Human Rights and Ethical
W. Prescott, Marilyn Fayre Milos and George C. Denniston
When the American
Academy of Pediatrics published its "Circumcision Policy Statement"
in the March 1, 1999, issue of Pediatrics a notable amount
of media and public commentary followed. The principle findings and
recommendations of the statement are:
- The scientific data are not sufficient to recommend neonatal circumcision
- The procedure is not essential to the child's well-being.
- Parents should determine what is in the best interests of the
- To make an informed choice, parents should be given accurate and
unbiased information and be provided the opportunity to discuss
- Existing scientific evidence demonstrates potential
medical benefits of newborn circumcision.
- Analgesia is safe and effective in reducing the procedural pain
associated with circumcision and should be provided if a decision
for circumcision is made.
- Circumcision should be done only on infants who are stable and
The full document
is available on the Web at http://www.nocirc.org/position/aap1999.htm.
While this statement
represents welcome progress in an area that has concerned many humanists
and free-thinkers for the better part of this century, it falls short
of taking an uncompromising stand on the issues of human rights and
medical ethics that surround the medicalization of ritual circumcision.
It also repeats the false claim that there are potential benefits
to the practice.
From a purely
medical standpoint, circumcision is justified only when performed
to correct a pathological condition, never to remove normal healthy
tissue, and the health benefits must outweigh the risks involved.
From the standpoint of medical ethics, experimental and clinical procedures
are not to be performed on a person who does not benefit from them.
The way defenders
of circumcision try to argue around these objections is to expand
the concepts of benefit and beneficiary to include a future class
of unknown persons who may or may not develop a clinical condition.
Within this class are not only the adult the infant may become but
women or men with whom the adult may have intercourse. Yet it is impossible
to predict whether any specific normal, healthy newborn or infant
will develop any future clinical condition that may merit a medical
circumcision or, by remaining whole and then failing to use proper
hygiene, may contribute to a medical condition in another person.
From the standpoint
of human rights, every newborn, infant, and child has a right to be
free from the compelled donation of body parts or tissue--in this
case, the foreskin--even if such might benefit a third party in the
future. This issue was central to the case of McFall v. Shimp
in the Court of Common Pleas of Allegheny County, Pennsylvania, in
which the plaintiff sought to force provide bone marrow on the grounds
of the plaintiff's dire need and the defendant's status as a rare,
compatible donor. In his decision of July 26, 1978, Judge J. Flaherty
For a law to compel the Defendant to submit to
an intrusion of his body would change every concept and principle
upon which our society is founded. To do so would defeat the sanctity
of the individual and impose a rule which would know no limits
and one could not imagine where the line would be drawn….Forcible
extraction of living body tissue causes revulsion to the judicial
In this context,
the AAP "Circumcision Policy Statement"
continues, in effect, to endorse, whenever parents so choose, a concept
that our common law condemns. This becomes particularly onerous when
the beneficiary of this "forcible extraction" is an unknown future
person where the incidence of alleged future diseases has been acknowledged
by the AAP in the same statement to be insufficient to justify the
application of routine circumcision.
further violates the "sanctity of the individual," denying the newborn,
infant or child the right to bodily security and integrity. Neither
the parent nor anyone else--even by proxy via the medical profession--should
have the right to inflict such harm or injury. In other contexts his
would be recognized as child abuse.
Nor should anyone have the right
to deny the newborn, infant or child his rights as a born person,
as set forth in the Fourteenth Amendment of the U.S. Constitution,
All persons born or naturalized in the United
States, and subject to the jurisdiction thereof are citizens of
the United States and of the State wherein they reside. No State
should make or enforce any law which shall abridge the privileges
or immunities of citizens of the United States; nor shall any
State deprive any person of life, liberty, or property, without
the process of law; nor deny to any person within its jurisdiction
the equal protection of the laws.
the equal protection clause in the above takes on new relevance given
the Federal Genital Mutilation Act of 1993 and Public Law No. 104-208
of September 30, 1996, both of which declare it a criminal offense
to inflict genital mutilation on a female. Males should receive equal
protection under these laws.
violates international law as well, specifically the Universal
Declaration of Human Rights, to which the United States is a signatory.
Article 3 states; "Everyone has the right to life, liberty and security
of person" and Article 5 which states, "No one shall be subjected
to torture or to cruel, inhuman or degrading treatment or punishment."
Similar protections are provided in the United Nations Convention on the Rights
of the Child, which the United States has signed but not ratified.
In light of all
the above, the AAP "Circumcision Policy Statement"
attempts on the basis of religious or cultural customs--to confer
on parents rights that they should not have and endorses the denial
of rights to the newborn, infant, or child. The AAP would be better
advised to restrict its recommendations and actions about circumcision
to medical procedures affecting pathological conditions. Attempting
to validate ritual or religious circumcision falls beyond the purview
and responsibilities of medicine and the AAP.
But if the AAP
insist on commenting about such matters, then it should amend its
statement to oppose the medical circumcision of normal, healthy newborns,
infants and children irrespective of gender, taking a position consonant
with its own 1998 policy statement opposing female genital mutilation
and 1999 position paper, The Role of the Pediatrician
in Youth Violence Prevention in Clinical Practice and at the Community
is a needless act of violence performed upon a resisting and nonconsenting
newborn infant, or child. The pain and trauma of the procedure cannot
be adequately ameliorated by anesthesia or analgesia, and the suffering
can continue long after the painkiller has worn off.
James W. Prescott, Ph.D is
a developmental neuropsychologist, a cross-cultural psychologist,
and director of the Institute of Humanistic Science. He can be reached
via e-mail at firstname.lastname@example.org. Marilyn
Fayre Milos, R.N. is founder and director of the National Organization
of Circumcision Information Resource Centers, the coordinator of the
International Symposia on Sexual Mutilations, and coeditor of
Sexual Mutilations: A Human Tragedy. She can be reached via
e-mail at email@example.com.
George C. Denniston, M.D., M.P.H., is president of
Doctors Opposing Circumcision, with members on six continents.
He can be reached via e-mail at firstname.lastname@example.org or on the Web
This article first appeared in The Humanist,
Volume 59, Number 3, Pages 45-46, May-June 1999.
This article was sent to the following people for review and action:
James P. Youngblood, M.D., President
American College of Obstetricians and Gynecologists
409 12the Street SW, POB 96920
Washington, DC 20090-6920
Nancy W. Dickey, M.D., President
American Medical Association
515 North State Street
Chicago, IL 60610
Robert Graham, M.D., Executive Director
American Academy of Family Physicians
8880 Ward Parkway
Kansas City, MO 64114
Carole Marie Lannon, M.D., MPH, Chair
Task Force on Circumcision
American Academy of Pediatrics
Elk Grove Village, IL 60009-0927
William R. Turner, M.D., President
American Urological Association
1120 North Charles Street
Baltimore, MD 21201