Thursday, December 27, 2012

The Circumcision Blame Game


In all my years as an intactivist (I've been against circumcision since I was about 16, I'm 31 now), I often come across the dilemma of who is responsible for the circumcision of children in America. Who's fault is it if you are circumcised and not happy with it?

Who should you blame?

Before going on, I'd like to introduce the above image. It was uploaded to Facebook by one Jonathon Conte, who is a pro-active intactivist in the San Francisco area, and belongs to the local group Bay Area Intactivists.

The caption read:

"This is the pattern that I continue to see when doing various intactivist protests and events. Nobody wants to accept responsibility and the blame goes round and round.

"Talk to the parents!" "Talk to the obstetricians!" "We don't do them. Talk to the pediatricians!" "Nobody told me it wasn't necessary!"

On the bright side, they used to all defend the practice, now they pass blame. Blame acknowledges a shameful act. Progress."
And Jonathon is right.

There is something suspicious going on when, instead of owning responsibility, it is being passed around like a hot potato.

Except, I think the above image is wrong. It places undue weight on parents, with them at the top and the doctors at the bottom. It implies parents are entitled to a choice, and physicians are loyal subjects who merely listen and obey.

But since when does medicine work this way?

For what other medical treatment or procedure are parents in a position of entitlement to "decide" at whim, without any kind of clinical indication or medical diagnosis? For what other surgery are surgeons slaves to demanding parents? Do parents actually wield so much power?

Aren't parents usually given the power to choose a method of treatment for their children AFTER a doctor has determined that there is some kind of clinical or medical necessity?

For these reasons and more, I believe Jonathon's image is a false paradigm. This delusion of "parental choice" is a false paradigm invented by doctors, the trade unions they belong to, and it is perpetuated by the media.

The image looks something more like this:






Doctors would like to pretend as if parents had this power over them, and they are nothing but loyal subjects at their beck and call. But let's analyze the balance of power here.

Professional Responsibility
First off, it must be be asked; who holds the professional license?

To earn the title of "doctor," physicians must go to school for a number of years. Additionally, they are also responsible for keeping their information up to date. They hang their certifications proudly on their office wall and constantly remind others that they are not to drop the title of "doctor" when being referred to.

It is a doctor's professional responsibility to know better than his patients. It is his professional responsibility to determine the presence or absence of a pathogen, and to determine whether or not treatment, surgical or non-surgical, is medically or clinically indicated.

It is why he is visited, and it is why he gets a paycheck.

And yet, when it comes to circumcision, they are suddenly clueless.

So clueless, that they must pawn the burden of determining the medical necessity of circumcision on parents, most of whom unfamiliar with medical literature.

The mighty and powerful doctor is suddenly too stupid to do his job, and thus hands it off to naive parents he, in most other circumstances, views as intellectually inferior to himself.

Who Wields the Knife?
Let's analyze the areas of medical expertise. Who performs circumcisions for parents?

Here, we see two types of physicians vying for a piece of the circumcision pie; pediatricians and obstetricians/gynecologists (AKA: OB/GYNs) It makes sense that pediatricians are performing surgery on children; a pediatrician's area of expertise is the health and well-being of children.

But wait, this is weird, OB/GYNs are trained in the health and well-being of WOMEN. Vulvas, vaginas, cervixes and ovaries (and much much more). One wonders why OB/GYNs are even part of the picture in the first place.



And yet, according to national surveys, OB/GYNs perform the bulk of infant circumcisions.



The only relation OB/GYNs seem to have with MALE infant babies is that, as caretakers of pregnant women, they are closest in proximity to intact male newborns, and thus have first dibs at cashing in on the procedure; pediatricians deal with the child once he's already out. As experts in FEMALE healthcare, it would actually make more sense for OB/GYNs to be offering sunat operations to expectant mothers.

Why are physicians, whose primary expertise is the health and well-being of WOMEN, profiting from performing non-medical surgery on healthy MALE children?

"You take care of a woman through her pregnancy, for nearly a year...and you're lucky if you see $1500. But a circumcision is 15 minutes, and it's $300 a pop. It's candy."
~OB writing in 'Parents' Place' on the circumcision turf war between OB/GYNs and pediatricians 

So Who's To Blame?
As medical scholars, as bearers of professional licenses, but most of all, as actual facilitators of the procedure itself, the answer is that it is physicians who bear full responsibility for circumcision.

