I compared infant male circumcision to tattooing a child based on a recent example from California. My original analysis translates to this story:

A Floyd County man has been charged with child cruelty after authorities say he tattooed his 3-year-old son.

Floyd County Police Sgt. Teri Davis said Eugene Ashley, 24, tattooed the back of his son’s right shoulder with “DB,” which stands for “Daddy’s Boy,” sometime this spring. The man told police he was intoxicated at the time, Davis said.
...

The children remain with their mother; Eugene Ashley was arrested May 21 and faces charges of child cruelty and tattooing a person younger than 18 years old, the latter being a misdemeanor, Davis said.

Like father, like son. Right? Or is there some limit to parental consent and imposition? Again, both a tattoo and a circumcision are a permanent mark on the child's body without the child's consent. There is justifiably a law against tattooing, but there are more dangerous risks - bleeding, infection, amputation, death - involved in circumcision, an unnecessary surgical procedure. This is a double standard with no justifiable defense.

As I wrote in my initial entry:

None of these possible exemptions satisfies the primary ethical flaw in either violation. The act is forced upon the child without his consent. Necessity requires an acceptance of limited proxy parental consent for infant male circumcision that does not exist for tattooing because the probability of a medical need for circumcision is not equal to zero. But when the surgery is unnecessary to the child's health, circumcision is the same violation, a permanent change to the child's body without his consent. The disparity in protecting the rights of children is obvious and inexcusable.

For a few opinions on this story, read through the mind-numbing comments at Momania, Theresa Walsh Giarrusso's blog hosted at the Atlanta Journal-Constitution. Is it informed to have an opinion no deeper than "what we do is good, what we don't do is bad"?

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Consider:

Police say 26-year-old Enrique Gonzalez held the boy while another gang member tattooed his right hip. ...

Gonzalez has been booked into the Fresno County Jail on suspicion of child abuse, mayhem, false imprisonment and a host of crimes with gang enhancements.

The (alleged) actions of the father are wrong, a conclusion virtually everyone will agree upon. Society is correct in prosecuting this as child abuse.

Yet, society's laws also allege that parents have an unquestionable right to circumcise their (male) children - a permanent change to the child's body - based only on a parental conclusion that some social benefit might exist for the child. We are not to judge those family decisions (on boys only, remember) made for subjective reasons.

Joel Stein satirized this mentality in a recent issue of Time when he wrote that "circumcision is something the U.S. does and Europe doesn't and is therefore awesome." Stein used this as a tongue-in-cheek way to introduce his skepticism on the issue. It wasn't funny because he recognized the violation of circumcision and still forced it on his son, but the attempt at humor was obvious. Someone like Dr. Edgar Schoen uses this same faux-patriotism in his books as an excuse to continue parental choice on infant male circumcision for social reasons without noticing the absurdity of this forced inclusion. The law sides with Schoen's stupidity on infant male¹ circumcision, which raises the question: How is tattooing a child any different than forcing unnecessary surgery on him?

The law permits parents to have no reason, but "like father, like son" is among the non-medical excuses most commonly provided. The medical community pushes this and few question it. Presumably the child in the news story above would've experienced greater acceptance and status among his father's peer group² by having the tattoo. Why is one ethical framework applicable in one scenario and inapplicable in an analogous scenario, if not to cherry-pick for outcome? Because one violation is uncommon and the other is practiced more than one million times each year? Because one leaves a mark accepted by most while the other leaves a mark shunned by most? I'm curious to know because the answer isn't logical.

None of these possible exemptions satisfies the primary ethical flaw in either violation. The act is forced upon the child without his consent. Necessity requires an acceptance of limited proxy parental consent for infant male circumcision that does not exist for tattooing because the probability of a medical need for circumcision is not equal to zero. But when the surgery is unnecessary to the child's health, circumcision is the same violation, a permanent change to the child's body without his consent. The disparity in protecting the rights of children is obvious and inexcusable.

¹ The law explicitly forbids this nonsense for female genital cutting, which is informative and worth exploring until the law changes. But it is beyond the scope necessary for this blog entry.

² It's also possible to make a reasonable comparison here to the locker room theory used to justify circumcising male children.

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Via KipEsquire's Twitter feed, here's an interesting case about the power of the government to overrule medical decisions made by parental proxy.

A Minnesota judge has ruled a 13-year-old boy with Hodgkin's lymphoma, a highly treatable form of cancer, must seek medical treatment over his parents' objections.

In a 58-page ruling Friday, Brown County District Judge John Rodenberg found that Daniel Hauser of Sleepy Eye has been "medically neglected" and is in need of child protection services. Rodenberg said Daniel will stay in the custody of his parents, but Colleen and Anthony Hauser have until May 19 to get an updated chest X-ray for their son and select an oncologist.

Going only this far into the story, I'm inclined to believe that this is wrong because other reports I've read state that the boy understands his condition. Thirteen is not objectively too young for the child to consent or refuse. There must be a sufficient standard (the details are difficult and beyond the scope of this entry) to judge the child's competence in the matter, but if the child passes that, I see no reason to interfere.

Rodenberg wrote that Daniel has only a "rudimentary understanding at best of the risks and benefits of chemotherapy. ... he does not believe he is ill currently. The fact is that he is very ill currently." Because of that and other evidence in the case, Rodenberg ruled there is a "compelling state interest sufficient to override the minor's genuine opposition."

Parents act irresponsibly if their child is incapable of deciding and they choose treatment (nutritional supplements and other alternative treatments) with no scientific basis instead of treatment (chemotherapy) with a high success rate. There are no perfect decisions in something as complex as cancer. Still, some level of objective comparison is possible, and success rates show this isn't close. Doctors say he has a 5 percent chance of survival without chemotherapy and up to 90 percent with it.

A court-appointed attorney for Daniel, Philip Elbert, called the decision unfortunate.

"I feel it's a blow to families," he said Friday. "It marginalizes the decisions that parents face every day in regard to their children's medical care. It really affirms the role that big government is better at making our decisions for us."

Government has a role to play when people make decisions for another person. Pick a scenario where that qualifier isn't involved and I will defend an individual's right to make subjective, possibly fatal decisions for himself. But within that scenario, which applies to medical (and non-medical) decisions parents make for children, the government's role is legitimate. It must protect the child from neglect and abuse, regardless of parental intention.

This case is similar to the case of Abraham Cherrix. My entry is here.

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One of the common defenses of infant male circumcision is that it's the parents' decision and that they make many decisions that may or may not be the best decision. The argument is that the State is no more qualified to make those decisions than the child's parents. I disagree with this, as I've explained before. (One example here.) And it's obviously ridiculous because we've already legislated against parental decision-making for the genitals of their daughters, prohibiting the same excuses we permit for the genitals of sons. There is no valid line of thought that supports that legal distinction.

I'd already reached that conclusion, of course. But I consistently missed a fallacious approach to the argument. If parents have "rights", a proxy power granted only to the genitals of their sons can't be legitimately referred to as a right unless we concede that the state is infringing upon their right to cut their daughters. This should be obvious, and it always has been to me. However, the argument based on rights generally leads to a statement that among the many decisions parents make for their children include such decisions as where to educate them, whether or not their friends are acceptable, and what to feed them. Those are all valid parental decisions.

Those are an unintentional distraction from the real question. The (male) circumcision decision for parents of a healthy (male) child is whether to allow their (male) child to keep his normal anatomy or not. The analogous decision is not whether to send their (male) child to school X or school Y. The analogous decision is whether to send their (male) child to school or not. The analogous decision is whether to allow their (male) child to have friends or not. The analogous decision is whether to feed their (male) child or not.

In every one of those examples, we immediately recognize the legitimacy of state intervention to prohibit objectively reckless decisions. (The anarchists don't, but that's a different blog entry.) The decision to circumcise a healthy male child is no different when properly analyzed.

Even when the claim is medical benefits, those benefits are merely potential benefits for risks that are universally low to begin with for normal males. The remaining non-medical reasons people offer simply cannot withstand any rational consideration of the truth that prophylactic circumcision is an invasive surgical procedure forced upon a healthy individual, with all the inherent risk of complications and without any direct medical need. Again, we fully understand this basic truth for the normal, healthy genitals of female minors. The notion that parents possess a right to proxy consent distinguished only by the gender of the child is indefensible.

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There's a new meme popular among advocates of routine infant circumcision referring to those who oppose routine infant circumcision as "foreskin fetishists". It's not a surprising strategy because it's the type of tactic deployed when one is on the wrong side of logic and facts. It's been deployed against me, and I've seen it deployed as a general tactic. It's unwise to the point of being odd, since it's so easy to dismiss with a simple observation. But it's clear those who use it do so because they realize that most people believe what they're told if it fits their opinions, not what fits with reality. Smear your opponent and some will buy it.

So, the claim itself. I support the right for each male to choose for himself. If he chooses circumcision for any reason, that's his right. If he chooses against circumcision for any reason, that's his right. My only concern is that each healthy child be left his choice for when he can consent or refuse.

Circumcision advocates believe that parents should choose. They are wrong, for the many logical reasons I continue to write about. This isn't the place to rehash most of those directly. However, there is one that is relevant. I'll point to a claim by Professor Brian Morris, linked in the entry I posted yesterday.

Getting circumcised will result in:
...

• A penis that is regarded by most as being more attractive.

And what about Dr. Edgar Schoen?

Women's Preference, Sexual Activity, Psych Effect:

Sexual function is not adversely effected by NC. On the contrary, published evidence shows that circumcised men have a wider variety of sexual activity, and women prefer circumcised men, mainly because of better genital hygiene.

I can find any number of further examples, but the point should be clear. If there are fetishists, which side contains the fetishists? Is it those who advocate for each male to choose for himself for his reasons or those who believe that parents may impose unnecessary surgery on their son's genitals because they believe his future partner(s) will find his circumcised penis more sexually appealing?

Anyone who tosses this meme around is engaging in propaganda.

For an example, consider this entry from Dr. Amy Tuteur. She labels herself "The Skeptical OB", but it will be clear that she is hardly skeptical in any meaningful way on circumcision. She opens:

A visitor from outer space might be forgiven for concluding that the most important part of the human body is the foreskin. It is, after all, the only part of the body that has multiple organizations devoted to its preservation in the natural state. The visitor might get the impression that the choice of circumcision is a fateful choice with profound implications for the rest of life.

It is the only part of the body that has multiple organizations devoted to its preservation in the natural state because it is the only body part we regularly remove from non-consenting individuals in its natural (i.e. healthy) state.

... Foreskin fetishists also employ inflammatory language to express their judgmentalism. Circumcision is “mutilation” and parents who choose to circumcise their sons are “mutilators”.

Does fetishist qualify as "inflammatory language"?

The foreskin fetishists are so obsessed with the foreskin that they actually dare to advance the misogynistic claim that male circumcision is analogous to female genital mutilation, in other words, that the foreskin is the analogue of the clitoris. The male analogue of clitoridectomy is is amputation of the penis. Comparing circumcision to clitoridectomy is like comparing ear piercing to having your ears cut off.

