It was about 4:00 in the afternoon in mid-October, 1997. Twenty-four hours before, I'd given birth to my first child: a healthy 7 lb. 11 oz boy named Nathan. I was relaxing with my new family when a knock came at the door and, as was usual, a few seconds later, in walks a medical professional. He's a youngish man - probably a resident - carrying a clipboard in one hand, and wheeling behind him a cart of medical paraphernalia in the other.
"I'm here to take Nathan down to be circumcised,". he announces to me, as he hands me the clipboard. I took the clipboard out of habit.
"But I already told THREE people: I don't WANT him circumcised!" I objected, huffily.
Each of the other times I'd been asked - by the Ob/Gyn and the nurses - I said No. And each time they smiled and replied, "Good!". So this time, it was my last straw.
The medic pressed the issue. "But, his name's up on the board," he whined.
At this, I practically shouted at him, "Well, take it OFF, then!"
This was my introduction to the world of Informed Consent for hospital newborn circumcision. I thought you just said Yes or No, signed the paper if it was "yes", didn't sign if it was "no", and that was it.
Not long after, I phoned my former childbirth class educator who worked as a midwife at the hospital about this. She told me that circumcision is ASSUMED for boys, unless noted otherwise. One would think that a hospital would keep to the law that says they must obtain a parent's written consent before performing a circumcision. Unfortunately, that is not always the case.
Two years later, while pregnant with my 2nd child, I mentioned this incident to my Ob. "They probably just didn't want to miss anyone who wanted it." This answer caught me by surprise. Better that they make sure they don't miss anyone who DOESN'T want it! Still, it wasn't that the man had simply asked me if I'd like it done; he TOLD me that he was there to take my son!
Neither of these two were good answers to me!
Medical Historian, Frederick Hodges, talks about medical informed consent during the 20th century:
"The process of adopting the concept of informed consent into standard hospital practice, especially for surgeries that had never been considered risky enough to require consent, did not get underway, in most cases, until the 1970s. This applies to neonatal circumcision as well as many other aspects of medical practice. In almost all cases the movement for informed consent was initiated by patients and their lawyers, rather than doctors and hospitals.
"In the particular case of circumcision, hospitals instituted their informed consent procedure, as minimal and unsatisfactory as it is, as a result of various lawsuits, which were reported in the medical press as warnings. Two of these critical lawsuits were brought against hospitals by Orthodox Jews, ironically, who were horrified that their babies had been circumcised in the hospital without their permission, thus destroying any possibility of a proper 'Bris Milah' on the 8th day.
"The 1940's saw the origin of routine circumcision itself, rather than any notions of informed consent. Doctors operated without bothering to inform the parents, simply because in the parternalistic medicine of the time, it was recognized that parents had insufficient information on which to make such a decision. Only a trained doctor could determine whether or not a baby required circumcision. Not surprisingly, most doctors determined that all babies required circumcision.
"During the transitional phase, when informed consent procedures were being introduced, many doctors could not adapt and continued to operate at their own discretion without bothering to either ask the permission of the parents or inform them of their intention to operate. Even today, there are many doctors who do not bother to inquire. They just assume that all parents would want all babies to be circumcised."
Knowing this, I often wonder why it is that those parents who choose to have their sons circumcised often proclaim, "It's my CHOICE!" (Or should that be, "It's MY choice!"?) As a mother who "chose" to not have her son circumcised, I am glad that we are even given a choice at all.
In March, 1999 the American Academy of Pediatrics announced that after having reviewed the last 40 years of studies on this subject, they could find very minimal evidence of medical benefits to infant circumcision, and therefore cannot recommend it be done for all boys in general.1. Even in light of this announcement, about 60% of newborn boys in the United States are circumcised at birth, today. This being the case, I wondered why parents choose to have their baby boys circumcised. I asked around and here is what I found:
After doing a bit of "tweaking" and "number-crunching", I discovered that they could all be put into 25 categories of reasons. I was surprised that there were so many. I asked expecting, new, and veteran parents what lead them to their decision to circumcise or not. With an average of 1 1/2 reasons per person, the most popular answer given in favor of circumcision was, "So he would look like his circumcised father." (47.6% of those in favor of circumcision)
The most popular reasons to not circumcise were that they wanted a totally "intervention-free" birth, boys are "naturally born that way", and they didn't want to add more stress to birth, especially if their baby was born prematurely. (37.5% of those against circumcision)
Of people who have, have but would not now, or would have their boy(s) circumcised other reasons FOR circumcision included:
Of people who have not, have but would not now, or would not have their boy(s) circumcised, other reasons AGAINST circumcision include:
While very few of these reasons - for or against - could be considered medical, circumcision in this country is seen mainly as "a simple medical procedure."
It's my opinion that circumcision is overwhelmingly a social issue. (There are some people I know who would even go so far as to say that even religious circumcision is mainly a social event.)
In the 1940's, being circumcised was seen as "cleaner." Part of this had to do with the fear of sexually transmitted diseases by soldiers during the First and Second World Wars.
"...the Commission placarded the camps with posters proclaiming: 'A German Bullet is Cleaner than a Whore.' Pamphlets (and posters) urged sexual purity in the name of patriotism. 'A Soldier who gets a dose 3., warned a poster, 'is a Traitor!'"4.
When hospital birth was introduced "en masse" at the same time, having a son who also had a "hospital penis" was almost a status symbol - a way of saying: "We have the resources to have a high-class hospital birth." Medical professionals were almost never questioned by parents, and so when hospital neonatal circumcision was implemented "full force", parents didn't object. Being the largest generation of the 20th Century, the "Baby Boomers" had one of the biggest impacts on circumcision. The "like-father-like-son" reason for infant circumcision had a big head-start.
However, after 30 years of true Routine Infant Circumcision, it was those parents who did not want their boys to undergo the procedure who helped get the rules changed in the 1970's. With the American Academy of Pediatrics declaring, "There are no valid medical indications for circumcision in the neonatal period," 5. and the "right" given to parents to not circumcise, circumcision rates dropped substantially.
I have no doubt that most parents have nothing but the best of intentions when they make this decision. And I'm sure that any mother or father would tell you that they are very glad to have "the final say" in this extremely controversial choice. With the law being what it is now, parents have a legal right to request the procedure for their sons.
On the other hand, maybe the title of this article should be:
"What would the boy choose, if able to give his informed consent?"
For more information on this subject, see Factors Affecting the Circumcision Decision at http://www.cirp.org/library/procedure and Informed Consent at http://www.nocirc.org/conset/ from the main chapter (which is in CA) of NOCIRC's website, not NOCIRC of MI.