Need to circumcise newborns debated

By Carrie A. Moore
Deseret Morning News
Published: Saturday, Jan. 26, 2008 12:25 a.m. MST

Rooted in religious tradition among Jews and Muslims for centuries, circumcision is still considered a religious ritual among many adherents, but the United States is the only industrialized nation where circumcision remains more a social norm than a religious one.

Two local philosophers and an anti-circumcision advocate say circumcision of newborn males is an unnecessary surgery that fails to provide any significant physical or emotional health benefits.

But some physicians disagree, writing in peer-reviewed medical journals that the procedure has been proven to help prevent disease.

Panelists at Utah Valley State College addressed the ethics of circumcision during a faculty seminar on Wednesday, contending that the decision to circumcise infants with no ability to understand or consent to the procedure is unethical and possibly profit-driven.

"Circumcision is an example of a social custom whose survival requires suspension of rational thought," said Steve Scott, educational outreach coordinator in Salt Lake City for NOCIRC — the National Organization of Circumcision Information Resource Centers. He said several pervasive myths continue to circulate as a justification for circumcision, including:
• Infants are incapable of feeling pain.

• Uncircumcised males have more difficulty with hygiene.

• If the procedure isn't done at birth, it will have to be performed later.

• Boys will suffer psychological or emotional damage if they're not altered to "look like their father" or don't match their peers.

• The foreskin causes disease.

"These social myths never would have existed if physicians didn't put this into our psyche," Scott said, adding the mandate doctors follow is "to do no harm." Yet those who perform circumcision violate that principle "when operating on a helpless individual and removing specifically designed body parts" without the child's knowledge or consent.

He said that, contrary to popular belief, the foreskin of circumcised babies isn't discarded but is sold to be used in medical research.

Jennifer Howard, an adjunct professor of philosophy and humanities at UVSC, said she and her husband allowed the oldest of their three sons to be circumcised as a baby — despite their concerns — because relatives, friends and health-care personnel told the couple it was necessary for the boy's physical health.

"They said he could get cancer and infection," so the couple consented to what they believed was "a necessary evil." The decision is one she regrets, she said. "I was misinformed. I know now I had no right to make that decision for my son." She said she was "able to protect my next two boys, but it wasn't easy."

She told her doctor explicitly during the next pregnancy that she did not want her son circumcised, and was assured it wasn't required. After he was born, nurses resisted her insistence that a note be placed in his bassinet, instructing doctors not to perform the procedure. When a nurse came to take the baby for the night, Howard asked where she was taking him. "The doctor is here to do circumcisions," was the reply.

"It wasn't even our pediatrician. Another doctor was there to do them all. Circumcision has become so routine that for a parent who questions it, there's distress among the doctors and nurses. ... To request unnecessary surgery on an unconsenting minor should require a raft of legal documents," yet most health-care professionals simply assume that male infants will be circumcised, she said.

The practice "thrives on ignorance and is perpetuated by thoughtless tradition," she said. "It ignores the human rights of the baby. Autonomy over one's own body is a basic human right."

Steve Bulger, associate professor of philosophy and humanities at UVSC, said he believes it will take "50 to 100 years" for Americans to successfully demand legislation that prohibits circumcision of minors, though he has no objection to the practice for consenting adults.

"Parents are obligated to maximize the best interests of their children. To the extent that parents are making decisions that don't do that, then it becomes questionable. I'm willing to listen to the arguments regarding the benefits of circumcision, but at this point in time it doesn't seem to exist," he said, adding "locker room fear" is highly exaggerated as a rationale when a large percentage of males are no longer circumcised.

Utah is one of 12 states where Medicare does not pay for the procedure because it is not recognized as a medical necessity, he said.

No physicians or health-care professionals participated in the panel discussion. But several medical journals have published articles in recent years that contend there are potential health benefits associated with circumcision, when comparing men who have had the procedure with those who haven't.

Dr. Edgar J. Schoen, clinical professor of pediatrics at the University of California in San Francisco, wrote in the December 2007 issue of Canadian Family Physician that "compelling published medical evidence, particularly over the past 20 years, has shown that circumcision offers protection against multiple medical conditions."

He writes that doctors have an important role in providing preventive health care, including childhood immunizations. "Consider newborn circumcision as a vaccine that has a preventive health role against not one but many disorders," he writes.

"In chronological order from infancy through old age, these include severe infant urinary tract infections (UTIs) during the first year of life; local penile infections (balanoposthitis) and mechanical retraction problems (phimosis) in childhood; sexually transmitted diseases, particularly HIV and AIDS, in young adults; and penile and cervical cancer in older adults. Circumcision makes genital hygiene easier throughout life."

Three recent studies in Africa show that circumcision offers a 60 percent to 70 percent protective effect for heterosexual males against contracting HIV, "an effect equivalent to that of many vaccines," he writes. "The results of these studies were so compelling that the trials had to be stopped early, as it was no longer ethical to put men in the uncircumcised control group. The protective effect of circumcision against HIV has been recognized since the 1980s."

According to Schoen, "The preventive effect of circumcision against HIV has now officially been accepted by the World Health Organization, the United Nations, and the National Institutes of Health, and some African countries have begun adult circumcision as a public health measure."

He also contends that circumcision as a protection against other sexually transmitted infections "is well documented," noting that in the past decade, "a large multinational study has shown that uncircumcised men are three times more likely than circumcised men to be carrying the human papillomavirus ... and that antibodies against Chlamydia infection are twice as common in women with uncircumcised male partners."

He writes that "the ideal time for circumcision is when a child is first born. Newborns are extremely resilient and are programmed for stress, having just experienced the trauma of birth ..." and "local anesthesia should always be used." At older ages circumcision is "riskier, more complicated, and about 10 times more expensive."

"It is time for the medical establishment to recognize the compelling evidence favouring newborn circumcision and catch up to the public," Schoen writes, adding that 80 percent of American males are circumcised.