We submitted the below letter to the Journal of the American Medical Association (JAMA) on September 9, 2013, in response to its recent one-page pro-circumcision article by Deborah Tolmach Sugerman titled, “Male Infant Circumcision.”
Questions to Ask Regarding Infant Circumcision
By J. Steven Svoboda, M.A., J.D.
Attorneys for the Rights of the Child
Deborah Tolmach Sugerman1 seems to take for granted the American Academy of Pediatrics’ (AAP’s) claim that the “benefits” of infant circumcision exceed the associated “risks.” Unfortunately, she does not seem to be aware of several major critiques of the AAP’s findings that have been published in recent months. These critiques, including one by 38 of Europe’s most distinguished medical and ethical authorities, substantially undermine the credibility of the AAP report.
Among other problems, the AAP fails to include in its risk/benefit calculus any consideration of the sexual, protective, and immunological functions of the foreskin, all of which are lost to circumcision. The AAP also acknowledges that it cannot quantify the risks and complications of circumcision, thereby conceding the impossibility of a meaningful risk/benefit calculation. Its conclusion, therefore, is based on a mere “feeling”, as it admits in the Journal of Medical Ethics (JME): “These benefits were felt to outweigh the risks of the procedure.”2
Sugerman poses eight “questions to ask when deciding about circumcision.” We pose eight “questions to ask when reading Sugerman’s defense of circumcision:
1. Why are the AAP and JAMA promoting a practice that is no longer common anywhere else in the developed world?
2. Why do the AAP and JAMA say nothing regarding medical ethics? (It has been argued that male circumcision violates core ethical principles endorsed by the American Medical Association.)
3. Why do the AAP and JAMA say nothing regarding challenges that have been raised as to the very legality of infant male circumcision, given the threats it poses to bodily integrity and self-determination?3
4. Why do the AAP and JAMA say nothing regarding concerns that infant circumcision may violate the human rights of the child?
5. To what other cosmetic surgical procedures on children are the “personal preferences and feelings” of the parents considered relevant?
6. To what other surgical procedures on children are the parents’ “religious and cultural beliefs” considered relevant?
7. How can the benefits be greater than the risks when the AAP itself admits that it does not know what the incidence of risks are?
8. When will we focus on providing needed medical services to improve the health of all people rather than squandering our resources on an outmoded procedure that medical associations around the world agree at best cannot be positively recommended,4 and may be actually harmful?5
1. Sugerman DT. Male infant circumcision. JAMA. 2013;310(7):759.
2. AAP Task Force on Circumcision 2012. The AAP Task Force on Neonatal Circumcision: a call to respectful dialogue. J Med Ethics;39(7):442-3.
3. Adler P. Is Circumcision Legal? Richmond J Law Public Interest 16(3):439-483.
4. Royal Australasian College of Physicians. Circumcision of male infants. Sydney: Royal Australasian College of Physicians, 2010.
5. Royal Dutch Medical Association. Non-therapeutic circumcision of male minors. KNMG, 2010.
Sugerman, Deborah T. “Male Infant Circumcision.” JAMA 2013.