My claim is that unnecessary genital cutting on a healthy, non-consenting individual is wrong. Gender makes no difference to that principle. That is a different, and more fundamental, claim than what Dr. Tuteur puts forth for people who state (accurately) that female and male genital cutting are comparable.

She adds to this in the comments:

The comparison is essentially misogynistic. FMG exists specifically to prevent female sexual activity by permanently removing the possibility of sexual enjoyment. Male circumcision is performed for religious reasons or for medical benefits. It has nothing to do with sexual satisfaction, and is certainly not meant to interfere in any way with male sexual satisfaction.

Every claim in that comment is incorrect. There is no misogyny in stating that males and females possess equal human rights. FGM exists for many reasons and in different forms, not all of them intended to permanently remove the possibility of sexual enjoyment. (They may still do that, and probably do in most cases. But that's obvious because parental intent does not guarantee good outcomes, another point not specific to the gender of the recipient.) Male circumcision is also performed so that parents don't have to learn how to care for a normal penis or so that the son will look like the father or so the mean kids won't pick on him in the locker room or because his parents think women won't sleep with him if he has his foreskin. The latter point is clearly about sexual satisfaction. And whether or not it is meant to interfere is subordinate to the truth that it interferes with male sexual satisfaction. That interference could be positive, negative, or neutral, but only the male himself can make the relevant determination to that subjective question.

Anti-circ activists like to claim that there only risks and no benefits to circumcision, but that is not true.

Dr. Tuteur links to zero sources making this claim. I don't doubt that some people are making that claim. People on both sides make ridiculous claims. Still, if one wants to make a sweeping claim, defend it with evidence.

Yesterday, I wrote that "[t]he reduction in UTI risk is likely real. The reduction in HIV-infection risk is likely real, at least in the short-term. And so on. I accept this." This is not complicated, but as I added after that statement, it is not enough to dismiss the fact that the child is healthy at the time of the surgery. That makes the ethical evaluation the primary focus. Non-therapeutic circumcision fails this test. Yet Dr. Tuteur seems uninterested in anything more than potential benefits as an excuse to permit parents to make the decision.

She defends this opinion in the comments:

Parents have the right to consent to ANY surgery, brain surgery, heart surgery, so consenting to removal of the foreskin is hardly a big deal. Moreover parents have the right to consent to piercing, removal of birth marks and other forms of body modification.

Do parents have the right to consent to non-therapeutic brain or heart surgery for their healthy children? A heart stent for a 2-year-old because he might have problems at 50?

The core evaluation is very simple. If the child is healthy, no surgery is indicated or justifiable. Chasing benefits for children is an illogical path that can be pursued to other irrational avenues and on both genders. It has no place in the proxy decision-making of parents for the genitals of their male children, as we already understand clearly for female children.

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I've written two posts responding to a series of statements and entries a blogger posted on infant circumcision. They're extensive, so I expect only the truly interested will read them. However, I'd like to point out an interesting and useful section from each. From the first entry, in response to a claim by Professor Brian Morris on the cost of circumcision for infants and adults:

Speaking strictly from a finance perspective, advocating for infant circumcision is the more expensive approach. His analysis is that the cost is 10 times 0.1 for his preference and 0.1 times 10 for his worst case. The present value of $1 spent over many years in the future is less than the $1 spent today. Professor Morris prefers the more expensive option.

From the second entry, apropo to this recent tweet directed to me, this:

Infant circumcision is a surgical procedure performed without medical need because it offers potential health benefits. The latter defense is what proponents obsess on, as the author does here. But just to prove that the author's last claim is ad hominem deployed to prop up her indefensible case, there are potential advantages to being circumcised as an infant. The reduction in UTI risk is likely real. The reduction in HIV-infection risk is likely real, at least in the short-term. And so on. I accept this.

But so what? That gives no validity to prophylactic infant male circumcision. There are better, more effective, less invasive ways to achieve every single benefit or to treat the maladies in the unlikely instances where they occur. The objective health is what matters for proxy consent for a child. Is the intervention indicated and necessary? Infant circumcision fails this core test. Moving forward is unethical because objective reality trumps the subjective chase for justifications.

As I responded to that tweet, I don't refute the scientific research. I reject the flawed (i.e. unethical) application of that research. There is a difference.

It's worth noting, too, that I can accept the scientific research because my position remains strong regardless. The position that relies on the scientific research without ethics or core facts pertinent to each individual case falls apart if it acknowledges anything beyond its talking points.

This does not mean that I think the studies looking for potential benefits are sound and will withstand the scrutiny of time and further research. I suspect many of them won't. The history of infant circumcision and the search for potential benefits demonstrates the belief in stagnant arguments for the procedure to be a silly proposition to defend with any certainty. Still, I can accept the findings as present scientific consensus. But I will continue to probe those potential flaws, as anyone who cares about science and furthering knowledge should. We don't stop just because we find the answer we want.

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Following on my last entry, Lauren at Can You Be A Part of My Life continues her series on circumcision with information from her next source, a list at Justmommies.com titled "Common lies about circumcision". I'll get to that in a moment. First, this from Lauren's second entry, "Follow Up Facts and Statements":

It isn't necessary for a Harvard bullshit artist to come and spout his manipulative opinions either or any other such nonsense. And furthermore there are serious HUMAN RIGHTS VIOLATIONS happening right now in the world toward women, mostly in MUSLIM countries right at this moment. Girls being "honor killed" and women being flogged or hung because they spoke to a man outside of their family or because they were raped by thugs. So please spare me the human rights cockamame argument about less than an inch of skin that is done to increase the health and well-being of little boys as well as grown men.

An action doesn't have to be "serious" to be a human rights violation. Major violations occur every day. They should not be overlooked. Killing a woman (or a man) is worse than cutting the genitals of a man (or a woman). This does not negate the argument that male genital cutting is a human rights violation. Unnecessary genital cutting on a healthy, non-consenting individual is wrong.

We can look at gender, but that is analyzing degrees of reality, not separating the two actions from each other. Anti-FGM laws rightly dismiss any reason for cutting a female minor other than immediate medical need. No consideration of religion matters. No consideration of extent of cutting matters. No consideration of potential benefits, either medically or socially, matters. Only the child's immediate, objective health needs inform the decision.

How is that logic exclusive to females? Males are equally human beings, with equal human rights. The undeniable fact that great atrocities occur against women in other parts of the world does not excuse violations in the Western world. Nor does calling infant male circumcision a violation suggest an indifference to or acceptance of genital mutilation (and other atrocities) committed against women. Again, unnecessary genital cutting on a healthy, non-consenting individual is wrong. How we punish each depends on the circumstances of the actual cutting on the individual and why, but gender is not the proper identifier for what is and is not harm.

Like her last entry, Lauren provides a list from her source without additional commentary. She lists the first four items. The justmommies.com list of "common lies" icludes twenty-six items. I will address the statements that need comment or rebuttal.

2) No organization in the world recommends circumcision:

... Both the World Health Organization (WHO) and the United Nations (UNAIDS) have recommended circumcision as a preventative measure against AIDS.

The studies WHO and UNAIDS rely on involved adult volunteers. Children are neither. Nor are infants sexually active, in need of protection against STDs. The ethical issue can not be dismissed simply by assuming that the findings from Africa, where the HIV epidemic is different, should be transferred to male minors in Western nations.

Remember, six days after the findings, UNAIDS stated that circumcision plans should start with infants. If there's an epidemic that warrants circumcision as an action plan, it is irrational to start with those males who will not be sexually active for more than a decade. I won't respect their judgment on ethical issues, which is what prophylactic genital cutting is.

4) Circumcision is a human rights violation:

Not true. I agree there are some people that think that circumcision should be a human rights violation and they have every right to feel that way. Still, that doesn't make it a reality. We have accepted organizations that deal with these issues and decide- based on many factors- which activities are acceptable and which violate basic human rights. These organizations have agreed that circumcision IS NOT a human rights violations because of it's a very safe procedure and it carries some medical benefits. This myth usually goes hand in hand with a comparison of male circumcision and Female Genital Mutilation (FGM). However, the two practices are completely different in every single aspect: physical, psychological, emotional, social and religious. They're not comparable in the slightest, but since they're both done is the same general area, and because FGM is a degrading practice and an accepted human rights violation, anti-circumcision activists usually use it to try to put circumcision in a more negative light. Sadly, it does the opposite. By comparing something as traumatic, damaging, dangerous and degrading as FGM with a simple, safe and beneficial procedure demeans the impact of FGM. It's a poor way of treating the women that have been victims of FGM and a way to demean their pain.
Finally, Amnesty International has directly declined to accept male circumcision as a human rights violation 3 times.

I've already addressed this, and the justmommies approach should convince no one otherwise.

To one specific claim, I've long thought that people who reject the simple claim that unnecessary genital cutting on a healty, non-consenting individual has no valid gender distinction are determined to believe that my argument intends to diminish the violation of FGM rather than change society's mistaken beliefs about male genital cutting. I have been very clear that FGM is mostly worse, and to a large extent. That does not change the core point. Murder is the ultimate violation, but that does not mean that a punch to the face is therefore valid because it is a lesser violation. The issue is the act, not the gender.

For a slight deviation to continue this point, in her entry Lauren responds to a comment with this:

@Rhonda- yes you did what you felt was best and right and that is the point. KUDOS! and hugs.

The point is is what is done, not why. They are separate. A well-intentioned action can be flawed. This gets to the core that the right belongs to the individual child, not to the parents to decide based on their preferences. Very often those preferences are objectively indefensible.

8) Circumcision affects sexuality

No reliable study has proven that circumcision has any effect on sensitivity and overall sexual function. ...

Circumcision clearly affects sexuality. That is not open to dispute because it changes the structure of the penis. How that change is evaluated may be positive, negative, or neutral. Only the person losing a portion of his healhty genitals is may make the unnecessary decision based on his conclusion on whether the change is positive, negative, or neutral. His evaluation may not match that of his parents.

10) Informed parents will choose not to circumcise

Actually, since information exists to support arguments from both sides, informed parents can make either choice.

The fact that there are two sides demonstrates that parents make a subjective decision. When that decision is unnecessary, as it is with almost every child circumcision, informed has no meaning. The parents act without input from the child on an irreversible - and, again, usually unnecessary - surgery. That is different than what #10 attempts to reject.

The shorter version: the circumcision decision for a child should be informed only by whether or not it is necessary.

12) Most babies are circumcised without pain relief-

Lies, lies. Unless you're stuck living in the 70s.
But for the rest of us who accept and embrace the new millenium, the vast majority of circumcisions are now performed with pain relief.

I was circumcised in the '70s, probably without pain relief. Was that a violation of my rights? And is it not a violation for the boys not in the "vast majority" who are given pain relief?

Proper pain relief does not make the surgery defensible. Behaving humanely in an indefensible action changes nothing.

13) Moms who choose not to circumcise are protecting their sons

Nice emotional outburst, completely in character of intactivism who love to use guilt and fear to spread their message, but completely false.
Protection is highly subjective and according to what we believe, our definition of "protecting" will be different. Sure they're "protecting" their children from initial pain and from the tiny risks of circumcision. But parents who choose to circumcise will tell you they're protecting their children from penile cancer, phimosis, balanitis and all that list we now know by heart.
It's a common anti-circ tactic- language twisting.

