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Statements regarding circumcision by various medical authorities

2020.10.30 15:25 DarthEquus Statements regarding circumcision by various medical authorities

🇦🇺 Australia & New Zealand 🇳🇿

Australian College of Paediatrics

"The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit. Whether these legal concerns are valid will probably only be known if the matter is determined in a court of law .....Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anaesthesia to remove a normal and healthy prepuce."

Australian Medical Association

"The Australian College of Paediatrics should continue to discourage the practice of circumcision in newborns."

Royal Australian College of Physicians

"After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand."

Royal Australasian College of Physicians

"Ethical and human rights concerns have been raised regarding elective infant male circumcision because it is recognized that the foreskin has a functional role, the operation is non-therapeutic and the infant is unable to consent. After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.
“The potential harms include contravention of individual rights, loss of choice, loss of function, procedural and psychological complications. . . . A boy circumcised as an infant may deeply resent this when he grows older; he may want what he cannot have – not to have been circumcised. . . . The option of leaving circumcision until later, when the boy is old enough to make a decision for himself does need to be raised with parents and considered. . . . The ethical merit of this option is that it seeks to respect the child’s physical integrity, and capacity for autonomy by leaving the options open for him to make his own autonomous choice in the future.”

🇧🇪 Belgium 🇧🇪

Belgium Advisory Committee on Bioethics

"In the absence of a medical indication, this intervention undermines personal physical integrity, and it is irreversible as interventions which aim to reconstruct the foreskin do not restore the original situation.
"Given the age of the baby or young child, he cannot give his opinion and his informed consent cannot be sought. It cannot be assumed that a child, and certainly a baby, would consent. An adolescent of 14 years old can be subjected to such social and familial pressure that it cannot be reasonably assumed that his consent has been proven.
"The best way forward would be to strive for a symbolic practice, in which physical integrity would be respected (in other words, no cutting of the flesh). In this way, all religious sensitivities would be respected, without transgressing anyone’s physical integrity."

🇨🇦 Canada 🇨🇦

Canadian Pediatric Society

"Neonatal circumcision is a contentious issue in Canada. The procedure often raises ethical and legal considerations, in part because it has lifelong consequences and is performed on a child who cannot give consent. Infants need a substitute decision maker – usually their parents – to act in their best interests. Yet the authority of substitute decision makers is not absolute. In most jurisdictions, authority is limited only to interventions deemed to be medically necessary. In cases in which medical necessity is not established or a proposed treatment is based on personal preference, interventions should be deferred until the individual concerned is able to make their own choices."

College of Physicians and Surgeons of British Columbia

"Under the Canadian Charter of Rights and Freedoms and the United Nations Universal Declaration of Human Rights, an infant has rights that include security of person, life, freedom and bodily integrity. Routine infant male circumcision is an unnecessary and irreversible procedure. Therefore, many consider it to be 'unwarranted mutilating surgery.'
"Many adult men are increasingly concerned about whether their parents had the right to give consent for infant male circumcision. They claim that an infant’s rights should take priority over any parental rights to make such a decision. This procedure should be delayed to a later date when the child can make his own informed decision. Parental preference alone does not justify a non‐therapeutic procedure.... Advise parents that the current medical consensus is that routine infant male circumcision is not a recommended procedure; it is non‐therapeutic and has no medical prophylactic basis; current evidence indicates that previously‐thought prophylactic public health benefits do not out‐weigh the potential risks..... Routine infant male circumcision does cause pain and permanent loss of healthy tissue."

College of Physicians and Surgeons of Saskatchewan

"While the College's primary mandate is public protection, we do encourage physicians to give careful thought to the downstream risks they may incur by taking an inappropriately casual approach to infant male circumcision driven exclusively by parental preference without valid medical indication for the procedure."

🇩🇰 Denmark 🇩🇰

The Danish Medical Association (Lægeforeningen)

"We are fundamentally opposed to male circumcision unless there is a medical reason such as phimosis for carrying out the operation. It's very intrusive that adults may decide for a newborn to undergo a surgical procedure that is not medically justified and it's effect is lifelong. When a boy reaches the age of consent, he may then decide, but until then the requirements of the individual's right to self-determination prevail."

Danish Society for Anaesthesiology and Intensive-care Medicine

"We cannot vouch for male circumcision under local anesthesia. There is a risk of insufficient assessment and we would never perform medically indicated penile surgery under local anesthesia. Children have the same right as adults to up-to-date pain relief before, during, and after surgery. That children rarely have the language to express pain, we see as an aggravating circumstance.
"We recommend that non-medically indicated interventions be postponed until the age of 18 years in which the patient himself is able to give consent.
"Circumcision is a surgical procedure with a risk of complications both related to the operation and the anesthetic."

