Board Games
Some doctors are not allowed to refuse to perform procedures that they find unethical.
I was talking to a prominent member of the staff at a local birth center the other day about a medical policy issue: specifically, what their circumcision policy was. I was surprised at her answer.
“You won’t find a single midwife here who is pro-circumcision. We know it’s best practice not to do them. No one here likes that we even offer them.”
“Then why offer them at all?” (The induction questionnaire for upcoming babies included the question: “If it’s a boy, would you like him circumcised?”)
“We have to offer them.”
“Why?”
“The board makes us.”
Anyone who answers ‘yes’ to the question gets referred to a third-party doctor who performs them, because the board mandates this policy.
This was interesting, though tragic, news to hear. It did, however, give me hope. And it alerted me to the fact that often we’re aiming at the wrong targets.
I’ve heard this discussed more and more in the last few months. Many times, it is not doctors who push circumcision – it is hospital, clinical, and organizational policies that mandate the attempt to continue this practice in the United States.
What can we do to help them be free to act ethically?
Many doctors whom we, as well as other activists and nonprofit groups, have talked to tell us the same thing over and over again: “I absolutely agree with you, this is wrong. But if I speak out against it, even subtly, I’ll be fired, blackballed, or worse.”
They agree with, but are powerless to implement, the medical ethics expressed this way in 1996 by the British Medical Journal:
“The European charter for children in hospital states that every child must be protected from unnecessary medical treatment. The United Nations Convention on the Rights of the Child states that children have rights to self- determination, dignity, respect, integrity, and noninterference and the right to make informed personal decisions. Unnecessary circumcision of boys violates these rights.”
What can they do? What can we do?
Elf on a Shelf & Alienating Allies (Christmas Day, 2015)
Flashback to Christmas 2015: two different circumcision-related stories unfold.
In the first story, two medical professionals post photos of themselves circumcising an Elf on the Shelf strapped to a Circumstraint. They mock the anti-circumcision movement openly in the photos. This cruel display of dark ‘humor’ is intended to be inflammatory. It shows how calloused some medical professionals are towards the notion that all people equally deserve the right to bodily integrity, no matter how small they are. These medical ‘professionals’ cannot be our target audience, because they are unwilling to see the truth of the matter.
In the second story, a doctor posts online that he must go into work first thing Christmas morning to circumcise two boys, instead of staying at home with his family. His post goes viral, and he gets tons of hate mail and outrage directed at him, including threats against his family and vitriolic epithets.
But this doctor is not pushing circumcisions. His colleagues all know he hates doing them. He tries as much as he can to dissuade parents from going through with them. At the end of the day, however, he is contractually obligated to perform them at the parents’ request, due to hospital regulations, and he happens to be the one on call that day.
The second doctor here has great potential to be an agent of change in his community. But his initial experience with anti-circumcision advocates leaves such a bad taste in his mouth that he doesn’t know whose side he should be on.
We need people like him. We need doctors who know there’s something wrong with the system, but don’t know how to go about making a change. And we need to help them make the change. As David Balaban, MD suggested in a video interview with protesters at the 2015 AAP conference, we must “provide physicians with the tools that you think they could use to help them properly inform parents.”
People become doctors because they care about helping others.
Resources are available.
Luckily, there are many resources coming out for physicians like the doctor mentioned above – physicians who endured years of schooling and mountains of student loan debt because they really want to make a difference in the world and help people. Doctors Opposing Circumcision has a mountain of resources available, including this pamphlet on becoming a conscientious objector to the practice as a medical professional. Nurses for the Rights of the Child has even more resources to help medical professionals exercise their rights in this matter.
Rewards and Risks of Speaking Out
Some of the nurses whom we at Little Images are in frequent contact with are active proponents of genital integrity. They and their like-minded colleagues save countless babies as they tactfully provide patients with information and support.
Unfortunately, as effective as conscientious objection might be for some doctors, nurses, and other staff, for others, this type of ethically saying NO may be grounds for immediate termination – or worse. It’s easy to play armchair quarterback and say, ‘just do it, you can always work somewhere else,’ but the people saying these things often don’t understand the intricacies of what could be at stake. Each case is different.
I talked to a medical professional a while back who, as a nurse in a prominent Boston hospital, once suggested to a family that they might not go through with cutting their child and gave them a quick overview of the risks. The family complained, and she quickly found herself in a closed-door meeting with the Hospital Director, who threatened her career if she ever spoke out of place on the issue again.
These stories cross our desks here at Little Images far too often. This is, unfortunately, the nature of the beast when taking on a deeply ingrained, culturally accepted endemic problem.
For this reason, I’d go a step further and say we need to equip them to help them take this issue to their boards of directors. Doctors cannot single-handedly change hospital policy.
They need support.
Our support.
So what can you do?
Your voice at a board meeting could have lasting impact.
