If it were ever banned in the US, would it SINK the US?

[DPX1]

You can't make something punishable ex post facto as per our constitution, so criminal penalties for past offenses is already out.

As for opening up the doctors to malpractice claims, they can probably point to the fact that they were respecting the parent's (supposedly) informed wishes in accordance with AAP guidelines. You can't really claim damages against someone who acted in accordance with the traditions of their established practice and training, I don't think. Even if they turned out to be wrong later on, most of those doctors were acting in good faith and following the rules. Of course, the ones who got drugged up moms to sign consent forms and all that... well, there's a special place in legal hell for them. But simply banning an obsolete medical practice will not create an enormous malpractice precedent that will bankrupt the nation. (Besides, we have perfectly good wars to do that for us )

I don't think anything of the like happened when they banned FGM, despite that having been practiced in American hospitals for hundreds of years by that point. The country will probably be okay, just more foreskin-y, which isn't much to complain about at all.

[Mister.Barbecue]

Originally Posted by DPX1

You can't make something punishable ex post facto as per our constitution, so criminal penalties for past offenses is already out.

Certain kinds of medical malpractice are punishable with prison, no?

Originally Posted by DPX1

As for opening up the doctors to malpractice claims, they can probably point to the fact that they were respecting the parent's (supposedly) informed wishes in accordance with AAP guidelines. You can't really claim damages against someone who acted in accordance with the traditions of their established practice and training, I don't think.

I'm not so sure. Medical ethics are quite clear. You could make a "should-have-known" argument against non-therapeutic, cosmetic surgery.

Might be a hard case, though.
It might require some evolution in the AAP's statements beforehand. However, in Canada they are already sounding the alarms, with some medical societies saying it *might* violate a child's rights, that proxy consent for non-therapeutic circ is dubious, that parental preference alone does not justify circ, etc. They say that "in the doctor's judgment", the circumcision must be "in the best interest of the patient". It's a bit different from the AAP's statement because it takes the focus of responsibility off the parents and puts it more on the doctors, who must justify it as in the child's interest for the procedure to be valid. Highly subjective territory.

Meanwhile the AAP justifies the practice on the principle that it's the parent's choice. But the AAP's circumcision policy statement also clearly contradicts its other bio-ethics stances on informed consent of minors (scroll down below FGM section). So it's arguable at least that doctors should know better.
For example, the AAP 1999 circ statement says "the procedure is not essential to the child's current well-being"
Meanwhile their stance on consent:
"A patient's reluctance or refusal to assent should also carry considerable weight when the proposed intervention is not essential to his or her welfare and/or can be deferred without substantial risk"
They also say,
Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. [...] the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent.
It would stand to reason that a baby who cannot communicate should not be circumcised because they can express no wishes, and the procedure can be deferred without substantial risk.
The AAP also has some problematic statements in their circ position, like:
"It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision."
But who says? Why should a doctor be willing or able to do surgery on a child because they're taking into account cultural factors? If this contravenes basic principles of medicine, it could be argued that the doctor should have known better.
It could also be argued that not using anesthesia after 1999 when the AAP said it "should" be used might constitute malpractice and unknown trauma.

Question on a forum by a doctor:
Dr. Edward Etchells and associates state, "Under common law, treating a patient without his or her consent constitutes battery, whereas treating a patient on the basis of inadequately informed consent constitutes negligence." Since a newborn cannot give consent, does neonatal circumcision constitute battery?
And an answer (which I found unsatisfying).

Originally Posted by DPX1

Even if they turned out to be wrong later on, most of those doctors were acting in good faith and following the rules.

What bearing does that have on malpractice suits?

[scotty]

Originally Posted by Mister.Barbecue

Certain kinds of medical malpractice are punishable with prison, no?

No, malpractice is a civil tort not punishable by incarceration. All a doctor has to do is to make a "good faith" claim and they are in the clear, I know that's difficult for a lot of people to accept but that's just the way it is. Malpractice is extremely hard to prove in most cases and for circumcision, unless it's horrendously botched it's not going anywhere. As long as it's not against the law, no doctor will ever go to jail for it or pay more than a minimum fine at the most. I'm not so sure that you can even go back and file once you reach 18, Florida does not reset the statute of limitations to allow that.