🇪🇺 European Union 🇪🇺

Council of Europe Parliamentary Assembly

Representing 47 countries
"One category [of children’s harm] is particulary worrisome, namely violations of the physical integrity of children which supporters tend to present as beneficial to the children themselves despite evidently negative life-long consequences in many cases: female genital mutilation, the circumcision of young boys for religious reasons, medical interventions during the early childhood of intersex children as well as the submission to or coercion of children into piercings, tattoos or plastic surgery. The Parliamentary Assembly should urge member States to promote further awareness in their societies of the potential risks for children’s physical and mental health of the above-mentioned procedures. Member States should take legislative and policy measures that help reinforce child protection in this context by giving primary consideration to the best interest of the child.”

🇫🇮 Finland 🇫🇮

Finnish Association of Pediatric Surgeons (Sulamaa Society)

"Let the boys decide for themselves the circumcision.
"Circumcision of boys is an irreversible and painful procedure that can also cause serious complications. For this reason, circumcision for a person who is unable to consent for non-medical reasons violates fundamental medical ethical principles.
"There are no health grounds for non-medical circumcision of boys in the Nordic countries. Factors that may support circumcision of adult men are very irrelevant to young children in the Nordic countries. Boys can later take a stand on the measure themselves when they are able to give their consent, given their age and level of development. As ombudsmen for children and pediatric medical professionals, we believe that circumcision of a child who is unable to consent without medical justification is contrary to Articles 12 and 24 of the Convention on the Rights of the Child. According to Article 12, the child has the right to express his or her views on matters concerning him or her."

Finnish Medical Association

"The parents requesting ritual circumcision of the boy should be discussed with giving up the procedure or postponing it to a time when the boy is able to decide for himself.
"Circumcision always exposes the patient to complications. Taken in a preventive sense, the measure will not bring any health benefits other than the possible prevention of HIV in developing countries. Thus, it is comparable to female circumcision. Because proper consent cannot be obtained from a small son, both ethically and legally, circumcision violates an individual’s freedom and personal integrity. As such, the procedure is contrary to medical ethics."

Finnish Central Union for Child Welfare

"The Central Union for Child Welfare considers that circumcision of boys that violates the personal integrity of the boys is not acceptable unless it is done for medical reasons to treat an illness. The basis for the measures of a society must be an unconditional respect for the bodily integrity of an under-aged person.
"Circumcision intervenes in the sexual integrity of a male child causing a permanent change in organisms and has consequences pertaining to both health and quality of life.
"The circumcision of girls is rightly considered as inhuman mutilation of the genitals and is punished abuse. Also boys must be guaranteed a similar protection by law."

🇩🇪 Germany 🇩🇪

German Pediatric Association

"Initially, it should be observed that there is no reason from a medical point of view to remove an intact foreskin from underage boys or boys unable to give consent. . . . The male foreskin is a part of the skin of the organ and fulfills important functions that protect the very sensitive glans. . . . Circumcision can lead to erectile dysfunction [and] . . . considerable limitations to sex life and cause psychological stresses. . . . Boys have, according to our sense of justice, the same basic constitutional legal rights to physical integrity as girls, they must not be disadvantaged due to their sex.”

🇬🇧 Great Britain 🇬🇧

Royal College of Surgeons of England

"The one absolute indication for circumcision is scarring of the opening of the foreskin making it non- retractable (pathological phimosis). This is unusual before five years of age. ...The parents and, when competent, the child, must be made fully aware of the implications of this operation as it is a non-reversible procedure."

British Medical Association

"It is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks. .... very similar arguments are also used to try and justify very harmful cultural procedures, such as female genital mutilation or ritual scarification. Furthermore, the harm of denying a person the opportunity to choose not to be circumcised must also be taken into account, together with the damage that can be done to the individual’s relationship with his parents and the medical profession if he feels harmed by the procedure. .... parental preference alone is not sufficient justification for performing a surgical procedure on a child. .... The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it."

🇮🇸 Iceland 🇮🇸

Icelandic Medical Association

"It's the general opinion of the Icelandic Medical Association (IMA) that unnecessary medical procedures should not be performed on children, and in that regards the IMA references the UN Convention on the Rights of the Child. The circumcision of boys, that has no medical purpose, but can lead to serious complications qualifies as such a procedure."

🇳🇱 The Netherlands 🇳🇱

Royal Dutch Medical Association

“There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene. Partly in light of the complications which can arise during or after circumcision, circumcision is not justifiable except on medical/therapeutic grounds. . . . Contrary to what is often thought, circumcision entails the risk of medical and psychological complications. . . . Non-therapeutic circumcision of male minors is contrary to the rule that minors may only be exposed to medical treatments if illness or abnormalities are present. . . . Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity. . . . Complications in the area of sexuality have also been reported as have extreme pain experiences in newborns causing behavioral changes which are still apparent years later. Similarly, the high social costs of circumcision as a result of complications have been cited. . . . The foreskin is a complex, erotogenic structure that plays an important role in the mechanical function of the penis during sexual acts, such as penetrative intercourse and masturbation. The many attempts by men to restore their foreskins by mechanical or surgical means also contradict the idea that the foreskin is a useless part of the body.”
This policy has been endorsed by several other Dutch organizations:

