April
2005
Nurses
Just Say No
By Angela Starks
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There is a surgical procedure performed on more than
a million newborn baby boys each year in the U.S. that the American
Academy of Pediatrics
(AAP) considers to be unnecessary. It’s a procedure that lasts
about 15 minutes and involves strapping a newborn boy to a restraining
board and amputating his foreskin (literally tearing it from the penis,
like a fingernail from a finger), usually without anesthesia. This
is routine infant male circumcision, and an increasing number of medical
staff are objecting to it.
Today, the U.S. is the only country in the world to circumcise the majority of
its newborn males (albeit a shrinking majority), mostly under hygienic pretenses,
with more than 90 percent being done for non-religious reasons.
The main concern with circumcision is the pain and suffering inflicted on the
baby. The AAP recently confirmed: “infants undergoing circumcision suffer
severe trauma and pain.” Moreover, virtually all of the medical arguments
for it—including improved hygiene—have been hotly debated and largely
discredited. The AAP says that the supposed benefits are not sufficient justification
for routine circumcision and the American College of Obstetrics and Gynecology
has also expressed concerns. Many eminent doctors and scientists go so far as
to declare that it should be completely discontinued.
Mary Conant’s Story
In 1986, four nurses at St. Vincent Hospital in Santa Fe, New Mexico, decided
not to participate in infant circumcision, but their supervisors said they had
no right to refuse. After several years, these nurses determined that they did
not need to seek permission to take a moral stance. Ultimately, 20 of their co-workers
joined them, declaring themselves “conscientious objectors to circumcision.” As
the hospital became increasingly polarized on the issue, the nurses called for
professional mediation. As a result, in 1995, a legally binding document was
drawn up called the Memo of Understanding for Circumcision Procedure which relieved
conscientious objectors from participating in circumcisions. Consequently, the
number of doctors performing circumcisions at St. Vincent’s dropped from
about 20 to just six. Some stopped performing the procedure altogether, while
others left the hospital.
In June 1995, two of the nurses, Mary Conant and Betty Katz Sperlich, announced
the formation of Nurses for the Rights of the Child, a nonprofit organization “dedicated
to protecting the rights of infants and children to bodily integrity” that
seeks to “protect unconsenting infants and children from surgical alterations
of their healthy genitals.” They initially formed this group to take their
activism outside of the workplace where it was causing so much antagonism. One
of their first objectives as an organization was to campaign for the use of anesthesia
during circumcision, believing this would open the doors for debate of all issues
surrounding circumcision, eventually leading to its abolition. They also provided
information to the public as well as medical staff, including information for
Jewish parents interested in alternatives to ritual circumcision.
I spoke with Mary Conant about her experiences at St. Vincent. She had difficulty
revisiting the issue, which is a testament to the extent of pain and suffering
that she witnessed in the babies. When I asked her what she remembers of a typical
circumcision procedure she confessed “this stuff is very emotionally draining.
I would like to skip over describing what happens during a circumcision, I just
can’t go there right now.” In fact, if you ask Mary what caused her
to stop participating in circumcision in the first place, she says simply, “the
sheer torture of it.” However, it took her a while to process this reaction
at the time, to arrive at a firm conclusion, and to develop a strategy to deal
with it. She contrasts this to her colleague Betty Katz Sperlich’s reaction,
who she says “seemed to have understood instantly with the first circumcision
she witnessed that something was horribly wrong.”
When Mary and her colleagues first wanted to take a stand against circumcision,
they began to work within the system, doing things “the proper way” she
recalls, describing that period of the campaign as the “Good Girl Phase.” They
outlined their objections to their supervisor, which included the medical, legal
and ethical cases against it. They voiced concerns about losing their nursing
licenses by taking part in what they saw as an “indefensible procedure” that
could render them vulnerable to lawsuits in the future, when boys might decide
to sue their circumcisers. Moreover, they were “appalled by the shoddiness
of the informed consent process that parents were provided prior to agreeing
to a circumcision,” because possible complications were barely touched
upon and the pain was not properly addressed. Still, the nurses were told by
the nursing director to just go ahead and keep on assisting. “I don’t
think she heard a word we said,” recalls Mary, “so it was back to
the drawing board for us.”