First, it's interesting that throughout the list the author rejects the simplifications used by those against infant circumcision, yet it's somehow reasonable to engage in the same behavior against those people.

To the issue in #13, saying that you're protecting your son from penile cancer, phimosis, etc. is the same tactic. The correct analysis in this silly use of protect is that not circumcising a healthy child protects him from the risk of complications. Without need, the risks inherent in the surgery are all that are immediate.

14) How can it be cleaner to have urine and feces directly up against an open wound?

Ok, first of all, the "open wound" lasts for like two days. ...

If it is "like two days", that's two days longer than an intact penis is an open wound.

16- Circumcision isn't "just a snip"

Actually, that's exactly what it is. You see, a "snip" is "to cut with a small, quick stroke, or a succession of such strokes, with scissors or the like." and "a small cut made by snipping". Both describing circumcision perfectly.
Why the common lie saying that it isn't a snip? Because intactivists love to say that the adult foreskin measures 3 x 5 inches. But we're not talking about adult foreskins, are we? At the moment the foreskin is removed, it's a small piece of skin, therefore, regardless of how big it becomes, at that moment, it's a "snip". So infant circumcision is just a snip. Adult circumcision is a little more complicated.

The author rebuts on semantics while ignoring the word that is the center of the argument. "Just a snip", not "just a snip". One word is an objective claim, a fact the author pointlessly focuses on. The other word is a subjective evaluation. Who is to decide what qualifies as just anything?

I could use a reference to boys who suffer serious complications and ask if they consider it just a snip. That's valid, but the more common outcome is more useful here. Does the male who receives the expected results from the surgery think it's just a snip? Would he value the subjective benefits of having his normal body more than the subjective value of the potential benefits his parents forced upon him? Words have meaning.

Like Lauren's use of "about less than an inch" in the excerpt above, the author thinks we should focus on what foreskin is removed rather than what will be if we don't remove the foreskin. But what will be there matters. Like in economics, what is unseen must still factor in the process. Removing X will have a result as an adult. Removing X - Y will have a different result as an adult. Removing X + Y will have a different result as an adult. X - Y can lead to adhesions. X + Y can lead to painful adult erections. It is impossible to know. That is the key. We can't pretend that what we want to be will be what is if we ignore inconvenient facts.

17) Doctors who perform circumcision violate the AMA's Code of Ethics:
...

A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

I'm going to break this excerpt apart to deal with two principles separately. With this one, surgically altering a healthy child who will most likely grow into a healthy adult is a violation of that child's human dignity and rights. The child is the patient. What he needs or doesn't need is the only factor in competent medical care. If it is wrong to cut a healthy female, it is wrong to cut a healthy male.

A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
...

VIII. And seeing as all medical organization agree that the "best interests" of the patient in the cases of infant circumcision are to be determined by the parents, a doctor abiding by the wish to circumcise doesn't violate this principle.

Responsibility to the patient is paramount, but somehow bowing to the wishes of the parents to surgically alter their healthy sons, even for non-"medical" cultural and religious reasons, doesn't violate this because medical organizations agree that it's okay? No. The analysis must focus on objective facts, not what people simply agree to believe.

Using the author's convoluted rationale, female genital cutting was acceptable in Victorian England and America in the 1800s because doctors agreed that it was beneficial. Or today, countries that cut females could use the same rationale because of what they collectively believe. The author's requirement that a majority consensus is all that's necessary is unbounded by principles, just socially approved behavior. How do we decide whether the medical organization is correct? Consensus means nothing by itself.

19) Considering male circumcision acceptable and FGM (Female Genital Mutilation) wrong is a "double standard".

First of all, what IS "double standard"? Here are some definitions.

American Heritage Dictionary - Cite This Source - Share This

double standard
n. A set of principles permitting greater opportunity or liberty to one than to another, especially the granting of greater sexual freedom to men than to women.
...

Now, if we STRICTLY adhere to what a "double standard" is by these definitions, then we can consider underage prohibition to drink, smoke or vote, the Olympics, non-smoking rules, etc, "double standards" and therefore unacceptable.

This means, obviously, that there are certain acceptable double standards. Furthermore, it means that in order to consider something an actual double standard, there are other considerations besides the treatment received by the two groups. So basically, to speak of an actual double standard, all things being equal, one group is being treated differently.

Men and women ARE different. I don't see anyone claiming that we should remove the gender categories from the Olympics because it's a "double standard". Why not let men and women compete against each other if we're SO "equal"? The answer is because we're not absolutely equal. It's a physical fact that men are generally stronger and faster than women. It would actually be unfair to have women compete against men as the former have a physical advantage.

And if we're saying that men and women are physically different, nowhere is this difference more pronounced than in the genitals. Male and female genitals are different. Therefore, the consequences of removing the foreskin cannot be compared with those of removing/altering female genitalia. And because of this, differentiating between the two IS NOT a double standard.

A female minor may not be cut even if the culture she is born into believes that cut female genitals are preferable, yet male minors may be cut for this cultural reason. How is that not included in "a set of principles permitting greater opportunity or liberty to one than to another"? Females are granted the liberty to decide what to do - or to not do - with their normal bodies that is not granted to males. That is a double standard.

The remaining arguments are unconvincing. To compare forced genital cutting to voluntary involvement in something like the Olympics is ridiculous. We do not agree that male and female genitals are different in the way they're being discussed. There is not a set of principles that apply to the vagina and another set of principles that apply to the penis. The set of principles apply to human beings. Human beings have genitals. Those genitals have reproductive, sexual, and excretory functions. Consideration of male versus female in how genitals should be protected is an incorrect deviation from logic. The individual human beings matter exclusively.

Yes, we make distinctions for smoking, drinking, and voting. However, those distinctions apply to everyone. The difference is that everyone has the the opportunity to be included in that group. Everyone will reach the minimum age for each (in most cases). Not everyone will meet the distinction the author demands for protection from unnecessary genital cutting on a healthy, non-consenting individual. There is no point in my life when I will become a female, reaching a basic level of protection. I was unprotected in childhood, and my genitals were altered. Females are protected from birth from having done to their genitals what was done to mine. That is a double standard.

21) Adult circumcision is easier and safer than neonatal circumcision

Nothing could be farther from reality.

And most males left intact will never need or choose circumcision. The fact that something can be done easier in childhood is not a justification that it should be done. It changes the decision from "Should it be done?" to "Is it difficult?". This is the "he won't remember it" defense. What else may parents do to their children because their children won't remember it? If a parent punches the child, the child will not remember it. And it will do less damage to the child than circumcision. But we know it's wrong to punch a child in the face. "Is it difficult" to recover from is not part of the equation.

23) Circumcision is a "cosmetic" procedure

No. Circumcision is a MEDICAL procedure, with proven HEALTH benefits acknowledged and admitted by every single medical organization in the world. Therefore, it's not just "cosmetic", it's prophylactic.

Why the intactivists' insistence that it's just "cosmetic"? Very simple, really. By saying that parents are doing something "cosmetic" to their children it makes the choice seem shallow, selfish and useless. By even admitting that there's one advantage to being circumcised, they would be giving some validity to circumcision and there's no way a self-respecting intactivist will ever agree to any validity. Therefore, they spread the lie that it's just "cosmetic".

Infant circumcision is a surgical procedure performed without medical need because it offers potential health benefits. The latter defense is what proponents obsess on, as the author does here. But just to prove that the author's last claim is ad hominem deployed to prop up her indefensible case, there are potential advantages to being circumcised as an infant. The reduction in UTI risk is likely real. The reduction in HIV-infection risk is likely real, at least in the short-term. And so on. I accept this.

But so what? That gives no validity to prophylactic infant male circumcision. There are better, more effective, less invasive ways to achieve every single benefit or to treat the maladies in the unlikely instances where they occur. The objective health is what matters for proxy consent for a child. Is the intervention indicated and necessary? Infant circumcision fails this core test. Moving forward is unethical because objective reality trumps the subjective chase for justifications.

However, if the author wishes to imply that the potential benefits dismiss the cosmetic nature of the surgery as a reason why some parents circumcise their sons, she is mistaken. There are parents who circumcise for cosmetic reasons. They find the foreskin "icky" or dangerous or bothersome. The fathers and mothers prefer circumcised penises sexually (for different reasons, obviously). They push this preference on their sons because they assume that the child's future partners will share their opinion on the aesthetic value of a circumcised penis and thank them. Sometimes, they also assume that the child will agree, although they assume that the opinion of his partners will determine his opinion. For this segment of parents, circumcision is a cosmetic decision. We allow child circumcision for this subjective reason because we mistakenly believe that this determination can be defended as the parents making a decision in the child's best interests. It is not because parents are not psychic. They can't know what he will prefer, or whether he would willingly enter a sexual relationship with someone shallow enough to expect his body to be changed to meer her (or his) expectations.

It is appalling that parents consider their opinions relevant on the subjective question of unnecessary genital cutting. It is obscene that they consider them superior to the child's opinions, both real and potential, for these irrational excuses. That is a shameful mark against our society, and should be recognized as such by the law.

Posted by Tony | Permalink | Comments (0)

In an entry titled "The Facts As Promised", Lauren at Can You Be A Part of My Life fails to consider the context of her selected (and occasionally incorrect) facts about infant circumcision. I expected little going in because she opened with her attributions. Among her three sources were the websites of Professor Brian Morris and Dr. Edgar Schoen. It would be difficult to find a greater propagandist than either of those two.

Throw that truth out, though. Where they are correct with statistics, they ignore the most important fact present in almost every case where they advocate infant male circumcision, which Lauren readily ignores along with them: the child is normal and healthy. No surgery is indicated. There is no need to weigh against the inevitable risks. That is the only proper evidence-based analysis. One need not reject any of the statistics claimed to understand that the individual does not require circumcision. Circumcision by parental proxy is therefore unjustifiable.

But the claims merit a response. Here is an excerpt from the first paragraph of substance on circumcision in Lauren's entry:

... And it is MUCH harder to keep this area clean in infant babies for various reason and therefore leads to: a higher risk of death in the first year of life (from complications of urinary tract infections: viz. kidney failure, meningitis and infection of bone marrow).

WebMD, a site that generally endorses unnecessary infant circumcision, states this about the normal infant foreskin, with emphasis in the original:

Do not force the foreskin back over the tip of the penis. At first, a baby's foreskin may be difficult to pull back over the tip of the penis. After the first few years of life (though it may take somewhat longer), the foreskin will gradually become more retractable. By the time a boy is age 3, his foreskin is usually fully retractable. Up to this time, wash the outside of the penis with soap and water. Pushing your son's foreskin back too early can cause scar tissue formation and damage.

Is washing the intact penis that MUCH harder to keep clean than the circumcised penis? Considering the process is identical, it's clearly not MUCH harder. Pretending otherwise is misinformation. It is also worth remembering that circumcision creates an open wound that must be cared for properly to avoid infection and readhesion. This makes care for the circumcised penis more complicated for parents than properly caring for the normal penis.