🇮🇸🇬🇱🇫🇴 Nordic Countries 🇳🇴🇪🇪🇦🇽

The Nordic Association of Clinical Sexology

Representing Danish, Estonian, Finnish, Icelandic, Norwegian, and Swedish clinical sexologists
"The penile foreskin is a natural and integral part of the normal male genitalia. The foreskin has a number of important protective and sexual functions. It protects the penile glans against trauma and contributes to the natural functioning of the penis during sexual activity. Ancient historic accounts and recent scientific evidence leave little doubt that during sexual activity the foreskin is a functional and highly sensitive, erogenous structure, capable of providing pleasure to its owner and his potential partners.
"As clinical sexologists, we are concerned about the human rights aspects associated with the practice of non-therapeutic circumcision of young boys. To cut off the penile foreskin in a boy with normal, healthy genitalia deprives him of his right to grow up and make his own informed decision. Unless there are compelling medical reasons to operate before a boy reaches an age and a level of maturity at which he is capable of providing informed consent, the decision to alter the appearance, sensitivity and functionality of the penis should be left to its owner, thus upholding his fundamental rights to protection and bodily integrity.
"Every person's right to bodily integrity goes hand in hand with his or her sexual autonomy."

Nordic Ombudsmen for Children and Pediatric Experts

Representing Norway, Sweden, Finland, Denmark, and Greenland
"Circumcision, performed without a medical indication, on a person who is incapable of giving consent, violates fundamental medical-ethical principles, not least because the procedure is irreversible, painful, and may cause serious complications. There are no health-related reasons for circumcising young boys in the Nordic countries. Circumstances that may make circumcision advantageous for adult men are of little relevance to young boys in the Nordic countries, and on these matters the boys will have the opportunity to decide for themselves when they reach the age and maturity required to give consent."

🇳🇴 Norway 🇳🇴

Norwegian Nursing Association

"[The Norsk Sykepleierforbund opposes] exposing healthy children to an irreversible, painful and risky intervention, without their own consent. ...There is no medical indication for the procedure. In our view, it is problematic to establish different legal standards depending on gender. Circumcision / genital mutilation of women is criminalized, while circumcision of boys is proposed institutionalized through the public health system.”

Norwegian Council for Medical Ethics

"Among other things, the council says that ritual circumcision of boys has no established medical benefit . . . . circumcision of boys is not consistent with important principles of medical ethics . . . it is an important factor that the child cannot give consent."

🇿🇦 South Africa 🇿🇦

South African Medical Association

"The Committee stated that it was unethical and illegal to perform circumcision on infant boys in this instance. In particular, the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission."

🇸🇮 Slovenia 🇸🇮

Slovenian Human Rights Ombudsman

"However, if the circumcision of the child is not medically indicated, but is only the result of the belief of his parents (religious or otherwise), such an intervention has no legal basis. It does not even matter whether the child explicitly opposed the procedure. Interference with the physical integrity of a child solely because of the wishes of his or her legal representatives or guardians therefore constitutes an inadmissible interference with his or her body and, in our opinion, also has signs of criminal conduct."

🇸🇪 Sweden 🇸🇪

Swedish Pediatric Society

"There is no medical reason to circumcise little boys; the procedure is painful, irreversible and can cause complications, according to Sweden's children's ombudsman and representatives for several healthcare organizations."
"It was emphasized that the aim should, as far as possible, be for the child / young man himself to be allowed to take a stand on circumcision.

The ombudsman Fredrik Malmberg, together with representatives from the Swedish Society of Medicine (SLS), the Swedish Society of Health Professionals (Vårdförbundet), the Swedish Paediatric Society (BLF), and the Swedish Association of Pediatric Surgeons (SLF), argues that:

"Swedish law requires that the child's will be taken into account wherever possible. Circumcision is a procedure which is typically carried out at a very young age and it is this issue of consent which is paramount, they argue. "We consider circumcision of boys without the child's consent to be in contravention of article 12 of UN Convention on the Rights of the Child (CRC) which gives children the right to have an opinion in matters which concern them." They furthermore argue for a change in Swedish legislation in order to meet the human rights of the child and medical ethics."

🇺🇸 United States 🇺🇸

American Academy of Pediatrics

The 2012 Policy Statement is often misquoted as a recommendation for circumcision. The AAP does not, nor has ever, recommended circumcision.
"Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks . . . . Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns."
The AAP's 2012 Infant Circumcision Policy was formally rejected by leading pediatric doctors in Austria, Britain, Denmark, England, Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Sweden, and the Netherlands and by senior pediatricians in Canada, the Czech Republic, France, and Poland. Their letter written in response to the AAP's task force opinion, Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision stated:
"Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the [AAP's 2012] report’s conclusions [claiming "benefits" of non-therapeutic circumcision justify it being covered by insurance] are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non–US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only one of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.
"There is growing consensus among physicians, including those in the United States, that physicians should discourage parents from circumcising their healthy infant boys because nontherapeutic circumcision of underage boys in Western societies has no compelling health benefits, causes postoperative pain, can have serious long-term consequences, constitutes a violation of the United Nations’ Declaration of the Rights of the Child, and conflicts with the Hippocratic oath: primum non nocere: First, do no harm."
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