At this point the nurses knew they would have to take a firm stance. They would
tell their employers that they would not participate in circumcision, rather
than simply asking permission not to. They wrote a letter to their immediate
supervisor, and when word got out, about half of the staff wanted to sign it
as well. Mary was surprised and inspired by this reaction. “This response
was totally unsolicited—we had been perfectly willing to take our chances
and get fired if that was what had to happen. We quickly realized that there
was no way that 25 or so highly skilled and experienced nurses would be fired.
That was very empowering. We knew we were on to something big.”
It wasn’t all plain sailing. Some of their colleagues thought that their
actions hurt the image of nurses in general. They were also faced with the hierarchical
system of the medical establishment. “Doctors are not accustomed to nurses
taking ethical positions on issues,” says Mary, “and there was anger
and ridicule around that. I believe that our flaunting of the traditional nurse/doctor
hierarchy paradigm was as important a factor in this as the issue of circumcision
itself. Some of them tried to get us fired.”
Mary says that she was a natural target for dismissal because she was also a
union delegate, always standing up for the oppressed or trying to effect change
in the hospital. However, it was Betty who came closest to being fired. “It
was just because of a facial expression!” says Mary. “She was changing
a diaper one day but had not been told that this baby had been circumcised. When
she saw the raw, bloody stump, she was taken aback. The mother reported her,
saying that Betty’s facial expression had made her feel guilty. The case
went through the official grievance procedure, and the hospital eventually backed
down because they knew we would go to the press.”
Gaining Ground
Interestingly, it was the debate over whether or not to give babies pain relief
for circumcision that at last provided the nurses with a tolerated, official
channel for voicing their concerns. Babies are rarely given pain relief for circumcision
because of concerns about its safety and effectiveness, but while many activists
believe that administering anesthesia might slow the progress towards a total
ban on circumcision, the nurses of St. Vincent saw it as progress. Mary explains, “We
were able to give a presentation about circumcision to our hospital’s bioethics
committee that was ostensibly about anesthesia, but we included all aspects of
the argument against circumcision, and this won us an ally or two in the process.” The
committee produced a recommendation that anesthesia be used with all circumcisions.
Mary sees this as a victory primarily because “we led them to the conclusion
that newborns do feel pain—duh!—and that it should be dealt with.
In making this case to the bioethics committee, we were able to show them we
were thoughtful, conscientious, well-informed professionals. This won us some
respect and credibility.”
As Mary points out, there is both a financial and a safety element to the anesthesia
debate. She says, “An anesthetist friend of mine says that the only adequate
anesthesia for circumcision would be a regional block (epidural or spinal) or
a general. Both of these are insanely risky for infants. You’d only use
them for a lifesaving procedure. And of course, this would also jack up the cost
and time needed to an outrageous level. People would be less willing to pay for
circumcisions. For now we have the myth that topical creams, sugar water, Tylenol,
and local injections are enough.”
Beyond the initial—and post operative—pain of the procedure, there
is also a litany of possible and probable complications which run the gamut,
from disfiguring scar tissue to brain damage from systemic infections. While
death from excessive bleeding is rare, it does occur, and local infections that
lead to urinary complications occur in about half of all circumcised babies.
Even in the absence of obvious side effects from the surgery, the fact remains
that boys are having a useful—some would say essential—part of their
anatomy removed. The foreskin has a number of functions. It produces cleansing
antibodies (contrary to the myth that a foreskin is ‘dirty’); protects
the sensitive glans from external abrasion and germs; maintains the glans as
an internal sensitive organ thus heightening sexual pleasure; and makes sexual
intercourse much smoother because it acts as a gliding sheath over the penis
as it moves within the vagina. The foreskin itself is the most sensitive erogenous
zone on the male body.
