050410 - Conscience? Ethics?

I sent this to Florida State University Medical School personnel on April 4, 2005, and have continued to provide them and others with information on the subject of importance of human genital integrity and to ask the President of thte University and the Dean of FSU's Medical School to call a conference there to review the current scientific and ethical knowledge about medically unnecessary, nontherapeutic, "elective" infant and child circumcision.

Van Lewis

FSU Physicians and related persons,

Does FSU’s physician and health care community have any conscience at all, or any sense of medical ethics?

Van Lewis, Administrator
Ashley Montagu Resolution
http://MontaguNoCircPetition.org


... circumcision, an archaic ritual mutilation that has no justification whatever and no place in a civilized society.

Ashley Montagu (1905-1999), Anthropologist
http://nocirc.org/symposia/second/montagu.html


The human penis is designed correctly the way it normally comes into
the world, with its foreskin intact; a male's possession of his own
penis - including his foreskin - is his inviolable birthright; and a
child's chances for health and happiness throughout his life are
greater - by far - if he is allowed to keep all of the penis he is
born with.

George C. Denniston, M.D., Founder and President
Doctors Opposing Circumcision
http://DoctorsOpposingCircumcision.org


We now know that infant male circumcision is harmful in itself and has
harmful consequences. Circumcision removes healthy, functioning, erogenous
tissue that serves important protective, sensory and sexual purposes. The
surgery also involves risks of further damage - ranging from minor to
serious damage to the penis or even its loss or death (of the child) ... Consequently, to
summarize, routine infant male circumcision cannot be ethically and legally
justified on the grounds that it is medically required.

Without medical indication, the circumcision of minors of both
sexes constitutes criminal assault.

Dr. Margaret Somerville, Founder and Director
Centre for Medicine, Ethics and Law
McGill University
Montreal, Canada
"Altering Baby Boys' Bodies - The Ethics of Infant Male Circumcision"
http://www.intact.ca/canary.htm
A chapter from
The Ethical Canary:
Science, Society, and the Human Spirit

MARGARET SOMERVILLE is the founding director of the Centre for Medicine, Ethics and Law at McGill University, where she holds the Samuel Gale Chair in the Faculty of Law and is a professor in the Faculty of Medicine. As a consultant to numerous government and non-governmental bodies, she has worked with the World Health Organization, the United Nations High Commissioner for Human Rights and UNESCO. She Has received a number of honorary doctorates in law and is the recipient of many awards, including the Order of Australia. She lives in Montreal.


... it is a barbarous thing to meet a newly born infant with the knife, with a deliberate mutilation.  And the part that is removed is not negligible; it has clear and valuable functions to perform.  Not circumcising a boy will not only spare him a brutal violence as he enters life; it will promise him a richer existence.  And that not only because the possession of a foreskin will increase his genital sensitivity and make possible more satisfactory and pleasurable sexual activity; but also because of the consideration with which this essay began: that the foreskin is the female element in the male.

To be sure, that is only a primitive insight, and has no standing in science.  Yet that is hardly a criticism.  What we consider to be male or female is largely cultural in any case; many of our conventional notions in this regard are now in flux and being challenged.  This one has more basis in reality than most.  Also unlike many unscientific interpretations of reality that are misleading and dehumanizing, this one can sustain, enrich and illuminate.  It offers some redress where it is most needed, in a world increasingly devastated and threatened with destruction by a rampant machismo, a mindless exercise of organized aggressive maleness. ...

...  The circumcised organ is only the beginning of it, and kept hidden.  What are displayed, like so much male plumage, are the penis surrogates and aggrandizements: the guns; the cars, named for predatory beasts, driven to and from work like PT boats; the flaunting of power and status; the devastation of the earth and the cultivation of a technology of death and destruction beyond any former imagining, all in the pursuit of an obsessive accumulation of wealth far beyond any possibility of use –– all the brutal, gaudy, pretentious and infinitely dangerous panoply of male aggression that now envelopes and threatens our lives.

This is no time to circumcise males.  They need all the female element they can get.

For every child is born into the world with much of one sex and a little of the other.  The mistake is by a mutilation to take that little of the other sex away.  It should be left as nature evolved it, as in the child, so that all our lives we can go on being much of one sex, and always a little of the other.