Here I'd like to add a special caveat. If you don't wish to care for normal, healthy children, don't reproduce. Otherwise, the proper care of your normal, healthy children is an obligation, not a chore to be discarded in reverence to fear and mistaken beliefs.

For the the remainder of this entry, I'll take the issues point-by-point. However, I want to make it clear that from this point forward, I'm challenging the claims of Professor Brian Morris. The bulk of Lauren's entry involves only a copy-and-paste from Morris' site. Lauren (wisely) provided some editorial input, omitting several absurdly irrelevant claims proffered by Morris. Of course, those should be considered to fully understand his judgment in pushing the other claims over the objective reality of health for most infant males. "A penis that is regarded by most as being more attractive" is not an indication of medical necessity. It's a sign of an ability to think only collectively, to not understand that all tastes and preferences are subjective and individual. That is flawed because it ignores ethics and human rights.

So, addressing Professor Morris' claims. (Link is here: http://www.circinfo.net/summary.html) Under the section titled "The benefits are clear" from Lauren's entry, this list from Morris titled "Getting circumcised will result in":

• Improved hygiene.

This is misleading, at best. See my comments above on this.

• Much lower risk of urinary tract infections.

The risk is lower, by a factor of approximately 10. However, the risk is already very low. More on this in a moment. (Note: The risk for girls is also approximately 3 times higher than it is for intact boys. We treat UTIs in infant girls if/when they appear.)

• Much lower chance of acquiring AIDS heterosexually.

Condoms and monogamy or condoms, monogamy, and circumcision. Those are the two choices. Circumcision is superfluous. Unprotected sex with HIV-infected partners will lead to infection. Circumcision has not helped me avoid HIV infection because I do not behave irresponsibly. Had my parents used this excuse, it would've been misguided. Parents are not Nostradamus.

Notice, too, how easily this omits the fact that the studies were performed on adult volunteers, not infants. Surgery is different technically and ethically for the two patient groups. The infant foreskin must be forcibly retracted. Infants aren't sexaully active.

• Virtually complete elimination of the risk of invasive penile cancer.

The risk of penile cancer is small, regardless of foreskin status. From the 1999 AAP statement on infant circumcision, the risk of penile cancer varies little among Western nations. It is generally around 1 per 100,000 males. Other risk factors appear to be more significant. The consensus seems to be that, circumcised or not, healthy, responsible living is the best way to protect against such illnesses.

For context, there were 1,250 new cases of penile cancer in America in 2008 and 290 deaths. There were an estimated 1,990 cases of invasive breast cancer in American men in 2008, including 450 deaths. Time to panic and remove infant male breast tissue? The logic would be the same.

• More favourable hygiene for the man’s sexual partner.

This can be read as either a claim that women prefer a circumcised penis because it is cleaner or that it improves female hygiene. I've already dismissed the former claim, and Lauren correctly points out the absurdity of suggesting that adult males are incapable of cleaning their foreskins. The latter claim would tie in to the next bullet point.

• Much lower risk of cervical cancer and Chlamydia (and thus infertility and other problems) in the female sexual partner.

The ethical questions aside, there is a vaccine for HPV. That aside, as it relates to the foreskin, personal responsibility among the sexual pair matters: "In men with low-risk sexual behaviour and monogamous female partners, circumcision makes no difference to the risk of cervical cancer." It is flawed to assume at birth that the male will be promiscuous. It is also flawed to assume that it's ethical to surgically alter one person to protect his potential sexual partners. For example, what if he is gay?

• More favorable sexual function and no reduction in sensation during arousal or in the sensitivity of the flaccid penis.

Circumcision clearly alters sexual intercourse. Whether or not that is "more favorable" - a subjective evaluation - can only legitimately be determined by the individual himself. The foreskin contains thousands of nerve endings. Again, removing those alters sexual intercourse. Whether or not that reduces sensation is impossible to compare once the foreskin is removed. Only the male himself is qualified to make that decision.

Now, to Morris' claims under "lack of circumcision" linked in Lauren's entry. He states:

Is responsible for a 12-fold higher risk of urinary tract infections in infancy. Risk = 1 in 20. Higher risk of UTI at older ages as well.

He provides no source for his claim of a 12-fold higher risk. I assume he's pulling this from a study by Thomas Wiswell, but I'm guessing, since he didn't source it. I have no idea where he found the risk to be 1 in 20. According to the more recent statement from the AAP, estimates are "that 10 of 1000 (1%) uncircumcised male infants will develop a UTI during the first year of life compared with 1 of 1000 (0.1%) circumcised male infants." Claims like "12-fold higher risk" don't look quite as compelling when considered in context. Also, females in the first year of life have a risk of UTIs equal-to or higher-than intact males. We treat those without surgery, even after they actually occur.

Confers a higher risk of death in the first year of life (from complications of urinary tract infections: viz. kidney failure, meningitis and infection of bone marrow).

I addressed this above with the hygiene issue, so here I'll take a different approach. What is that risk of death? Professor Morris does not state the risk, nor does he link to a source for his claim. I have no problem accepting that it's true, but are we debating a 50% risk of death from the foreskin? A 25% risk? Or are we discussing a risk significantly lower than 1%? I would wager the third option is closest to the truth. Ultimately life has risks. We can't live in bubbles to prevent bad things from happening, particularly when those bad things are very unlikely.

One in ~400-900 uncircumcised men will get cancer of the penis, which is over 20 times higher in uncircumcised men. A quarter of these will die from it and the rest will require complete or partial penile amputation as a result. (In contrast, invasive penile cancer never occurs or is extraordinarily rare in men circumcised at birth.) (Data from studies in the USA, Denmark and Australia, which are not to be confused with the often quoted, but misleading, annual incidence figures of 1 in 100,000).

The often-quoted figures are quoted by the AAP. I'm willing to consider that it's misquoted, and I'll correct if it is. But Morris does not show here how this statistic is misused. He merely attempts to scare us with a few numbers that are not impressive in the context of actual population sizes and risk factors. He expects the reader to accept his cost-benefit analysis, weighing the 400-900 and 200 against the 1,000,000+ infant males circumcised to achieve these results. I do not because we are discussing surgery on individuals, not groups. Actual human beings, with opinions, preferences, and needs are involved. I refuse to behave like an irrational collectivist.

Is associated with 3-fold higher risk of inflammation and infection of the skin of the penis. This includes balanitis (inflammation of the glans), posthitis (inflammation of the foreskin), phimosis (inability to retract the foreskin) and paraphimosis (constriction of the penis by a tight foreskin). Up to 18% of uncircumcised boys will develop one of these by 8 years of age, whereas all are unknown in the circumcised. Risk of balanoposthitis = 1 in 6. Obstruction to urine flow = 1 in 10-50. Risk of these is even higher in diabetic men.

Balanitis

Balanitis is easily treated. Practising good hygiene and avoiding substances that irritate the penis will often clear the balanitis. (See the Treatment section for more information).

The rest...:

Phimosis

Phimosis is when the foreskin is very tight and cannot be pulled back over the head of the penis (glans). It's normal for the foreskin to be attached to the head of the penis up until about age five. Parents should not try to pull the foreskin back because it can cause pain or injury. However, after the age of five, the foreskin will usually separate by itself and can be pulled back.

In some boys, phimosis can continue up to the age of 10 and, occasionally, it can continue into adulthood. Boys who have phimosis, and are under the age of six, do not usually require circumcision, but it may be considered after this age if the foreskin is damaged. Damage can happen as a result of severe or repeated infections. However, in the majority of cases, the foreskin will loosen naturally, with true phimosis (see below) only accounting for about 1% of cases.
...

Paraphimosis

Paraphimosis is a tight foreskin that cannot be pulled back, meaning the penis is squeezed, which causes pain. It forms a ring around the penis, cutting off some of the blood flow to the glans, and making it swell up. Doctors can sometimes treat paraphimosis by gently squeezing the trapped glans until the foreskin is able to slide over it. However, if this is not possible, circumcision may be needed.

I do not deny that risks exist, and that maladies occur. These conditions indicate a legitimate need for medical treatment. If parents must make a decision here, so be it. But the clear evidence is that these can - and therefore should - be treated with methods less invasive than circumcision, if possible. That is the reasonable medical approach to a permanent, irreversible decision.

Means increased risk of problems that may necessitate 1 in 10 older children and men requiring circumcision later in life, when the cost is 10 times higher the procedure is less convenient, and the cosmetic result can be not as good as when done in infancy.

Morris would circumcise 10 in 10 male infants to avoid circumcising 1 in 10 males later in life. He states that the cost is 10 times higher. The overall financial burden to society is unchanged, contrary to what he's trying to convey through fear. (Future financial burden is not a valid reason to circumcise a healthy child.)

Speaking strictly from a finance perspective, advocating for infant circumcision is the more expensive approach. His analysis is that the cost is 10 times 0.1 for his preference and 0.1 times 10 for his worst case. The present value of $1 spent over many years in the future is less than the $1 spent today. Professor Morris prefers the more expensive option.

Nor should convenience be considered. That is not a medical indication. If the male wishes circumcision more than the inconvenience, he will choose it. If not, it is not acceptable for parents to choose that for him, against his (probable, based on statistics) future choice.

As for cosmetic results, this is simply insane. Circumcising an infant places the parents' aesthetic sexual preference as the justification, even though the child may not choose it. He gets zero choice, and the cosmetic results aren't guaranteed to be good by whatever future subjective standards he develops. If he is left with his decision, he can decide if he values the risk of a poor cosmetic outcome versus his normal penis.

Increases by 2-4 fold the risk of thrush and sexually transmitted infections such as human papillomavirus (HPV), syphilis, chancroid and, in some studies Chlamydia.

And:

Is the biggest risk factor for heterosexually-acquired AIDS virus infection in men. 3 to 8-times higher risk by itself, and even higher when lesions from STIs are added in. Risk per exposure = 1 in 300.

And:

In the female partners of uncircumcised men is associated with a 5 fold higher incidence of cervical cancer (caused by sexually transmitted HPV), pelvic inflammatory disease, infertility from blockage of fallopian tubes, extopic pregnancy (each caused by Chlamydia), genital herpes, and other conditions.

Condoms and monogamy are necessary, regardless. Forcing circumcision on sexually-inactive infant males does not change the necessity of practicing safe sex when they become sexually active. At its core, this is merely a belief that males will be irresponsible and/or female health is more important than a male's normal body. It also assumes that his future female (or male?) partners will not be responsible enough to protect themselves from STDs.

The core evaluation is very simple. If the child is healthy, no surgery is indicated or justifiable. Chasing benefits for children is an illogical path that can be pursued to other irrational avenues and on both genders. It has no place in the proxy decision-making of parents for the genitals of their male children, as we already understand clearly for female children.

UPDATE: I corrected one point of grammar and added the word males to "1 in 10" for clarification. I also added if possible to my statement that less invasive treatments should be used to treat foreskin ailments. Circumcision is sometimes necessary, of course, but it should be used as the last option, not the first.

