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Risks, benefits, complications and harms: neglected factors in the current debate on non-therapeutic circumcision
Insights
The American Academy of Pediatrics
Area of Science:
- Medical ethics
- Pediatric policy
Background:
- The debate on infant circumcision often centers on risks versus benefits.
- The American Academy of Pediatrics (AAP) policy suggests benefits outweigh risks.
Observation:
- Critics argue the AAP's conclusion is unwarranted due to insufficient data on complication incidence.
- The AAP's narrow definition of risk (surgical complications) is insufficient for the circumcision debate.
Findings:
- The AAP's risk-benefit analysis for infant circumcision is logically and empirically flawed.
- A broader conceptualization of harm, including the value of the foreskin and ethical considerations, is necessary.
Implications:
- Re-evaluation of circumcision policies is needed, incorporating a wider range of harms and benefits.
- Ethical considerations for non-consenting minors are paramount in medical decision-making regarding circumcision.
Unlabelled:
Much of the contemporary debate about the propriety of non-therapeutic circumcision of male infants and boys revolves around the question of risks vs.
Benefits:
With its headline conclusion that the benefits outweigh the risks, the current circumcision policy of the American Academy of Pediatrics [AAP] (released 2012) is a typical instance of this line of thought. Since the AAP states that it cannot assess the true incidence of complications, however, critics have pointed out that this conclusion is unwarranted. In this paper it is argued that the AAP's conclusion is untenable not only for empirical reasons related to lack of data, but also for logical and conceptual reasons: the concept of risk employed-risk of surgical complications-is too narrow to be useful in the circumcision debate. Complications are not the only harms of circumcision: the AAP and other parties debating the pros and cons of circumcision should conceptualize their analysis more broadly as risk of harm vs. prospect of benefit, thereby factoring in the value of the foreskin to the individual and the physical and ethical harms of removing it from a non-consenting child.
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