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Barbara Kay Is Mistaken on Circumcision.

I've read many bizarre, irrational rants advocating for non-therapeutic child circumcision. This recent opinion piece by Barbara Kay in Canada's National Post is the worst drivel of that sort I've encountered. (It's a response to a counter opinion piece by Jackson Doughart.)

She begins:

In 1970, some 97% of American males, and about 70% of Canadian males were circumcised. Those numbers have fallen dramatically, thanks in large part to ardent activism by anti-circumcision “rights” groups.

Jackson Doughart believes that the Canadian government should pass legislation that would prevent religious leaders and health-care legislators from performing or authorizing the ritual circumcisions of newborn children. He bases his argument on two often-adduced moral grounds: that the circumcision of infants violates their human rights, because they cannot give informed consent to the procedure, and that male circumcision is a “mutilation,” comparable to female genital mutilation (FGM), already outlawed.

Non-therapeutic genital cutting on a non-consenting individual is morally and ethically wrong. It violates the individual's human rights (e.g. right to be free from harm), regardless of the individual's gender or the subjective reasons provided for the surgery. It would be no less ethical to cut off healthy, functioning fingers or ear lobes than to cut off a healthy, functioning foreskin.

To her second point, there are forms of FGM that are less invasive than male circumcision and performed for many of the same non-therapeutic reasons. Yet, these forms of FGM are still illegal. We recognize that they violate the child's rights because they cause unnecessary harm.

Before addressing Mr. Doughart’s moral concerns, I stipulate to set aside any religious argument for our debate. I can assure Mr. Doughart that Jews, myself included, would unequivocally renounce the ritual of male circumcision if scientists provide a causal link between circumcision and increased risk for morbidity. But after 5,000 years of what is essentially a massive controlled study of Jewish and Muslim men, from which no negative effects can be ascribed to male circumcision, that is unlikely to happen.

She establishes a ridiculous straw man in an attempt to demonstrate that, religious argument aside, child circumcision is moral. It's unfortunately all too easy to prove that circumcision increases the risk for morbidity, but that's not the proper argument. There's far more to the ethical question than her implication that it's obviously good and unassailable if it doesn't kill the patient. And the 5,000 year "controlled study" of Jewish and Muslim "men" really involves children who become men. There's an important difference there beyond the obvious issue of consent since circumcision of an infant is subtly different from circumcision of an adult.

Carrying the straw man to its illogical conclusion, she writes:

Conversely, Mr. Doughart should stipulate to endorse male circumcision if it can be shown to decrease the risk for morbidity. Which it can.

She's ignored the ethical argument of rights, apparently because putting quotes around a word proves it doesn't apply. Somehow. But she's also dismissed the concept of ethics. To her, any intervention is ethical if it decreases the risk of morbidity. In her misguided view, it doesn't matter if the person wants it or is ever likely to need that intervention. If it can decrease some risk, it's automatically ethical.

That's ridiculous, of course. Should we begin studying female genital cutting to determine whether or not it reduces some risk, no matter how small the absolute risk is? What about removal of breast buds from infants? If SCIENCE! trumps any ethical concern, as Kay expects the reader to accept, then there is no intervention on children that can be considered irrational or offensive if it reduces the risk of morbidity in some way. To Kay, science and the application of science (i.e. medical ethics) are the same. They are not the same.

The World Health Organization (WHO) recommends male circumcision on the basis of irrefutable evidence that it dramatically lowers the rate of HIV, not just in men, but in women and children (according to one British researcher, “The foreskin of the penis is a magnet for HIV.”)

With the availability of Google, it's not difficult to learn what WHO recommends. Its recommendation isn't what Kay states it is:

... WHO/UNAIDS recommendations emphasize that male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence. ...

That statement does not describe the United States or Canada. Ignoring that - to the point of calling the finding a "miracle" in the next paragraph - is egregious. I'd be curious to understand why she and her editor made this inexcusable mistake, but regardless of the reason, she's wrong. Its actions show that it ignores ethics, like Kay, but WHO does not recommend male circumcision, full stop.