Posted by Tony | Permalink | Comments (4)

I don't think much of Men's Health magazine after its recent, flawed article on male circumcision. This entry on the Men's Health Life blog still managed to disappoint. The author describes having his sons circumcised, yet manages to work in this sentence without any apparent awareness:

The beautiful, fragrant flesh of a newborn shouldn't mix with steel blades unless absolutely necessary.

And yet, he and his wife hired a doctor to unnecessarily take a steel blade to the "beautiful, fragrant flesh" of their newborn sons. Should anyone expect more throughout the rest of the article? After implying that the risk of severe complications is the only risk involved in circumcision, and comparing that to the risk of an individual getting hit by a rogue asteroid, the author attempts to defend his action with this:

Much more likely is the scenario that that beautiful boy grows up, is considered beautiful by another of our species (male of female), and begins expressing that attraction through sex. And that's when the superfluousness of the foreskin morphs into a decided health threat. ...

His foreskin is only a threat if he engages in unprotected sex with infected female partners.

Notice, too, the inclusion of "superfluous" to describe the foreskin. That's a subjective word. The foreskin has sexual functions, so its removal changes his sexual experience. Does the male himself consider his foreskin superfluous?

In the U.S., then, circumcision can be regarded as a worthwhile precaution against debilitating STDs later on in life. ...

The findings on circumcision involved voluntary, adult circumcision. I have no problem accepting that voluntary, adult circumcision can be regarded as a worthwhile precaution against anything, down to the owner's revulsion at his anatomically-normal body. That is not what the author is suggesting. His perception of the risk of STD for his sexually inactive sons is enough for him to make their decision. That's ignorant.

... In Africa, where AIDS runs rampant and garden-variety STDs are a contributing factor to transmission, circumcision is a humanitarian issue. ...

That's a very convenient reframing that ignores the actual epidemic in Africa. Unprotected sex with multiple concurrent partners is the problem. Circumcision status is possibly related only to the extent that individuals regularly ignore safe sex practices. Who wants to put confidence in that as a long-term solution?

If a small bit of skin is the only sacrifice needed to stop a humanitarian and health crisis, I say off with their heads!

When the person who makes the sacrifice and the person who makes the decision to sacrifice are different, the decision is unethical. Of course, as I mentioned regarding safe sex, circumcision is clearly not the only "sacrifice" needed. But call it a humanitarian issue and the circumciser becomes noble.

Still, this is the key paragraph:

But the N.O.C.I.R.C. people will be after my own head, now that I've joined the anti-foreskin forces. And listen, I understand their emotion. The penis is a sensitive body part, and babies are a very touchy subject. Combine the two, and people's forehead veins begin to bulge. But N.O.C.I.R.C.'s bellicose attitude toward the debate is pushing aside rational consideration of the evidence, and scaring parents into making decisions that are against the best interest of their babies. And society at large.

The only person pushing aside rational consideration of the evidence is the author (and every pro-infant circumcision advocate). Here is the proof:

The beautiful, fragrant flesh of a newborn shouldn't mix with steel blades unless absolutely necessary.

The child is healthy at birth. No indication exists for surgical intervention. Therefore, no intervention is justified. The only guarantee from routine/ritual infant circumcision is the child's exposure to surgical risk. That is not in his best interest.

If we didn't follow this, any intervention on children could be excused based on scientific studies on adult volunteers. The author claimed to believe that evidence matters, but he dismissed the fundamental evidence that was inconvenient to what he wanted to do. That is pushing aside rational consideration of the evidence.

Posted by Tony | Permalink | Comments (0)

I'm slow getting to this story, but the United States loves irrational fears when it comes to the foreskin, so it's still as relevant today. A re-evaluation of one of the studies used to claim that (voluntary, adult) male circumcision reduces the risk of female-to-male HIV transmission suggests that (voluntary, adult) male circumcision reduces the risk of herpes transmission by 25% and HPV transmission by 30%.

To the extent that adult males want to volunteer for these reasons, so be it. Everyone is entitled to his own decision. Personally, I'd rely on safe sex, not surgery. But that's not how the data are being used in the U.S. Here, it's predictably OMG 25% 30% OMG YOUR SON IS GONNA DIE A SAD HORRIBLE PAINFUL DEATH IF YOU DON'T CIRCUMCISE HIM BEFORE HE HITS THE DOCTORS HANDS IN THE DELIVERY ROOM OMG! OH AND WOMEN PREFER CIRCUMCISED PENISES WINKWINK. From one of the researchers involved:

Dr Judith Wasserheit went on to say: "All providers who care for pregnant women and infants have a responsibility to assure that mothers and fathers know that circumcision could help protect their sons from the three most common and most serious viral sexually transmitted infections, all of which cannot currently be cured."

Again, notice how easily Dr. Wasserheit dropped voluntary and adult from the study's results. If voluntary, adult circumcision was enough to protect the men involved in the study, surely the exact same is capable of protecting American males. Maybe she wants to suggest that the American STD situation is more dire than the situation in Uganda to justify dropping voluntary or adult?

But to her point, all providers for infants have a responsibility to assure that mothers and fathers know the objective status of their son's foreskin health. Almost always that will mean a statement that no intervention is indicated or warranted. There is no defensible reason to impose surgical risks for a surgery that is a) not needed and b) can be postponed until the child can choose. That was the ethical standard applied in the study. American public health officials have not explained why American infant males should be provided fewer ethical protections.

As the BBC journalist shows, it's possible to find different views. First, the key point that everyone forgets in the hysteria:

The reason why a foreskin might increase the risk of infection with various viruses is unclear.

Whatever the data reflect, this should not be forgotten. It's reasonable to consider the possibility that there is a methodological flaw, for example. What if improper controls existed? What if the timeline was too short? This should not be ruled out, which further highlights the already clear ethical flaw in pushing these results as an excuse to circumcise infant males. And what if the mechanism suggests that some level of female genital cutting would also reduce risks? Would the current advocates endorse that research, or are findings like the current re-evaluated study merely a solution in search of problems?

Dr Colm O'Mahony, a sexual health expert from the Countess of Chester Foundation Trust Hospital in Chester, said the US had an "obsession" with circumcision being the answer to controlling sexually transmitted infections.

He said: "Sure, a dry skinned penis is a bit less likely to contract HIV, herpes and possibly genital warts but it will get infected eventually."

That's what I mean by a flaw in the timeline. If a male has unprotected sex - the only way circumcision could provide protection - with HIV-positive females, he will become infected. The choices are condoms/monogamy/circumcision or condoms/monogamy. Circumcision is superfluous and unnecessary, so infant circumcision is indefensible.

Keith Alcorn, from the HIV information service NAM, also warned against a knee jerk reaction.

He said: "We have to be careful not to take evidence from one part of the world and apply it uncritically to others.

Given the U.S. reaction, it's too late for that.

"Male circumcision will have little impact on HIV risk for boys born in the UK, where the risk of acquiring HIV heterosexually is very low.

The same applies to the United States.

Posted by Tony | Permalink | Comments (2)

For a few days I've mulled over whether or not I should comment on this story:

Accepting a plea bargain that her attorney described as unprecedented in American jurisprudence, a 22-year-old Maryland woman yesterday agreed to cooperate in the prosecution of other defendants in the death of her son under the condition that charges against her be dropped if the child rises from the dead.
...

The boy's mother, Ria Ramkissoon, is shaping up as prosecutors' star witness against a 40-year-old Baltimore woman named Queen Antoinette. Prosecutors allege that Queen Antoinette led a small cult, called One Mind Ministries, based in a West Baltimore rowhouse. In early 2007, prosecutors say, Queen Antoinette instructed Ramkissoon and others to deprive Javon of food and water because he didn't say "amen" before breakfast.

I'm inclined to make a comparison to infant circumcision for religious reasons. It's easy to make even though there are many steps between the two points, but I worried about the perception that I'm claiming a moral equivalence between circumcision and death. I am not, so I stayed away. Then I read this entry by Rogier van Bakel, which I think gets the angle correct (emphasis in original):

Yeah, no insanity there. I mean, since she felt compelled by God to let her baby die a drawn-out, miserable death, why would anyone question her mental capacity? That just wouldn't be respectful to the Big Guy, and to people of faith, now would it?

I'm more or less agnostic on religion, and I don't care what people believe. My only concern is how our civil government uses religion as a guidance on rules. Specifically, I'm concerned about how government treats what one person does to another in the name of religious faith.

This case demonstrates that we collectively believe our government must not rebuke religious intent in individuals who inflict objectively harmful practices on another. And we must punish only the most egregious examples. In America, belief in a higher being is a sign of increased rationality. We mistakenly accept that parents may undertake certain unjustifiable actions against their children because we do not wish to imply that the verifiable is superior to the unverifiable. That is wrong.

This case is obvious, so the deference to religion in pursuit of convictions is understandable, if not entirely acceptable. The mother is obviously incompetent, so we shouldn't pretend that she is. That will only perpetuate further violations of the rights of children because it gives religious justifications credibility they do not deserve.

Posted by Tony | Permalink | Comments (0)

One more story for today that draws a parallel to the gender-bias in child genital cutting in America. (Note: The names of the minors should be redacted, but they're obviously known, so I'm leaving them in the excerpt.)

Alan Jepsen was playing videogames at his home in Sheboygan, Wisconsin, when the cops came knocking on his door. He was handcuffed in front of his sister and thrown in jail. In the words of his attorney, Jeffrey Purnell, “This child, this 17-year-old high-school kid, had to spend a week in jail—they locked him up and they put him in jail with grown-ups.”

His crime: Having sex with his 14-year-old girlfriend. And, perhaps, being a boy.

The day after Alan's arrest, Sheboygan authorities arrested Norma Guthrie, also 17, for having sex with her 14-year-old boyfriend. Norma, however, did not have to spend a single day in jail. She was released immediately, on signature bond, while Alan was held on a $1,000 cash bond, which his family could not afford. Sheboygan County Assistant District Attorney Jim Haasch is handling both cases.

The disparity in the punishment of these 17-year-olds, both accused of having sex with the 14-year-olds they were dating, goes much deeper. Haasch charged Alan with a Class C felony, which, according to court records obtained by The Daily Beast, carries a maximum prison sentence of 40 years. Norma, on the other hand, was charged only with a misdemeanor, which carries a maximum sentence of nine months in jail.

If the facts are as they appear, this is despicable. And entirely predictable. Males are viewed as possessing endless sexual appetities. Females are viewed as sexual victims. The typical defense of the non-existent ethical distinction between genital cutting on male and female minors rests solely on the mistaken notion that female genital cutting is strictly designed to limit the female's sexuality, if not destroy it completely. (And imposed by women, even when it isn't.) For males, we pretend that potential medical benefits dismiss the same ethical issues involved in female genital cutting because parents say their intentions are good. Anyway, we're told, males enjoy sex more than enough, and genital cutting doesn't affect male sexual experience. And if it does, although it doesn't, that's exclusively a good thing, except removing nerve endings couldn't possibly alter sexual experience, so why are you worried?

