German court bans circumcision of young boys

[Rasmus]

That's for the law to specify. Tattoo artists don't remove tissue, so a clear distinction can be drawn.

Dave

where do people get branding and body modifications, inserts and that sort of thing?

I guess the holes for regular piercings don't actually remove any tissue, either, right?

But I think the distinction of "not removing tissue" isn't enough: I mean it's not medicine in the same way that homoeopathy isn't medicine. Whatever they do is not going to make sick people feel better.

 

[zeggman]

In the UK, the number of circumcisions dropped like a brick when the NHS stopped reimbursing them for non-medical reasons.

Maybe that would be all it would take, then. I would support a policy of requiring medical justification for insurance reimbursement of circumcisions a lot more readily than I would support an outright ban. That's especially true as the government (and thus my taxes) begin to underwrite insurance reimbursements.

 

[Megalodon]

where do people get branding and body modifications, inserts and that sort of thing?

Where do babies get branding, body modifications, inserts and that sort of thing?

How long would it take for charges to be brought to a professional that pierced a baby's nipples, or genitals? Or tattooed them?

 

[Rasmus]

Where do babies get branding, body modifications, inserts and that sort of thing?

I should hope that they don't.

But that wasn't my point at all. This was about "medicine" vs "other stuff", and whether circumcicions would count as practising medicine at all, if not performed for medical reasons. I don't think who the person is that is being circumcised shouldn't matter here.

How long would it take for charges to be brought to a professional that pierced a baby's nipples, or genitals? Or tattooed them?

Minutes, presumably.

and chances are nobody involved in the process would see anything wrong with male circumcision ...

 

[Dave Rogers]

I'm suggesting that the medical reality behind this article and others like it is that there are both pros and cons.

Stop backpedalling. You suggested that this one article was 'all the "pretext of need" a local practitioner would typically require.' Now you're realising that it's such a stupid claim that you want to pretend you never made it.

The medical reality is that the medical profession has already examined the supposed benefits of circumcision and determined that they're not enough to justify it. One article in one newspaper is irrelevant; doctors don't draw their medical opinions from newspaper reports.

Dave

 

[Dave Rogers]

where do people get branding and body modifications, inserts and that sort of thing?

I guess the holes for regular piercings don't actually remove any tissue, either, right?

But I think the distinction of "not removing tissue" isn't enough: I mean it's not medicine in the same way that homoeopathy isn't medicine. Whatever they do is not going to make sick people feel better.

Chop logic all you want, but there is sufficient difference between the service offered by a tattoo parlour and the service offered by a mohel that it would be perfectly practicable for a law to be drafted that distinguished between the two. Anyway, circumcision is a medical operation that is in certain circumstances performed to meet a defined medical need, so it can be defined as medicine. If that weren't the case, then how would you prosecute someone with no medical qualifications who carried out amputations?

Dave

 

[ddt]

but they aren't practising medicine any more than a tattoo artist is practising medicine.

In practice, that depends on your jurisdiction. But circumcision is, without doubt, a surgical procedure, and thus medicine, whereas you can very well discuss the medicine aspect of tattooing.

 

[zeggman]

Stop backpedalling. You suggested that this one article was 'all the "pretext of need" a local practitioner would typically require.' Now you're realising that it's such a stupid claim that you want to pretend you never made it.

********. If you have a doctor who sees nothing wrong with circumcision, and a parent who sees nothing wrong with it, but the Foreskin Police have managed to pass a law that says "Cut without justification, go to jail," a study which shows the risk of UTI dropping to 10% of the uncircumcised rate would be more than enough "pretext of justification".

Look at how easy it is to get a prescription for medical marijuana.

The medical reality is that the medical profession has already examined the supposed benefits of circumcision and determined that they're not enough to justify it.

If that was true, nobody would be performing them.

As far as I know, the official position of the American Academy of Pediatrics is neutral, but is being re-evaluated in light of increasing evidence of benefits. Suppose, for the sake of argument, that further studies reveal further benefits, and a day comes when the AAP decides the benefits outweigh the risks and adopts a positive stance.

Or suppose no further benefits are revealed, but stricter procedures cut the risks associated with circumcision, with the same result.

Would it be your position that you know better than the medical professionals, and somebody oughta ban it anyway?