Yet Mr. Doughart shrugs off this miracle, claiming there are “far better ways” to eliminate HIV, like “educating youth about sexual health and condom use.” Actually, both have been tried. They don’t work in significant numbers (although sexual-fidelity campaigns have been effective: is Mr. Doughart on board for those?).

There are (at least) two problems with this. First, the studies in Africa were not long-term. We do not know if the percentage of HIV infections among circumcised males will eventually match the percentage among intact males. There are portions of Africa where circumcised males have higher HIV infection rates. It's reasonable to suggest that males engaging in unprotected sex with HIV-positive women over a long-enough period will become HIV-positive, that circumcision can't prevent HIV. Or they could wear condoms...

Second, the ethical problems with non-therapeutic circumcision of non-consenting individuals isn't resolved by studies on groups of people. The individual is an individual, with his own preferences and possible actions. "Most" males may not use condoms, but any male might. The preferences of an individual who never engages in risky sexual behavior should not be ignored because some number of his peers engage in risky sexual behavior.

Passing to the moral realm, the argument of “informed consent” is easily demolished by the fact that we routinely vaccinate our children against disease without their consent for their own good. Even before we knew of the HIV connection, amongst those circumcising their sons, health and hygiene were always the reason. STDs are much more common in uncircumcised men, and circumcision causes a 12-fold reduction in the incidence of urinary tract infections. Complications from circumcisions performed by experienced surgeons and mohels are as rare as those springing from dental procedures or vaccinations: that’s to say, statistically negligible.

Vaccinations are a red herring. They protect against diseases by activating the body's natural immune response. Circumcision amputates healthy skin on the theory that it might cause problems. (Worth noting: The link between circumcision and reduced risk of female-to-male HIV transmission is not fully understood.) This comparison ignores the likelihood of problems or the means by which the individual becomes sick. An individual can get measles by doing nothing more than venturing into his community. Becoming HIV-positive requires a bit more active behavior, and specifically with one's penis. Preventing such infections is easy, and the method is known. Proxy consent for circumcision can't be sufficiently compared to proxy consent for vaccinations.

As for the rest, earlier in her essay, Kay said there were no negative effects from circumcision. Now she's acknowledging that there are, in fact, complications. That's relevant to her mistaken belief that only increased morbidity matters. She should also prove that such complications are "statistically negligible." (Are they negligible to the males who receive those circumcision complications?)

Kay is also engaging in the common tactic of presenting relative risk rather than absolute risk. For UTIs, the relative risk is impressive in the absence of critical thinking. She neglects to mention that this benefit only exists for the first year of life. The absolute risk of a UTI, however, is not as impressive. It's only 1% for intact males, which is less than the 3% risk of UTIs for females in the first year of life. For the majority of those in the 1%, treatments less invasive than circumcision will be sufficient to resolve the infection.

On to the pernicious myth that male circumcision, a 30-second procedure, is a “mutilation” and the obscene canard that it is the equivalent of sexist FGM. FGM is a horribly protracted and painful cutting of girls under terrifying circumstances, with the specific intention of eliminating the capacity for sexual pleasure, and rightly considered a criminal action. According to UNICEF, at least 100 million women have been genitally mutilated. Compared to their uncut peers, these women are 69% more likely to hemorrhage after childbirth, and up to 55% more likely to deliver a dead or mortally ill baby. For every 100 deliveries, the WHO estimates FGM kills one or two more children.

Not all FGM is "sexist" in the way Kay implies, since it's perpetuated and carried out by women. Nor is all FGM performed with the "specific intention of eliminating the capacity for sexual pleasure." This is the most common result, but we don't look at intent when criminalizing this in the Western world. The federal anti-FGM act in the United States explicitly excludes any parental intent. The act is separate from why it's performed. Parents who cite reasons similar to what society permits for male circumcision are given no more credence than those who intend to inflict the vilest outcomes. The act itself, rather than intent, is the sole criteria. The same must be true for boys.

“Mutilation” is a disgusting word to apply to the excision of a non-essential bacteria trap, nearly painless and instantly forgotten (those who claim otherwise are fantasizing; no credible study demonstrates lasting effects). Unlike ordinary circumcised men, FGM victims know they have been mutilated in the real sense of the word. Feminists constantly remind us that men have all the power. If true, how is it that after so many thousands of years — coincidentally up to the advent of the sexual revolution and the privileging of erotic freedom over ethical mating — so many millions of intelligent and even powerful Jewish and Muslim males never spoke up about their alleged victimhood?

