USA: AAP policy does not address non-consent

BioEdge
September 1, 2012

US doctors' stand on circumcision changes again

By Michael Cook
For the fourth time in 40 years the American Academy of Pediatricians has changed its tune on the controversial topic of infant circumcision. It now says that “preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure”. These benefits include: “significant reductions in the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquisition of HIV and the transmission of other sexually transmitted infections”.

The AAP has worded its new policy carefully. The benefits do not appear to be significant enough to justify recommending routine circumcision, but enough to justify it for parents who insist on it. This neat compromise will allow Jewish and Muslim families to circumcise their sons without acrimonious disputes.

On the ethics of circumcision, the AAP has little to say. Its brief statement did not address the problem of non-consent from the infant. In the US the popularity of the procedure has been in decline, but half of newborn boys are still circumcised. Opponents, known as “intactivists”, claim that it is a potentially dangerous cosmetic procedure which amounts to genital mutilation.

Neither side seems to have an open-and-shut case. Elizabeth Reis, of the University of Oregon, points out in the Bioethics Forum of The Hastings Center that the AAP has changed its mind on the issue several times. In 1971 the AAP decided that it was not a medical necessity; in 1989 that it might be helpful; in 1999 that it probably wasn’t; and now that it probably is.

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