You want to stop the practice? Shut off the money for performing it. Lobby state legislatures to ban Medicaid from paying for it; most states that did that have seen a drop in circ rates. Lobby all insurance companies to stop covering a cosmetic procedure; claim it makes everyone's rates go up when there are complications.

[admin]

Originally Posted by Mister.Barbecue

Medical ethics are quite clear.

"providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. [...] the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent."

Damn straight.

[airpud]

Originally Posted by sexyshades

Circumcision sunk the US into a hellish pit decades ago. It will never be headline news, but the writing is on the wall for anyone who is awake to the problem.

This is very insightful! Also, there are reasons that the USA is behind the times. The reasons may or may not be similar to the reasons the USA still uses the avoirdupois system of ounces, pounds, inches and miles. Who else uses this system? Oh, Burma, Liberia...

Call it the axis of ignorance. Or the time warp axis.

[airpud]

What people need during these dark times is legal gobbledegook.

A simple scream just doesn't "cut it"?

A simple scream isn't something understood by today's "people"?

We aren't in the A.D. (anno domini) era anymore. We are now in the B.P. era - "beyond pathetic".

----

Consent for circumcision
Online posting: Oct. 30, 1996
Published in print: Jan. 1, 1997 (CMAJ 1996;156:18) In response to: R.S. Van Howe

Re: Bioethics for clinicians: 1. Consent, by Edward Etchells, Gilbert Sharpe, Phil Walsh, John R. Williams and Peter A. Singer, CMAJ 1996;155:177-80 [full text / résumé]
A neonate is incapable of providing consent. As we stated in our article, incapacity is not an exception to the requirement for consent, and substitute consent should be sought. If circumcision were performed without substitute consent, this would constitute battery.

In most cases, this substitute consent is provided by the neonate's parents. Dr. Howe states that "parental permission is only acceptable when the medical intervention is of clear and immediate medical necessity." He cites the Committee on Bioethics of the American Academy of Pediatrics, which also suggests that "the pediatrician's responsibilities to his or her patient exist independent of parental desires or proxy consent," and that providers of care to neonates "have ethical and legal duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses."[1]

These statements suggest that the authority to provide substitute consent for a neonate lies with the clinician rather than the parents. However, this view is inconsistent with existing Canadian legal, ethical and professional standards. The authority to provide substitute consent lies with the parents. Some limits to parental authority have been established though law or professional policy. For example, the Supreme Court of Canada has ruled that parents may not subject their children to nontherapeutic sterilization,[2] and the College of Physicians and Surgeons of Ontario, in its policy on female circumcision, excision and infibulation, states that "the performance of any of these procedures by a physician who is licensed in Ontario will be regarded as professional misconduct."[3] However, there are no established limits to parental authority in regard to consent to male circumcision. The Fetus and Newborn Committee of the Canadian Pediatric Society has recommended that circumcision of male newborns not be routine, but that the decision be made based on the social, rather than the medical concerns, of the parents.[4]

Dr. Howe cites a study that showed that parents were unaware of all of the risks and benefits of circumcision. The same study found that most parents did not want to be informed of all of the risks and benefits: "mothers in the current study frequently did not desire a comprehensive disclosure of the medical complications, and often seemed to resent the physician for presenting it to them. In this case, a desire to have a partial disclosure of the medical complications may be a result of the social, traditional, or religious considerations that motivate the request for [circumcision]."[5] On the basis of these observations, it is difficult to conclude that failure to disclose all known risks is actually negligent.

We suggest that clinicians provide parents with adequate information about the risks, benefits and alternatives that a reasonable person in the parents' position would need to know to make a decision. A nonjudgemental inquiry into the parents' reasons for the circumcision may be a useful step in disclosure. If the parents' decision is based on strong cultural beliefs and practices, a detailed, impersonal disclosure of all known risks and benefits would probably not be relevant or helpful. However, if the decision is based on personal experiences (e.g., the father was circumcised), a detailed discussion of the risks and benefits may be useful in helping the parents to come to a decision.

