The Circumcision Discussion

Specialties Ob/Gyn

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Joe12

39 Posts

I also want to object to the idea that Jewish physicians would circumcise a non-Jewish child without permission (unless it was hospital policy back in the day). According to Jewish law, it is not religiously mandated that non-Jews to circumcise their children.

Until the 1970s consent was almost never obtained; it was done automatically. Couriously that only changed when a Jewish coupled sued the hospital because they could then have a proper Bris, somewhere in the early 1970s I think. In any case, consent is really the crux of the issue. Setting aside religious circumcision for a moment, is there any reason to believe (aside from the fact that is what we do currently) that the parent's consent is truly valid? Remember we are talking about something that really has no therapeutic value.

vashtee, RN

1,065 Posts

Specializes in DOU.
Until the 1970s consent was almost never obtained; it was done automatically. Couriously that only changed when a Jewish coupled sued the hospital because they could then have a proper Bris, somewhere in the early 1970s I think. In any case, consent is really the crux of the issue. Setting aside religious circumcision for a moment, is there any reason to believe (aside from the fact that is what we do currently) that the parent's consent is truly valid? Remember we are talking about something that really has no therapeutic value.

I consented, but it was for religious reasons. However, men are waiting in line in Africa to have it done to reduce their risk of contracting HIV. I consider their consent valid.

I know many of you like to deny there is any therapeutic value, but even the American Academy of Pediatrics is is reviewing its position because of recent studies.

I wonder how much evidence you will need to have in order to change your position? Also, I wonder if the vehemently anti-circ people are the same group who tend to be anti-vaccine?

AirforceRN, RN

611 Posts

I consented, but it was for religious reasons. However, men are waiting in line in Africa to have it done to reduce their risk of contracting HIV. I consider their consent valid.

As do I. They are men and are able to make that decision. Can't really say the same for a 3 day old.

The American Academy of Pediatrics is apparently reviewing their position after the study that I posted earlier was brought to their attention.

Show me that a higher percentage of uncirced men have aids/herpes/genital warts in a western population and I'll reconsider my position.

I think you'd be surprised at the vaccine response. Just because parents choose not to cut off part of their son's member doesn't make them an antiscience granola eating treehugger. I'm obviously against circumcision but believe that not vaccinating your child is one of the most ignorant decisions a parent can make.

Joe12

39 Posts

I consented, but it was for religious reasons. However, men are waiting in line in Africa to have it done to reduce their risk of contracting HIV. I consider their consent valid.

As do I. And as long as they limit it to adults, I have no personal problem with that anymore than getting a tattoo or a Prince Albert. I think it's weird but it isn't my decision. They are adults after all. But it is a bit hard to imagine why one would consent when given the following facts:

1. You can get circumcised but you must be choosy about your sexual partners and always where a condom to protect yourself from HIV.

2. You don't need to get circumcised but you must be choosy about your sexual partners and always where a condom to protect yourself from HIV.

This is why you have to focus on children because it's easier in terms of compliance.

I know many of you like to deny there is any therapeutic value, but even the American Academy of Pediatrics is is reviewing its position because of recent studies.

I am certainly aware of that. The thing that surprises me is that most other first world countries have properly categorized this approach as context sensitive, limited to countries of high prevalence; even the WHO guidelines state as much. The Australian's published their information sheet regarding this situation in late 2007 as did the relevant groups in France and some other places.

I wonder how much evidence you will need to have in order to change your position? Also, I wonder if the vehemently anti-circ people are the same group who tend to be anti-vaccine?

Well wonder no more, I'll tell you. The procedure must be medically therapeutic and by that I mean that:

1. The overall the medical benefits should outweigh the risks and harms of the procedure required to obtain them.

2. This procedure is the only reasonable way to obtain these benefits.

3. These benefits are necessary to the well-being of the child.

Especially in the situation of proxy consent, it is necessary that we use the most conservative approaches that are reasonably expected to work first. Since circumcision isn't, by far, the most effective or least invasive approach it should be deferred. Even in Africa but especially in first world low prevalence countries like the US.

Since you bring up vaccinations though I'll point out that they meet the criteria outlined above. All vaccines I can think of (most anyway) protect against diseases that I can get just by being in public. I don't really have to do something specific to get Measles for example. I am also pretty sure that a vaccine is the most efficient and most reasonable way to protect myself or a child from measles (if you know a better way please let us know though I am not sure living in a bubble counts.). Therefore it is a reasonable and ethical intervention that can be authorized on behalf of the child.

As far as the men in Africa, I am not quite sure they are getting the full story or understand the situation completely but they are adults; here is a better analogy. When you see intact European, Australian, Chinese, South and Central American and Canadian men lining up to get circumcised by the bus load, then you've proabably found a reasonably ethical reason to perform it on an infant.

Joe12

39 Posts

As do I. They are men and are able to make that decision. Can't really say the same for a 3 day old.