Before treatment can be administered, it is the responsibility of a physician to perform a diagnosis, to determine the presence or absence of a pathogen or medical condition, and to determine whether or not surgical intervention is necessary to treat said medical condition.

The standard of care for therapeutic surgery in most of the rest of the world requires the medical benefits of the surgery to far outweigh the medical risks and harms, or for the surgery to correct a congenital abnormality. Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is unethical and inappropriate to perform surgery for therapeutic reasons where medical research has shown there to be other techniques to be at least as effective and less invasive.

Circumcision seems to be the only instance in medicine where standards of care are overridden in lieu of "parental choice."

How Physicians Absolve Themselves
It is the professional duty of a physician to determine the validity of the treatment they administer, and of the procedures they conduct.

In the special case of circumcision, however, physicians get away with profiting from this non-medical procedure on healthy, non-consenting individuals, by pawning off their responsibility on parents. Doctors push the paradigm of "the great parental decision" forward, and the media helps perpetuate it.

In their latest statement, the American Academy of Pediatrics came very close to, but stopped short of recommending infant circumcision for all infants (contrary to popular belief). Despite touting over and over again that "the benefits out weigh the risks," they must still admit that the "benefits are not enough to recommend the procedure," concluding that "the final decision should be made by parents." (This was their exact position in their last statement in 1999.)

The result is a spineless, non-committal statement that sounds like an endorsement, if not outright recommendation, but is actually nothing more than self-absolution of professional responsibility, and the undue placement of an onus on parents.

Let me run this by readers again; the AAP, a professional medical organization, could not use the latest "benefits" in order to issue a recommendation for circumcision. Yet, parents, most of whom are incapable of discerning medical literature, are expected to take the same information, that medical professionals could not use to recommend circumcision, and somehow come up with a more reasonable conclusion (than medical professionals with professional licenses???).

Parents are being given the duty to make the medical value judgements, that actually belongs to the professionals carrying out the procedure.

The doctor stokes in parents a false sense of entitlement, convinces them to sign a ready-made release form, and thus he is legally (or illegally?) absolved from any responsibility whatsoever.

Thus, doctors profit at the expense of healthy, non-consenting individuals.

Our legal court system seems to be deliberately looking the other way at this practice.

Is This Actually Legal?
Currently having parents sign a consent form for non-therapeutic surgery on healthy, non-consenting individuals seems perfectly legal. But is it?

Without medical or clinical indication, can doctors actually be performing surgery in healthy, non-consenting individuals, much less be eliciting any kind of "decision" from parents?

How is approaching parents of a healthy, non-consenting child, and soliciting a non-therapeutic, permanently altering procedure and eliciting some kind of "decision" NOT charlatanism or medical fraud?

How is it not a criminal act to physicians to place the duty of making a medical value judgement on naive parents, who are trusting them for non-interested medical advice?

What parents WOULDN'T choose circumcision for their children, being told that they would succumb to cancer and AIDS otherwise?

Doesn't it strike people as odd that doctors are asking parents to weigh "benefits and risks" that could not bring medical organizations in or outside the US to endorse infant circumcision?

Why don't doctors inform parents of this fact, instead of stoking in them a false sense if entitlement?

Shouldn't doctors know better than to realize a procedure they know has no therapeutic value in healthy, non-consenting children?

Even if the parents demand circumcision for their children, isn't it the duty of a physician with integrity to refuse to do this? (As he would with any other non-medical procedure a parent would demand?)

Why are physicians able to absolve themselves by pointing to parents and saying "They made me do it?"

Cut Parents Some Slack
On various mediums where the circumcision debate is happening, it seems the prevailing attitude amongst people against circumcision, and even amongst angry circumcised men themselves, is to blame parents. On foreskin restoration forums, on Facebook, on news commentaries, I often read about angry circumcised men who resent their parents, who have had nasty fights with them to the point of breaking off relationships.

It doesn't help that there is also this attitude amongst parents who have circumcised their children, or plan on circumcising their future children, to have a sense of entitlement to having their children circumcised. "I'm the parent, I decide," seems to be the prevailing attitude amongst parents who advocate for infant circumcision. Of course this attitude draws the ire of angry men and angry intactivists, aggravating the situation.

Adding to the situation is that, as already mentioned, medical professionals place the onus of "the great decision" on parents. Angry intactivists, angry sons, and the very medical profession fleeing from professional responsibility. So much weight on parents' shoulders!

But what do parents say when asked as to why they had their sons circumcised?

