by David Balashinsky
It is now the AAP's position that parents should not spank their children. As it stated in this morning's press release announcing the publication of its newly revised policy statement on corporal punishment ( "Effective Discipline to Raise Healthy Children") "the use of spanking as a disciplinary tool . . . is ineffective. . . . In fact . . . it may cause harm. . . ." In brief, you shouldn't spank your child.
But it's still okay to cut off part of his penis.
Several years ago, Morten Frisch et al. published a commentary in Pediatrics (April, 2013; Vol. 131/Issue 4) in which it criticized the AAP for the "obvious" cultural bias that had led to its 2012 policy statement on non-therapeutic circumcision. Virtually everything that the AAP has said and done since then only confirms this bias. It is impossible to conclude otherwise than that the AAP has two sets of criteria by which it judges customs, practices, policies, procedures or behaviors that affect children. One set is reserved exclusively for non-therapeutic circumcision, the other, for everything else.
The AAP's latest policy statement on corporal punishment is a case in point. It cites evidence that suggests that there are significant harms associated with the practice. Yet when its task force looked at non-therapeutic circumcision several years back, it gave little or no consideration to the harms associated with it. As Brian D. Earp pointed out , the AAP itself conceded at the time that "the true incidence of complications after infant circumcision is unknown" (AAP Circumcision Policy Statement; Pediatrics; September 2012; Vol. 130/Issue 3, as cited in Brian D. Earp: "The AAP report on circumcision: bad science + bad ethics - bad medicine" [Practical Ethics; 27 May 2013]). As far as I am aware, the AAP still steadfastly refuses to acknowledge or even consider any of the evidence for long-term adverse effects of neonatal circumcision, starting with the most obvious one: namely, that non-therapeutic infant circumcision carries with it a 100% risk of permanent loss of functional and sensitive genital tissue.
As many critics have pointed out, circumcision is a harm in and of itself in the sense that any non-consensual amputation of a body part, when not medically indicated, constitutes a harm. (See in particular, Brian D. Earp and Robert Darby: "Circumcision, Sexual Experience and Harm" [University of Pennsylvania Journal of International Law {Online Symposium, re: Vol. 37, Iss. 2}, April 3, 2017], Peter W. Adler: "Is Circumcision Legal?" [Richmond Journal of Law and the Public Interest; Vol. XVI:iii, 2013], and J. Steven Svoboda: "Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury" [AMA Journal of Ethics, Aug. 2017].) Each of these critics approaches what is inarguably an unnecessary surgical amputation of erogenous tissue as a harm in and of itself. One might assume it to be a foregone conclusion that any surgical amputation of part of a child's body that is medically unnecessary and performed mainly as a custom constitutes a harm. Such is non-therapeutic infant circumcision. Yet the AAP jealously preserves its moral blind spot with respect to this and only this practice, and thus continues to advance the argument that parents have a right to subject their sons to circumcision provided only that they "weigh [the] medical information in the context of their own religious, ethical, and cultural beliefs and practices."
Now that the AAP has issued an updated policy statement on corporal punishment, what, we may ask, does it have to say about the religious, ethical and cultural beliefs and practices that countenance spanking? There are, no doubt, many people who believe spanking to be not merely consonant with their religious and cultural beliefs but ethical, too. Indeed, there are probably many parents who believe it to be unethical to "spare the rod" lest they end up spoiling the child. Yet nary a mention is made in the AAP's revised policy statement about cultural or religious justifications for corporal punishment.
That is not to say that the statement does not address the particular factors that lead some parents to inflict corporal punishment on their children, but the authors cite only two - parental depression and the influence of past parental trauma - and these are obviously regarded by the authors as pathological causes of spanking. Spanking then, is treated as a pathological phenomenon: not only in its effects but in its causes. Contrast this with the AAP's treatment of neonatal circumcision, of which it has stated "In the pluralistic society of the United States, where parents are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare, it is legitimate for the parents to take into account their own cultural, religious and ethnic traditions, in addition to medical factors, when making this choice."
Yet even as it consigns spanking to the realm of pathology, as opposed to cultural norms, the AAP's revised policy statement nonetheless acknowledges the broad social acceptance of corporal punishment, including the fact that it appears to be declining, as a way of contextualizing its discussion of the practice. The fact that, as recently as 2012, 70% of Americans believed that a "good, hard spanking is sometimes necessary to discipline a child" certainly suggests that spanking is integral to parenting in our culture. And if the percentage of those who supported spanking in 2012 reflects the percentage of those who engaged in it, spanking - at least in 2012 - was certainly more prevalent - and thus, it could be argued, more culturally relevant - than non-therapeutic neonatal circumcision.
It is highly significant, then, that the authors of the revised policy statement cite the 1989 United Nations Convention on the Rights of the Child as part of the historical background in which it seeks to contextualize its newly revised policy of affirmative opposition to corporal punishment. As it happens, the fact that non-therapeutic neonatal circumcision violates this very document (referring, undoubtedly, to both the letter and the spirit of its text) is one of the reasons given by Frisch et al. for the emergence of a "growing consensus among physicians, including those in the United States, that physicians should discourage parents from circumcising their healthy infant boys. . . ."
