Circumcision

[Southwind17]

Ah.

It seemed to me a little like an attempt to intimidate after having to back down on the 'grey area' thing. Of course, I could be wrong. I certainly am not intimidated, I've met a few members of the legal profession.

Were they circumcised 'members', by any chance?!

 

[3point14]

Were they circumcised 'members', by any chance?!

Oh, you definitely win a prize for the worst gag of the day!

 

[fls]

http://www.emohel.com/faq.htm See FAQS 13 and 14.

Per those FAQS, this traditional mohel doesn’t use pain relief, except for sweet wine and sugar water. His FAQ refers to the Harvard Health Letter: Vol. 16, No. 8; 6/91 to backup his assertion that sugar water provides the infant pain relief. Does anyone have access to that health letter?

You don't need the Harvard Health Letter. It's a news source, rather than the source of the original research.

He does not recommend anesthesia for infants. He provides reasons, but doesn't provide references to any studies.

I’m skeptical. Isn't anesthesia normally provided for infants that have to have surgery in the hospital while they are still only days old? Is a baby’s physiology so different that sugar can act like an anesthetic?

It isn't that sugar acts like an anesthetic. It reflects that at least some of the response has nothing to do with pain, but with getting upset over something else (or nothing at all as any parent can tell you ).

Linda

 

[Southwind17]

I am simply trying to convey that I mean for my statement to apply to whatever it is that you are concerned about. If I have somehow mis-worded it so that you think I am referring to something else, I assure you that whatever it is that you are talking about is what I am talking about.

But it can't apply to whatever it is that I'm concerned about without you completely contradicting yourself. That's exactly my point. First you said "our best interest", then, when challenged, you changed it to "our children's best interests", then, when challenged again, you changed it essentially back to the collective 'our' best interests, but instead of concentrating on the issue in question you chose to try to appear smart by categorizing and listing all the different age groups that sprang to mind, and now it's back-fired on you.

So, as things currently stand, you seem to be in favour of non-medical circumcision in respect of certain groups of people in the interests of all members of such groups, of which the child himself is but one (and a non-consenting one at that). Would you care to elaborate on what those 'best interests' are?

There are usually several issues to be taken into consideration whenever one is attempting to form an opinion. If I mention one issue as the most relevant in a particular situation, please don't take that to mean that other issues don't become relevant if the situation is slightly changed. And please don't take that to mean that the same issue would be the most relevant when considering an entirely different situation altogether. And if I don't mention every single factor than may have bearing on a particular situation, or may have a bearing on any and all other situations that could ever be considered, please be assured that I do so in the interests of being direct, rather than in the interests of trying to hide something. I will usually attempt to find that perfect balance between saying too much and saying too little.

I think you could try a little harder - seriously; this is a debating forum afterall, not a multiple-choice questionnaire. Please feel free to flesh out your responses beyond a single sentence, even a single word, in places, if you feel that in not doing so you might not convey the true meaning of your response. That would be immensely helpful all round.

But I can absolutely guarantee that I will be unable to please you. I'm okay with that, by the way. I'll still try.

That sounds rather defeatist for you, Linda, and you shouldn't be OK with it. All I'm looking for is straight answers to straight-forward questions. It's not hard if you just apply yourself and give them due thought before hitting the 'Submit Reply' button.

The "nope" was in response to whether or not I would whole scale remove a practice if I had the power to do so.

So your answer applies to the practice of suicide bombing (amongst other practices), clearly.

The "I don't know" was in answer to whether the world is better off with suicide bombers. One possibility for me to consider is that the process of eliminating the practice strengthens humankind's ability to recognize practices that are harmful and prevent them from arising with the same ease. If I eliminated that process by waving my magic wand, when the suicide bombers disappeared, something else would simply fill the gap.

Don't you mean 'weakens', and not 'strengthens'? I don't follow your reasoning otherwise.

So, you think we should accept the 'status quo' that acts such as suicide bombing and genocide derive in society, because if we were to eliminate them then something equally appalling would 'simply' arise instead? Regardless of how insanely flawed that reasoning sounds, it seems to me that we'd have nothing to lose and potentially much to gain by elimination. I reckon I'd take my chances with the elimination option, if I held the wand! But more to the point, as Ivor has already asked, what equally atrocious act do you think would fill the 'gap' that would be left gapingly open if circumcision was outlawed?

I'm damned if I do and damned if I don't, in other words.