Non-therapeutic genital cutting on a non-consenting individual is mutilation. Among the definitions of mutilate is this: To make imperfect by excising or altering parts. Kay just described circumcision as excision. She is wrong to maintain this disconnect between her accurate word and her inaccurate understanding.

Beyond that, calling the foreskin non-essential ignores the individual. It's absurd. Anything that doesn't kill the individual can be considered non-essential. The term has no relevance to proxy consent for non-therapeutic genital cutting. A male may value and prefer what she considers non-essential on his body. Her belief that the opinion of a male's parents' matters with regard to what is non-essential on his body is wrong. Each person is the arbiter for himself. As long as the individual is healthy, removing any normal body parts is unethical.

Calling the foreskin a "bacteria trap" is no more accurate than calling the vagina a bacteria trap. Bathing is quite easy in our society. Surgically excising a child's foreskin is an abdication of parental responsibility, not a prudent response.

The ability to make a procedure painless does not render it ethical. The ability to "forget" the surgery assumes that the child's experience during the procedure and healing are irrelevant. That is a monstrous view. And the implicit "you can't miss what you never had" argument is equally ridiculous. Circumcision removes the male's foreskin, not his brain. The male is capable of knowing that he has been mutilated, even in the typical scenario where his mutilation is less severe than a female victim's.

The obvious reason why so many men, including but not limited to Jewish and Muslim males, never speak up is because they were circumcised as children. They incorrectly perceive circumcision as normal, rather than common. And, from my discussions with other men, there is a very strong defense mechanism against seeing themselves as harmed. (This same response can be seen among victims of female genital cutting, some of whom don't view themselves as victims.) Our world is more complicated than this imaginary world Kay conjured up.

The responses of these millions of men is irrelevant to the ethical question involving individuals. Kay ignores this. What the individual prefers for himself is what matters for non-therapeutic surgery. If he does not want non-therapeutic genital cutting, he is correct for himself. The rights Kay incorrectly dismisses belong to the individual, not to the majority opinion within his society. If any right belongs to the majority, it is meaningless. Stating that most males don't care about being circumcised is not a defense for forcing it on any individual male.

On the point about "erotic freedom over ethical mating", it's a strange non-sequitur that ties into her last paragraph. So far, she's propped up her indefensible argument with ignorance, straw men, and selective fact-checking. She ends with ad hominem:

Set aside the rights-based rhetoric. It’s about sex: Circumcised men have greater pre-orgasmic endurance; non-circumcision permits more frequent ejaculations. What matters most to the anti-circumcision activists is their diminished pleasure with frequently changing sexual partners, as befits an era where the number of conquests is a more common metric of romantic success than long-term relationships. Our legislators have better things to worry about than this.

On par with calling the foreskin a "bacteria trap", stating that circumcision imparts "greater pre-orgasmic endurance" is propaganda. She is saying that circumcised males take longer to reach orgasm, which she expects us to grasp as "good". She's making a value judgment that endurance is objectively better. It isn't because she's unavoidably declares that sex is changed by circumcision. Again, all individual tastes and preferences are subjective. Some males will value "pre-orgasmic endurance." Some will not. Each is right for himself, so imposing it on all is unethical.

Instead of attempting to prove that the subjective is objective, she states that males against non-therapeutic child circumcision merely want to have lots of promiscuous sex with as many people as possible. She presented no evidence to suggest what activists prefer or what circumcised males would do if left intact. Her smear attempt is embarrassingly stupid.

However, it's worth exploring the implicit sentiment in her ad hominem attack. "Ethical mating" is supposed to be better than "erotic freedom" in some objective, provable manner to Kay. Since circumcision allegedly promotes "ethical mating", circumcision is allegedly good. But what she's saying is that circumcision can and should be used by parents as a tool to control male sexuality. She rightly denounced sexism that attempts to excuse female genital mutilation, so why does she endorse sexism to excuse male genital mutilation?

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