Yet even as it consigns spanking to the realm of pathology, as opposed to cultural norms, the AAP's revised policy statement nonetheless acknowledges the broad social acceptance of corporal punishment, including the fact that it appears to be declining, as a way of contextualizing its discussion of the practice. The fact that, as recently as 2012, 70% of Americans believed that a "good, hard spanking is sometimes necessary to discipline a child" certainly suggests that spanking is integral to parenting in our culture. And if the percentage of those who supported spanking in 2012 reflects the percentage of those who engaged in it, spanking - at least in 2012 - was certainly more prevalent - and thus, it could be argued, more culturally relevant - than non-therapeutic neonatal circumcision.
It is highly significant, then, that the authors of the revised policy statement cite the 1989 United Nations Convention on the Rights of the Child as part of the historical background in which it seeks to contextualize its newly revised policy of affirmative opposition to corporal punishment. As it happens, the fact that non-therapeutic neonatal circumcision violates this very document (referring, undoubtedly, to both the letter and the spirit of its text) is one of the reasons given by Frisch et al. for the emergence of a "growing consensus among physicians, including those in the United States, that physicians should discourage parents from circumcising their healthy infant boys. . . ."
I, for one, congratulate the AAP on its strengthened anti-corporal-punishment policy. I have always felt spanking to be nothing more or less than an act of violence. I do not see how, short of an act of self-defense, even the best of intentions can justify violence toward anyone else and certainly not toward one's child. I also believe that spanking, per se, by which I mean in its particulars, has a peculiarly demeaning and humiliating quality to it (which, I would imagine, may explain, at least in part, its appeal in some adult quarters as a sexual fetish). I believe that children can be taught and encouraged and reared to adulthood successfully without recourse to such debasing and antiquated practices as spanking or other forms of corporal punishment.
In fact, I would have to say that, being a humanist, I oppose spanking for the same reasons that I oppose genital cutting. Both are acts of violence, both are demeaning to the victim, both are harmful - immediately and in the long-term - and both violate internationally recognized principles of bodily autonomy, human dignity and individual rights.
It seems perfectly reasonable that the AAP should adopt a position in opposition to corporal punishment which is why, at the same time, it is so perfectly unreasonable for this organization to persist in its defense of non-therapeutic neonatal circumcision. But, again, it all boils down to the double standard with which the AAP appraises non-therapeutic circumcision on the one hand and virtually everything else on the other.
In choosing to place evidence and reason over custom and religion, the AAP has wisely chosen to take a dispassionate and objective view of corporal punishment, which it now condemns. It can only be that the AAP was brought to this inevitable and irresistible conclusion by narrowly circumscribing its field of view, which is, after all, what one has a right to expect of a professional medical organization. The AAP should be applauded for approaching spanking not with deference to its broad, if waning, cultural acceptance or religious justifications (and what hasn't been excused or justified by cultural prevalence or religion at one time or another?) but strictly by weighing its observable harms (which the AAP believes spanking entails) against its efficacy (which the AAP believes it lacks).
But this is in marked contrast to the AAP's 2012 conclusions regarding non-therapeutic circumcision in defense of which (and notwithstanding the lack of sufficient evidence to warrant its routine practice) the AAP chose to defer to the cultural and religious preferences of the parents. It is impossible to conceive of the AAP's coming to the same conclusion as it did in 2012 on infant circumcision had it applied the same standards and principles to that cultural practice as it now has to the cultural practice of corporal punishment.
It seems perfectly reasonable that the AAP should adopt a position in opposition to corporal punishment which is why, at the same time, it is so perfectly unreasonable for this organization to persist in its defense of non-therapeutic neonatal circumcision. But, again, it all boils down to the double standard with which the AAP appraises non-therapeutic circumcision on the one hand and virtually everything else on the other.
In choosing to place evidence and reason over custom and religion, the AAP has wisely chosen to take a dispassionate and objective view of corporal punishment, which it now condemns. It can only be that the AAP was brought to this inevitable and irresistible conclusion by narrowly circumscribing its field of view, which is, after all, what one has a right to expect of a professional medical organization. The AAP should be applauded for approaching spanking not with deference to its broad, if waning, cultural acceptance or religious justifications (and what hasn't been excused or justified by cultural prevalence or religion at one time or another?) but strictly by weighing its observable harms (which the AAP believes spanking entails) against its efficacy (which the AAP believes it lacks).
But this is in marked contrast to the AAP's 2012 conclusions regarding non-therapeutic circumcision in defense of which (and notwithstanding the lack of sufficient evidence to warrant its routine practice) the AAP chose to defer to the cultural and religious preferences of the parents. It is impossible to conceive of the AAP's coming to the same conclusion as it did in 2012 on infant circumcision had it applied the same standards and principles to that cultural practice as it now has to the cultural practice of corporal punishment.
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