Here's an example:

Between 2002 and 2003, Turkish scientists studied how circumcision influences male sexual functions. They only studied men who were circumcised for aesthetic or religious reasons. The average age of those surveyed was 22.3 years old, and their sexual functions were equal before and after circumcision. After the survey was carried out, scientists concluded that circumcising grown men does not negatively effect their sexual functions. On the contrary, the fact that it causes a delay in ejaculation is more of an advantage than a complication.

Circumcision affects sexual function. It delays orgasm, which is an objective claim. Whether or not that is positive or negative is subjective to the individual, yet it's treated as an objective finding. It's not stated here, but most commonly the argument relies on some defense that women prefer this outcome, so it is good. (Check virtually any propaganda by Brian Morris or Edgar Schoen.)

If a man likes large breasts, he does not have the right to impose breast augmentation on his daughter to achieve this positive outcome. We understand that, of course, because it involves controlling a female's sexuality. But we embrace a double standard when the roles are reversed, even though the ethical issue is the same. We must not deviate from the belief that men are predators and women are delicate flowers. So, no, I'm not surprised that there is a double standard involving prosecution of these two Wisconsin teens.

Original link via Radley Balko.

Posted by Tony | Permalink | Comments (0)

I've seen this story floating around for a few days, from multiple sources.

Things could get hairy in New Jersey this summer for women who sport revealing bikinis or a little bit less.

The painful Brazilian wax and its intimate derivatives are in danger of being stripped from salon and spa menus if a recent proposal to ban genital waxing is passed by the state’s Board of Cosmetology and Hairstyling.

Before I get into my brief take, I'll stress what I think explains this, which is what Brad Warbiany pointed out at The Liberty Papers:

[Cherry Hill, New Jersey salon owner Linda] Orsuto said that the proposal may be the state's way of diverting a long-established salon procedure "perfected by aestheticians" to the medical community, where hair can be removed via laser treatment by dermatologists.

As Mr. Warbiany stated perfectly:

Follow the lobbying money.

Those four words explain most government actions, no?

My take: If this passes, it will be illegal in New Jersey for a woman to have her pubic hair waxed from her genitals, but she will still be free to have her son's healthy foreskin surgically removed for any reason she can imagine. We have a long way to go before people understand individual liberty.

Posted by Tony | Permalink | Comments (0)

From England:

It took a death threat to stop Abdi’s wife from circumcising their two daughters, aged 2 and 4. She called him from Somalia while on holiday to say she wanted to carry out the procedure.

Abdi, a London-based Somali, said that his wife’s eagerness to circumcise their daughters was fuelled by a combination of religious, cultural and tribal pressures placed on her after she took the girls to Somalia for a brief summer break last year.

But he refused to be swayed, despite his wife’s argument that the girls would improve their chances of attracting a good husband because they would be perceived as being more traditional and pure.

First, notice the third paragraph. I can't and won't begin a detailed analysis because it would be speculation, but the information there suggests that this reasoning is at most a difference of degree between this and what Western parents often choose for their sons. The focus is on how to make the child more attractive to a future partner, not what the child needs. Attempt to build a defense of infant male circumcision on the grounds of potential benefits, but ultimately this reasoning must make no distinction between those alleged-but-not-really medical reasons and the nonsense that what the child's future sexual partners might want is relevant to what to do to his genitals. The whole notion is absurd.

Second, this one example proves nothing. However, it demonstrates that those who perpetuate the belief that female genital cutting is exclusively perpetuated by men are mistaken. At some point we have to lay down our agenda of blame and figure out how to stop these violations. I suspect the desire to blame is responsible for much of the inability to see the similarities between male and female genital cutting. Medically unnecessary genital cutting on a non-consenting person is unethical. That is a statement of principle free from the ramifications of gender-specific reasoning and outcomes. It considers only the victim. That's what matters.

Posted by Tony | Permalink | Comments (0)

Stories like this warrant mentioning because the hypocrisy isn't going away:

Suriname has launched a three-month pilot project offering free circumcisions in a bid to cut sexually transmitted diseases, Health Minister Celsius Waterberg said Friday.
...

Some two percent of the Suriname population is HIV-infected, about 10,000 people, and the project aims to carry out the operations on 100 men aged between four and 21 years old over the next three months.

How many four-year-old men do you know? When public health officials discuss the potential reduction in HIV risk from voluntary, adult male circumcision, they always forget voluntary and adult. Always.

If successful then the project will spread nationwide, Waterberg said.

This circumcision program seeks to reduce sexually-transmitted HIV infection because three studies determined that (voluntary, adult) circumcision reduces the risk of female-to-male HIV infection through vaginal intercourse. By what standards do you think the program's coordinators will use to judge the program successful in reducing HIV transmission among the four-year-olds? When will they reach their conclusion?

Posted by Tony | Permalink | Comments (0)

The Atlantic's Ross Douthat is the new conservative columnist for The New York Times. I haven't read enough of his work to suggest that this is unwarranted. And he is, in fact, a talented writer. It's just that I've been unimpressed with his thinking whenever I've encountered it. He shows very little interest in liberty or constructing a government that respects the interests of those with whom he disagrees.

In this entry from early last year, I criticized Mr. Douthat's thinking on two topics, prostitution and infant circumcision. His position in both cases was objectively weak, at best. I'll leave you to follow the link for my challenge to his views on prostitution. Here, I'd like to repost what I wrote in response to his tongue-in-cheek-yet-mind-numbingly-stupid view on infant circumcision.

Of course, since it's apparently okay to ask questions unrelated to the topic, let me ask a question: Why is it automatically self-harm worthy of prohibition for an individual to sell sex, even when it's voluntarily sold, yet it's reasonable to permit parents to surgically alter the genitals of their healthy sons - who may or may not approve of such permanent, physical alteration - as Mr. Douthat suggested last year in defense of infant circumcision?

The answer to how one person can hold two incongruent opinions rather obviously rests in a willingness to use personal, subjective tastes and preferences to inform the legal code of a diverse, secular, civil society. It's the same central planner impulse that resides in every individual who seeks to dictate which freedoms are abhorrent.

Since I'm off on the tangent, in that entry, Mr. Douthat states:

Proponents, like myself, point out that even saying the word smegma is really disgusting. Again, I think we pretty much win the debate right there, without even getting into the whole HIV question.

I get the tongue-in-cheek nature of the comment, whether he meant it or not. I think he did because I think he views circumcision as inconsequential. (Remember subjective tastes and preferences?) But any understanding of human biology demonstrates the stupidity of such an argument. Female genitals produce smegma, as well. We do not cut female minors for that reason. Or, more to the point, we do not permit parents to cut their daughters just because they, the parents, are disgusted by the mere mention of the word. We manage to find the correct reasoning to prohibit that. But for males, parents can use only the mere mention of smegma as an excuse to cut. Or they can reject even that reason and order it because it's fun to check "yes" on the consent form. The law is based on our conditioned beliefs rather than facts.

This wasn't in my original response, but it warrants a comment in light of the weight Mr. Douthat's opinions will now receive because he is a columnist for The New York Times. From his entry on circumcision (emphasis in original):

... I believe I have the weight of the American experience on my side when I say that any such dampening [of sexual pleasure] would have to be extremely negligible.

He proves that he can't possibly know this from experience with his next sentence:

All of which is to say that I'm gratified that my parents took it upon themselves to have a procedure performed on my infant self ...

Without any sexual experience with his foreskin, he knows it's "extremely negligible". How? "I have experience with one side of the debate, so I am an expert on both sides of the debate" is not a sign of a great thinker. It is a sign of a mind interested in selecting the necessary facts to reach a desired, self-centered conclusion. I'm unimpressed.

Posted by Tony | Permalink | Comments (0)

I'm trying to figure out a way to criticize Michael Gerson's column in yesterday's Washington Post that properly registers the obliviousness to the contradictions of his protests. If I spent enough time to develop something pithy, it would be scathing. Instead, I'll jump into his opening paragraphs:

There is a common thread running through President Obama's pro-choice agenda: the coercion of those who disagree with it.

Obama has begun providing federal funds for international groups that promote or perform abortions overseas. He has moved to weaken conscience protections for health-care professionals. And he has chosen the most radical possible option on the use of embryonic stem cells -- a free license for researchers, with boundaries set only by the National Institutes of Health.

So, when the president wants to use public funds to pay for abortion, we must think of those who disagree with abortion. But when the president wants to direct public funds to faith-based organizations, Gerson misses the flaw. When the president wants to direct public funds to pay for circumcising healthy African infant males, Gerson misses the flaw. What's good to Michael Gerson is apparently all that's good, and you should pay for it, too. But how dare you not place limits on government for issues that he opposes.

Michael Gerson is a hypocrite.

Posted by Tony | Permalink | Comments (1)

When I wrote about comparative effectiveness research, I focused on the merits of including funding in the deficit spending bill as a path to more socialized health care. I haven't changed my opinion on that, but it's worth noting that the idea behind this research is reasonable. Do our interventions produce results?

Following that, here's an interesting analysis of comparative effectiveness research that focuses on the relevant issues (link via Kevin, M.D.). The analysis contains useful examples, and is worth reading. I don't think we'll get what we expect from the newly-funded research unless we expect more decision-making power handed to bureaucrats. Still, the idea behind comparative effectiveness research is reasonable.

But the more useful, immediate discussion is this:

Here’s where things get dicey. A chief medical officer I know was once discussing unnecessary procedures in his healthcare system. In a rare moment of unvarnished truthtelling, one of his procedural specialists told him, “I make my living off unnecessary procedures.” Even if we stick to the correct side of the ethical fault line, doctors and companies inevitably believe in their technologies and products, making it tricky to get them to willingly lay down their arms. ...

You can probably figure out that I'm going to discuss this in the context of infant circumcision. First, let me make this clear, in case anyone's missed me saying it previously: I do not believe there is a conspiracy to circumcise infant males. It is a common, actively-pursued goal, but it does not fit the nefarious intent behind a conspiracy.

That does not mean that individual doctors are immune to the undeniable point that genital surgery is not indicated for most infant males. The ethical claim is impregnable to excuses based in cultural and moral relativism. What incentive does a doctor like Dr. Neil Pollock have to begin deferring to his patients' needs rather than his own?

Dr. Neil Pollock, who performs about 2,500 infant circumcisions annually in Metro Vancouver, travelled to Rwanda in December to teach his circumcision method to local surgeons.
...

Pollock is hopeful that the painless [ed. note: Even if true, the ethical claim must win out.] nature of his technique, which takes less than a minute to perform, will persuade many Rwandan parents to consider circumcision for their infants.

Once again: When public health officials discuss the potential reduction in HIV risk from voluntary, adult male circumcision, they always forget voluntary and adult. Always.

Looking at comparative effectiveness research, Dr. Pollock is based in Vancouver, British Columbia, outside the realm of the deficit spending bill's reach. He's good anecdotal evidence, though, because he shows what it means to be uninterested in placing your patient's needs and rights first. He's built a practice around performing more than 12 infant circumcisions per business day. Will he readily give that up, since he's so clearly invested in continuing the involuntary procedure?