I'm sorry you think that Linda, given that it's completely unfounded.

 

[Southwind17]

It reflects that at least some of the response has nothing to do with pain, but with getting upset over something else (or nothing at all as any parent can tell you ).

I'm one of those parents, and there's always a reason, regardless of how trivial it might seem to a rational adult (and sometimes irrational adults!).

 

[Southwind17]

Oh, you definitely win a prize for the worst gag of the day!

Thanks, but there are 10 hours to go yet, where I am!

 

[fls]

Because the law of the U.S. is rather important here, since some (like myself) actually suggest that such an act should be prevented by the medical society (for violations of the Hippocratic oath) and/or law.

We don't really follow the Hippocratic oath. Considerable parts of it would be considered unethical by today's standards (like giving preference to the children of physicians, for example).

I presume you are thinking of the "non-maleficence" component of most formulations of medical ethics. That's the rub. In order to show maleficence, you'd have to be able to show harm. But if you could show harm, then the practice would be dropped.

I think Southwind has it right (the practice gradually diminishing) as it describes what has happened in most other developed countries. Maybe that's an argument for the US implementing a universal health care system, since the dropping of circumcision from the list of medically necessary procedures is arguably what led to the decline in some countries.

Linda

 

[Lonewulf]

"led to the decline"?

 

[Ivor the Engineer]

<snip>

It isn't that sugar acts like an anesthetic. It reflects that at least some of the response has nothing to do with pain, but with getting upset over something else (or nothing at all as any parent can tell you ).

Linda

For medical circumcisions it probably has something to do with being strapped by their wrists and ankles to a table. Most adults tend to get upset by that too (unless it's consensual).

Also, isn't it amazing how all the children "get [really] upset over something else" exactly when the ripping and cutting starts

 

[Ivor the Engineer]

"led to the decline"?

In the UK it was Gairdner's report that helped, along with the formation of the NHS. There was also a great deal of respect for physician's opinions then too, which has largely evaporated from society.

 

[Lonewulf]

Less circumcision = decline of country? I'm not sure if I get this.

 

[Ivor the Engineer]

Less circumcision = decline of country? I'm not sure if I get this.

Read it again. Linda is saying that having to ration what treatments get paid for leads to a decline in the procedures that have a high cost/benefit ratio.

The decline of the UK started when the Americans waited until we were on our knees in two world wars before helping us out.

 

[3point14]

Thanks, but there are 10 hours to go yet, where I am!

Oh, don't worry, there are about 12 left here, but the best anyone's going to manage is a tie, trust me!

 

[Lonewulf]

Read it again. Linda is saying that having to ration what treatments get paid for leads to a decline in the procedures that have a high cost/benefit ratio.

Ah.

Okay.

 

[Southwind17]

Read it again. Linda is saying that having to ration what treatments get paid for leads to a decline in the procedures that have a high cost/benefit ratio.

Couldn't be higher, in fact, given that anything divided by zero is infinity!

Seriously, I doubt that paying the cost of circumcision privately would put many parents off, given their apparent motives for wanting it in the first place. It would be interesting, though, to see what price people would put on it. A lot less than the price I'd need to be paid to have it done by a factor of around 1,000, I reckon!!!

 

[Ivor the Engineer]

Couldn't be higher, in fact, given that anything divided by zero is infinity!

Seriously, I doubt that paying the cost of circumcision privately would put many parents off, given their apparent motives for wanting it in the first place. It would be interesting, though, to see what price people would put on it. A lot less than the price I'd need to be paid to have it done by a factor of around 1,000, I reckon!!!

Your doubts are not groundless. In states in the US where Medicaid does not cover non-therapeutic circumcision the rates have generally dropped. However, there appear to be regions where there is no cover and yet still have high circumcision rates, indicating that there are other significant motivations for parents to have their infants circumcised.

IIRC, a private circumcision in the US costs about $200.

ETA: http://www.cirp.org/library/statistics/USA/staterates2004/

 

[Southwind17]

IIRC, a private circumcision in the US costs about $200.

I was thinking $250k as a threshold, but I suppose I could be persuaded to drop to $200k, provided pain relief's administered!!!

 

[Kaylee]

In a part of the UK (Bradford) with a high concentration of Muslim families the local hospital provides an infant/child circumcision service. The staff have been trained to use a ring block (the most effective pain relief technique for circumcision) on the infant.

