Circumcision Policy Under Fire | European Doctors Denounce AAP Position
Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision
Doctors from 16 European countries denounce the American Academy of Pediatrics (AAP) 2012 Circumcision Policy Statement. In an article published in the American Academy of Pediatrics publication “Pediatrics,” these doctors state:
Circumcision conflicts with children’s rights and doctors’ oath and can have serious long-term consequences, state an international group of 38 physicians from 16 European countries in Pediatrics today. They comment on the American Academy of Pediatrics’ new policy on infant male circumcision.
There are no compelling health arguments in favor of circumcision, while it can have serious long-term urological, psychological and sexual consequences. And performing medically unwarranted circumcision of underage boys conflicts with good medical practice. Male infant circumcision conflicts with children’s rights and the doctors’ oath not to do harm.
Morten Frisch, MD, PhDa, Yves Aigrain, MD, PhDb, Vidmantas Barauskas, MD, PhDc, Ragnar Bjarnason, MD, PhDd, Su-Anna Boddy, MDe, Piotr Czauderna, MD, PhDf, Robert P.E. de Gier, MDg, Tom P.V.M. de Jong, MD, PhDh, Günter Fasching, MDi, Willem Fetter, MD, PhDj, Manfred Gahr, MDk, Christian Graugaard, MD, PhDl, Gorm Greisen, MD, PhDm, Anna Gunnarsdottir, MD, PhDn, Wolfram Hartmann, MDo, Petr Havranek, MD, PhDp, Rowena Hitchcock, MDq, Simon Huddart, MDr, Staffan Janson, MD, PhDs, Poul Jaszczak, MD, PhDt, Christoph Kupferschmid, MDu, Tuija Lahdes-Vasama, MDv, Harry Lindahl, MD, PhDw, Noni MacDonald, MDx, Trond Markestad, MDy, Matis Märtson, MD, PhDz, Solveig Marianne Nordhov, MD, PhDaa, Heikki Pälve, MD, PhDbb, Aigars Petersons, MD, PhDcc, Feargal Quinn, MDdd, Niels Qvist, MD, PhDee, Thrainn Rosmundsson, MDff, Harri Saxen, MD, PhDgg, Olle Söder, MD, PhDhh, Maximilian Stehr, MD, PhDii, Volker C.H. von Loewenich, MDjj, Johan Wallander, MD, PhDkk, and Rene Wijnen, MD, PhDll
The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence.
Seen from the outside, cultural bias reflecting the normality of non-therapeutic male circumcision in the United States seems obvious, and the report’s conclusions 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 1 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.
Department of Epidemiology Research, Statens Serum Institut, Copenhagen and Center for Sexology Research, Department of Clinical Medicine, alborg University, Aalborg, Denmark; Department of Pediatric Surgery, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France; Lithuanian Society of Paediatric Surgeons, Kaunas, Lithuania; Department of Pediatrics, Landspitali University Hospital, Reykjavik, Iceland; Children’s Surgical Forum of the Royal College of Surgeons of England, London, United Kingdom; Polish Association of Pediatric Surgeons, Gdansk, Poland; Working Group for Pediatric Urology, Dutch Urological Association, Utrecht, Netherlands; Departments of Pediatric Urology, University Children’s Hospitals UMC Utrecht and AMC Amsterdam, Netherlands; Austrian Society of Pediatric and Adolescent Surgery, Klagenfurt, Austria; Paediatric Association of the Netherlands, Utrecht, Netherlands; German Academy of Paediatrics and Adolescent Medicine, Berlin, Germany; Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Pediatrics, Rigshospitalet, Copenhagen, Denmark; Departments of Pediatric Surgery, Landspitali University Hospital, Reykjavik, Iceland, and Karolinska University Hospital, Stockholm, Sweden; German Association of Pediatricians, Cologne, Germany; Department of Pediatric Surgery, Thomayer Hospital, Charles University, Prague, Czech Republic; British Association of Paediatric Urologists, London, United Kingdom; British Association of Paediatric Surgeons, London, United Kingdom; Committee on Ethics and Children’s Rights, Swedish Paediatric Society, Stockholm, Sweden; Ethics Committee of the Danish Medical Association, Copenhagen, Denmark; Ethics Committee of the German Academy of Pediatrics and Adolescent Medicine, Berlin, Germany; Finnish Association of Pediatric Surgeons, Tampere, Finland; Department of Pediatric Surgery, Helsinki University Children’s Hospital, Helsinki, Finland; Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada; Ethics Committee of the Norwegian Medical Association, Oslo, Norway; Estonian Society of Paediatric Surgeons, Tallinn, Estonia; Norwegian Paediatric Association, Tromsø, Norway; Finnish Medical Association, Helsinki, Finland; Latvian Association of Pediatric Surgeons, Riga, Latvia; Department of Pediatric Surgery, Our Lady’s Children’s Hospital, Dublin, Ireland; Department of Surgery, Odense University Hospital, Odense, Denmark; Department of Pediatric Surgery, Landspitali University Hospital, Reykjavik, Iceland; Department of Pediatrics, Helsinki University Children’s Hospital, Helsinki, Finland; Swedish Pediatric Society, Stockholm, Sweden; Department of Pediatric Surgery, Dr. v. Haunersches Kinderspital, Ludwig-Maximilians Universität, Munich, Germany; Commission for Ethical Questions, German Academy of Pediatrics, Frankfurt, Germany; Swedish Society of Pediatric Surgery, Stockholm, Sweden; and Dutch Society of Pediatric Surgery, Rotterdam, Netherlands