Of course, the conclusion on infant circumcision is already in. Here's what the Canadian Pediatric Society says about routine infant circumcision:

Recommendation: Circumcision of newborns should not be routinely performed.

I see no reason to believe there will be any difference in the US. Most American doctors already ignore the ethical case for protecting the rights of infant males. There are people invested in perpetuating the imposition of unnecessary genital cutting. No government study is going to change that.

Posted by Tony | Permalink | Comments (0)

Do you want to want to pay for another man's circumcision? Too bad:

Top on the Ministry of Health’s five-year strategy is the free circumcision, to be made available in all public health centres.

Sh960 million from the US government has been injected into the project to buy surgical materials, mobilise communities and provide counselling. With a budget of Sh2,000 for each volunteer, the campaign targets 500,000 uncircumcised men in Kenya.

I'm not naive enough to think that men means males who've reached an age of consent. But I'll assume that's what it means for this story. Given that 500,000 is a very large sample, how many men do you think we'll pay to develop this attitude?

The Kenyan government launched a campaign to promote male circumcision in 2008, but it has not yet reached most parts of the country. In the northwestern district of Turkana, where the practice is not part of the culture and few have even heard of it, IRIN/PlusNews spoke to Isaac Ikone, 22.

"The government has not yet come here to talk about male circumcision, but I have heard about it from friends. They say it prevents HIV and sexually transmitted diseases. If that's true, I would definitely go for it so I can remain healthy.

"A while ago a friend and I found out we had the same sexually transmitted disease, and when I began to wonder how that happened, he told me he had slept with a girl I had also slept with in town. He is the one who told me that if we were circumcised, we would not have got sick.

"My girlfriend is still in secondary school and when she is not around I try to abstain from sex, but I'm not always successful. I don't like condoms; if there is a better way to prevent HIV so that I can enjoy sex skin-to-skin, I will do it.

Yes, it's anecdotal. It's also where we end up when we push circumcision as a panacea for genital diseases. Responsible behavior gets lost. And I'm being forced to pay for this, which will ultimately further entrench a human rights violation when it leads to more infant circumcisions.

As it will, because the push for infant circumcision is purposeful. This is from Uganda, but the sentiment is universal:

Most men and women in Uganda support medical male circumcision as a way of lowering HIV risk, and up to 62 percent of uncircumcised men would consider being circumcised, a new study has found.

The study, conducted by Uganda's Makerere University and Family Health International, which works to promote reproductive health, with funding from the United States Agency for International Development, surveyed 1,675 men and women in four districts; the results were released in the capital, Kampala, in December 2008.

Support for circumcising sons was even greater: almost 100 percent of circumcised men supported the circumcision of their male children, while 59 percent to 77 percent of uncircumcised men were in favour of having their sons circumcised, and between 49 percent and 95 percent of women wanted the procedure performed on their male children. [emphasis added]

I don't think this is a conspiracy. Those public health officials who ignore what the individuals want probably have good intentions. They're pursuing it because they know it works. Our government is happily joining the ride.

And what about those children who will be circumcised as a result?

"The purpose of the research was to find out what is on the ground regarding the capacity to conduct medical male circumcision, and its acceptability among the public," said Dr Alex Opio, assistant commissioner for national disease control. "It was also done to pave the way for developing a policy, because all policies need evidence."

An opinion poll somehow qualifies as evidence. What the individual wants is irrelevant, subjugated to the opinion of his parents. This is what it looks like to start with an outcome and create the necessary support.

Posted by Tony | Permalink | Comments (6)

Oklahoma lawmakers think eyeball tattoos are a dangerous menace:

Senate Republican Whip Cliff Branan said, "Kind of a counter culture trend, the same folks may chose to pierce certain body parts, it's kind of the next level up."

Senate Bill 844 has unanimously passed through the Health and Human Services Committee. Oklahoma City Senator Cliff Branan says it was brought to him by the Oklahoma Academy of Opthamology. He says it's becoming more trendy to tattoo eye liner or eye brows, but this goes too far.

"It is completely patently disgusting and crazy to do it. We as a good public health policy we felt it was important to stop that trend before it goes any farther here in the state of Oklahoma," Sen. Branan described.

In 2006 Oklahoma's infant male circumcision rate was 72%. Parents in Oklahoma may freely surgically alter their child's son's healthy genitals for any reason, and a majority do. That's acceptable in Oklahoma. But an adult willingly choosing to tattoo his (or her) own eyeball is unacceptable because it is "patently disgusting and crazy".

Our society is not sane.

Via Nobody's Business.

Posted by Tony | Permalink | Comments (0)

Imagine you work for Reuters and this study crosses your desk.

Conclusion.The key factor associated with acquisition of HPV was lifetime number of sex partners, whereas circumcision was the most significant determinant for clearance of any HPV infection and oncogenic HPV infection.

You deem that worthy of a write-up. How do you write that up? If you highlighted the greatest risk factor the study identified, you'd be thinking like a responsible journalist. You'd also be unqualified to work at Reuters, apparently, as the story (run by Fox News) shows:

Men who are circumcised may be more protected against persistent infection with the virus that causes genital warts, a new study suggests.

The study, which followed 285 men ages 18 to 44, found that among those who became infected with the human papillomavirus (HPV), circumcised men were more likely to have their immune systems "clear" the virus by the end of the 18-month study.

When it came to the risk of acquiring the virus in the first place, the biggest risk factor was having a large number of lifetime sex partners, the researchers report in The Journal of Infectious Diseases.

The story waits until the third paragraph to present the largest finding, and then it's only as an afterthought. The key lesson we're supposed to take is that circumcision appeared to protect men. That's bias, a conclusion seeking support.

Yet, notice how the article must clarify. The risk is identified "among those who became infected". Isn't that a useful key? We know how men (and women) can protect themselves. Don't sleep with lots of people. Wear a condom. Actions have consequences.

If adult men want to use this study to justify circumcising themselves, I don't care. I think it's unnecessary because there are better ways to protect themselves. Someone else might think differently. But that's not the point of headlines like this. It seeks to push infant circumcision. "See, it has medical benefits," proponents claim. It's propaganda wrapped in the appearance of good intentions.

Posted by Tony | Permalink | Comments (2)

I've been in an on-and-off circumcision debate on Twitter recently with an individual named NotStyro. (My Twitter link.) I find the debate useful because I find his responses inadequate. However, 140 characters isn't enough to debunk the flaws in the link he typically provides. I have a different qualm, but first, a representative tweet from NotStyro on the subject.

just to inform, not debate... [link redacted] ...let me know if you would like more information

I find this understandable within the limitations of Twitter, but unsatisfactory overall because the site he links makes this offer:

Why should you consider circumcision ?

With the anti-circumcision propaganda on the net, consider the following facts:

If parents will make a choice (that isn't ethically theirs), I want more than a list of seven facts of questionable legitimacy. To the extent these facts are facts, they still do not support what NotStyro recently promised a father questioning his son's pending circumcision to go forward with the surgery:

... he'll appreciate your decision later in life.

As he's been in our debate, NotStyro is indifferent to the reality that men, including me, do not appreciate that decision by our parents. This is our fundamental disagreement. I demand only that each individual retain the choice to decide about his body. NotStyro argues differently. But we can't get to it until we agree on facts.

There's too much information in his link for one post, so I'm going to break this up into its logical parts. The list NotStyro links to has seven items. Each item will get an entry. Once I've posted an entry, feel free to debate (i.e. defend) a position. No e-mail or web address is necessary to comment. I'm establishing only one rule beyond normal etiquette: inappropriate links will be deleted. Most links will stay if they're defended. (No canned answers, please; address the items from the list.) But I will not allow a direct link to the list of seven items under any circumstance. The site is a pro-circumcision fetish site, complete with circumcision fiction. I will not promote it. If you must visit it (NSFW), follow the link through NotStyro's tweet above. Anyone may participate, of course. To NotStyro directly, I'm asking for more information.

On to item #1:

1. The foreskin increases the risk of male and female infections.

• 'Current new-born circumcision may be considered a preventative health measure analogous to immunisation in that side effects and complications are immediate and usually minor, but benefits accrue for a lifetime’

"May be considered" is a claim, not a fact. Nor is infant male circumcision analogous to immunization. The threats are distinct. Unvaccinated, I could catch measles by simply going out in public. I am not going to become HIV-positive without specific sexual behavior I can control, regardless of whether or not I have my foreskin.

There is a further complication to the comparison. The recent, actively-touted studies looked only at female-to-male HIV transmission. This is the least common transmission among those involving men. For example:

Female-to-male HIV infection was not observed in long term stable monogamous relationships. These results emphasize the relative uni-directionality of heterosexual transmission in non-promiscuous couples.

That suggests what we already know. HIV is transmitted through promiscuous, unprotected sex. Pretending that circumcision is a significant benefit when neither of those conditions exists is wishful thinking. Circumcised or not, if an individual behaves recklessly, there are consequences. That is the lesson. Parents will be more successful at keeping their sons (and daughters) safe from HIV if they teach them about responsible sexual behavior. No medical expert proposes that circumcised men may now ignore condoms. Circumcision is superfluous and unnecessary. This is particularly true in the United States, where HIV infections result primarily from IV drug use and male-to-male transmission. Circumcision is irrelevant to the former and ineffective to the latter.

The rest of the claim is questionable, as well. Minor complication is subjective, as determined by the victim. You may think a skin tag is "minor"; I would not. I prefer to think of complications as treatable and not treatable. In this case, yes, most complications are treatable. That raises the obvious ethical question of imposing surgical risk on a non-consenting, healthy individual, which I will save for another post in this series.

But what about those complications that are not treatable? These can be lesser problems such as tight, painful erections. If we move up the spectrum, we can discuss males who lose portions or all of their glans. Are we still in the territory of "minor"? What if we go to the extreme, death. It happens. I won't pretend it happens often, but how many times may it happen before we suggest that maybe healthy boys dying from by-definition unnecessary surgery is unacceptable? The lack of medical need demands the answer be 0. It isn't, which demonstrates that we do not rely on facts when circumcising healthy infant males.

Continuing from the list:

• Circumcision reduces the risk of vaginal infections.

Probably, based on some of the studies I reviewed. If, of course, the results were properly controlled and the results are transferrable to industrialized nations. Maybe, maybe not, but I'll concede the point for argument's sake. This is a factual claim. So what?

The underlying issue here is the ethical flaw. It is unethical to alter a non-consenting individual's body to reduce the risk that his future partners - if he is heterosexual - will suffer vaginal infections. That is a decision for him to make. He may include his female partners in the decision-making process. But that is within only his discretion. All else is a speculative guess. A speculative guess involving another's healthy body is indefensible, even if his parents make the speculative guess.

To put it in perspective, a male can't cause vaginal infections if we prohibit him from having sex with women. He can't cause vaginal infections if we remove his entire penis. These are extreme, ridiculous hypotheticals. But they demonstrate that just because we can do something does not mean we should. There is more involved in permitting parental proxy decisions than just the fact that Action X generates Result Y.