 

[Staffsknot]

Not sure if it has been posted yet: http://www.bbc.co.uk/news/world-europe-18833145

Angela Merkel backs circumcision right after German ruling

The German government says Jewish and Muslim communities should be able to continue the practice of circumcision, after a regional court ruled it amounted to bodily harm.

 

[jdp]

I'm suggesting that the medical reality behind this article and others like it is that there are both pros and cons. Doctors and parents should be able to discuss these in light of their specific circumstances when deciding whether or not to circumcise a child, just as they can when deciding wither or not to extract "unnecessary" teeth.

As long as this is qualified by medical necessity. For example, given your UTI example an individual boy who is found to be at particularly high risk for recurrent UTI. On the other hand, introducing Cranberry juice into his diet might be a preferable first step.

We should make sure that everyone has the best information available, trust that both doctors and parents want what's best for the child, and let them make an informed decision.

When it's reasonable or necessary to make a decision.

********. If you have a doctor who sees nothing wrong with circumcision, and a parent who sees nothing wrong with it, but the Foreskin Police have managed to pass a law that says "Cut without justification, go to jail," a study which shows the risk of UTI dropping to 10% of the uncircumcised rate would be more than enough "pretext of justification".

Not really, context matters. To provide a different example, NGOs are starry eyed over an underwhelming 50 - 60% relative risk reduction in F->M HIV acquisition in circumcised men in Africa. Even more misguided western doctors (mostly American) believe that is a circumcision justification in the US even though the real risk reduction to the average American would amount to a change of only a few hundredths of a percent over their lifetime. The UTI situation is similar, the incidence doesn't support the intervention in most situations.

Looked at another way, if some researcher published a paper that said, "Circumcision nearly eliminates the risk of small pox." or "Circumcision nearly eliminates the risk of Measles." Would you see that as a reasonable justification?

Look at how easy it is to get a prescription for medical marijuana.

I am not sure how that is relevant. Except perhaps to illustrate another policy that American's are largely misguided on.

If that was true, nobody would be performing them.

I doubt this, I've read in countless places just this past month Jewish leaders quoted that they would continue their tradition regardless of the situation. And I believe them, one needs to look no further than the fundamentalists giving boys Herpes in NY.

As far as I know, the official position of the American Academy of Pediatrics is neutral, but is being re-evaluated in light of increasing evidence of benefits. Suppose, for the sake of argument, that further studies reveal further benefits, and a day comes when the AAP decides the benefits outweigh the risks and adopts a positive stance.

I don't believe that will happen but I, personally, give American health agencies' opinion on this matter little weight. They're too biased to provide an objective evaluation of the matter. Now if, for example, the Dutch made such a statement, I'd be more inclined to believe their evaluation; I don't see that happening though.

Here is a link to the current (and I think first) Dutch statement:

http://knmg.artsennet.nl/Publicatie...rapeutic-circumcision-of-male-minors-2010.htm

Not sure if it has been posted yet: http://www.bbc.co.uk/news/world-europe-18833145

Angela Merkel backs circumcision right after German ruling

The German government says Jewish and Muslim communities should be able to continue the practice of circumcision, after a regional court ruled it amounted to bodily harm.

Yep sounds like they'll buckle; boys get the shaft.

 

[ddt]

Not sure if it has been posted yet: http://www.bbc.co.uk/news/world-europe-18833145

Angela Merkel backs circumcision right after German ruling

The German government says Jewish and Muslim communities should be able to continue the practice of circumcision, after a regional court ruled it amounted to bodily harm.

As if this is a matter that is decided by politicians.

This ends at the Bundesgerichtshof, the German supreme court, in case of a new prosecution with an actual conviction, or at the Bundesverfassungsgericht, the German constitutional court, in case parliament introduces a law explicitly allowing circumcision.

 

[jdp]

700,000 $ court settlement in Massachusetts, I hope it was worth it.

http://arclaw.org/announcements/700000-circumcision-settlement-massachusetts

 

[Rolfe]

I wouldn't be giving the parents money for doing that to their baby, that's for sure....

Rolfe.

