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Science Requires Ethics, Part 3

Jake responded to my last entry in our ongoing series. (My first and second entries.) I'll just jump in. Addressing my view that he is a pro-circumcision advocate, Jake writes:

I find this a rather peculiar statement. I suppose in a sense that any attempt to weigh benefits against risks will have some subjective qualities, and perhaps that can't be avoided altogether. However, as subjective values are meaningless to another person I would hope that most observers try as objective as is reasonably possible. I certainly try; I can only hope that I succeed.

I am uninterested in convincing or encouraging parents to circumcise their sons, and have been careful to avoid making a recommendation either way. Anyone sufficiently interested (not to mention patient) can verify this by working through the many thousands of my public comments over the years - I use the same name everywhere, so it is not difficult to find them via Google. Indeed, I believe that such advocacy would be contrary to my pro-parental choice position: I genuinely believe that parents should make that decision, not me.

Unlike my perception of many individuals I've encountered when discussing circumcision, I believe that Jake advocates parental choice with the intention he states, which is that I think he accepts the decision by parents who do not choose to circumcise their sons. Many parental choice advocates do not believe that decision is valid in their parental choice worldview. In that respect, my saying that Jake "uses his conclusion to encourage parents to circumcise" was incorrect.

Rather, I believe that he is effectively a pro-circumcision advocate because he views his assessment of circumcision as containing some level of objectivity. It can't, just as my assessment can't. The difference between our views, I think, is that mine involves the child's opinion, placing it above that of his parents.

I don't have an opinion on circumcision, per se. I think it's an odd choice for a healthy male to make, but that's the lens of my preferences and experience. Jake has his own opinion, which is clear from his choice to have himself circumcised as an adult. Again, I think that's odd, but my opinion on that is irrelevant because his choice is valid for him.

On the topic before us, though, the focus of infant circumcision must be infant circumcision, not infant circumcision. I write from the former, while I believe Jake writes from the latter. That difference is why I claim that his conclusion is subjective and incomplete.

Next, Jake considers my take on an appeal to authority:

My first inclination was to agree, but on reflection I think it would depend on the situation. Consider the following hypothetical scenario:

PERSON A: Circumcision is awful because the AAP don't recommend it.
AAP: [Introduces a recommendation in favour of circumcision]
PERSON A: Oh, the AAP are biased, ignore them.

Here the appeal to authority is utterly invalid. It is quite apparent that it is a sham: the AAP are being presented as an authority merely because the person hopes to gain an advantage by doing so. The person clearly has no integrity, nor any credibility, and can and should be ignored. ...

This scenario is close to what I considered. Although I wouldn't go as far as Jake does in condemning the person's integrity without more information, it is the response I predict any person to have to the scenario and why I despise appeals to authority.

Even though Jake's first scenario exemplified my point, his second scenario is instructive:

... Now consider this:

PERSON A: Circumcision is awful because the AAP don't recommend it.
AAP: [Introduces a recommendation in favour of circumcision]
PERSON A: Okay, the AAP now recommend it, so it's okay.

In this situation, it seems to me that this is a valid appeal to authority, in that the person is willing to adapt their position once the authority changes theirs.

I disagree, again because the focus of the appeal is infant circumcision, not circumcision. It's an abdication of judgment in favor of someone else's conclusion. If Person A is the individual being circumcised, I am indifferent to his acceptance of the authority's conclusion and judgment. That's not what's at stake.

It's possible to make this too broad. I am not suggesting that expert opinion is worthless or should be ignored. I am saying that, when the focus is on infant circumcision, and specifically the circumcision of healthy infants, citing the authority's subjective conclusion of a net benefit (or neutrality) is a diversion from the individual child's lack of need and possible preference for keeping his normal foreskin. The AAP is relatively neutral today, and I contend they're wrong because they ignore facts (out of philosophical ignorance).

Next, on circumcision versus vaccination:

I see: Tony applies a different standard for surgery and vaccinations. This doesn't make much sense to me, for several reasons. Firstly, from an admittedly pedantic point of view, is there really that much of a difference? Surgery involves risk. Vaccinations involve risk. Surgery involves cutting the skin. Vaccinations (as delivered by a needle) also involve cutting the skin, albeit in a minor way. So I have to ask, where exactly would you draw the line?