It is understandable, therefore, that many boys arrive at maturity with the realization
that their circumcision resulted in a loss of function, as well as learning that
it was a painful assault imposed upon them without their consent. Some boys are
now suing their circumcisers, which is what Mary says she “predicted and
prayed for.” Why is this so important to her? “Because Betty and
I have always felt that lawsuits would be the catalyst that does this thing in.
And now it’s happening. The obstacles for attorneys and plaintiffs have
been tremendous, but the wall is being torn down—brick by brick. You have
to always remember we are a circumcising culture. This is as natural to us as
breathing oxygen. Deconstructing circumcision to judges and juries is a tedious
process, because all of them—all of us—have been complicit in some
way. Their minds wander or shut down because it is very unpleasant news. But
there have been some lovely victories.”
Examples of victories include the case of William Stowell, who settled with the
doctor and the Long Island hospital where he was circumcised at birth. He waited
until he was 18 and then sued. “This is a historic case,” says Mary, “because
he was the first person we are aware of to sue his circumcisers after he reached
the age of maturity. There are other young men who are planning to do the same.” Boys
in other countries are suing too, such as Shane Peterson in Australia, who was
awarded $360,000 for a circumcision that was botched.
The lawsuits are certainly encouragement to activists who believe that circumcision
should be completely banned, although Mary thinks that other forces will conspire
to end circumcision before it is made illegal. She says “I hope hospitals
will see the wisdom in ceasing to offer genital mutilation services after a few
lawsuits occur, after reimbursement dries up, and when the public figures out
this is not a good thing to do to a baby.”
What about circumcisions that are performed for religious reasons, whether in
a hospital setting or not? This can be a sensitive issue, yet many nurses who
have joined Nurses for the Rights of the Child are themselves Jewish. This gives
Mary hope that one day all circumcisions—religious as well as so-called
medical ones—may come to be seen as unnecessary and cruel. In the meantime,
she expects to encounter some hostility from religious communities. She tells
me that her colleague Betty, who is Jewish, has been accused of anti-Semitism
even by non-Jews.
It’s easy to see why the battle against infant male circumcision can sometimes
feel like an uphill struggle. Mary acknowledges that “the deconstruction
of cultural ‘givens’ on circumcision is slow and requires great patience
and an ability to constantly examine, reflect, and reinvent.” She continues
to educate others about the issue, but is somewhat relieved to no longer be working
in obstetrics. She is now a hospice nurse, working with dying patients and their
families, and while this can have its emotional challenges as well, she is happier
that she is removed from what she calls “the trenches” and “having
my everyday reality consumed with newborn infants, circumcisers, and parents
who are condemning their beautiful babies to the knife. I was reliving it at
night, worrying about what I did or did not do. I am no longer only a few feet
away from the bloodcurdling screams.”
Mary Conant’s experience enables her to offer support to other nurses who
are suffering in their roles as circumcision assistants. “At Nurses for
the Rights of the Child, we suggest strategies and offer advice. I think I have
scared a lot of nurses away, because I always encourage them to do a lot of soul
searching about what they are trying to accomplish and try to impress upon them
the potential for repercussions in the workplace. I don’t want to be responsible
for someone cavalierly getting into a volatile situation without a clear-eyed
notion of what might happen. We were willing to accept the prospect of getting
fired. Other nurses must be willing to do the same. But they can also learn from
our mistakes and some reactions that took us by surprise can now be anticipated.”
Mary called me several days after our interview with something she wanted to
add. She said “I’ve just visited the web site of your magazine and
it made me so happy to see that we are on the same path. There is such a connection
between all the issues that relate to human rights and global justice, including
animal rights. And you know, healing the earth has to include compassion for
the individuals who populate it. It was my circumcision activism that led me
to become a vegan. I saw that cruelty to animals, like cruelty to babies, is
an abuse of power.” To quote a phrase that is familiar to Satya readers,
she describes this as “connecting the dots.”
To learn more about Nurses for the Rights of the Child, contact www.nurses.cirp.orgor (505) 989-7377.
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