George Wald (1906 – 1997), Nobel laureate in Physiology and Medicine (1967)
http://www.sicsociety.org/crick-wald.htm
http://nobelprize.org/medicine/laureates/1967/index.html


We can easily forgive a child who is afraid of the dark;
the real tragedy of life is when adults are afraid of the light.

Plato


http://www.nyspirit.com/Issue131/article5.html

Under the Knife
The Medical Myths of Infant Male Circumcision
by Angela Starks

Published April & May '05
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"The public is generally unaware of the controversy about circumcision, because circumcision has never had the full and open debate that many believe it deserves.” - - Ronald Goldman, Ph.D.
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No one can say exactly why or when infant male circumcision originated, but it is an ancient practice that has been connected with ritual, identity and even punishment. It first appeared in this country during the puritanical Victorian era as an attempt to curb masturbation. When this failed, other reasons to circumcise came into vogue in a society that did not understand the causes of disease. Doctors mistakenly claimed that it could prevent everything from bed-wetting to polio.

Today, circumcision is one of the most commonly performed surgeries in the United States. Many parents take it for granted that they will have their son circumcised and that it is the normal, perhaps the healthiest, thing to do. Many people fear that their child will feel out of place among his circumcised peers, and circumcised fathers often resist the idea of a son who does not resemble him. Parents are also led to believe that they are saving their sons from having to undergo the procedure later in life, but that scenario is unlikely to occur: for example, infants in Finland are almost never circumcised and only about 1 in 16,700 are deemed to require it when they are older.

The medical rationale for circumcision includes the rumor that foreskin makes a penis difficult to clean and subject to disease. Moreover, most people imagine circumcision to be a minor procedure attended by very little discomfort and no side effects. It is understandable, therefore, that we think it prudent to get it over and done with in infancy, especially if we presume that the foreskin is a mistake of nature that serves no useful function.

What most people do not know, however, is that the rate of infant male circumcision in the United States has plummeted in recent years, from 85 percent in the 1980s to about 55 percent today, and only 23 percent in the western states. And the rate continues to shrink. In all likelihood, babies circumcised today will be in the minority when they are older, which rules out ‘conformity’ as an incentive for non-religious circumcision.

Why are increasingly fewer parents choosing circumcision for their sons? Perhaps, in this age of information, parents are becoming aware of the medical facts. Some doctors and parents are also heeding the advice of the American Academy of Pediatrics (AAP), which after analyzing almost 40 years of research has concluded that the supposed benefits are not sufficient justification for routine circumcision. In fact, the AAP questioned routine circumcision as early as 1971, and in 1983 the American College of Obstetrics and Gynecology also expressed concerns. Many eminent doctors and scientists go so far as to declare that it should be completely discontinued on the grounds of pain, trauma and complications. Famous pediatrician Benjamin Spock did a u-turn from his original support of circumcision; he says it is “at least mildly dangerous. I also believe there is a danger of emotional harm.”

Almost 90 percent of the world’s male population remains uncircumcised. America is the only country that still performs non-religious male circumcision on a large scale. In Britain, the rate has fallen from a high of about 40 percent in the 1930s to virtually zero. Circumcision is an incongruity in Europe, South America, and non-Muslim Asia. Canada, Australia and Britain all have official position statements opposing it. The prestigious BMA (British Medical Association) describes routine circumcision as ‘unethical and inappropriate.’

Young men are starting to file claims against their circumcisers, and the first cases have already entered the courts. One settled in 2003 for a substantial sum. By the time your son is a teenager, these lawsuits may be common. What do these men, the rest of the world, official medical associations, a growing number of doctors, and parents of uncircumcised boys know?

Most parents who choose circumcision for their baby do so without knowing what the procedure entails.

All normal males are born with a protective sheath of skin called the prepuce, or foreskin, that covers the glans (head) of the penis. Circumcision is the surgical amputation of the foreskin. Most circumcisions are performed in the hospital by the obstetrician within 48 hours of birth. The baby is strapped down, spreadeagled, to a plastic restraining device called a Circumstraint. In one popular method, the doctor first inserts pliers into the orifice at the end of the foreskin then applies a clamp to crush the blood vessels. Next, a probe is pushed between the foreskin and glans. The doctor forces the probe around the glans several times until the foreskin is torn away from it. A bell-shaped device is placed on the open wound and a thumbscrew device or a suture is applied to squeeze off the blood supply. The foreskin is then cut away. (A different method involves tying the remaining foreskin tightly around a plastic devise with a piece of string so that the skin necrotizes and falls off in a few days). The entire procedure lasts from five to fifteen minutes. Anesthesia is not usually given because 1) there are concerns about its safety in newborns, 2) it is not very effective in circumcision, and 3) some doctors think babies do not feel intense pain.