Secondly, does it make sense to create multiple standards? To my mind, no. But I may be biased: I'm trained as an engineer, and when I observe lots of different little rules I see a situation in which there ought to be one, more general rule. Special cases are usually an indication that the general rule needs some more attention. Maybe one shouldn't apply engineering principles to ethics. I don't know, but I can't see any reason why one shouldn't...

Yes, there is a difference. Surgery removes a healthy, functioning body part. Vaccination does not. I draw the line between them for that primary reason. So, yes, it makes sense to create multiple standards.

In turn, it doesn't make sense to create multiple standards for boys versus girls for the same parental activity and justifications. Later, in response to my view that anti-FGM laws would not be overturned if female genital cutting was shown to have potential benefits, Jake writes:

In an ideal world, I wish I could say that anti-FGC laws would indeed be overturned if scientific knowledge changed significantly. However, I'm sorry to say that Tony is probably right in that they wouldn't be. I don't think that this has anything to do with rights, though: it's a simple case of collective prejudice. The notion that FGC is horrific is deeply ingrained into modern, Western society, and it takes an awful lot to dislodge that notion. I know this from personal experience: I have to make a conscious effort to think about FGC objectively, and have to fight the knee-jerk reaction. And I consider myself very open-minded.

I accept that circumcision can have potential benefits. I am opposed to prohylactic┬╣ infant genital cutting because pursuing these potential benefits for an individual who can't consent is unethical. It is unethical because there are real and potential harms. Jake is wrong in his view because he is valuing science in a manner that leaves it insufficiently tethered to ethics. It's a view that, because we can achieve something, it is ethically valid to pursue it. I find that approach abhorrent. It gives parents the choice to pursue an option that is not theirs to pursue. Their opinion must be subordinate to the objective facts of their child's healthy body.

To my point that adults can choose condoms and that parents can't know if their sons will be irresponsible, Jake replies:

To both points, I agree. Nevertheless, it seems difficult to deny that if it were performed during infancy, circumcision would help to reduce this risk when the child became an adult.

I'm not denying that it might help reduce this risk, but it requires a specific, low-risk, low-probability situation to be effective. The choice of surgery to chase a miniscule benefit must be left to the individual.

Of course, it's worth a reminder that the studies in Africa involved adult volunteers. Leaving aside the ethical difference, declaring that circumcision would help males (especially Western males) circumcised as infants is speculation. There are more variables involved, including the foreskin's adherence to the glans in infants and the prevalence of HIV in the society.

In response to my review of his opinion on "most effective/least invasive":

Here I believe Tony has misunderstood, or at least has not considered the issue with sufficient care. If there is a medical problem to address, then the physician's responsibility is to solve that problem while exposing the patient to the least risk. That's the essence of the "most effective/least invasive" standard. But if there is no medical reason for considering circumcision, then it is meaningless to even consider the "most effective" solution. If circumcision is being considered for non-medical reasons then it is in all probability the only solution to the problem (that being that the child is not circumcised). So it is the wrong standard to apply.

I believe I've understood him correctly. He is wrong. If there is no medical reason (i.e. need) for circumcision, it's unacceptable to permit it on children. Normal genitals are not a "problem," no matter how opposed the boy's parents are to his normal genitals. I repeat my earlier criticism: Jake is begging the question he wants to answer. Medical need is the standard for proxy consent to surgery. Without medical need, the process stops. No intervention is valid.

Next:

At this point Tony declined to list '"surgeries we recognize as offensive" that are valid when benefits and risks are properly weighed', stating:

I am not citing any particular science or surgeries because that was not my point.

This is a shame. I had hoped that Tony would at least try. I cannot think of any, and my suspicion is that this is because none exist. And if none exist, then Tony's earlier objection that "Setting the ability to chase potential benefits as the ethical standard opens the range of allegedly valid parental interventions to include any number of surgeries we recognize as offensive" seems a rather empty objection.

