Heated Circumcision Debate Pitches One Parent Against Another

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The Plastibell Circumcision Device - Azoreg at Wikimedia Commons; CC License 3.0
The Plastibell Circumcision Device - Azoreg at Wikimedia Commons; CC License 3.0
Circumcision decisions between parents have been so acrimonious it has led to court cases. Decisions on this surgical procedure can leave parents agonized.

Parents face tough choices if they disagree on the issue of circumcision. Suite101 asked the American Academy of Pediatrics spokesperson and pediatrician Vandana Bhide about the pros and cons of this type of surgery, how it is conducted and the AAP's stance on circumcision. With new evidence suggesting that circumcision offers new health benefits, for the first time ever, the CDC is preparing to issue recommendations that could be, in direct oppostion to the AAP's.

A Heated Debate – Parents and Doctors Often Disagree

Outside of religious beliefs, circumcision can be a monumental decision for many parents. When opinions on circumcision differ between partners, a battle of wills can ensue not served by an equally divided medical field. When doctors disagree, the confusion between parents grows deeper. Fueled by divisive research, medical or otherwise, parents quickly realize that a final decision on circumcision may be influenced by the strength of personal convictions.

Until 1999, the American Academy of Pediatrics, AAP, routinely recommended circumcision before switching to a neutral stance which the academy reaffirmed in 2005. A study, "Circumcision: We Have Heard From the Experts; Now Let's Hear From the Parents," that appeared in Pediatrics Vol. 107 No. 2 in February 2001 – the official journal of the AAP – concluded that two factors emerged to influence parents about the decision to circumcise: finance and lack of information. Consequently, the neutral stance adopted by the AAP, led to some insurance companies refusing to fund the surgery.

The Push for Circumcision Seems Imminent

Circumcision rates have been in decline. After a peak of about 80% in the 1960s, the newborn male rate for circumcision now sits at around 56%. In January 2010, the circumcision debate heated up further with media reports that the US Centers for Disease Control will, for the first time ever, issue a statement on circumcision recommendations. These recommendations will be based upon new research that indicates the procedure may have newly recognized health benefits.

The CDC says that while "recent reports have speculated about the Centers for Disease Control and Prevention’s (CDC's) upcoming public health recommendations on male circumcision for HIV prevention in the United States," The "CDC’s final circumcision recommendations will be completely voluntary." Possibly indicating, that the CDC will eventually endorse circumcision as a preventative procedure. Whether the AAP will follow suit in light of the new evidence remains to be seen.

With an increasing emphasis on children's rights, opponents of circumcision include medical associations, parental groups and organizations calling for a protection of both children's and men's future rights. In May 2010, the Royal Dutch Medical Association, citing the protection of children's rights, called for a ban on non-therapeutic circumcision.

Dr. Dean Edell, author of the book, Life, Liberty and the Pursuit of Healthiness, issued a statement in Feb. 2010 at Drmomma.org, announcing his "vociferous opposition to the practice of routine male circumcision." Dr. Edell discusses several myths surrounding circumcision, including the AAP's rate on circumcision complications being at least one in 100. Furthermore, Dr. Edell says, referring to a circumcision study that ended early due to infant trauma, "Newborns experience extreme pain and significant stress during a circumcision which, unfortunately, is performed most of the time without any analgesia whatsoever."

A Parent's Decision is Often a Lonely One

Couples disagreeing about the decision to circumcise really do tread a solitary path when at odds with one another. In June, 2006, the Times newspaper reported on a divorced couple from Chicago in complete disagreement about the issue of circumcision. The father adamantly opposed the "barbaric" procedure and consequently sued his ex-wife in court. In another 2007 court case, James Boldt, a convert to Judaism, was given permission by lower-courts to circumcise his son after his ex-wife objected.

What can parents do to make an informed decision in light of conflicting and often volatile rhetoric? The Circumcision Decision Maker is a tool parents and adult men might utilize in weighing up the pros and cons of circumcision. Some say that the tool is biased towards anti-circumcision, readers can choose for themselves. Another factor to consider is surgery risks. American Academy of Pediatrics spokesperson and pediatrician, Dr. Vandana Bhide, told Suite101.com that the main "risks of circumcision include bleeding, infection and pain."

