Educate me: Who is responsible for cirumcision?

[Ensemble]

I want to better understand the institutional forces which are perpetuating circumcision in the United States, and to what degree each is responsible.

I want to understand how hospitals work, and what their role is. Clearly physicians who perform it have a primary responsibility, since they perform the act. Also there are the medical associations which give them cover. Insurance companies which pay for it without medical need also play a role, as do government programs which do the same.

Clarity on these issues seems crucial for effectively applying the pressure necessary to elevate medical ethics above other influences.

Note: I am not talking about parents/relatives here. They can only buy what the medical establishment is selling/offering.

[attachedmamaof3]

Actually, most insurance companies don't even cover circs any longer. I'm not sure about hospitals, but I'd think that if insurance doesn't cover it...you'd have to request it. They may offer it, but I don't think it's anything like "We're taking your child to get circed now." or anything.

IMO, it's the parents/relatives.

[PassionateWriter]

the AAP doesnt even recommend it anymore.

as the OP said, parents and relatives. fathers have a lot of blame IMHO but mothers are equally at fault for succumbing to their husbands on this issue.

whoever is at fault..the boys are the ones that suffer.

[paquerette]

Of course, it's a complicated issue, with no one easy answer. You could say it's the professionals performing the circumcisions, since if they were truthful with the people requesting it and refused to do it, it would stop (except for the diehard do-it-yourselfers). You could say it's the mothers, since it is almost always they who sign the consent form. You could say it's the fathers who often convince or bully the mothers into signing. You could say it's the media, presenting biased and incorrect information in both supposed journalistic pieces and fiction such as TV shows and movies. There are a lot of possibilities and I think it's hard to argue that any one group bears full responsibility. Everyone needs to pull their head out of the collective sand.

[Ensemble]

Originally Posted by attachedmamaof3

Actually, most insurance companies don't even cover circs any longer. I'm not sure about hospitals, but I'd think that if insurance doesn't cover it...you'd have to request it. They may offer it, but I don't think it's anything like "We're taking your child to get circed now." or anything.

IMO, it's the parents/relatives.

I deliberately did not mention parents because that's not what I'm interested in. Parents/relatives can want anything, but it's of little consequence if nobody is offering to provide the service because it would be unethical for them to do so.

[snazzy_mom]

Originally Posted by Ensemble

I want to better understand the institutional forces which are perpetuating circumcision in the United States, and to what degree each is responsible.

I want to understand how hospitals work, and what their role is. Clearly physicians who perform it have a primary responsibility, since they perform the act. Also there are the medical associations which give them cover. Insurance companies which pay for it without medical need also play a role, as do government programs which do the same.

Clarity on these issues seems crucial for effectively applying the pressure necessary to elevate medical ethics above other influences.

Note: I am not talking about parents/relatives here. They can only buy what the medical establishment is selling/offering.

This is a tough question, but a good one. Luckily, over the past few years we have seen a steady decline in the number of circs done. I know in the state of Florida, Medicaid will NOT pay for a circ (at least not at birth, I don't know about for "complications" that may arise later.)

My insurance company doesn't pay for it either (I have United Healthcare) but I don't know if that is just part of my plan or if they, as a whole company, don't offer to pay for it.

I am hoping that this trend continues, hopefully picking up speed.

The reason that I chose the Dr. that I did is because he doesn't offer circ, but other Dr's in his practice do. He says that it's crazy the things people do to come up with the fee that they charge to do the circ and the number one *reason* they hear is that the parents want the baby to look like daddy. Not wanting the child to be teased is a close second.



I have also read alot about uses for foreskins so I imagine that hospitals and/or Dr's probably profit above and beyond the cost of doing the surgery. I'm willing to bet that that and Dr ignorance/lack of education are key driving factors as to why it's still offered.

[perspective]

Originally Posted by Ensemble

I want to better understand the institutional forces which are perpetuating circumcision in the United States, and to what degree each is responsible.

I want to understand how hospitals work, and what their role is. Clearly physicians who perform it have a primary responsibility, since they perform the act. Also there are the medical associations which give them cover. Insurance companies which pay for it without medical need also play a role, as do government programs which do the same.

Clarity on these issues seems crucial for effectively applying the pressure necessary to elevate medical ethics above other influences.

Note: I am not talking about parents/relatives here. They can only buy what the medical establishment is selling/offering.

Honestly, its everyone, from the doctors, and institutions all the way down to the parents. All of us (in the US) live in a pro-circ society. Everything is colored by this. In that sense we are all responsible. Yet I would put more blame on medical institutions and doctors because unlike parents, their role in society is to spread unbiased, and trusted information that parents take as fact. Its their bias that does the most harm. Even with their oath of "do no harm" the medical community as a whole has not been able to stretch beyond our culture to the truth.

I think I know what your thinking here, and your right. The heart to changing the circ issue in the United States is changing the practices of health insurance companies (not covering cir, and labeling it as cosmetic surgery), hospitals(getting them to not present the surgery to parents as the default option for boys) , and medical schools (teaching them the proper medical care of a intact and circumcised penises, and present the foreskin as the healthy norm, and the circumcised penis as the cultural variation).