Circumcision is extremely painful and traumatic for the infant.

The above description of the procedure contradicts our perceived notions that circumcision is ‘just a snip,’ a view that has understandably caused us to minimize its painfulness. However, a cursory examination of penile anatomy illustrates that it must be excruciating.

The amputated foreskin is not a mere flap of skin at the end of the penis nor a loose appendage that can easily be removed. It is a continuation of the penis itself that extends from the base to beyond the tip and folds back in upon itself. Circumcision thus removes up to 80 percent of the penile skin system.

The site of surgery is extremely sensitive. The foreskin is highly innervated, and the glans is a sensitive internal structure. In virtually all newborns, the foreskin and glans are attached to each other, therefore circumcision necessitates literally tearing the foreskin off like tearing a fingernail from a finger. This leaves the entire glans as a raw wound. In addition, a sensitive ligament called the frenulum is often completely or partially cut away.

The pain does not end with the procedure. The wound takes one to two weeks to heal, during which time urination stings, contact with diapers and changing of diapers is uncomfortable, and being held closely can be painful.

Sadly, many people still learn that infants barely experience or remember pain. Science has now proven (as if proof were needed) that infants do feel pain, and that their responses can be more intense than adults’. They also remember a trauma, and the circumcision experience leads to symptoms that are consistent with the official definition of post traumatic stress disorder. The AAP recently confirmed: “infants undergoing circumcision suffer severe trauma and pain.” Indeed, medical writers have frequently compared an infant’s experience of circumcision to torture.

A baby nearly always emits piercing screams in response to circumcision. He will usually struggle frantically to the limited extent that he can beneath the straps. Some babies defecate and vomit, and some lapse into a coma. A common reason that some do not cry during circumcision, or cease to cry halfway through, is that they can’t because they enter a state of shock. Also, if the mother received anesthesia for labor – especially general anesthesia for a cesarean – this would have entered the baby’s bloodstream and while not reducing the pain of circumcision, it may dull his responses. Scientific observation has proven that babies who exhibit quieter responses are nonetheless suffering, as evidenced by a heart rate of up to 200 beats per minute and up to a fourfold elevation in blood cortisol whether the baby was crying intensely or not. In one study, researchers concluded: “This level of pain would not be tolerated by older patients.”

Circumcision carries the risk of side effects and permanent complications.

There are numerous immediate surgical risks and at least 20 documented side effects that may become apparent days, weeks or even years later. There may be additional risks that have not yet been documented or understood. The rate of complications is almost certainly under-reported, but one study published in the Canadian Medical Association Journal revealed a rate of 55 percent (www.cirp.org/ library/procedure/patel/). Dr George Denniston maintains that the complication rate is 100 percent because circumcision always results in a loss of natural function.

Some problems are relatively minor. Some require further surgery. Others are irreparable, leading to permanent damage. Death from circumcision is rare, but does occur (estimated at 230 per year), and is usually caused by uncontrolled bleeding or systemic infection.

Complications that have been observed include, but are not limited to:
- Slow or painful urination when scar tissue partially obscures the urinary opening.
- Local infection at the site of surgery, leading to ulceration. (Occurs in half of all circumcised babies, and almost never in the uncircumcised).
- Systemic infection such as tuberculosis and meningitis.
- Excessive bleeding.
- A bowed or twisted penis resulting from uneven skin removal.
- A shortened penis resulting from contracted scar tissue; in rare cases, the penis completely retracts into the body.
- Loss of entire penis due to infection.
- Adhesions resulting from the body’s attempt at repair.
- Skin tags from shreds of foreskin left behind.
- Permanent pits and scars from segments of glans being removed with the foreskin. In rare cases, the whole glans is lost.
- Breathing difficulties and injury to internal organs from prolonged, intense crying.
- Painful swelling of the penis, because the circumcision severs lymph vessels and lymph flow is disrupted.
- Failure to breastfeed and interrupted parent-infant bonding when shock causes the infant to withdraw and pain affects his mood.
- Long term psychological and nervous system damage from the pain and trauma.
- Sexual complications when older: Tight, painful erections and / or difficulty ejaculating.