The procedure, she says, "Should never be done before 24 hours of age because babies are born with an immature liver and do not have adequate vitamin K stores (made by bacteria in the gut, which do not colonize the gut until several days after birth), which is required for the liver to make clotting factors. All babies are given a shot of vitamin K at birth and this helps prevent bleeding complications."

While Dr. Bhide acknowledges that "it does decrease the risk of penile cancer and the spread of HIV," which may be relevant in African countries with a high rate of HIV, the AAP, currently "feels that circumcision is an optional procedure that does not need to be done for medical reasons." As to the procedure itself, Dr. Bhide says, "Use of the Gomco device and the Plastibell are the most commonly used procedures by physicians."

It is often the nature and method of the procedure that many parents resent, fearing the pain inflicted on their newborn. Dr. Bhide says that, "Sugar water has been shown to decrease the pain of circumcision and vaccines in babies. A dorsal penile block with a numbing agent such as lidocaine is recommended to help treat the pain of circumcision. General anesthesia is recommended if the baby is over one month of age at the time of circumcision."

Even with the use of anesthesia, babies still have to endure a certain amount of pain; either prior to the procedure or post procedure and until this changes, opponents to circumcision perhaps have a valid medical argument for the protection of children's rights.

Elizabeth and Streak, Elizabeth Batt

Elizabeth Batt - Elizabeth Batt is a former large animal nurse, certified NREMT, lover of equines and conservationist.

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13 Comments

Comments

Jul 25, 2010 2:17 PM
Restoring_Tally :
Why is there no mention about the person most affected by circumcision, the son? I am a son who was circumcised shortly after birth. I do not like being circumcised. There are many other men who feel the same way. I dislike being circumcised so much that I am restoring my foreskin.

There is no clear medical need to support infant circumcision. Babies are healthy when they are born. Let them keep all their parts until they are old enough to decide for themselves. It is my sex organ, not my parents. I am the one who uses my penis, not my parents. I am the one who should decide if part of my sex organ should be removed, not my parents. My body, my choice.
Jul 25, 2010 2:24 PM
Elizabeth Batt :
This article was aimed at parents faced with the decision as to whether to circumcise or not. I am considering an article about adult males opinions of circumcision. If you would like to contribute to this article, please get in touch with me; I'd be more than happy to promote your point of view. Thanks for stopping by.
Jul 25, 2010 9:49 PM
Guest :
Having a foreskin is what Nature/The Creator wants. Why should there be a discussion about something that is inherent in the grand design of the male body? It simply is 'what is.' End of the discussion.
Jul 26, 2010 8:25 PM
Guest :
"Male Circumcision"
A long habit of not thinking a thing wrong gives it a superficial appearance of being right.
Jul 26, 2010 8:36 PM
Guest :
β€œFor tens of thousands of years, Billions of men kept their foreskin without a problem. And now, in the last 100 years, it suddenly poses a risk?”
Humans are out of touch with their true nature and thus we have male genital mutilation in the US in 2010.
Jul 27, 2010 11:56 AM
Guest :
What if circumcised guys think that they are off the hook and decide that they don't need to wear a condom, after all they can still get HIV and other STDs, though they may not be as susceptible as their uncut brothers. Wouldn't that create a bigger public health problem? Kind of reminds me of when light cigarettes were introduced back in the 70s. Everyone thought that reducing tar and nicotine levels would eliminate the health risks. Most smokers switched to lights and but smoked even more, so any health benefits (if there ever were any) were negated.
Jul 27, 2010 12:15 PM
Guest :
Those parents who would offer 'personal hygiene' as the reason for circumcising their newborn sons, apparently don't believe they(as parents) are capable of teaching their sons how to wash themselves or they don't believe the boy is capable of learning such a task...or is it a combination of both?
I wonder if these same parents ever considered that their male dog or male cat gets along quite well without their genitals being mutilated?
Jul 29, 2010 9:47 PM
Guest :

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http://www.law.com/jsp/article.jsp?id=1202464033969&Atlanta_Lawyer_T akes_on_Botched_Circumcision_Claims_Nationwide


Atlanta Lawyer Takes on Botched Circumcision Claims Nationwide
Katheryn Hayes Tucker

07-29-2010

Although the $10.7 million default judgment David J. Llewellyn of Johnson & Ward just scored may be tough to collect, the case is a dramatic statement about the Atlanta attorney's development of an unusual national practice: suing over botched circumcisions.

