatrics (AAP), which lauded the benefits of circumcising infants, while admitting that evidence for such benefits is lacking, acknowledging that the risks have never been adequately studied, and ignoring the ethical problems inherent in permanently removing normal genital tissue from individuals who cannot consent.”
Chapin noted further that the AAP’s 2012 report advocates for insurance companies and Medicaid to pay for circumcisions.
The AAP’s 2012 pro-circumcision report, released last summer and endorsed by ACOG the same day, recently came under sharp criticism from a group of 40 international pediatricians, urologists and medical ethicists, whose article Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision (published in the AAP’s own journal, Pediatrics), claimed the AAP task force was biased in favor of circumcision before its members even began their deliberations. The article’s authors, all Europeans except for one Canadian, said the purported health benefits cited by the AAP could be achieved by far less drastic measures than the removal of healthy, functioning tissue from the genitals of baby boys.
The physicians’ critical view of circumcision position is identical to that of Intact America. “There is growing consensus… that physicians should discourage parents from circumcising their healthy infant boys,” the physicians say, “because non-therapeutic circumcision of underage boys in Western societies has no compelling health benefits, causes postoperative pain, can have serious long-term consequences, constitutes a violation of the United Nations’ Declaration of the Rights of the Child, and conflicts with the Hippocratic oath: primum non nocere: First, do no harm.”
“Intact America’s intent for this demonstration in New Orleans,” said Chapin, “is to make sure ACOG hears and understands the ethical quagmire they have put themselves into.”
Intact America is based in Tarrytown, N.Y. Visit Intact America at www.intactamerica.org, on Facebook, and on Twitter.
I need your help.
Last week, the Huffington Post published “First, Do No Harm,” an article I wrote in response to the American Academy of Pediatrics’ recent endorsement of routine infant circumcision. I am so grateful for the supportive and heartfelt feedback I’ve received from so many.
Judging from the dozens of comments posted publicly and sent to me privately, it seems that my statement calling circumcision a “human rights violation on a massive scale” was a consciousness-raising tipping point for both readers new to the issue, and those already familiar with it.
I want to ask all of you— if you haven’t already done so—to share your thoughts directly on the Huffington Post’s website, which reaches millions of readers. In addition to me wanting to know what’s on your mind, it’s really important for the media, Huffington Post in this case, to see firsthand the breadth of conviction and the diversity of support that exists for keeping baby boys intact. Of course, your positive comments also serve as important information and validation for casual readers who are newcomers to the intactivist cause.
After you’ve commented, I’m hoping you’ll show your support in another way: by donating to Intact America. On October 20, I will be flying to New Orleans with Intact America staff members Amy Callan and Joe Jensen to join other intactivists for the AAP’s annual conference.
We’re working on an Open Letter for the New Orleans Times Picayune, which costs beaucoup bucks, as well as educational handouts and fliers, banners, and much more.
We need your help to carry all of this off. Thanks to a matching pledge from a prominent intactivist, all gifts will be matched dollar for dollar, up to $10,000. This means your donation will have twice the impact. I know money is tight—but it is really critical that we have a strong presence in New Orleans.
Both the Intact America booth inside the Convention Center and the activities taking place outside promote the intactivist message in a whole new way, featuring the photos and stories of brave men who are speaking from their hearts about how circumcision has affected them. Here is the awesome, 10-foot banner that doctors will see when they walk by our booth. To those men who sent photos for this (ongoing) project: thank you, thank you, thank you!
This is why we have to be in New Orleans—to give voice to all the babies who are at risk of being cut, and to protect the bodies and rights of these babies and the men they will become.
Thank you so much.
On August 29, Intact America launched an email campaign, inviting our followers to tell the American Academy of Pediatrics what they think about the new Circumcision Task Force’s Technical Report on Circumcision. The Report, which concedes that the purported health benefits of infant circumcision are not great enough to justify recommending it, and that the risks of circumcision have not been adequately documented, somehow concludes that the “benefits” outweigh the risks. The Report also states that the decision to circumcise baby boys, who cannot consent to have this unethical, medically unnecessary surgery performed on their bodies, should be left to the parents, and, that parents’ non-medical decision to have their child’s genitals unjustifiably altered should be abetted by having Medicaid and private insurance companies pay doctors to do the cutting.
