A couple of years ago, I extracted all references to ethics from the various medical organization position statements on circumcision. Following are my synopses of these extracts. I have all the excerpts themselves in a 10-page document (along with the following synopses). PM me with your email address if you would like a copy of the file.
The references and urls for all these statements, plus a number of other ethics resources, are listed at the bottom of this post.
Gillian
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American Medical Association: Neonatal Circumcision, 1999: [No mention of ethics.]
American Academy of Pediatrics: Circumcision Policy Statement, 1999, reaffirmed 2005:
The AAP discusses the ethics of circumcision in terms of 1) the concept of and need for informed consent, 2) parents’ right to make decisions as to what constitutes the best interest of the child, and 3) the legitimacy of parents making the decision based on “cultural, religious, or ethnic tradition.” The statement does not discuss the patient’s (child’s) rights, nor analyze what constitutes “best interest”. Physician responsibilities listed include: 1) providing information on risks and benefits of the procedure, 2) assuring that parents understand that it is elective, and 3) acting so as not to coerce parents.
American Academy of Pediatrics, Committee on Bioethics: Informed Consent, Parental Permission, and Assent in Pediatric Practice, 1995:
This document emphasizes the points that 1) the child’s wishes and opinions should be considered in decision-making when possible, 2) the child’s preference should carry special weight when the procedure is not essential or can reasonably be deferred, and 3) physicians should base their actions on what the child-patient needs, not on parental desires. It focuses on the older child without specifically extrapolating these ethical concepts to infants, nor does it specifically discuss circumcision. Parental assent is discussed in reference to diagnostic or therapeutic procedures; parental assent for non-therapeutic procedures is not discussed.
American Academy of Family Physicians: Position Paper on Neonatal Circumcision, 2002:
The AAFP statement describes, without in-depth discussion, the core ethical problem of neonatal circumcision: that it is a medically unnecessary procedure performed on an individual without his consent. The statement raises the question of how to provide informed consent under these circumstances, and notes the importance of respecting parental beliefs.
Canadian Pediatric Society: Neonatal Circumcision Revisited, 1996, reaffirmed 2002: [No mention of ethics].
College of Physicians and Surgeons of British Columbia: Infant Male Circumcision, 2004:
Written in the wake of a highly publicized circumcision death in British Columbia, the CPSBC’s statement contains one of the most extensive analyses of the ethics of infant male circumcision of any current medical position statement. It mentions: 1) problems regarding the non-therapeutic nature of the procedure and the issue of proxy consent, 2) accepted standards of human rights which may be violated by infant circumcision, 3) the unnecessary and irreversible nature of the procedure, 4) the need to question procedures that have become routine, 5) the recommendation to include ethics in informed consent discussions with parents, and 6) the legitimacy of conscientious objection by practitioners.
The Royal Australian College of Physicians: Policy Statement on Circumcision, 2004:
The RACP statement mentions: 1) the right of parents to make medical decisions for their child, but only when it is in their best interest, 2) the difficulty of determining “best interest”, 3) the case for deferring decision-making until a child can express his own preferences, 4) the importance of the quality of information provided to parent decision-makers, and 5) concern for whether this standard of information is routinely met.
Australian Association of Paediatric Surgeons: Guidelines for Circumcision, 1996:
The AAPS asserts that a normal body part should not be removed in the absence of a definite medical indication. It expresses concern for the child’s right to have a choice about removal of a normal part of his body.
British Medical Association: The Law and Ethics of Male Circumcision – Guidance for Doctors, 2006: The BMA statement is an in-depth examination of male circumcision in the light of the Human Rights Act of 2000, which incorporated articles of the European Convention on Human Rights into medical practice in the UK. The BMA considers the importance of both the child’s and the parents’ rights, as well as the limitations on parents’ rights. It 1) specifies rights enumerated by the European Convention on Human Rights which may be relevant to non-therapeutic circumcision, 2) analyzes the concept of “best interest” in detail, and 3) concludes that “parental preference alone is not sufficient justification for performing a surgical procedure on a child.” It acknowledges the right of practitioners to conscientious objection.
