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Argument: Hippocratic oath obligates doctors to avoid circumcision

Issue Report: Infant male circumcision

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Somerville, Margaret (November 2000). “Altering Baby Boys’ Bodies: The Ethics of Infant Male Circumcision”. 2000. – Physicians who undertake infant male circumcision could be legally liable for medical malpractice (civil liability in battery or negligence), which can result in an award of damages simply for carrying out the circumcision even if it was competently performed. They could also, as explained, be charged with criminal liability for assault. In both ethics and law, a physician has a primary obligation of personal care to the patient. This obligation requires the physician both to place the patient first and to first do no harm. Physicians who undertake surgery on patients must prove that it is justified. The usual justification is that the surgery is necessary therapy and that the patient—or if incompetent, the patient’s legal representative—gave informed consent to the surgery. In general, parents cannot authorize non-therapeutic interventions—that is, routine circumcision—on their children. A competent adult man could consent to non-therapeutic circumcision on himself, but this does not mean he may consent to it on his son. If the parents’ consent to the circumcision of their son was held to be legally inoperative, the physician would be liable. Moreover, if, in the light of new medical evidence, a reasonably careful and competent physician would not consider it medically necessary to undertake circumcision on a child, to do so could result in legal liability regardless of the parents’ consent. Such liability is even more likely if a reasonably careful and competent physician would consider it not just unnecessary but contrary to a reasonable standard of medical care to undertake circumcision on a particular child in given circumstances. A long-recognized example of such a situation is when the child suffers from haemophilia, a condition that could cause him to bleed to death from circumcision. But as our knowledge of the risks and harms of circumcision expands, the range of circumstances in which undertaking routine circumcision on any child is a breach of a reasonable standard of medical care also expands. To summarize, it seems to me clear that, certainly outside the religious context, recent medical research on routine infant male circumcision shows that this operation cannot be ethically or legally justified on the basis of its potential medical benefits.

George C. Denniston, MD, MPH. “Circumcision and the Code of Ethics”. Human Medicine Health Care. – “Violation of Ethical Principles

First, circumcision violates the Golden Rule: Do unto others as you would have them do unto you. If the doctor were intact, it may be fairly assumed that he would not want anyone to remove his foreskin without his permission.

Secondly, it violates a major tenet of medical practice: First, do no harm.

Last, but not least, circumcision violates all seven Principles of Medical Ethics. Let us look at each principle in turn (AMA 1992).

“Principle I. A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity.”

“Competent medical service” implies that each procedure is medically indicated, and is done only with fully informed consent. Since 1971, both the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists (1975) have stated: “There are no medical indications for routine neonatal circumcision.”3 In addition, informed consent is never obtained from these young patients, and fully informed consent rarely, if ever, from the parents.

Circumcision causes severe pain.4 Does a doctor who unnecessarily causes severe pain practice “with compassion?” Doctors may use a local anaesthetic; this does nothing for pain and suffering during the healing process. Also, does a doctor who removes a normal part of another person’s body without his consent “respect human dignity?” Every individual is entitled to an intact body and to fully informed consent before any part of his body is removed. These principles apply even more strongly to a healthy normal body part.

“Principle II. A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception.”

Physicians do not “deal honestly” with patients if they fail to provide fully informed consent. For example, some doctors use the threat of penile cancer and urinary tract infection to promote circumcision and, thus, misinform the public. Penile cancer is so rare that one cannot possibly justify a routine surgical procedure as a preventive measure. Urinary tract infections, also quite rare, are treated with antibiotics, not by operation.1

“Principle 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.”

The law permits a doctor to operate on another human being, but only if it is in the best interest of that individual. Many men who now speak out against the circumcision that was imposed on them claim that it was not in their best interests.

“Principle IV A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidences within the constraints of the law”

A patient has the right to an intact body, and has the right (and duty) to refuse to have a normal, valuable part of his penis removed unnecessarily.

“Principle V A physician shall continue to study, apply and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.”

Telling the parent that circumcision is in any way useful constitutes a failure to make “relevant scientific information available to that parent.” However, even if we could show that some disease is more likely to occur in the intact male, it does not follow that it is ethical to use this risk as a reason to circumcise. In all studies to date, the risks of circumcision have always exceeded any alleged benefits, a fact that often is not made clear to parents.

“Principle 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 services.”

A physician is free to choose not to remove part of the penis of a male infant, especially if it is “inappropriate patient care,” even if the parents “demand” it. Modern medical ethics state that parents may make medical decisions for their child, but their actions must be “in his best interest.” Circumcision is unnecessary and harmful: therefore, not in the infant’s best interest. Maimonides, the great Jewish sage, said, “Circumcision should never be done except for reasons of pure faith.” In the absence of religious reasons, no such claims can be proved. How can physicians continue to claim that they must carry out the wishes of the infants’ parents?

“Principle VII. A physician shall recognize a responsibility to participate in activities contributing to an improved community.”

The United States is the only country in the world that removes part of the normal penis from a majority of its males for nonreligious reasons. Thus, stopping a procedure that many consider profoundly harmful and sexually debilitating will contribute to an improved community.

Telling the parent that circumcision is in any way useful constitutes a failure to make “relevant scientific information available to that parent.” However, even if we could show that some disease is more likely to occur in the intact male, it does not follow that it is ethical to use this risk as a reason to circumcise. In all studies to date, the risks of circumcision have always exceeded any alleged benefits, a fact that often is not made clear to parents.

“Principle 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 services.”

A physician is free to choose not to remove part of the penis of a male infant, especially if it is “inappropriate patient care,” even if the parents “demand” it. Modern medical ethics state that parents may make medical decisions for their child, but their actions must be “in his best interest.” Circumcision is unnecessary and harmful: therefore, not in the infant’s best interest. Maimonides, the great Jewish sage, said, “Circumcision should never be done except for reasons of pure faith.” In the absence of religious reasons, no such claims can be proved. How can physicians continue to claim that they must carry out the wishes of the infants’ parents?

“Principle VII. A physician shall recognize a responsibility to participate in activities contributing to an improved community.”

The United States is the only country in the world that removes part of the normal penis from a majority of its males for nonreligious reasons. Thus, stopping a procedure that many consider profoundly harmful and sexually debilitating will contribute to an improved community.

“Is Non-Therapeutic Circumcision Ethical?” National Organization of Circumcision Information. Opposing views – Physicians who practice circumcision are violating the first maxim of medical practice, “Primum Non Nocere” (First, Do No Harm), and anyone practicing genital mutilation is violating Article V of the United Nations Universal Declaration of Human Rights: “No one shall be subjected to torture or to cruel, inhuman or degrading treatment.”