In her column of
March 31[, 2001Calgary Herald], "Ancient ritual does no harm," Catherine Ford
provides a stunning example of ignorance regarding the current medical
knowledge about infant male circumcision. She demonstrates a similar
lack of
understanding of the ethical and legal arguments relevant to
circumcision
that are set forth in my book, The Ethical Canary.
She is wrong when
she says there is medical evidence the procedure does no
harm to the child. Leaving aside circumcisions that go wrong -- and in
rare
cases have even resulted in death -- and the serious pain involved,
circumcision removes healthy, erogenous tissue with specialized
mechanical,
protective and sexual functions.
But even if Ford
were correct about the medical evidence, it would not
justify circumcision. To justify, ethically and legally, carrying out
surgery on persons unable to consent for themselves, the surgery must be
necessary therapy and the least harmful and invasive way to obtain the
therapeutic benefit. Routine circumcision fulfils neither of these
requirements.
Ford accuses me of
seeking to break the covenant that circumcision
constitutes for Jews by speaking against it. She also accuses me of
wanting
to marginalize religions that mandate circumcision by my suggesting
that,
if circumcision were generally prohibited, it might be able to be
justified
on the basis of a charter right to freedom of religion, for those people
for
whom it is a religious obligation.
In other words,
I'm damned if I speak against it (as I believe ethically
I must) and I'm damned if, in doing so, I act on the basis of a deep
respect
for people's religious beliefs and practices (as I also believe
ethically
I must).
The freedom of
religion charter claim raises very complex issues about
parents' rights to impose their religious beliefs on their children (see
the
Sheena B case, Supreme Court of Canada). And such a right is in conflict
with the child's charter right to security of his person and protection
of
his bodily integrity.
Ford obviously
does not understand the legal basis of the charter challenge
to circumcision that is based on the Criminal Code prohibition on female
genital mutilation. The argument is that in passing a law to protect the
bodily integrity of girls and not giving similar protection to boys, the
law
discriminates on the prohibited ground of sex and, therefore,
is unconstitutional.
The aim is
certainly not to wipe out the protection of genital integrity
given to girls, but to have a respectful discussion of what we owe to
boys
in terms of protecting them.
No reasonable, properly informed person, including rabbis who strongly
support infant male circumcision, believes it is like a manicure, as
Ford
describes it.
Ford might like to
consider that the reason the baby was so quiet after the
procedure was he was in a state of shock. The serious pain of
circumcision,
and of the resulting open wound which is in contact with the child's
acid
urine for about a week, is a matter of common sense.
There is also
medical evidence of the impact of the pain, with possibly
life-long effects. We can speak of a human right not to have pain
unjustifiably inflicted on us, and this includes children. The fact that
circumcision has such important religious significance makes it an
extraordinarily difficult and sensitive issue to discuss. But sometimes
it
is unethical to avoid such discussions, which must be carried out in an
atmosphere of deep mutual respect.
I was not sure
whether Ford was implying that my statements were
anti-Semitic. But if she were, she might be interested to know that when
the
same has been alleged in the past, many Jewish people, including rabbis,
have expressed their dismay at such labeling.
Margaret A.
Somerville,
Montreal, Que. Canada
And from her book,
The Ethical Canary. 2001:204-205)
"A common error made by those
who want to justify infant male circumcision on the basis of medical
benefits is that they believe that as long as some such benefits are
present, circumcision can be justified as therapeutic, in the sense of
preventive health care. This is not correct. A medical-benefits or
"therapeutic" justification requires that overall the medical benefits
should outweigh the risks and harms of the procedure required to obtain
them, that this procedure is the only reasonable way to obtain these
benefits, and that these benefits are necessary to the well-being of the
child. None of these conditions is fulfilled for routine infant male
circumcision. If we view a child's foreskin as having a valid function,
we are no more justified in amputating it than any other part of the
child's body unless the operation is medically required treatment and
the least harmful way to provide that treatment".
_________________________________________________
From The Human Sexes, A Natural History of
Man and Woman, by
Desmond Morris:
After the
dramas of birth and baptism, a child's
ordeals are far
from over. In many cultures the
children must
face the ritual genital mutilation we
call
circumcision. This extraordinary procedure which,
were it not
hallowed by ancient tradition, would be
prosecuted as
child abuse, occurs in several forms in
different parts
of the world, sometime applied to
young males and
sometimes to young females. Literally millions of cases of these genital
assaults
occur annually and a whole range of preposterous
excuses and
explanations have been given as to why
this savaging of
young humans is necessary. In earlier
days most of the
explanations had to do with religious
dictates, sacred
demands that could not be queried
rationally. With
the fading of religious beliefs in some countries in later years, new
excuses had to be
found and a set
of spurious medical reasons invented.