Central Union for Child Welfare in Finland: Position Statement on the Circumcision of Boys, 2003: The CUCW unequivocally states that circumcision of boys is a violation of personal, bodily, and sexual integrity. It asserts that it is only acceptable when medically necessary, and should otherwise be prohibited by law.
REFERENCES:
American Academy of Pediatrics Committee on Bioethics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics 1995;95(2):314-317.
http://www.cirp.org/library/ethics/AAP/
Position Statement on the Circumcision of Boys. Helsinki: Central Union for Child Welfare. 25 August 2003.
http://www.cirp.org/library/statements/finland2003/
American Academy of Pediatrics, Task Force on Circumcision. 1999, reaffirmed 2005. Circumcision policy statement. Pediatrics 102(3):686-693.
www.cirp.org/library/statements/aap1999
Beasley S, Darlow B, Craig J, et al. 2002. Policy Statement on Circumcision. Sydney: Royal Australasian College of Physicians.
www.racp.edu.au/hpu/paed/circumcision
College of Physicians and Surgeons of British Columbia. 2004. Policy Manual: Infant Male Circumcision. Vancouver, BC: College of Physicians and Surgeons of British Columbia.
http://www.cpsbc.ca/cps/physician_re...ual/malecircum
Commission on Clinical Policies and Research. 2002. Position Paper on Neonatal Circumcision. Leawood, Kansas: American Academy of Family Physicians.
www.cirp.org/library/statements/aafp2002
Committee on Medical Ethics. 2006. The Law & Ethics of Male Circumcision: Guidance for Doctors. London: British Medical Association.
http://www.bma.org.uk/ap.nsf/Content...rcumcision2006
Fetus and Newborn Committee, Canadian Paediatric Society. 1996, reaffirmed 2002. Neonatal circumcision revisited. Canadian Medical Association Journal 154(6):769-780.
www.cps.ca/english/statements/FN/fn96-01
Leditschke JF. 1996. Guidelines for Circumcision. Australasian Association of Paediatric Surgeons. Herston, QLD, Australia.
www.cirp.org/library/statements/aaps
Position Statement on the Circumcision of Boys. Helsinki: Central Union for Child Welfare. 25 August 2003.
http://www.cirp.org/library/statements/finland2003/
Circumcision Information and Resource Pages. “Medical Organization Official Policy Statements.” Rev. 30 April 2006.
http://www.cirp.org/library/statements/
OTHER ETHICS RESOURCES:
The Circumcision Information and Resource Pages. “The Bioethics of Circumcision of Male Children.” Rev. 25 November 2005.
http://www.cirp.org/library/ethics/
Svoboda JS, Van Howe RS, Dwyer JG. Informed Consent for Neonatal Circumcision: An Ethical and Legal Conundrum. 17 J Contemporary Health Law Policy 61 (2000).
http://www.cirp.org/library/legal/conundrum/
National Organization of Circumcision Information Centers. “Answers to Your Questions About the Bioethics of Infant Circumcision.” (Pamphlet). San Anselmo, CA. Jan 2004.
http://www.nocirc.org/publish/10pam.pdf
Doctors Opposing Circumcision. “Conscientious Objection to the Performance of Non-therapeutic Circumcision of Children.” (Pamphlet). July 2005. Seattle, WA.
http://www.doctorsopposingcircumcisi...pdf/co7-05.pdf
Doctors Opposing Circumcision. “International Human Rights Law and the Circumcision of Children.” June 2006. Seattle, WA.
http://www.doctorsopposingcircumcisi...ort2006-04.pdf
Doctors Opposing Circumcision. "Medical Ethics and the Circumcision of Children." June 2006. Seattle, WA.
http://www.doctorsopposingcircumcisi...hicsReport.pdf
