UPDATE:I corrected a word from the original entry to clarify my intent. I understand that the AAP is not a government organization. I’ve corrected the poor wording.
The American Academy of Pediatrics’ Committee on Bioethics issued a new policy statement on female genital cutting, titled “Ritual Genital Cutting of Female Minors”. It updates the organization’s previous stance. Mostly it’s predictable statements against all female genital cutting (FGC), which won’t be controversial in the United States. But there are a few bits of odd reasoning included.
From the abstract:
… The American Academy of Pediatrics opposes all types of female genital cutting that pose risks of physical or psychological harm, counsels its members not to perform such procedures, recommends that its members actively seek to dissuade families from carrying out harmful forms of FGC, and urges its members to provide patients and their parents with compassionate education about the harms of FGC while remaining sensitive to the cultural and religious reasons that motivate parents to seek this procedure for their daughters.
This is unobjectionable without focused reading. But it explains what is coming in the policy statement. Most Americans will read “opposes all types of female genital cutting that pose risks of physical or psychological harm” to mean no cutting should be permitted on healthy girls. The policy statement doesn’t refute that because, as it acknowledges, all non-therapeutic genital cutting on female minors is prohibited in the United States. In the body of the statement, this:
Protection of the physical and mental health of girls should be the overriding concern of the health care community. Although physicians should understand that most parents who request FGC do so out of good motives, physicians must decline to perform procedures that cause unnecessary pain or that pose dangers to their patients’ well-being.
Reading what isn’t being said demonstrates that the committee fails to endorse complete opposition to FGC, either. For example:
… Most forms of FGC are decidedly harmful, and pediatricians should decline to perform them, even in the absence of any legal constraints. However, the ritual nick suggested by some pediatricians is not physically harmful and is much less extensive than routine newborn male genital cutting. There is reason to believe that offering such a compromise may build trust between hospitals and immigrant communities, save some girls from undergoing disfiguring and life-threatening procedures in their native countries, and play a role in the eventual eradication of FGC. It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm.
I think there’s merit to this argument. It fits the details of proposed accommodations at Harborview Hospital in the ’90s for Somalian immigrants. From a practical standpoint, a ceremonial nick to draw a drop of blood is better than an excision. Discussion without invectives would be helpful.
However, I don’t want to imply that I endorse this strategy. I reject it as a matter of law and practice because children possess the same basic, natural human rights as adults. (There’s no distinction for the gender of the child, which I’ll address shortly.) Legislating such an exception, or refusing to prosecute such violations of existing law, legitimizes ritual and cultural genital alteration. It moves the discussion from should it be allowed to how much should be allowed. It dismisses the child, the individual whose genitals face the scalpel.
Related to that, the statement includes this:
There is also some evidence (eg, in Scandinavia) that a criminalization of the practice, with the attendant risk of losing custody of one’s children, is one of the factors that led to abandonment of this tradition among Somali immigrants.
There are options and paths to pursue before we embrace moral relativism.
Predictably, the statement avoids acknowledging American hypocrisy on the topic of male genital cutting. This is particularly worth noting as some seek to move the AAP’s (and assorted governmental bodies) official stance on non-therapeutic male child circumcision from its relative neutrality to deliberate advocacy. In the introduction of its updated FGC policy, it states:
The language to describe this spectrum of procedures is controversial. Some commentators prefer “female circumcision,” but others object that this term trivializes the procedure, falsely confers on it the respectability afforded to male circumcision in the West, or implies a medical context. …
Any fair, honest treatment of its words would recognize that male minors have the same rights. That excerpt should be rewritten to state that referring to female genital cutting as circumcision “confers on it the false respectability afforded to male genital cutting in the West”.
This follows the last excerpt:
… The commonly used “female genital mutilation” is also problematic. Some forms of FGC are less extensive than the newborn male circumcision commonly performed in the West. …
This is from the same organization that “opposes all types of female genital cutting that pose risks of physical or psychological harm.” The newborn male circumcision commonly performed in the West imposes objective physical harm in every case, yet the AAP refuses to reject it, preferring platitudes about parental choice. From the abstract of its policy statement on male child circumcision:
Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. 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. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.
According to the AAP, parents may impose physical harm on their sons, violating the “principle of nonmaleficence” cited as a reason to reject FGC. Yet, in its revised FGC policy statement, the committee writes:
Parents are often unaware of the harmful physical consequences of the custom, because the complications of FGC are attributed to other causes and are rarely discussed outside of the family.
Changing “FGC” to “MGC” in that statement makes it no less accurate. Briefly perusing almost any news article or essay discussing male circumcision will reveal this.
Near its conclusion the committee writes:
The American Academy of Pediatrics policy statement on newborn male circumcision expresses respect for parental decision-making and acknowledges the legitimacy of including cultural, religious, and ethnic traditions when making the choice of whether to surgically alter a male infant’s genitals. Of course, parental decision-making is not without limits, and pediatricians must always resist decisions that are likely to cause harm to children. …
Including cultural, religious, and ethnic
traditions when making the choice of whether to surgically alter a male infant’s genitals is not legitimate. It is unethical, immoral and offensive to anyone who alleges to respect universal principles against causing harm. The committee’s second sentence shows its hypocrisy. It tells pediatricians to respect and aid parents who (ignorantly but unintentionally) wish to harm their sons. It’s moral relativism instead of clear principles respecting individuals. It’s unworthy of a civilized society.
Contrary to my initial concern, the revised policy statement does not explicitly advocate acceptance of lesser forms (i.e. Type IV) of female genital cutting. But it hints that it’s willing to look the other way if anyone wants to substitute Type IV for a type that won’t be practiced in the United States. Discussing such substitutions is a reasonable approach, but the committee cowardly avoids taking a stance, choosing to introduce the topic while letting others draw conclusions. It attempts to straddle both sides of the FGC debate to let each side read into its statement what it wants, if they’re unwilling to question or acknowledge anything that contradicts their preferred, limited viewpoint. Anti-FGC advocates are (correctly) upset, but the appeal of this approach is to those who believe that a potential benefit is science but the objective current health of a child is not. The AAP can plausibly say it opposes all female genital cutting, while also plausibly saying it recognizes the complexity of FGC as it’s practiced and is sensitive to the people who practice it on their children.
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“Contrary to my initial concern, the revised policy statement does not explicitly advocate acceptance of lesser forms (i.e. Type IV) of female genital cutting.”
You can see the 1999 and 2010 policies side by side at the Intactivism Pages. What’s striking is what is in the old policy that is missing from the new: “4. Recommends that its members decline to perform any medically unnecessary procedure that alters the genitalia of female infants, girls, and adolescents.” And the AAP have no evidence that a “ritual nick” will in fact “do no harm”. I can’t see how it would even be ethical to do the experiment to find out.
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