So apparently they don't agree with this statement in FAQ 14 on this mohel's web site:
http://www.emoil.com/faq.htm

A penile block consists of multiple injections of Lidocaine in and around the base of the penis. I never really understood why anyone would do this. I have observed the injections being administered and it seemed to me that the pain of the injections was greater than that of the bris. Also, in my experience, the baby has never not cried after having been given a penile block. And, as above, while toxicity and/or the possibility that it may be absorbed by the baby's system is remote, if it is, it could cause seizures or cardiac arrest.

He's not backing up his statements with any peer-reviewed studies, but as a traditionally trained mohel I would assume that he has a position of trust by many in the Jewish community. I personally find the wide disparity of how anesthesia is handled for infants disturbing. After all this time wouldn't clinical experience provide enough data for concensus?

Has any of this happened for parents in the US who would have liked to have had their daughters circumcised?

I can't answer that question, I don't even know what the current legal status of FGM is in the USA. I did a search in Google and the best I could come up with is this article in The Atlantic Magazine dated October 1995.

http://www.theatlantic.com/doc/199510/female-genital-mutilation/3

It appears to be very well written so I'll include some cuts and pastes:

The United States has not given FGM the attention or the illegal status that many other nations have given it. The United Kingdom has a full-fledged and longstanding anti-FGM movement that involves the country's social-service agencies. France, Canada, Denmark, Switzerland, Sweden, and Belgium all have outlawed the practice. The first attempt to prohibit FGM here died in the previous Congress. However, the legislation has been reintroduced by its original co-sponsors, Representatives Pat Schroeder, of Colorado, and Barbara-Rose Collins, of Michigan. Senator Harry Reid has proposed similar legislation in the Senate. Three states, New York, Minnesota, and North Dakota, have passed laws making the practice of FGM a felony unless it is medically necessary.


<snip>

this country (my comment: USA) is at best ambivalent about its role and responsibility in preventing and punishing FGM. In fact, other than in the three states previously mentioned, there is almost no legal protection against FGM for girls in the United States, both because it's difficult to uncover and because, absent a specific law against the practice, courts are unsure about how to punish it. One effort at prosecuting a woman in Georgia who cut off her niece's clitoris failed in part because of the legal confusion surrounding the problem.

<snip>

Unlike the United States, these countries take it for granted that FGM is occurring. Even though most U.S. legal experts interpret child-abuse laws broadly to cover FGM, very few preventive measures, such as education and community outreach, have been implemented in this country.

<snip>

IN this legal vacuum doctors and others who provide social services that could educate and inform communities about FGM and protect uncircumcised girls are caught in the ethical bind of trying to show respect for another culture and at the same time guide people away from a harmful practice that is very much a part of that culture. For instance, in response to growing concern about FGM, the American College of Obstetricians and Gynecologists released a statement opposing all medically unnecessary surgical modification of female genitalia (although doctors here continue to perform cosmetic reduction surgery on both the clitoris and the labia), and declared that FGM should be stopped; but its guidelines end there. Some hospitals and doctors continue to reinfibulate women and to say nothing against parents' plans to circumcise their daughters. An article published in 1993 in the American Journal of Obstetrics and Gynecology clinically details one obstetrician's efforts to deliver a child vaginally from an infibulated woman. The article, written as a guide for dealing with such a situation, ends with a recommendation on how to perform reinfibulation and concludes, "The issue of whether the woman will want her own infant daughter circumcised also needs to be discussed so that she can make an individual, culturally appropriate and educated choice."

<snip>

Beletu, a thirty-five-year-old Ethiopian immigrant, lives with her husband and their three daughters just outside Washington, D.C., in Maryland. She has had all three of her daughters circumcised—the youngest, two and a half, just last summer, during a short trip back to Ethiopia. "People practice without knowing," Beletu says regretfully, now that she has learned about the harmful aspects of the procedure. "Even though I lived here years, I didn't know. Nobody told me. I wouldn't have put my daughters in this situation if I had known." Five months pregnant with another girl, she vows to leave this one uncircumcised.
"My mother told me it's protection for us—from boys," says Azza, the Egyptian immigrant in Louisiana. "It's very bad pain. I don't want my daughter to have it, but it depends on what the doctor tells us." When told that information exists about the medical effects of the procedure, she begs for it to be sent to her. "The more education the better," she says. "It's done from generation to generation by word of mouth. But why is it done? I'm confused about it."

