CONFLICT OVER CIRCUMCISION

ABC reports yet another court battle between estranged parents who disagree on whether to circumcise their son http://abcnews.go.com/US/wireStory/fla-boys-circumcision-spurs-lengthy-legal-battle-protests-28320788?page=2

This is the first case I know of that does not involve religious motivation. The boy’s father, who wants the procedure, has said “Just the normal thing to do,” while the mother, who had originally agreed to the surgery, now says that the risk is not worth it. It appears that the court will allow the surgery. As a bioethicist, I am more interested in whether a physician should perform elective surgery when parents are not in accord.

Although the American Academy of Pediatrics gives moderate support to routine newborn circumcision, it is important not to overstate the case. AAP found that the health benefits of the procedure “outweigh the risks,” but also that the benefits are not great enough to recommend universal newborn circumcision. The AAP’s 2012 policy statement says that “the final decision should still be left to parents to make in the context of their religious, ethical and cultural beliefs.” We need to remember that the risks of routine circumcision are quite small, as laid out in the AAP technical report http://pediatrics.aappublications.org/content/130/3/e756.full and therefore the benefits do not have to be very great to ”outweigh the risks.” Benefits include some protection against early urinary tract infections and also against sexually transmitted diseases (including some protection for female partners as well). Because the child in question is already four years old, the risk of the procedure is somewhat higher (it will require general anesthesia) and healing will take longer; at least one of the benefits, a lowered risk of urinary tract infection, is no longer relevant, since those occur mostly in the first year of life.

So here we have two caring parents, divided over what is in the best interests of their son, against the background of a procedure that has small risk and moderate benefit. The procedure is irreversible, so going ahead with circumcision makes a decision for 4-yrear-old Chase that he could be left to make for himself when he is older. Given these facts, I believe that the responsible pediatrician should decline to operate.

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