Determine official hospital policy, then communicate with the board of directors or hospital director:
- Submit a signed, informative community petition, preferably with locals signing; or
- Show up at a board or staff meeting and give a personal presentation; or
- Get pro-intact medical professionals from a variety of places to agree to sign a letter with you to the board or director; or
- Significantly support someone else’s petition or presentation. Spread the word about current policies so others can take action.
What should your letter, petition, or presentation say?
- Let the people in charge know that people are talking about their policies.
- Let them know why circumcision is a harmful violation of children’s rights.
- Show them that it’s not a best practice to remove healthy tissue from non-consenting human beings.
- Alert them to the official statements of the rest of the world’s medical professionals (see some here).
If you can’t make it in person to a board meeting or don’t feel comfortable doing so, consider donating to Little Images. Your funding helps us put people out in the community, meeting with doctors, boards, and other key people to help bring about real change on this issue.
Just text Protect 10 to 50155 or give here to complete a donation. All gifts are tax deductible.
Thanks for supporting us and helping us reach the people with the authority to change our world for the better.
Doctors cannot single-handedly change hospital policy. They need support. Our support.Click To Tweet
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David J. Biviano, Ph.D. says
This is all commendable and a worthy approach to changing hospital policies. Of course those hospital policies are concerned with the bottom line – RIC is the most frequently performed surgery worth millions of dollars to hospitals – AND DOCTORS!
Of course, an individual doctor may not be able to change policy, but he or she can insist on abiding by the Hippocratic Oath when confronting unethical hospital policy.
Also, doctors are very good at organizing their professions and promoting and protecting their practices. What would it take for all those doctors who are said to object to RIC ORGANIZING a protest and going to the Board themselves!
I find the handcuff image interesting as a way to say the doctor’s hands are tied. Please! I immediately thought of my reaction to RIC that the doctor should be arrested for child sexual abuse and mutilation! And malpractice!
No hospital should be allowed to force a doctor to commit malpractice – when will the doctors stand up and say – I refuse!
Jennifer Blanchard says
Then dont offer! ! Be ethical.
Linda Honey says
Ina Mae does circumcisions
Sinéad Evans says
Their hands aren’t really tied. They just have to follow the Hippocratic Oath they swore on. If they amputate healthy tissue just because the parents want it, they should be fired because they broke medical ethics.
Tammy Smith says
We need doctors to raise a fuss. We NEED doctors who will refuse to do harm. We NEED this to be in the news and all the evidence brought before a court. How else will this barbaric practice ever be brought into the light, and made illegal? We need to not just discourage it, but ban it! Ask the mothers of the approximately 100 babies who die from it every year in the US if it was worth it? My friends baby *almost* died and now she opposes it. Don’t just protect little girls from it, also protect little boys who need to be able to make the choice themselves.
Jennifer Christian Moeller says
I’m sorry, but if they had any balls/backbone, their hands wouldn’t be tied. People who are willing to take risks and pay a price are the ones who change things, not the timid who are afraid to lose their jobs. As to Ina May, what an awful stain on her otherwise stellar legacy. But no one is perfect, clearly.
Karen Kennedy says
Regardless of whether a dr is able to refuse to do them, there is nothing stopping them from giving full information before seeking consent. I have never ever heard of a doctor who sat the parents down and said, “We can amputate part of your healthy baby, and this is how it’s done – the probing, crushing, clamping, cutting, all of it. This is what your child will be losing. This is how it will affect him sexually. He will be urinating and defecating into the open wound. You will basically have to masturbate your child every diaper change, as you push back the skin that will attempt to heal over his raw bloody penis.” Don’t tell me they don’t have time to do that – most drs certainly have time to talk to patients about things like vaccines. So why not a procedure that will negatively affect a man his whole life?
Sarah Taylor says
One of the only midwife groups in my area advertise on their website that they offer circ in their office.. my former obgyn also did them in office. I had to call around to a ton of places before I found an office that doesnt do them in office. I could not stand to hear another baby being tortured while im just trying to get my yearly over with.
Shayla GaiaMom says
In a perfect world, their livelyhoods and passion would not be threatened by taking a stand. But it can be… We don’t want those who stand with us to lose their jobs, then we would be stuck with ignorant, uneducated, untrained “doctors” who have no idea how to care for our babies. We just need to fight to allow these amazing medical professionals to have the right to decline performing unethical procedures!
Barbara-ann Horner says
I’m so confused. Circumcision is a cosmetic surgery 100% unnecessary. As a mom to two intact boys. I am alarmed some choose to circ when it is illegal for women and most countries for boys.
Barbara-ann Horner says
Europe it is also illegal.
Barbara-ann Horner says
Weird. Thanks for the info. I was corrected by a mom that it was. Either way. Circumcision is not necessary it is mutilation. No baby boy / girl should be subjected.