Here’s my letter:
Dear AAP Leadership,
What were you thinking?
How can you approve a report that extols the benefits of removing the foreskin, a normal body part, without one single word devoted to the function of that body part, or why it’s there in the first place? How credible is such a report, which neglects to mention that the vast majority of the world’s men are intact (or as the report says, “uncircumcised”), and that these men do just fine?
What were you thinking when you deputized as co-author of the report a doctor who has openly boasted about circumcising his own son? The American Medical Association’s code of ethics (AMA E8.19) states: “Physicians generally should not treat themselves or members of their immediate families” … “In particular, minor children will generally not feel free to refuse care from their parents.” In 2009, the AAP’s own Committee on Bioethics clearly stated that pediatricians who treat their own children “violate a fundamental professional obligation.”* How can we trust the neutrality or the ethics of a Task Force member who so flagrantly violated his own organization’s bioethical principles?
What were you thinking when you named a specialist in adult sexually transmitted diseases to chair a Task Force to examine infant circumcision? Babies and children don’t have sex, and thus they are not at risk of contracting an STD. It seems to me, by selecting this individual as chair, the Task Force already knew what it was looking to conclude.
Would it not have been relevant for the Task Force to mention the limitations of its recommendations? Specifically, even if circumcision were to confer some protection from HIV for adult heterosexual men, as claimed by the studies cited, it was found to confer none for women, or for men having sex with men, or for intravenous drug users. And, again, it confers no protection for babies and children. Furthermore, shouldn’t the Report have mentioned that if or when an adolescent or adult becomes at risk, there are other nonsurgical ways of avoiding sexually transmitted diseases? Shouldn’t the words “safe sex” or “condom” or “abstinence” have appeared at least once in the Report?
Given the Task Force’s unequivocal conclusion that the “health benefits of newborn male circumcision outweigh the risks,” are you not concerned by the Report’s utter failure to address the risks? Specifically, how do you justify the contradictions and doublespeak in the following statements?
The true incidence of complications after newborn circumcision is unknown, in part due to differing definitions of “complication” and differing standards for determining the timing of when a complication has occurred (i.e., early or late). Adding to the confusion is the comingling of “early” complications, such as bleeding or infection, with late complications such as adhesions and meatal stenosis…. (p. 772)
Based on the data reviewed, it is difficult, if not impossible, to adequately assess the total impact of complications, because the data are scant and inconsistent regarding the severity of complications. (p. 775)
The majority of severe or even catastrophic injuries [such as] glans or penile amputation, … methicillin-resistant Staphylococcus aureus infection, urethral cutaneous fistula, glans ischemia, and death are so infrequent as to be reported as case reports (and were therefore excluded from this literature review). (p. 774)
Did you not notice any potential liability problems for the AAP and for pediatricians who circumcise that might arise as a result of the Report? For example, while discussing the Mogen clamp in its review of complications from particular circumcision techniques and tools, the Report says:
There were no specific studies of complications … because complications are rare; thus, one can only rely on available case reports of amputation. (p. 775)
No note is made of the fact that the manufacturer of the Mogen is bankrupt, due to lawsuits resulting from these “rare” complications and amputations, and that any doctor sued for an adverse outcome from a Mogen will be on his own (unless, of course, he can implicate the AAP for failing to inform him of the facts). Also, the review of techniques and tools neglects to cross-reference a mention elsewhere of “devastating burns” that can occur when electrocautery is used in conjunction with the metal Gomco clamp. Sloppy, at best.
Did anybody think to ask why no data has ever been found in the developed world showing a correlation between circumcision and disease? Since when is sub-Saharan Africa, with high rates of poverty, illiteracy, and disease, the gold-standard comparison population for American pediatrics? Did anybody wonder how it can be that Europe, where very few men have been circumcised, has lower rates of STDs and HIV than the U.S. and better overall health status, along with lower per capita health expenditures?
Has the leadership of the AAP, knowing that a Task Force was preparing recommendations about infant circumcision, noticed that medical associations in European countries are increasingly calling for doctors to refuse to perform this surgery, on the basis that it is risky, medically unnecessary, and a violation of the child’s rights? How can you completely ignore the principles and actions of your learned colleagues in other countries?