I’ve watched a few Jewish circumcisions on Google video and there appears to be a large variation on technique, the time it takes and (presumably) the amount of foreskin removed, the finished results and the amount of pain inflicted. Some were over in 30 sec., others took several minutes. So it makes me wonder exactly how much foreskin needs to be removed to please the parents God.

I tried to see how specific the Talmud was on the laws concerning the bris milah (Jewish cirumcision). I looked it up on line and as far as I could tell it was quite cryptic. I don't know where to find the specific laws and customs that are taught to Jewish mohels, so I unfortunately I can't really address your comments -- sorry!

Just out of curiosity, did the Google videos make clear who was performing the bris? I remember when I was growing up that a few parents in my synagogue (in a small city, so the congregation reflected many different viewpoints as most preferred to have one congregation rather than split into a few different ones) opted for a physician (not the way to go according to Jewish law!) instead of a mohel much to the rabbi's distress. What I'm trying to say is that I suppose its very possible that not all Jewish brises are carried out according to the same set of traditions. Despite being Jewish, I don't know if all or most of the mohel's trained to do circumcisions are Orthodox Jewish, or if other branches of Judaism have trained their own mohels. Perhaps LossLeader knows.

I think the religious excuses need to be challenged, just as they are for the other commandments that are flat-out ignored, such as a Jew only marrying another Jew, or stoning blasphemers.

As I'm sure you know there are different branches of Judaism. Some branches believe that religion is inspired by God but not dictated by Him per say, other branches believe that the written religious law was dictated by God and therefore is not subject to change, and yet other branches believe something in between the two extremes. Also the more conservative branches of Judaism believe that while its OK to add additional religious laws and requirements, it's not OK to reduce them (i.e., make any of them null and void so to speak). Couple that with a phrase found in the Torah that says that uncircumcised Jewish men will be "cut off by God" (that's the loose translation and there is no agreement as to what it means) I'm not sure that the extremely Orthodox Jews will ever stop circumising their sons. As for the other branches, I wouldn't be surprised if they continue to adjust the religious laws and customs to reflect evidence based science.

There appear to be both Jewish and Muslim groups who oppose circumcision. These groups should be supported, just as women who protest against FGM are. I think most reasonable people would agree that how you behave has more to do with the rewards and punishments your parents provided you with as a child than the amount of foreskin they had removed from your penis. Though traumatic events can interrupt breastfeeding and are recommended to be avoided if possible.

For the vast majority of parents in the US circumcision has no religious meaning at all. It is merely a custom, foisted on them by the medical profession.

I think the AAP policy statement is problematic. It should more clearly state that circumcision is not recommended for healthy baby boys instead of merely saying that it is not medically neccesary. And IMHO most physicians are not informing their patients what the policy has been since 1999. If they have, I don't think that more than half the baby boys born in the USA in 2003 would have been circumcised. As you say most American parents regard it as something that is always done, but not for religious reasons. I think most of them think that it is medically preferable for "cleanliness" reasons and of course they wouldn't think that if they were informed what the current AAP policy was.

Yes, they should, but the point I was trying to make was that parental consent for non-therapeutic circumcision does not remove the requirement for the individual performing the circumcision to operate in the best interests of the child.

OK, thanks, I understand your point of view better now.

 

[Kaylee]

You don't need the Harvard Health Letter. It's a news source, rather than the source of the original research.

Well, hopefully that issue of the Harvard Health Letter citated the original research which is what I'm looking for.

It isn't that sugar acts like an anesthetic. It reflects that at least some of the response has nothing to do with pain, but with getting upset over something else (or nothing at all as any parent can tell you ).

http://www.emohel.com/faq.htm

Sugar water (24%) can be given to the baby to reduce his discomfort. He may suck on a gauze pad soaked in concentrated sugar water prior to, and during, the Brit Milah ceremony (Harvard Health Letter: Vol. 16, No. 8; 6/91.). In my experience it is the safest and best way to reduce the baby's discomfort.

Kosher sweet wine can be given to the baby before the bris or following the bris during the naming portion of the ceremony. (It's the sugar content, not the alcohol content that helps reduce discomfort.) In combination with the sugar water, the baby's recovery time increases significantly.
(comment -- I added the emphases)

www.dictionary.com
One of the definitions provided for anesthetic

1. An agent that causes loss of sensation with or without the loss of consciousness.

 

[Kaylee]

For medical circumcisions it probably has something to do with being strapped by their wrists and ankles to a table.

Ivor, at a traditional Jewish bris the infant is not strapped down.