Don’t Ask, Don’t Sell.

Intactivists often argue about whether or not we should be calling for laws prohibiting infant circumcision, or whether we should pursue interim steps of “harm reduction” in the form of more detailed informed consent, which– in theory at least– would make some parents decide against circumcising their babies.

The merits of a legal ban are a topic for another day. But I argue that efforts spent developing better consent forms are efforts wasted. We know

that doctors and nurses spend little time actually informing patients about the risks of circumcision, that patients almost never decide to forego a treatment because of what a consent form says, and that – most important – parental consent, no matter how “informed,” is not valid for a medically unnecessary procedure.

Think of it this way: If you take your daughter to a doctor, and tell that doctor you want your baby to look like you, and that you lost a finger in an accident many years ago, will the doctor say, “No problem – I’ll cut off her finger, so long as you’re willing to sign a consent form detailing the pain and risk of infection from the surgery”? Not likely; chances are better you’d be reported to Child Protective Services.  (Please, please don’t try telling me that cutting off one of your daughter’s fingers is way worse than cutting off the most sensitive part of your son’s penis.)

So, consent forms aren’t the way to go.

But here’s a form of “harm reduction” I can get behind. I’ll call it “don’t ask, don’t sell.”

I just listened to an interview on National Public Radio with Thomas Farley¹, New York City’s health commissioner. Farley was talking about his newest proposal that would require stores to keep cigarettes away from public view – not just in the current Plexiglass cases (which, in my opinion, do more to discourage theft than smoking), but out of sight altogether.

Here’s how it would work for circumcision: Doctors, nurses, midwives, and all other medical professionals and hospital staff would be prohibited from offering circumcision, or even bringing it up. If, as doctors often claim, it’s really the parents who push for the procedure, not mentioning it shouldn’t be a problem. Let the parents raise the topic first; then, and only then, would the doctor be permitted to discuss circumcision. And, of course, the doctor would be required to tell the parents the truth – that it’s not only unnecessary, but painful and risky to cut off a baby’s foreskin.

If this seems like a revolutionary concept, it’s because circumcisions are sold all the time.

A nurse walking down a hospital hallway, peeking into the rooms of new mothers and asking, “Will we be needing a circumcision here?” – that’s selling.

Handing a blank circumcision consent form to a pregnant woman during a prenatal care visit – that’s selling.

Including a circumcision form in the packet of papers a woman is asked to sign when she’s admitted to the hospital or (even worse) when she’s in labor or in a postpartum fog – that’s selling.

Countless mothers have told me they never gave circumcision a thought until their obstetrician brought it up. Countless parents, including Intact America’s founding donor, have told me they were pressured and solicited many, many times – first by obstetricians and later by hospital nurses – to circumcise their sons. Social media (blogs, the Facebook pages of Intact America and The Whole Network, Twitter) is replete with accounts from parents who were lied to; coerced into believing that circumcision is painless, quick and desirable; and harassed into fearing their son would hate them (and live a miserable existence) if they did not have him circumcised.

Without a doubt, these shameless, financially motivated  sales tactics – as opposed to some innate desire of parents to see their newborn sons surgically altered – are what drives the demand for circumcision in this country.

You don’t need to look too hard to find support for the “don’t ask, don’t sell” concept. Here’s what Opinion 2.19 of the Code of Ethics of the American Medical Association² says:

Physicians should not provide, prescribe, or seek compensation for medical services that they know are unnecessary.

Nobody, not even the AAP in last year’s scientifically and medically bankrupt Task Force Report on Infant Circumcision, dares to claim that routine infant circumcision is medically necessary.

Of course, “don’t ask, don’t sell” won’t wipe out circumcision overnight. Some parents will still ask doctors to surgically reduce their son’s penises. If that occurs, it’s a doctor’s duty to inform those parents that circumcision is not necessary; that it causes the baby pain and distress; that it interferes with breastfeeding and maternal-infant bonding; that it can cause infection and hemorrhage; and that a number of babies die each year as a result of having been circumcised.

But it’s a safe bet that many others won’t even think to bring it up, any more than they would ask the doctor to remove their daughters’ labia—or finger. And more and more boys will grow up intact, so that, just one generation later, the argument for looking like Dad can have a new, natural result!

Primum non nocere (“first, do no harm”) hasn’t gotten us very far in ending circumcision. So let’s try this:

Ne quaeras noli vendere. Don’t ask, don’t sell.

Georganne Chapin

 

1. http://m.npr.org/news/Health/175119412?start=90
2. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page