Did anybody ask the Task Force to make sure its Report was consistent with other AAP policies, including the statement by the AAP’s own Committee on Bioethics on “Informed Consent, Parental Permission, and Assent in Pediatric Practice”? The policy, still in effect, states in part:
Proxy consent poses serious problems for pediatric health care providers. Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses… [The] pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent. (p. 315)
In placing the burden of deciding whether to circumcise their sons squarely on the shoulders of parents (who are not medical professionals), is the Task Force Report on Circumcision contradicting this statement on Informed Consent? By referencing religion and culture as valid elements in parental decision-making (p. 759), is the Report attempting to give doctors a free pass? Religion and culture (in the American context) generally lead to circumcisions, but human rights, medical ethics and the mandate to doctors to do no harm clearly lead to leaving a boy intact.
Most important, have you not noticed the growing outcry among parents, complaining that they were duped by doctors into agreeing to allow harmful surgery to be performed on their baby boys? Are you ignoring the growing body of complaints from adult men protesting that they were robbed of an important part of their sexual anatomy, without their consent?
Are any of these considerations not relevant to the pediatrician who would strap down a helpless, screaming baby and cut off part of his penis?
I look forward to your response.
Georganne Chapin, MPhil, JD
* Committee on Bioethics, Pediatrician-Family-Patient Relationship: Managing the Boundaries. Pediatrics 124(6), Dec. 1, 2009: 1685-88.
Every mother, every parent, looks back on things we regret doing or failing to do for our children. Probably one of the most common parental regrets is “I was too busy; I didn’t spend enough time with my child” (the song Cat’s in the Cradle, by Harry Chapin, was all about this).
But I have never heard more pain and remorse than what is expressed by mothers who didn’t protect their baby sons from circumcision, and later realized the brutality their boys had suffered.
This pain, for many, never fades. The first time I was invited to talk about circumcision on a radio program that accepted call-ins, a woman who I’ll call Bea came on the line and began to recount her experience. In a shaky voice, Bea said she’d never thought or even heard about circumcision until a nurse came to her in the hospital while she was holding her newborn son, and asked her to hand him over. At this point in the story Bea began to cry. “The nurse told me it was time for him to be circumcised – and she was going to give him that gift. She took my baby away.” She paused. “And then I heard the scream. I will never, ever forget that scream; it was like nothing I’d heard before or since. A few minutes later, the nurse brought me my son – and he was a different person.” Bea went on to say that before he was taken away, her baby had been awake and calm, and making eye contact with her. After he was circumcised, he was disassociated, refused to nurse, and was later inconsolable when he cried. The first time she changed his diaper and “saw what they had done,” Bea said she “wanted to die.”
I asked, “How is your son now?”
“He’s fine,” she said. “But I am not. I feel guilty every single day.”
“How old is he?” I asked, envisioning a baby, or maybe a young toddler.
“He’s 28,” she said.
I thought of my own son, who was also at the time of this conversation, 28 years old. I reflected on how lucky I am to have had the information I needed to protect him from circumcision, to have had the support of his father, and – unlike Bea and so many other mothers I have met – to have escaped pressure from doctors, nurses, or others intent on perpetuating this horrible custom.
But why should I have been surprised that, 28 years later, Bea’s trauma remained as acute as ever? Marilyn Milos, my close friend and the “mother of the intactivist movement” has worked every day for the past 35 years to save babies from circumcision, and their mothers from the pain and remorse she feels for having ignorantly acquiesced to having her three sons’ circumcised (Marilyn awareness and trauma began when – as a newly trained nurse – she witnessed her first circumcision). Marilyn’s grown sons, like Bea’s son, are “fine” and have forgiven her – but Marilyn, Bea and so many mothers I have heard from since that radio program, have not forgiven themselves and remain haunted, decades later.
What could I say to Bea? I said the words I learned from Marilyn: “You didn’t know any better, so you couldn’t do any better. Now you know, so speak up and speak out to save babies, and to save other mothers from this regret.”
Happy Mother’s Day to Bea, Marilyn and all mothers who – whether out of ignorance or fear or pure bad luck – were unable to protect their sons from circumcision. Happy Mother’s Day, and good karma, to every mother who tells the truth about circumcision. Live in peace.