Hans Castorp says
‘As David Balaban, MD suggested in a video interview with protesters at the 2015 AAP conference, we must “provide physicians with the tools that you think they could use to help them properly inform parents.”’
That honestly sounds like a cop-out on the part of this doctor. After all, isn’t HE the expert?
The is already an abundance of information readily available on the harm of circumcision.
Doctors don’t need “tools”; they just need to start obeying the Hippocratic oath.
Debra says
I don’t even think doctors have much to do with it. Think about it. You have a son in the hospital. Sometime after that a nurse walks up to you and asks you if you would like your son circumcised. What doctor is it that is supposed to educate the parents? The obstetrician? No. Their patient is the mom. The pediatrician does the circumcision. A pediatrician is assigned to the baby after it is born. Perhaps you say the pediatrician should inform the parents. Wrong. His patient is the baby. That is what is so great about Little Images. They have taken it upon themselves to try to inform. God bless Little Images now and forever.
Frank McGinness says
It’s my understanding the mother and newborn are the patient being still as one, before birth and after. As soon as they leave the hospital, then they are two individuals. By doling the circumcision after birth before leaving, the charges are streamlined as part of the birthing charges by the OBGYN. The charges for circumcising the infant after leaving the hospital are more paperwork and is done by the pediatrician. Of course not all are the same as this.
Anonymous says
Baby becomes separate patient/admit at birth.
Michelle says
My mother is an ObGyn who performs circumcisions on almost all of the baby boys she delivers. She told me how, after I had my son and did not have him circumcised, that in all the years of her working as an ObGyn, she has had only ONE patient who has refused to circumcise her son. She also went on to act like I”M the one who’s being less compassionate because, according to her, my son is more likely to spread diseases to women, but “Obviously, you don’t care about HER,” she told me. She also talked about how her dermatologist friend thought it was a horrible idea for me not to have my son circumcised because he’s seen patients with skin problems, and how most women prefer the look of a circumcised penis, etc. I just let her say what she wanted to say and kept my mouth shut.
The thing is, my mother took me to a circumcision when I was 11 years old. She wanted me to grow up and become a doctor like her so she wanted me to see a “simple” procedure. Can you imagine the horror??? Here I had witnessed the most horrific thing any human being can do to another person. If you think about evil things people can do….I feel like torture is more cruel than murder, and torture in the genitals is worse than other areas, and torture of an innocent victim is worse than torture of a guilty person – so the mutilation of a day-old infant is about as evil as you can get!!
I had no idea what I was about to watch, although I had a vague sense that it would be removing some excess, unnecessary skin on the penis. She gave me the sense that it would be about the equivalent of cutting the umbilical cord or maybe clipping some toe-nails. Well, she proceeded to torture the poor baby, who screamed for a few seconds and then slipped into a state of shock. And my mother said, “See? He’s just sleeping.” Ummmmmmm, no, I did not have to be medically trained to recognize that the baby was in the most unfathomable level of pain one could imagine. The nurse acted really traumatized by the whole thing, but my mother acted like it was nothing to bat an eyelash at. I was left feeling numb as I didn’t know what to do with what I had just witnessed. How could my own mother do such a thing? I had to shut the whole incident out of my mind as much as I could for many years because I needed to trust my mother for my own survival.
Two years later, my mother had a son, and her ObGyn refused to perform a circumcision on him because of ethical reasons! But my mother went ahead and found someone else to perform it on him. I saw how much pain my brother was in for many days after we brought him home, and I remembered just trying to turn off any feelings of compassion that I had. I don’t think I could have withstood my own emotional pain if I had truly faced what I knew and had seen. When my stepmother had a son when I was 17, I remember my mother scoffing at everything my stepmother did, and I even now feel guilty that I was cruel enough to even think about how people would make fun of him and how maybe my stepmother was making the wrong choice. But I saw how my uncircumcised brother was a normal happy baby, just like his sisters – completely different from my mother’s son, and although at the time I was still denying my own instincts out of respect for my mother, I knew deep down that my stepmother was absolutely right and showing immeasurably more compassion than my own mother.
My son is now 1 and I’m pregnant again. I am really so distraught that this is still legal and I feel like I am making no impact to make the world better. When my sister-in-law was pregnant, I begged her not to have her son circumcised. I was sending her articles and videos and talking to her whenever I could to try to convince her not to do it…But she did it anyway! And then when they brought him home, he apparently spent only 4 hours a days sleeping and the other 20 hours a day screaming.
I wish more people would wake up to the horror that is being committed every day. My mother continues to obviously believe and encourage her patients to get the procedure done. I think the doctors that promote circumcision are the hardest people to convince. I can’t even talk to my mother about this – she’s an extremely headstrong person, and I obviously feel very strongly about this issue myself. But I feel horrible for all the babies that she continues to do this to, and all the mothers who make uninformed decisions about something that they really don’t know anything about.