Most parents have their sons circumcised out of tradition, because it is a religious conviction, or because the father and his father were circumcised. But, almost as if parents knew this weren't enough, these alibis are reinforced with "My doctor told me it was best." Or "My doctor told me it's cleaner and it prevents many diseases."

I say, parents should be cut some slack.

It would be one thing if parents actually ponied up, bought an exacto knife and attempted to perform the procedure themselves. Most just agree to it because they are told not doing so will result in penile cancer or AIDS. I believe that most parents actually have the well-being of their children in mind. I believe that most parents, being given the facts not being disclosed to them by their physicians, would refuse to have this done to their children. I believe that most parents, once they understood what circumcision is, would take it all back if they could.

Parents shouldn't be blamed.

(They also shouldn't be congratulated and/or encouraged to "celebrate" their ignorance, but I already address this on another blog post.)

Maybe some can, but most simply don't know.

Remember who holds the professional license.

Remember whose professional duty it is to know better.

Remember who ultimately holds the knife.

The following pie chart demonstrates how many circumcisions are carried out by parents in this country.



It's physicians in which parents place their trust.

And it's physicians who betray this trust.

This Is Not About Judging Parents
I think it needs to be made clear to both intactivists and parents of circumcised children alike; the point of intactivism is not to be making parents feel guilty.

One of the greatest obstacles for intactivism is that parents who circumcised their chidlren will often get on the defense, accusing those who oppose circumcision of "judging" and trying to make parents feel guilty, when that's not the point at all.

The point of intactivism is to bring attention to the fact that the forced circumcision of healthy, non-consenting minors is a violation of the most basic of human rights, and to educate and enlighten both doctors and parents alike, so that this madness ends.

Parents who honestly wanted the best for their children need not feel judged. If I didn't know what I know now, and a doctor told me that my son would surely develop penile cancer and die of AIDS, I think I would probably choose circumcision too.

Can parents be blamed because they were asked to make choices based on skewed or limited information? If they were even given information at all?

No.

As I express in this blog post, the burden of responsibility rests in physicians who disseminate misinformation, and who profit at the expense of parental naivete, and the fact that children cannot speak for themselves. While parents, at least for the time being, are given the final say, it is doctors who choose what information to give to, and not give to parents. Doctors are either guilty of dispensing misinformation, or failing to update their information databases. (Actually, they're guilty of even bringing the subject up in the absence of medical necessity.)

In avenues where I have expressed this, I have often been berated by angry intactivists and men. They tell me:

"The information is out there. Maybe one day parents could claim ignorance, but now we have the Internet. You've got to be real dumb, or willfully ignorant if you say you don't know better."

This is true to a certain extent. Yes, the information is out there, and people can look if they wanted. Parents, if they took the time, could sift through all the medical gobbledygook, and come to their own conclusions.

But whose job is that?

Isn't it doctors who are paid big bucks to determine the medical validity of a surgical procedure?

Doctors are supposed to have gone to school for many years to learn their trade.

Why would parents, most of whom never went to medical school, be more qualified than a learned doctor to determine the medical necessity of a surgical procedure?

That's what I don't understand, and I've asked this above.

The AAP has concluded, as it did in its last statement, that the "benefits are not enough to recommend circumcision." They still place the onus on parents to weigh the "pros and cons," and make a "decision." "Pros and cons" that could not convince an entire body of qualified medical professionals to endorse circumcision. But suddenly, parents will have better knowledge and the power to discern the medical literature an entire professional medical organization could not?

The bottom line is that parents, and most people, would still rather believe a man in a white lab coat than they would some website on the Internet, or some angry activist who can be easily dismissed as a conspiracy theorist. That people place too much trust in doctors, putting them up on a pedestal and deifying them is a sad state of affairs, but its reality.

It's also why doctors, of all people, are responsible. They are given trust by well meaning parents. And they, taking advantage of their position of power, betray this trust.

So intactivists, go easy parents.

Angry men, don't judge your parents so harshly.

They are not to blame.

Instead, blame physicians who continue to profit at the expense of the basic human rights of healthy, non-consenting individuals and their parents.

Blame the complacent system that allows this kind of charlatanism and medical fraud to continue unchecked.

Challenge institutions of higher education and professional medical organizations that continuously shirk their professional responsibilities and pawning them off on naive parents.