An intact penis is easy to care for and is not dirtier than a circumcised penis.
Many doctors and parents are unfamiliar with an intact penis, which leaves them confused about how to care for it. There are no complicated rules: just bathe the infant in the normal way, allowing the genitals to become immersed in water. Just as you would not lift the eyelid to clean beneath it, you should never retract a baby’s foreskin for cleaning or examination. Besides causing pain and injury, doing so can lead to irritation and disruption of the natural antibiotic environment beneath the foreskin. At some point during childhood the foreskin will be retractable, at which time a boy may choose to gently rinse beneath it. Soap is not necessary. In the meantime, the infant foreskin’s secure attachment leaves just a tiny opening at the tip for urine to escape, reducing the entry of bacteria.
According to the prestigious British Journal of Urology, “Not only do circumcised boys require more care, they are also more likely to develop penis problems.” Of course, a circumcised penis can be kept clean. It should not be implied that circumcised penises are ‘dirty’, but extra vigilance is warranted because the unnaturally externalized glans and urethral opening will always be more exposed to contaminants. In infancy, this takes the form of contact with urine and feces in the diaper, which is particularly problematic while the circumcision wound is still raw. In addition, wrinkles and folds that often form around the scar can harbor dirt and germs.
The white emollient under the foreskin is called smegma. Pediatrician Paul M. Fleiss describes it as “the most misunderstood, most unjustifiably maligned substance in nature.” Far from trapping dirt or being unclean in itself, as the physicians of the 1800s supposed, this natural secretion with its cleansing and antimicrobial properties helps to keep the penis clean and healthy, in the same way that tears clean and lubricate the eyes. Smegma appearing beneath an infant’s foreskin is a normal indication that dead cells are being sloughed off in preparation for the day that it will retract. You can simply wipe the smegma away. As the boy matures, he will learn that keeping his penis clean is much simpler than brushing his teeth.

Circumcision does not prevent cancer of the penis or cancer of the cervix in partners of circumcised men.
The theory that smegma might be carcinogenic has been disproved. The American Cancer Society states that it “does not consider routine circumcision to be a valid or effective measure to prevent cancers” and that “penile cancer rates in countries which do not practice circumcision are lower than those found in the United States.” Besides, penile cancer is very rare; a man has a higher chance of dying of breast cancer or from the circumcision itself.
It used to be imagined that circumcision also helped to prevent cervical cancer because it was once found to be rare in Jewish women. However, non-Jewish partners of circumcised men do not have a lower rate of cervical cancer. Also, European women do not have a higher rate than American women, even though European men are rarely circumcised.

Circumcision does not prevent sexually-transmitted diseases (STDs) or urinary tract infections (UTIs).
It has never been proven that circumcision reduces the rate of STDs and UTIs. The studies that supported the claims have been discredited by the AAP as flawed. The AAP also found that circumcised men actually have a higher risk of gonorrhea, genital warts, chlamydia, and certain types of herpes.
UTIs occur in only about one percent of baby boys and are not related to circumcision status. Most cases are due to congenital abnormalities of the urethral tract. As for the Human Immunodeficiency virus (HIV) that is purported to be the cause of AIDS, it is said to be passed on via body fluids having nothing to do with the foreskin. The United States has the highest percentage of sexually active circumcised men in the Western world and one of the highest rates of AIDS and an epidemic of STDs.

A foreskin that is attached to the glans, or a non-retractable foreskin, does not necessitate circumcision in infancy.

Doctors should be expected to know that a newborn’s foreskin is meant to be attached to his glans. This is neither a defect nor an abnormal ‘adhesion’. It protects the penis during infancy, and will separate as the boy grows. The foreskin should never be forced apart prematurely. Doing so causes pain and injury, possibly resulting in true adhesions which may require further surgery.

Phimosis -- a condition whereby a tight foreskin will not retract -- cannot possibly be diagnosed at birth because the foreskin is not even meant to retract until between three years of age and puberty. In childhood, tightness of the foreskin is a safety mechanism that protects the glans and urethra from exposure. Even if the foreskin does not completely retract for the first twenty years of your son’s life, there may be no cause for alarm. Some men’s foreskins never fully retract and they often have no problems. As long as he can urinate, he is fine. If genuine phimosis is diagnosed in adulthood, a man may choose to be circumcised, but there are non-surgical treatments available. Paraphimosis, whereby the retraced foreskin remains trapped behind the glans, can be resolved manually in virtually all cases.