The Jewish faith
calls for circumcision on the
eighth day
following birth. The baby suffers acute
pain, but is
otherwise uninvolved in the ritual. In
some countries,
however, the mutilation is deferred
until the male
children are fully aware of what is
going on. When a
boy is selected, his mother may not
intervene. He is
held down by his godfather while his
foreskin is cut
away. Afterwards he is given a diploma
and must kiss
the hand of the man who has mutilated
him. No other
species behaves in this bizarre way
towards its
young· No matter how cruel or pointless
they may be,
they become stubbornly resistant to
common sense or
objective medical opinion.
________________________________________________
Are
experiments on the effects of neonatal circumcision pain ethical
if
circumcision is not necessary for the health of the child?
_________________________________________
Charles
Hartshorne
(June 5, 1887-Oct. 9, 2000)
famous American philosopher at 97 years old
commenting on circumcision in a letter to Duane Voskuil (4/94):
“About circumcision, the only serious mistake my parents
made about me was in that. The effects you specify I can identify in my
case, except that it was so different from all the other things my
parents did that some of the shock to the child-parent relationship was
mitigated.... But on the whole I agree such things should not be done
to either sex. My sex has a lot of misbehavior to answer for. Our
species is both the best and the worst of the earth’s animal species,
the wisest and the most foolish. Our radical superiority in linguistic
power is a somewhat self-destructive advantage.”
________________________________________
American Medical
Association's
Principles of Medical
Ethics
Preamble:
The medical
profession has long subscribed to a body of ethical statements
developed
primarily for the benefit of the patient. As a member of this
profession, a
physician must recognize responsibility to patients first and
foremost, as
well as to society, to other health professionals, and to self.
The following
[11] Principles adopted by the American Medical Association are not
laws, but
standards of conduct which define the essentials of honorable
behavior for the
physician.
I. A physician
shall be dedicated to providing competent medical care, with
compassion and
respect for human dignity and rights.
II. A physician
shall uphold the standards of professionalism, be honest in
all
professional interactions, and strive to report physicians deficient
in character or competence, or engaging in fraud or deception, to
appropriate entities.
III. A physician
shall respect the law and also recognize a responsibility
to seek
changes in those requirements which are contrary to the best
interests
of the patient [patient, not parent].
IV. A physician
shall respect the rights of patients, colleagues, and other
health
professionals, and shall safeguard patient confidences and privacy
within the
constraints of the law.
V. A physician
shall continue to study, apply, and advance scientific
knowledge,
maintain a commitment to medical education, make relevant
information
available to patients, colleagues, and the public, obtain
consultation,
and use the talents of other health professionals when
indicated.
VI. A physician
shall, in the provision of appropriate patient care, except
in emergencies,
be free to choose whom to serve, with whom to associate, and
the environment
in which to provide medical care.
VII. A physician
shall recognize a responsibility to participate in
activities
contributing to the improvement of the community and the
betterment of
public health.
VIII. A
physician shall, while caring for a patient, regard responsibility
to the
patient as paramount.
IX. A physician
shall support access to medical care for all people.
_________________________________________________
Found in the American Medical Association website.
For centuries, physicians have taken oaths to uphold certain moral values
and virtues. The most famous of these, of course, has been the Hippocratic
Oath. But others have been used, such as the Prayer of Maimonides and the
Declaration of Geneva. Today, some medical schools even use their own
crafted oaths, sometimes drafted by faculty members, sometimes drafted by
students. The last few years has witnessed a general increase in the
frequency of oath-taking among medical students. This ritual of
oath-taking suggests a strong renewal of the commitment of medical
students and physicians to the moral enterprise of medicine. The Oath
Registry contains the oaths currently being administered in US medical
schools. This will provide educators an opportunity to compare their own
oath with other schools.
The University of North Dakota School of Medicine and Health Sciences: The
Contemporary Oath of
Hippocrates Today.
In the presence of family, friends,
teachers, and colleagues, I dedicate myself to the profession of Medicine.