I close with my Mission Statement, which can always be viewed in my About page:

Mission Statement
The foreskin is not a birth defect. Neither is it a congenital deformity or genetic anomaly akin to a 6th finger or a cleft. Neither is it a medical condition like a ruptured appendix or diseased gall bladder. Neither is it a dead part of the body, like the umbilical cord, hair, or fingernails.

The foreskin is not "extra skin." The foreskin is normal, natural, healthy, functioning tissue, with which all boys are born; it is as intrinsic to male genitalia as labia are to female genitalia.

Unless there is a medical or clinical indication, the circumcision of a healthy, non-consenting individual is a deliberate wound; it is the destruction of normal, healthy tissue, the permanent disfigurement of normal, healthy organs, and by very definition, infant genital mutilation, and a violation of the most basic of human rights.

Without medical or clinical indication, doctors have absolutely no business performing surgery in healthy, non-consenting individual, much less be eliciting any kind of "decision" from parents.

Genital integrity, autonomy and self-determination are inalienable human rights. I am against the forced circumcision of healthy, non-consenting minors because it violates these rights.


Genital mutilation, whether it be wrapped in culture, religion or “research” is still genital mutilation.

It is mistaken, the belief that the right amount of “science” can be used to legitimize the deliberate violation of basic human rights.

DISCLAIMER:
The views I express in this blog are my own individual opinion, and they do not necessarily reflect the views of all intactivists. I am but an individual with one opinion, and I do not pretend to speak for the intactivist movement as a whole, thank you.

8 comments:

  1. I agree with at least 95% of what you say above.

    For several years now, I have commented hither and yon on the internet, giving my ethical bottom line: I blame American medical schools for the tragedy that is RIC in the USA. My line of attack is as follows.

    Lidocaine was first marketed in 1950. But medical schools did not begin teaching doctors to use it while performing RIC until the late 1990s. Hence even now, a majority of RICs in the USA are still done with no meaningful pain reduction. This despite the fact that the pain and stress of RIC have been well documented in the medical literature.

    Second, circumcision removes parts of the human body that are directly involved in foreplay and penetrative sex. Therefore doctors must research the possible consequences of circumcision on adult sexual pleasure and functionality. Yet for at least 100 years, American medical research (nearly all of which is carried out in medical schools) has refused to take a long hard look at what infant circumcision does to the adult penis and its sex life. Hence American doctors who perform RICs cannot carry out their duty to "first do no harm."

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    1. "Therefore doctors must research the possible consequences of circumcision on adult sexual pleasure and functionality," you say.

      "It is difficult to get a man to understand something, when his livelihood depends on his not understanding it."
      ~Upton Sinclair

      I agree that part of the problem is that doctors aren't taught about the foreskin, its function etc. in American medical schools. America has yet to update its curriculum, as the only thing they teach regarding the foreskin is that it is superfluous and must be cut off.

      The problem with this is that the information, the research, the studies, are out there. In Europe, doctors and researchers are making a conscious effort to catch up (or are already caught up; see Frisch). While parents cannot be expected to understand studies and research, let alone look it up, as licensed professionals, it is the duty of physicians to update their information, possibly even report observations themselves, in America, they do not.

      The fact of the matter is that circumcision is a moneymaker, and physicians who profit from it have vested financial interest to protect. Reporting adverse circumcision effects puts their yearly circumcision stipend in jeopardy, not to mention the disrepute it would bring to American medicine.

      Doctors have reputations to uphold, pocketbooks to line and protect from lawsuits. With so much to lose, there is incentive to ignore all the research concerning the functionality of the foreskin, and evidence of circumcision's detriments.

      So in part, American schools are to blame for American doctors' inability to carry out their duty to "first do no harm." But I continue to blame doctors themselves for not thinking to, perhaps even refusing to educate themselves.

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  2. Yes, I blame the doctor. My Mother is also a victim.

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  3. Your explanation of how this 'cutting' culture operates is excellent. You brilliantly elucidate how this medical fraud is perpetuated. You're right when you say responsibility lies with the 'cutters' themselves- but they're not alone. Sorry, but you've completely forgotten to mention how society has granted parents with the most powers of guardianship than anyone else. Medical fraud does not absolve parents for failing in their responsibility to protect their children from harm. In the same way that parents entrust their children to be alone with priests, some children are going to be raped. Another example: parents have ceded their authority to priests, who are working under a perverse vow of chastity(unnatural) that they, as men, cannot fulfil so they prey on easy victims with devastating consequences for children.
    'The bottom line is that parents, and most people, would still rather believe a man in a white lab coat than they would some website on the Internet, or some angry activist who can be easily dismissed as a conspiracy theorist. That people place too much trust in doctors, putting them up on a pedestal and deifying them is a sad state of affairs, but its reality.'
    So really, according to your arguments regarding responsibility, all parents are too simple to think and question for themselves so we should just shrug our shoulders? Wrong. Handing over your child to a mutilator means you're an accessory to a human rights crime. You enabled the heinous crime- it could not have happened without you. Deceived or lied to, maybe, but free from responsibility, no. How we deal with that enabling is another matter.