Edward Etchells, MD, MSc, FRCPC
University of Toronto Joint Centre for Bioethics
Department of Medicine
Toronto Hospital
Toronto, Ont.
eetchells@torhosp.t oronto.on.ca

Gilbert Sharpe, BA, LLB, LLM
Professor
Faculty of Health Sciences
McMaster University
Hamilton, Ont.
Director
Legal Services Branch
Ontario Ministry of Health
Toronto, Ont.

Phil Walsh, BSc, LLB
Student-at-law
Legal Services Branch
Ontario Ministry of Health
Toronto, Ont.

References

American Academy of Pediatrics Committee on Bioethics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics 1995;95(5 pt 1):314-7.
Re Eve, [1986] 2 SCR 388
Female circumcision, excision, and infibulation. Toronto: College of Physicians and Surgeons of Ontario. 1992. College notices, 1992, issue number 25.
Fetus and Newborn Committee, Canadian Pediatrics Society. Neonatal circumcision revisited. CMAJ 1996;154:769-80.
Christensen-Szalanski JJ, Boyce WT, Harrell H, Gardner MM. Circumcision and informed consent. Is more information always better? Med Care 1987;25:856-67.

[airpud]

Originally Posted by Mister.Barbecue

You could make a "should-have-known" argument against non-therapeutic, cosmetic surgery.

I should make a "should-have-known" nuclear bomb argument against the hospital for not recognizing what a scream is.

The "doctor" (duck-turd) should have known that a scream means the baby was in pain.

During this era, people are retarded.

Watch the movie "Idiocracy". The reality is worse.

What Americans need to do is step back away from everything and spend a few decades thinking WITHOUT doing anything. After they have thought enough they should act. For now they are only acting without thinking. They are in Zio-slave mode.

[scotty]

Originally Posted by airpud

What Americans need to do is step back away from everything and spend a few decades thinking WITHOUT doing anything. After they have thought enough they should act. For now they are only acting without thinking. They are in Zio-slave mode.

Amen to that! We americans are no longer taught to think critically; that has been replaced by reaction. People too often listen to "authority figures" and follow their advice without analyzing things. Of course, when they do that it completely relieves them of any sense of responsibility when things go wrong.

[sexyshades]

Originally Posted by airpud

What people need during these dark times is legal gobbledegook.

A simple scream just doesn't "cut it"?

A simple scream isn't something understood by today's "people"?

We aren't in the A.D. (anno domini) era anymore. We are now in the B.P. era - "beyond pathetic".

Unfortunately some babies can't even scream because they go into paralysis from the shock. That it was what apparently happened to me cause according to both of my parents I never screamed during my circumcision and "slept though the whole thing" instead.

IMHO relying on legal gobbledygook has been the problem all along. As horrible as it sounds to "civilized people" I honestly believe the problem will only resolve itself when mutilated men go "barbaric" on today's barbaric circumcisers.

[DPX1]

Originally Posted by Mister.Barbecue

What bearing does that have on malpractice suits?

A lot. Simply put, malpractice damages are awarded when the physician makes a mistake or acts negligibly and hurts the patient. Unfortunately, with regards to circumcising doctors, they did their job "correctly" as per the standards of their field. They can say "we were following official policy and what we learned in medical school."

Of course, we really do know better, and have bioethical standards in place that seem to apply to everything but the penis, but the fact of the matter is official policy and clinical standards in the US have not put two and two together. The knowledge is out there, but it's only accepted by a minority, and hasn't really been gathered up in a formal "circ isn't good western medicine" by an authoritative voice.

It'd be like if we discovered tomorrow that drilling cavities or something was actually really harmful. You can't just sue your dentist for having drilled cavities in the past when it was the recommended procedure. You would have to prove that he knew better but acted otherwise and harmed you.