 

[lopeyschools]

Having read quite a bit of this topic I find myself agreeing with the Canadian Paediatric Society study below (see link for more detail):

http://www.cps.ca/english/statements/fn/fn96-01.htm#SEXUALLY TRANSMITTED DISEASES

Conclusions

We undertook this literature review to consider whether the CPS should change its position on routine neonatal circumcision from that stated in 1982. The review led us to conclude the following.

There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1% to 2%.
The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2% to 2%. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision.
Evaluation of alternative methods of preventing UTI in infancy is required.
More information on the effect of simple hygienic interventions is needed.
Information is required on the incidence of circumcision that is truly needed in later childhood.
There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases.
When circumcision is performed, appropriate attention needs to be paid to pain relief.
The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed.
When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. Their decision may ultimately be based on personal, religious or cultural factors.

I disagree ultimately with their conclusion that the decision should be left to personal, religious or cultural factors. I believe they would have been heavily influenced by the Canadian tradition of political correctness in the face of diversity and thus hoped to not offend anyone. I do not believe that without an overwhelming clear evidential basis for the reduction of harm, subjective cultural practices should not be allowed to take precedence of a child's inherent right to bodily interegity.

I would change my opinion if it became clear that circumcision provided benefits that overwhelmed the harm of circumcision, but the science simply doesn't appear there. The CPS review noted that there multiple problems with the STD/HIV correlation with circumcised status and that further research was need. Mind you the review is from 2009, but I haven't heard that the CPS is considering revisiting this issue based on new data.

There are also huge gaps (no pun intended) in our knowledge of what the foreskin does beside provide pleasure and a mechanical action. It is entirely possible the foreskin may prevent some types of infection or protect in other matters. We should bear in mind that the foreskin is widespread throughout mammals and appears to be evolutionary conserved. The foreskin may have benefits that are yet undiscovered, simply because we have not sought to look for them.

Cheerio,

 

[jdp]

I wouldn't be giving the parents money for doing that to their baby, that's for sure....

Rolfe.

That's a real tough spot, the parents don't deserve squat. They knew the risks but we do have the boy to think about he's probably looking at a few years of corrective surgery. And when you think about it, it was all for nothing. When he asks his parents why he had to go through all that what possible answer could they give him?

And it's not even that uncommon. Two years ago an Atlanta lawyer sued the manufacture of one of the most common circumcision devices, the Mogen Clamp, on behalf of another boy. The company was sued into utter destitution losing more than 10 million dollars.

http://www.ajc.com/news/nation-world/atlanta-lawyer-wins-11-573890.html

 

[ehcks]

That's a real tough spot, the parents don't deserve squat. They knew the risks but we do have the boy to think about he's probably looking at a few years of corrective surgery. And when you think about it, it was all for nothing. When he asks his parents why he had to go through all that what possible answer could they give him?

And it's not even that uncommon. Two years ago an Atlanta lawyer sued the manufacture of one of the most common circumcision devices, the Mogen Clamp, on behalf of another boy. The company was sued into utter destitution losing more than 10 million dollars.

http://www.ajc.com/news/nation-world/atlanta-lawyer-wins-11-573890.html

I'm not a judge, but I would have put the money in a fund that only the boy can take out of and only when he turns 18. He's the one who needs it.

 

[Dave Rogers]

********. If you have a doctor who sees nothing wrong with circumcision, and a parent who sees nothing wrong with it, but the Foreskin Police have managed to pass a law that says "Cut without justification, go to jail," a study which shows the risk of UTI dropping to 10% of the uncircumcised rate would be more than enough "pretext of justification".

Wow, you've covered quite a distance from what you said originally. Remember, your original claim was that one newspaper article on one study that doesn't even recommend circumcision should be enough to convince a doctor to carry out a circumcision.

Now you seem to have dreamed up the strawman argument that people are suggesting that circumcision should be outlawed if a doctor thinks it's medically justified. Weird.

If that was true, nobody would be performing them.

It is true. You admit it yourself when you say,

As far as I know, the official position of the American Academy of Pediatrics is neutral,

So you seem to be arguing mostly with yourself here.

Dave

 

[zeggman]

Wow, you've covered quite a distance from what you said originally. Remember, your original claim was that one newspaper article on one study that doesn't even recommend circumcision should be enough to convince a doctor to carry out a circumcision.