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    1. "Sorry, but you've completely forgotten to mention how society has granted parents with the most powers of guardianship than anyone else."

      I disagree. Society grants SOME powers of guardianship to parents, but not all. At least in the US, we have a little something called Child Protective Services. There is such a thing as "abuse," and when it is defined, parents can face charges, prosecution and/or loss of custody of their children.

      The problem with our society is the double-standard that cutting a boy's genitals is considered "parental choice," when a parent "chooses" this (I ask from the beginning, why are doctors allowing parents to "choose" in the first place?) for their (male) children, while under no circumstances could a parent "choose" to cut, or have cut, their daughter's genitals.

      DO parents have full reign on what they can do with their children?

      The answer is no. I've written of other instances where parents simply don't have the full "powers of guardianship" that you speak of. The father who went to court for tattooing his child in Fresno, for example. The woman who lost custody of her daughter because she injected Botox into her face to make her attractive for childrens' beauty pageants for example. Parents in Oregon and in several other states who may no longer refuse to take their children to the hospital based on religious beliefs.

      American society has decided to grant parents the power of "choice" to mutilate their sons, but in double-standard, make a federal ban that forbids the same parents tihs power of "choice" if the child they cut is female.

      Why the double-standard?

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    2. "Medical fraud does not absolve parents for failing in their responsibility to protect their children from harm."

      I say that, unless parents are actually taking the scalpel and doing it themselves, then yes, it does.

      It does, because medical practitioners have the professional responsibility to do first do no harm.

      The cardinal question that should always be asked is this:

      Without medical or clinical indication, can doctors even be performing surgery on healthy, non-consenting minors, let alone be giving parents any kind of "choice" in the matter?

      "In the same way that parents entrust their children to be alone with priests, some children are going to be raped."

      Priests, as well as doctors, should be held responsible for betraying the trust of parents. Parents should not be blamed for trusting what are otherwise supposed to be figures of trust.

      The priest should know better than to be molesting children entrusted to him; doctors should know better than to be offering non-medical procedures to parents of male (or female) children.

      "Another example: parents have ceded their authority to priests, who are working under a perverse vow of chastity(unnatural) that they, as men, cannot fulfil so they prey on easy victims with devastating consequences for children."

      It's not "another" example, but the same one above. Parents cede their authority to people they trust. Can parents be blamed if others who are supposed to be professionally responsible betray their trust?

      Would you argue that a doctor's vow to "first do no harm" is as "unnatural" as the chastity sworn to by a religious priest?

      I'm afraid this is not the best analogy.

      A doctor has professional responsibility to "first do no harm." A priest has a religious conviction to remain chaste; I think ALL adults, no matter what religious conviction, should be held responsible if they molest or abuse children.

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    3. "So really, according to your arguments regarding responsibility, all parents are too simple to think and question for themselves so we should just shrug our shoulders?"

      It is somebody's professional responsibility to research and make a value judgement as to the medical validity of a form of treatment, whether that treatment be the administration of drugs, or the carrying out of a surgical procedure.

      To whom does this professional responsibility belong?

      Is it the doctor with a professional license?

      Or the lay parent whom, for all we know, may have never graduated from high school?

      I don't think we should "shrug our shoulders" as much as I think that those whose paid job is to know better should be held responsible.

      I don't think it makes any sense to prosecute parents for "choosing" a procedure for their children that was offered to them by doctors whose professional responsibility is to know better.

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    4. "Wrong. Handing over your child to a mutilator means you're an accessory to a human rights crime. You enabled the heinous crime- it could not have happened without you. Deceived or lied to, maybe, but free from responsibility, no. How we deal with that enabling is another matter."

      I will continue to ask the cardinal question:

      Without medical or clinical indication, can a doctor even be performing surgery on a healthy, non-consenting minor, let alone be giving parents any kind of a choice?

      How are parents responsible for acceding to a procedure that medical professionals should not be offering to parents in the first place?

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