Monday, October 21, 2013

Went to med school to talk about ethics

I got to see the raging bias that interferes with the logic of doctors in regard to male circumcision first hand this weekend when I attended the annual Pitts Lectureship in Medical Ethics at the Medical University of South Carolina.  Among other debates, there was a debate on infant circumcision between Attorney for the Rights of the Child's Steven Svoboda, JD, and the AAP’s circumcision task force member Dr. Michael Brady.  Audience participation was encouraged after each debate, and at the all inclusive seminar that wrapped the conference.  Also present, Dr. Diekema of the same AAP task force fame (who, interestingly enough, gave a great talk on not turning away children/families who have not been vaccinated).  Eye opening in some regards, frightening and sad in others, the discussion made it clear that these people (the most argumentative pro-circers there) are incapable of accepting 4 things:

1.   The foreskin has function. Even when a few of the many functions were described in detail by someone who HAD one, their response was “you don’t know that”, and back to the beginning again with insisting there are no functions (or none that matter since we wear clothes). 

2.  Men WANT their foreskins.  A lot of emphasis was put on various surveys of newly circumcised men showing satisfaction, or anecdotes of men wanting circumcisions while serving in the armed forces.   Even though 99% of circumcisions are forced, and 99% or better of men in the world left intact from childhood die that way, or that thousands of men are going to the trouble of restoring their foreskins, it was still stated “men do not value their foreskin”.  No logic got through.  When it was pondered that breast bud removal could provide a gross benefit to society’s health, the objection was (of course) that women wouldn’t appreciate that when they got older, so, best to leave it for then.

3.   Boys have a right to their healthy bodies.  When the bad habit of assuming that the risk vs benefit analysis can apply to healthy body parts, even though it is clearly meant to guide a physician through evaluating NEEDED treatment, was challenged, the conversation ended up back at “it’s better”, an opinion.  Thanks Doc., that’s very respectful of you.  

4.  This culture (and they themselves) are biased in favor of circumcision.  It was said in several ways by more than one person that if you don't have a foreskin, and live in a culture that disregards its value, perhaps your vision might be skewed, preventing you from acknowledging points 1 - 3.  Interestingly enough, this wasn't denied, challenged, or defended in ANY way. It was almost like they were pretending they didn't hear it.

Disappointing, but all in all, not a shock.  God was only mentioned once, but validity of ritual, validity of culture, validity of tradition, validity of sheer numbers performed, and validity of proxy consent were all mentioned, even though those things have nothing to do with the ethical requirement in medicine to not interfere where interference is not needed.  

I do think that some people present actually “got it”.   The points were made and made well, biases were challenged with no logical or meaningful retort (other than continuing to argue in favor of circumcision) and I think it was pretty obvious to the people listening that the points and challenges were valid, which makes it all a success!