In the latest case, Llewellyn brought a suit on behalf of a boy and his parents against Mogen Circumcision Instruments, claiming one of its devices severed the head of the boy's penis during a bris, a Jewish ceremony for a male infant. The company failed to answer the suit, and Senior U.S. District Court Judge Jack B. Weinstein of the Eastern District of New York ruled the company owed the eight-figured sum.
"He's the expert in this field," said Llewellyn's New York co-counsel on the Mogen case, John L. Juliano, a personal injury and medical malpractice attorney in East Northport, NY. "I don't know many other people who handle these cases."

Llewellyn said he has sued doctors, hospitals and medical supply makers around the country for circumcision-related malpractice and personal injury during the past 15 years. He has won, lost and settled in the area, which he estimated is about half of his practice, with the other half a broader range of personal injury and malpractice litigation.

Last year he won a $2.3 million verdict in Fulton County against the doctors of a child injured during a circumcision. That was his biggest award before the recent New York case.

"I didn't set out to be a circumcision lawyer; it just sort of happened," said Llewellyn.

According to his firm's website, Llewellyn was born in Salem, Mass., in 1950, grew up in South Carolina and Pennsylvania, and went to college and law school at the University of Virginia, with a four-year stint in the U.S. Navy in between.

In the early 1990s, he said he and his wife had begun researching the subject of circumcision to make decisions for their own children. In 1993, he started a group called the Atlanta Circumcision Information Center, which opposed the practice.

One of his group's guest speakers was an anti-circumcision activist who later got a call from a lawyer in Alabama looking for help with the case of an infant who was circumcised without his parents' approval. She recommended Llewellyn.

He said he remembers putting up with laughing and joking and questions like, "what does it matter?" But he said jurors went silent after he played a videotape of a circumcision procedure on an infant. After the jury went out to deliberate, he remembers an elderly bailiff sitting down somberly and saying, "If I'd have seen that before, I wouldn't have done that to my boy."

He said he and his co-counsel, Hugh V. Smith, won a $65,000 verdict. Afterward, they settled for a smaller, undisclosed immediate payment.

Soon, Llewellyn began getting calls for other cases of wrongful circumcision or circumcision injuries. He's handled cases in Alabama, Colorado, Kentucky, Texas, Arkansas, Illinois, Pennsylvania, Indiana, Maryland, Nevada, Missouri, Georgia and Canada.

"Part of the reason I do this work -- which isn't making me a rich man -- is to inform people," Llewellyn said. "That's part of the function we perform as lawyers. These cases are important."

As his practice has evolved, so has his reputation as a speaker on the subject of circumcision, which he contends is unnecessary and harmful. This week Llewellyn is speaking on the subject at the University of California at Berkeley for the 11th International Symposium on Circumcision, Genital Integrity and Human Rights.

"The circumcision of infants is the American sickness, and unfortunately, we're spreading it around the world because of a small group that's pushing it," Llewellyn said.


The American Academy of Pediatrics has not taken a pro-or-con view on circumcision. In a 1999 report, which the group reaffirmed in 2005, it said, "In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child."

The report cited studies estimating that that the complication rate of circumcisions "is somewhere between 0.2% and 0.6%."

Most of the complications that do occur are minor," the report added.

One regular courtroom adversary, Roger E. Harris of Owen, Gleaton, Egan, Jones & Sweeney, said Llewellyn's position is not mainstream based on the testimony of opposing experts.

"David Llewellyn is a very passionate attorney and believes strongly in his cause. He's a strong litigator who advocates well for his clients," Harris said. "Obviously, I disagree with him when it comes down to the way the facts are portrayed."

Harris represented a pediatrician, Cheryl J. Kendall, who treated a child after a circumcision injury in the case that resulted in a $2.3 million verdict last year. Llewelyn and Harris said they reached a private post-verdict settlement.