The American Academy of Pediatrics is apparently reviewing their position after the study that I posted earlier was brought to their attention.

Show me that a higher percentage of uncirced men have aids/herpes/genital warts in a western population and I'll reconsider my position.

I think you'd be surprised at the vaccine response. Just because parents choose not to cut off part of their son's member doesn't make them an antiscience granola eating treehugger. I'm obviously against circumcision but believe that not vaccinating your child is one of the most ignorant decisions a parent can make.

The Academy has been doing this since 2007, these new reports didn't start that process. Two things I find courious, with such an efficient HPV vaccine, they keep investigating HPV and circumcision. I just read today on AidsMap that in addition to protecting nearly 100% against the 2 strains that cause at least 70% of cervical cancer, it has been shown to also protect at least 40% against the next 2 most common and like 25% against 8 others. The FDA is likely to approve it for boys to, many countries already offer it to boys. I am not sure I see how circumcision will contribute anymore to this (in any substanative way). I also find it interesting how different countries discuss the new studies. The US press would have you believed they cured HIV or cancer but the British evaluation seems much more reserved, more rational. They describe it as a small reduction. Which reminds me, does anyone know the general efficency of vaccines? I read somewhere (in conjuntion with HIV vaccine research) that any intervention that didn't show at least 35% efficency was considered a failure. I am pretty sure that most vaccines are in the 60-90% range is that right? I'll have to dig into that because then 25% would almost certainly be a pittance.

First of all, the men "waiting in line in Africa" to get circ'ed so they won't "get HIV" are ignorant if they think that getting circ'ed is going to prevent HIV. That is a bunch of horsesh*t!!! Just because you are ciecumcised doesn't mean you can go around having sex with whomever you want and you won't get HIV. You have to BE SAFE and you PROBABLY won't get HIV. Plenty of circumcised men have HIV....there are thousands, hundreds of thousands of men in the US where circ is "popular" who have HIV. I work with HIV+ people...and I guarantee most if not all of them are circumcised.

And this statement:"Also, I wonder if the vehemently anti-circ people are the same group who tend to be anti-vaccine?"

No, I AM vehemently against circumcision....and am also vehemently PRO-vaccine!!!!!

Joe12

39 Posts

First of all, the men "waiting in line in Africa" to get circ'ed so they won't "get HIV" are ignorant if they think that getting circ'ed is going to prevent HIV. That is a bunch of horsesh*t!!!

I have read several stories about this program and they frequently print quotes from local men who describe circumcision as an invisible condom or otherwise imply complete protection. It's hard to know how wide spread this problem is but I am worried it is proabably quite large. I have my doubts as to whether it will be recognized though or just swept under the rug. It will be a really long time before we know for sure.

lamazeteacher

2,170 Posts

Specializes in OB, HH, ADMIN, IC, ED, QI.
Actually, according to bible stories, God set out to kill Moses for not circumcising his son. Moses' wife Sephora saved Moses by taking up a sharp stone and immediately cutting off her son's foreskin. The story appears somewhere in Exodus, chapter 4.

I like my story better - it's less violent.

I'm so glad Moiles haven't repeated the sharp stone technique. Lighten up, folks. :bow:

Specializes in Emergency Dept. Trauma. Pediatrics.

All 3 of my sons were circ'ed and I had problems with all 3 of the circs, if I knew than what I know now I would not have had it done, I feel a lot of guilt having it done.

I didn't research I just did what everyone told me I should do.

My husband is not cut, some ex's weren't either. My husband is not embarrassed at all about it and has never had any problems regarding it, he has been around guys many times and never had any issues but even if people did tease him he is such a confident person it wouldn't have bothered him. I wish I could go back and not have done it.

consult2

67 Posts

"I wonder how much evidence you will need to have in order to change your position?"

First off, I specifically require SCIENTIFICALLY CREDIBLE evidence.. then I require that there be enough benefits to override the risks and harm, and that there be no other less invasive procedure available.

consult2

67 Posts

"I'm not sure what exactly you were intending to have me read (can you narrow down your links?), but I can tell you that the book of Exodus is believed to have been completed around 450 BCE, or about 400 years before you claim the priests invented circumcision"

Sorry for the typo, I meant to post 550BCE. My bad! That is when the circumcision "covenant" was invented by the priests--research has shown that circumcision was NOT in the original Jewish texts on the covenant--but a much later insertion..

The specific links are:

http://home.comcast.net/~consult2/god.html

http://home.comcast.net/~consult2/enigma.html

I have read several stories about this program and they frequently print quotes from local men who describe circumcision as an invisible condom or otherwise imply complete protection. It's hard to know how wide spread this problem is but I am worried it is proabably quite large. I have my doubts as to whether it will be recognized though or just swept under the rug. It will be a really long time before we know for sure.

I know...what I was saying is that it is a bunch of ********* if that they think that....like they are ignorant for thinking such a thing. Sorry, I guess I should have clarified!

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