Immediately following my objection, I wrote that "I am attacking a way of thinking," which is to say that I reject the notion that because we can achieve a potential benefit, it is ethically valid to pursue it. At its core, prophylactic infant circumcision is about chasing potential benefits. I reject that for the multitude of reasons I've presented. Speculating that I did not cite any because none exist is a straw man.

Citing "surgeries we recognize as offensive" is a pointless diversion. However, I'll play along briefly. I nominate removing the breast buds from infant females to reduce their risk of breast cancer. I have no idea if this would work or it's been studied in any manner. It doesn't matter, because my point was to reject the thinking that believes a potential benefit may be chased. I suspect this would be offensive to most parents, as it almost always is when I raise it in debate. Non-essential, healthy, functioning breasts are different from non-essential, healthy, functioning foreskins, somehow. My guess is that Jake's approach to this would be his utilitarianism, which would assess whether removing breast buds has a potential benefit. (Unless he has some objection I haven't determined.) If it does in his evaluation, it is a valid choice for parents, even if only chosen by those few parents who don't find it offensive. I reject that because the healthy girl may not want the intervention.

Next:

It is meaningful to compare female genital cutting to male genital cutting because, ethically, they involve the same issue. Unnecessary surgery on a non-consenting individual is wrong.

If you take that last sentence as axiomatic, then you will probably see the two issues as similar (although, presumably, there's no reason to focus on genital surgery in particular). Those of us who adopt a different ethical principle - something like "harmful surgery on a non-consenting individual is wrong" see no problem with circumcision, and a problem with female genital cutting.

(I realize that I'm about to object to an issue of semantics in his axiom, but I'm certain I've gotten the gist of any future clarification correct.)

All surgery is harmful, including circumcision. It's meant to achieve some benefit greater than the harm. Jake concludes that circumcision is, at worst, neutral. But that is his subjective evaluation. It is as irrelevant as my opinion that it is a net harm. Proxy consent is not valid for prophylactic infant circumcision because circumcising healthy infants is objective harm pursuing subjective benefits. Jake writes:

... Evaluation of potential benefits should not be dismissed as mere opinion. The literature contains a relatively large amount of data, which can be summarised in the form of objectively quantifiable data.

Potential benefits are based on objectively quantifiable data. Determining the value of applying those objectively quantifiable data to the objectively healthy penis of an infant male is subjective, mere opinion. Deriving an opinion is only valid for the male himself as applied to his body.

Finally:

There is an obvious double standard. Girls may not have their healthy genitals cut for any reason. Boys may have their healthy genitals cut for any reason. That's the valid comparison.

That's not even correct. Try getting a surgeon to perform a glansectomy on a healthy boy. Or castrate him. Or perform any number of other surgeries on his genitals. He or she will refuse. Most such surgeries are a net harm (except when actually needed, in which case the benefits are considerably greater, thus making them a net benefit), and cannot therefore be ethically performed. Circumcision is unusual precisely because it is a surgery which is neutral or (depending who you ask) a net benefit. And that's why the reason for a specific circumcision doesn't really matter.

I think it's obvious that my declarative statement about genital cutting implied "as it's commonly practiced in Western society," which would preclude intentional glansectomy, for example. Moving on.

What Jake omits here is telling. Circumcision is neutral or a net benefit, according to him. He's ruled out that prophylactic infant circumcision can be a net harm, the glaring mistake in his analysis.

A male who suffers a serious complication from circumcision would unquestionably qualify as experiencing a net harm. That risk is inherent in every circumcision. But leaving that aside, a "normal" circumcision has results. Evaluating those results, even if just on a cosmetic level, is a subjective process. There is no correct, objective way to evaluate a change, which is what circumcision is. All tastes and preferences are subjective to the individual. Even a preference regarding the potential health benefits of circumcision. The possibility of "No, thank you" is why infant circumcision is unethical.

┬╣ I am no less opposed to ritual infant circumcision. Discussing it in depth here would be a distraction. For a primer on my opinion, see here.

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