Sometimes a boy’s penis naturally retracts early in childhood, only to become tight again. This is often caused by exposure to chlorinated pools, chemicals in toiletries, a high-sugar diet, or taking antibiotics, all of which disturb the natural bacterial balance beneath the foreskin. It becomes chapped and less mobile. This can be remedied with a barrier cream and acidophilus ointment.

A foreskin should not require amputation just because it becomes reddened.

The tip of the foreskin sometimes becomes reddened as a result of being in contact with diapers for so long. Commonly known as diaper rash, this occurs when normal skin bacteria and feces react with urine to produce ammonia which irritates the skin. If the foreskin were amputated, the rash would occur on the glans instead and could spread into the urethra. The reddened foreskin is doing it’s protective job, acting as the first line of defense.

Most infections of the foreskin are actually caused by washing it with soap which should not be applied to the foreskin. A red foreskin can also be a normal reaction to artificial perfumes and chemicals in diapers and ointments.

The foreskin has important functions.

As a protective covering, the foreskin maintains the glans as the internal organ that it was designed to be, shielding it – and the urinary opening – from abrasion, foreign materials, and germs. Even if the glans and foreskin separate naturally in infancy, the foreskin lips will dilate only enough to allow for the passage of urine. This feature protects the developing glans from premature exposure.

The foreskin’s inner surface is a mucous membrane similar to the underside of the eyelid or inside of the cheek. It produces lubricants, cleansing secretions and antimicrobial proteins (such as lysozyme, also found in tears and breast milk). It also maintains ideal pH balance and temperature.

In adulthood, the foreskin plays a role in sex. It’s specialized design as a movable sheath allows the penis to move unabrasively in and out of the vagina within its own sleeve. This makes intercourse more comfortable for both partners and is less likely to dry up the female’s natural lubrication. The movement of the foreskin is also a means by which the entire penis is stimulated, leading to greater sensory pleasure for the male.

The foreskin is the major erogenous zone on the male body, containing more specialized nerve receptors than any other part of the penis. Its removal results in the loss of 240 feet of nerves, and over 20,000 sensitive nerve endings. Circumcision may also result in the loss of the highly erogenous frenulum. Since the foreskin maintains the glans as a moist internal organ, the glans is more sensitive in an intact male, not having been subjected to constant abrasion from clothing which toughens the skin.

But surely there must be some benefits to circumcision, or why else would so many doctors still do it?

Despite the proven disadvantages of routine circumcision and the misgivings of medical organizations, many doctors and hospitals continue to sanction it. Some go so far as to ardently recommend it and may exert very strong pressure on undecided parents. This is a confusing situation: we want to have faith in our doctor and we want the best for our children.

Thomas J. Ritter, a doctor and surgeon, says to his colleagues who still perform circumcisions: “It should interest you to know that you are violating the….major tenet of medical care, First Do No Harm; and all seven Principles of the American Medical Association Code of Ethics.” Ronald Goldman, PhD, adds that these doctor’s are breaking the Hippocratic Oath that says the patient’s welfare shall be the doctors first consideration. So why does it continue? The issue is a complex and sensitive one, but it needs to be part of the debate, otherwise many parents will automatically assume that doctors condone circumcision only for sound medical reasons. Therefore, I would like to leave you with these additional thoughts to take into account:

- Some doctors are genuinely unaware of the latest research.
- Most of today’s doctors were circumcised themselves and may not be familiar with how to care for an intact penis or the importance of the foreskin.
- Doctors who were circumcised themselves may understandably be reluctant to highlight circumcision’s inappropriateness.
- After doing something hundreds of times and teaching that it is necessary, it is only human to defend your actions.
- Doctors always risk denigration by their establishment and colleagues if they challenge customary practice.
- A doctor may do it only because the parents insist and not because he believes in it. Especially, he may not want to offend parents who request it for religious reasons.
- A doctor is not just a doctor: he has his own philosophical and religious beliefs which may dampen his tendency to question circumcision.
- An doctor charges between $100 and $300 per circumcision. In a busy practice, this may garner an average of $30,000 a year.
- Human foreskins are in great demand for various commercial enterprises in research, medicine and cosmetics. It is a billion-dollar-a-year industry.