I pledge myself to the service of humanity. I will use my skills to care
for all in need, without bias and with openness of spirit. The health of
my patients will be my first concern. I vow to hold sacred the bond
between doctor and patient. I will hold in confidence all that my patients
entrust to me. I will strive to alleviate suffering. I will respect the
dignity and autonomy of my patients in living and in dying. As a
Physician, I recognize my duty to society. I will work to promote health
and prevent disease. I will advocate for the welfare of my community. Even
under duress, I will not use my knowledge or my skills against humanity. I
will acknowledge my limitations and my mistakes so that I may learn from
them. To uphold these responsibilities, I will maintain my own well-being
and the well-being of those close to me. I will promote the integrity of
the practice of Medicine. In the tradition of my profession, I honor all
who teach me this Art. Through honest and respectful collaborations with
my colleagues, I will uphold the highest standards in the service of
patients. I will seek new knowledge, reexamine ideas and practices of the
past, and teach what I have learned. Above all, the health of my patients
will be my first concern. This Oath I take freely and upon my honor.
________________________________
The College of Physicians and Surgeons of British Columbia issued
a guide for physicians regarding routine infant male circumcision which
reads in part [emphasis added]:
Legal Considerations
To date, the legality of infant male
circumcision has not been tested in the Courts. It is thus assumed to
be legal if it is performed competently, in the child’s best
interest, and after valid consent has been obtained.
....However, proxy consent by parents is now being
questioned. Many believe it should be limited to consent for
diagnosis and treatment of medical conditions, and that it is not
relevant for non-therapeutic procedures.
Human Rights Considerations
The matter of infant male circumcision
is particularly difficult in regards to human rights, as it involves
consideration of the rights of the infant as well as the rights of the
parents.
Under the Canadian Charter of Rights and Freedoms and
the United Nations Universal Declaration of Human Rights, an infant
has rights that include security of person, life, freedom and
bodily integrity. Routine infant male circumcision is an
unnecessary and irreversible procedure. Therefore, many consider
it to be “unwarranted mutilating surgery”.
Many adult men are increasingly concerned about whether
their parents had the right to give consent for infant male
circumcision. They claim that an infant’s rights should take priority
over any parental rights to make such a decision. This procedure
should be delayed to a later date when the child can make his own
informed decision. Parental preference alone does not justify a
non-therapeutic procedure.
Others argue that this stance violates the parents’
right to religious or cultural expression, and that adherence to their
religious and cultural practices would be in the best interests of the
infant.
Ethical Considerations
Ethical considerations regarding infant
male circumcision centre on the welfare (or “best interests”) of the
infant and the potential benefit and harm associated with the
procedure. Ethics points us to corrective vision, i.e. to question
practices that have become routine, or which we take for granted.
Therefore, each request for the procedure should be carefully
evaluated, and an agreement to perform the procedure should take into
consideration the ethical principles of beneficence (duty to benefit);
non-maleficence (do no harm); veracity (accurate information);
autonomy (consent); and justice (fairness).
__________________________________________
The PIAA top ten reasons that Pediatricians are sued
>http://www.aapca1.org/aapca1/nl972.html
Submitted by George Thomasson, MD to
AAP of California
1. Failure to diagnose
meningitis
2. Brain damaged infant
3. Routine infant and child health checks
4. Congenital dislocation of the hip
5. Failure to diagnose appendicitis
6. Premature infant
7. Asthma
8. Cerebral palsy
9. Circumcision's adverse outcomes
10. Respiratory problems of the newborn
_________________________________________________
The Second General Assembly of
the World Medical Association 1948.
The Medical Code of Ethics Declaration
of Geneva, 1948
At the time of being admitted as a Member of the
medical profession I solemnly pledge myself to consecrate my life to the
service of humanity : I will give to my teachers the respect and
gratitude which is their due; I will practise my profession with
conscience and dignity; The health and life of my patient will be my
first consideration; I will respect the secrets which are confided in
me; I will maintain by all means in my power, the honour and the noble
traditions of the medical profession; My colleagues will be my brothers
: I will not permit considerations of religion, nationality, race, party
politics or social standing to intervene between my duty and my patient;
I will maintain the utmost respect for human life, from the time of its
conception, even under threat, I will not use my medical knowledge
contrary to the laws of humanity; I make these promises solemnly, freely
and upon my honour...