"I respect him for his advocacy but I disagree with his opinions," Harris added.

The case against the Mogen circumcision instrument company involved a circumcision that went wrong in Florida. According to a magistrate judge's assessment of the case, the boy was examined by a pediatric urologist who found that all of the penile shaft skin was missing and the glans penis, or head, was completely severed. The severed tissue was reattached, but the surgery was not completely successful. Part of the reattached portion became necrotic and black and had to be removed later. As a result, the boy does not have a glans penis. He will likely require more surgery and have other medical problems, according to the plaintiffs.

The plaintiffs presented testimony from a child and adolescent psychiatrist, Joseph A. Shrand, who said the boy is "greatly at risk" for psychiatric disorders, possibly even increased suicide risk, and would need ongoing psychiatric treatment, as would his parents.

The case was heard in a teleconference by U.S. Magistrate Judge Marilyn D. Go, who issued a report and recommendation to the district judge, Weinstein, for the $10.7 million in damages. She noted an instructional brochure accompanying the Mogel clamp stating that "no injury to glans is possible," even though other amputations had been reported.

The telephone number for the Mogen company was disconnected.

The Atlanta Journal-Constitution last week quoted a representative of the Mogen company in New York saying that the company didn't have enough money to defend itself in court. The woman added that the Mogen clamp is safe when used properly.

Llewellyn said his clients have already settled privately "for a modest amount" with the mohel, a person trained in the Jewish ritual, who did the procedure.

Discussing his role in so many circumcision cases around the country, Llewellyn said he was reluctant to "give away his trade secrets," adding, "Anyone who is interested can call me and I'll talk with them. I'll probably wind up assisting them in their case.

One secret Llewellyn did share is that he has a unique perspective on circumcision. Although he was born during an era when most American baby boys were circumcised, he was not. The reason: he was born premature, and the doctor refused to do the circumcision because he weighed less than five pounds.

"I think if I were not intact -- if I were circumcised -- I would not understand this," he said. Similarly, he added, "If you had not had something since birth, it would be impossible to imagine the advantages of being intact."
Aug 13, 2010 4:12 PM
Guest :
Circumcizion has been performed successfully for centuries, there is a reason it is still practised. Just like the tonsils and the appendix, humans no longer require a foreskin on the penis. There are many health benefits for circumcized boys. Infections can occur later in life requiring the foreskin to be removed. It is also benefitial for the future female sex partners for the male. There is a lower risk for women to get cervical cancer if their partner is circumsized. Also, condoms were not built for circumsized men are likely to slip off. I have been married twice, once to a man who is circumsized, and a man who was not. I prefer a man be circumsized. Thank you.
Oct 25, 2010 7:17 PM
Guest :
That Plastibell looks like it is painful. I looks like the head of his penis is red and sore as anything. Also is that not where most of the nerves are located in the penis? The only place there are more are in his testicles.
Dec 29, 2010 9:26 AM
Guest :
I grew up intact, but had many UTIs growing up... nasty. By the time my boys were born I had learned of the minimal circumcision, which removes only the bundle or tube at the end of the foreskin. This is enough to prevent UTIs, improve a guy's aim, keep it out of his zipper, and to the casual observer, it looks "normal." It's intact improved. 3 boys, 3 minimal circs, no infections and no complaints.
Jan 6, 2011 12:09 PM
Guest :
as the picture of the plastibell shows the circumcised penis of a baby is not a nice thing to see even when its healed knowing what has been lost is very distressing even to the most casual observer the penis looks deformed . its well known that exposing the glans of a child is not a good idea as it is not an external body part and is meant to be protected by the foreskin. in circumcision of a baby the foreskin is fused to the glans surface and has to ripped away by force, the discomfort cannot be accurately measured but must be extremely painful in the extreme,it is unacceptable to put babies or children through this experience and circumcision should be banned as soon as possible. the mythical protection its gives against hiv is dubious at best and a condom is far more effective against all std's period .
Sep 21, 2011 8:47 AM
Guest :
Are there any pcitures of adult male circumsion? I need one and want to know what will happen.
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