[Fyrestorm]

Bottom line....if doctors stopped doing them...they would stop happening! i Blame those holding the scalpel.

If the answer to every parent asking a doctor to mutilate their son is "you won't find a doctor in this state that will chop up your son" I think we would see a HUGE decrease!

Minus the do-it-yourselfers

[mntnmom]

I didn't BECOME a pro-circ society until the medical institution started pushing it as best. If doctors were honest with parents about the benefits of NOT doing it, it would die out in a generation.
But what encourages doctors to keep doing it, even the ones who know better? If it became more difficult for them and the hospital to get paid for it, they would stop soliciting it to uninformed parents.

[Frankly Speaking]

The primary responsibilty falls on individual doctors, primarily OB/GYNs. Despite the AAP having a policy statement that circumcision does not have benefits to justify routinely circumcising, doctors will often give information directly conflicting with their own associations. Doctors are the singular group that could end the practice without help from anyone else. Dr. Dennis Kendall of The Saskatchewan CPS had been warning Canadian physicians about the danger of personal and professional liability of performing circumcisions but was ignored by the Canadian medical profession until the death of Ryleigh McWillis. Suddenly, their exposure became obvious and as a result, almost all Canadian physicians now refuse to provide the procedure. This has resulted in the newborn circumcision rate falling to less than 6% in Canada.

Hospitals have some responsibility. They provide the facilities and in return, participate in the profits. I figured one hospital in my area profits more than $100K annually. Essentially, the hospitals are providing a convenience for the doctors and parents and has some effect in driving the practice to wit the oft asked question "If it's so bad, why do they do it?"

Medicare and private insurance companies have a major influence. The perception is that if the procedure didn't have benefits, they wouldn't pay for it. The reality is that they use it as a selling feature. That is, it is something that they use to sell their policies thus benefiting their stockholders, not the children or their parents. As long as the profits outpace the costs, they will continue to provide this benefit.

The Medical Associations also play a part. They give a very mixed message when they indicate there are no medical benefits or that they are insubstantial but they also acquiesce to the cultural and religious demand. Here they clearly step outside the realm of their expertise and take on the role of cultural anthropologists, a role they are clearly not qualified to take. You also have to realize the ultimate role of the Medical Associations. They are simply a trade group established for the benefit of their members, not their patients. With circumcision being a billion dollar a year business, it would not be in the best interest of their membership to come out with a policy statement that slams the procedure or the members that provide it. The medical associations in other countries can do this and do it simply because the circumcsion rates are so low that there are so few dollars involved that they won't significantly impact their members earnings.

Finally, our culture is to blame. But the medical profession is to blame here. Up until a court decision in 1973, doctors shamelessly sold the procedure and even forced it on parents by circumcising boys even against the parent's specific instructions. To justify this, they told the parents lies about diseases circumcision would prevent, about the ridicule intact boys would receive, about the emotional and psychological harm that would befall the child and about difficulties in finding a sexual partner. All of this became ensconsced in our "common knowledge" and accounts for the continuation of the procedure today even all of those have been disproven. These myths by the medical profession have become so established that even when presented with documented refutals, parents refuse to believe them. They even refuse to believe when a doctor presents the correct information



Frank

[ZoshaMosha]

I was pretty impressed with how my hospital where I delivered ds dealt with the circ. issue. It just simply never came up. I think this is a really positive sign.

The hospital has a hand-out they give new parents on newborn infant care--umbilical cord care, bathing, feeding, etc... absolutely nothing on circumcision care.

The only time circ was ever mentioned was when my CNM said "you guys aren't planning on circumcizing, right?"

[fruitful womb]

Originally Posted by TeresaZofia

I was pretty impressed with how my hospital where I delivered ds dealt with the circ. issue. It just simply never came up. I think this is a really positive sign.

The hospital has a hand-out they give new parents on newborn infant care--umbilical cord care, bathing, feeding, etc... absolutely nothing on circumcision care.

The only time circ was ever mentioned was when my CNM said "you guys aren't planning on circumcizing, right?"

Thats amazing! That is really hard to believe, to be honest. Where are you from? Can you tell us what hospital your ds was born in? Or would that alarm the the pro-circ lurkers to put pressure on that hospital to solicit genital reduction surgery on healthy newborns? If thats the case, please pm me. I would really like to know. This is unheard of. It might help me influence the circing hospitals in my area. I can present your hospitals as a good example. You're very lucky.

[Frankly Speaking]

There are hospitals that will not allow circumcisions on their premises. Unfortunately in most cases these are hospitals that have been stung in wrongful circumcision lawsuits or have had circumcision deaths in their facilities.


Frank

[MyBoysBlue]

Frank where did you get the 6% stat for Canada? The most recent stat I can find is from 2003 and that was 13.9% Not that I doubt you. I just want the link so I can use it elsewhere. I have heard stories about Canadian Mom's complaining that they have to travel to other provinces to get their child circumcised. Very few doctors do them here, which is really great. I think that and the fact that it isn't covered by our health care is why the rates are dropping so fast. So dropping to 6% in 5 years seems very likely to me.