Convince? I never said any such thing, and it is a lie to state that I did.

I was having a conversation with jdp, and said I thought my own circumcision was probably performed just because it was fashionable at the time. JDP said that's the problem, there is not even a "pretext of need." I offered the article as something that would provide a "pretext of need" for any doctor and parent even if they really only wanted to do it because they thought it looked nice or because "everybody's doing it."

No "pretext of need" is required currently in the United States. The neutral stance of the AAP neither encourages nor discourages circumcision, and lets physician and parents decide whether or not to perform one.

Now you seem to have dreamed up the strawman argument that people are suggesting that circumcision should be outlawed if a doctor thinks it's medically justified. Weird.

If you think every anti-circumcision activist will be happy with a law that merely requires some medical justification, when medical justification (the study I cited) is currently available to anyone who wants to circumcise their child for any reason, then it's a strawman.

If such a law were in effect today, it would simply mean that anyone who wanted to circumcise her son could do so, and anyone who didn't want to wouldn't have to. Since that's the same situation we have without such a law, I'm not sure what the point of passing such a law would be.

I assume that anyone who thinks an additional law is necessary would not be satisfied with one which doesn't alter the status quo.

It's possible that further research will reveal that there is some subset of the population for whom circumcision does not diminish the risk of UTI, or indeed that all studies which suggest any such reduction are flawed and invalid. In that case, perhaps having such a law already on the books would reduce the number of circumcisions performed.

I continue to maintain that education, rather than legislation, is likely to be the most effective deterrent. If I was actively working to discourage circumcision (and I'm not), that's where I'd focus my activity.

 

[jdp]

No "pretext of need" is required currently in the United States. The neutral stance of the AAP neither encourages nor discourages circumcision, and lets physician and parents decide whether or not to perform one.

And this is part of the problem. Such procedures, performed by proxy consent, should have a therapeutic intent. That's basic in the ethical practice of medicine.

If you think every anti-circumcision activist will be happy with a law that merely requires some medical justification, when medical justification (the study I cited) is currently available to anyone who wants to circumcise their child for any reason, then it's a straw man.

Such is the situation for prescription drugs; when enough of them are prescribed though, the fraud becomes obvious.

If such a law were in effect today, it would simply mean that anyone who wanted to circumcise her son could do so, and anyone who didn't want to wouldn't have to. Since that's the same situation we have without such a law, I'm not sure what the point of passing such a law would be.

We could say the same thing about most laws, FGM for example, that doesn't mean we should proscribe it. And I disagree that a law would not be effective. We won't get there in the US for some time, we're too backwards, but other countries could. Places where circumcision is already properly recognized as pointless as a routine procedure.

I continue to maintain that education, rather than legislation, is likely to be the most effective deterrent. If I was actively working to discourage circumcision (and I'm not), that's where I'd focus my activity.

Actually, the best approach is multimodal. Education does occur, working with doctors does occur, removing the procedure from public assistance does occur, lawsuits do occur, and legislative approaches do occur. They all have their place. Those who feel harmed, have a right to stand up and be heard. They should be encouraged, supported, and listened to.

Edited by jhunter1163: 

Moderated content removed.

 

[zeggman]

And I disagree that a law would not be effective. We won't get there in the US for some time, we're too backwards, but other countries could. Places where circumcision is already properly recognized as pointless as a routine procedure.

Since the evidence is ambivalent (ambiguous?) I don't agree that leaving the decision in the hands of parents and doctors makes the U.S. "backward". I understand that different people can reach different conclusions.

You think the rare instances of really bad outcomes justifies raising the bar on when circumcision is justified; I think the small benefits which accrue to a large population of people who suffer no harm at all (and the fact that it's not being required of anyone) justifies leaving it low.

According to the CDC, circumcision rates in the United States increased from 48.3% to 61.1% between 1988 and 2000, and decreasee from 62.5% to 56.9% between 1999 and 2008. So, even in the United States, rates had fallen to less than half before the possibility that it helped prevent transmission of HIV and HPV was known, only rose by 20% in light of that information, and are declining again now.

In terms of actual circumcisions performed, I don't think these rates show we're all that backward at all. They show that people are making informed decisions in light of the medical information they have available, which is (in my opinion) just how it should be.