Whether or not this generates a debate, and how long that debate transpires, will determine when part 2 appears. I will continue the series, regardless.

Posted by Tony | Permalink | Comments (150)

I want to pass along an e-mail sent to David Wilson of Stop Infant Circumcision Society. There is rough language throughout, but it demonstrates a valuable point. [sic everywhere]:

I've seen the nasty ass excuse of a dick you rocket pop weilding bastards have I love my circumsized penis it is the prettiest dick I've ever laid my eyes on it doesn't smell if I miss a shower either you sick fuck why would you want to inflict a circumcision on a full grown man any way have you seen the process fuck you my dick is gorgeous I love my wang and I sure as fuck wouldn't of made the decision myself as an adult what kind of a fucked up world are you trying to create where an eighteen year old has to decide weather a mental scar like that is worth hygene

I am told that the choice to circumcise only male children for non-medical reasons is a parental right. This is objectively wrong, and this e-mailer is the too-typical anecdotal proof. I will posit that he is not qualified to make medically necessary decisions for a child, so medically unnecessary, permanent decisions should be prohibited. Despite this easy-to-understand truth, he is allowed to circumcise a male child with this thinking because no politician or judge has the courage to reject the status quo and defend the individual rights of all children. Our society is not yet sane on this topic.

Posted by Tony | Permalink | Comments (0)

I loosely follow a rule in my blogging that I don't bother with press releases. They're skewed to push the angle of whoever is paying the bill. It might be worth picking out the propaganda from a press release to find the facts, but I can usually achieve that with less effort by going to news sources to make a point. (Of course, most news sources reporting on circumcision are filled with propaganda, too.) Generally a press release is only good for demonstrating propaganda. This recent press release is a good example:

Hospitals in states where Medicaid does not pay for routine male circumcision are only about half as likely to perform the procedure, and this disparity could lead to an increased risk of HIV infection among lower-income children later in life, according to a UCLA AIDS Institute study.

The first half is fact. The second half is conjecture. News, then propaganda. The HIV-circumcision studies researched the effect of voluntary, adult male circumcision in reducing the risk of female-to-male HIV transmission from heterosexual intercourse. It is inaccurate to draw the conclusion that the foreskin puts men at higher risk of HIV. Unprotected sex with HIV-infected partners increases an individual's risk of HIV infection. The male must first engage in that specific activity to become infected. Focusing on the foreskin distracts from efforts to reduce such behavior.

But that doesn't sell the way fear sells.

But recent clinical trials in South Africa, Kenya and Uganda have revealed that male circumcision can reduce a man's risk of becoming infected with HIV from a female partner by 55 to 76 percent. In June 2007, the AAP began reviewing its stance on the procedure.

By now you know what was left out of that summary, right? When public health officials talk about voluntary, adult male circumcision, they never mean voluntary, adult. Never.

As the press release so helpfully theorizes in its opening line:

Lack of coverage puts low-income children at higher risk of HIV infection

Think of the (poor) children. That's not very original. It has the added bonus of being inaccurate. Are these children sexually active? Specifically for the age of the children discussed in this press release, the answer is no for 100% of them. They are not at risk of (female-to-male) sexually-transmitted HIV infection. But those necessary, contradictory details must be ignored. Think of the (poor) children.

That is how propaganda is done.

Not to let an opportunity go to push for a collective response to an individual problem, the Family Planning Cooperative Purchasing Program helpfully regurgitates this press release, with the necessary bits of speculation helpfully emphasized in bold. An example:

In addition to the overall lower circumcision rates, the researchers found that the more Hispanics a hospital served, the fewer circumcisions the hospital performed. For Hispanic parents, the circumcision decision was about more than simply cost, since male Hispanic infants were unlikely to receive the procedure even in states in which it was fully covered by Medicaid.

What point is FPCPP trying to make with that emphasis, given the sentence that follows it? The only justification I infer is an implicit suggestion that we need to encourage Hispanics to "Americanize". That wouldn't surprise me because it's the typical, mindless support for non-therapeutic genital mutilation in America. And FPCPP files this under "Public Policy", among other categories. See above re: voluntary and adult. If it's not that, I'm stumped.

You and I, through a grant from the National Institute of Mental Health, paid for this research. Mental Health? With mission creep like that, who could possibly worry about government-run health care?

However, this raises the question of national health care and the future of routine infant male circumcision in America. I've long held that the former would not end the latter. The political environment for defending non-therapeutic circumcision is too strong, as evidenced by studies like the one leading to the above press release. No politician is going to say that parents can't circumcise, despite the clear constitutional flaw in our status quo.

Ending public funding isn't sufficient. The state should not pay for mutilation, but fails to end the practice. Poor parents pay for the surgery out-of-pocket. They complain about it, citing the potential benefits as an excuse for why Someone Else should pay, but they pay the cost anyway. Their sons are not protected by their state's lack of Medicaid reimbursement. And ending government reimbursement doesn't always end government reimbursement, as Minnesota's politically-motivated solution showed.

Still, I need to have a think on my position. I won't suddenly support government-run health care, but I should explore the nuances further.

Posted by Tony | Permalink | Comments (2)

LINK: Think government manipulation of intervention in the economy is good? Read George Will's latest column. (H/t: Cafe Hayek)

LINK: Jim Harper has an entry on Cato @ Liberty discussing President Obama's pledge to post all bills for 5 days of public comment before signing them. Mr. Harper reviews the steps the administration has taken and offers a positive review of the idea, although he correctly criticizes the administration for playing loosely with the 5 day timeline.

I agree with that in principle, but that's not my concern here. The deficit spending bill mistakenly labeled The American Recovery and Reinvestment Act of 2009 is now online for public comment. I thought about adding comments, but why? I'm realistic enough to understand that what I say will not matter. It will not matter how many people comment against it, this is a done deal. The five days concept as implemented is worthless political propaganda. Honestly, if members of Congress can't be bothered to read the bill, yet they'll happily vote by party line, they don't care what the American people think. They're trading favors for power. The game hasn't changed. So, wake me when this fails and tell me what the next stupid idea is.

LINK: I reject non-therapeutic infant circumcision because it is logically and ethically unacceptable. I question the science surrounding claims, particularly those involving HIV risk reduction, because there are obvious holes in the argument. However, unlike (too) many activists, I have no problem with vaccines. I think the logical and ethical arguments differ, and I don't believe in conspiracy theories about Big Pharma. And from what I've read, the autism-vaccine link appears weak, at best. This report seems to confirm that (link via Kevin, MD):

THE doctor who sparked the scare over the safety of the MMR vaccine for children changed and misreported results in his research, creating the appearance of a possible link with autism, a Sunday Times investigation has found.

I would use this as a lesson for everyone who thinks that a claimed HIV risk reduction for (adult, voluntary) male circumcision need to be concerned about the long-term reality of their idea. I think we will eventually look back on the HIV-foreskin connection and realize the mistakes in the studies. But I do not approach the topic from that angle. I don't need it, of course. I can concede the point for the argument and rely on ethics and objective indications of health and easier methods prevention.

For now, it's too late anyway. The link has gained widespread acceptance because people want to believe it, regardless of facts or reasonable caution. The mindset is the same, as this excerpt from Orac's post at Respectful Insolence suggests. (I read the post, but there's too much to parse easily, so I'm using the summary pulled by Kevin, MD.)

"None of this will matter to antivaccinationists," he writes, "who view Wakefield as . . . a persecuted scientific hero . . . I'm sure that [anti-vaccine proponents] will wax ridiculous about what a great doctor and man Wakefield is and how it's big pharma and its minions who, frightened by the implications of Wakefield's work, are working hard to demonize him and suppress his 'science.'"

When emotion precedes logic in an objective debate, reason is lost. That would be unfortunate but defensible if it only affected the decision maker. It does not. The individual fears of parents results in poorly conceived decisions for children. Vaccinate but circumcise. Don't vaccinate and don't circumcise. Neither combination is justifiable when weighing the evidence with logic and ethics.

LINK: To lighten things up just a bit, will the Mets never learn?

"Whatever they did last year, they already got paid," [Francisco] Rodriguez told the New York Daily News. Whatever they did, I have all the respect in the world. They worked hard and they deserve it. This is a different year and different ballclubs now. I don't want to make any controversy, but with me and (J.J.) Putz and the additions in the bullpen, I feel like now we are the team to beat."

K-Rod should ask Carlos Beltran how that worked out last year. However, I love this rivalry.

Posted by Tony | Permalink | Comments (0)

The madness continues [emphasis added]:

About 150 patients in the U.K. have already received injections of Vavelta, a foreskin-derived skin treatment aimed at rejuvenating and smoothing skin withered with age or damaged by scarring from acne, burns and surgical incisions, according to a spokesperson for Intercytex, PLC, the Cambridge, England-based company that makes the product. The U.S. Food and Drug Administration (FDA) has not approved Vavelta, nor have any other federal agencies outside the U.K., where it was introduced in June 2007.
...

The fibroblasts in Vavelta are isolated from the foreskins taken from baby boys [ed. note: healthy baby boys], given several months to grow and multiply in the lab, and then packaged into treatment vials that are shipped to a select group of U.K. physicians. Each vial costs approximately 750 pounds, or $1,000], according to the company spokesperson.

I discussed Vavelta in November.

Last week I saw news links similar to this article.

It sounds like just another uber-meltable cheese product, but Vavelta is actually miles away from anything you'd want to put in your mouth. It's a radical new treatment for facial pitting, scarring, and wrinkles made out of—what else?—newborns' foreskins.

I didn't write about it because it's just a new example of something I've discussed before. And, while I'm happy an ethical issue appeared in the article...

There are also ethical issues to consider, especially if the folks behind Vavelta start paying parents for their sons' severed sheaths.

... it hints at the wrong ethical issue. Parents do not own their sons' foreskins. That's why they don't have the right to cut them off, much less demand payment for them. If a similar value worked for freshly circumcised adult foreskins, adult males should be free to sell for the highest price. They're not, because the state thinks selling parts of your body is "wrong". But taking healthy, functioning body parts from a child for no objective reason without his consent? That's somehow a valid parental choice. It's madness.

There was more in the original post, but it's not necessary to repeat for this. I'll add that discarded foreskins from adult males do not work well for this procedure. That changes nothing surrounding the ethical argument that demands stopping this practice.

Posted by Tony | Permalink | Comments (0)

Arguing in favor of circumcising male infant to reduce their risk of HIV infection is flawed thinking, even in places like Africa. It's exceptionally ridiculous when looking at the extent to which pro-circumcision advocates bypass logic. From a recent Reader's Digest Australia article on male circumcision, included in the section labeled "Verdict", this quote:

"‘If it ain’t broke, don’t fix it’ is the understandable attitude of many Australians," says [University of Melbourne] Professor Roger Short. Yet he questions this wisdom. "Australia is blessed with a low prevalence of HIV infection, but parents need to remember their children will encounter high rates in many countries they visit."

How does he know male individuals will visit other countries? How does he know that those countries will have high rates of HIV infection? How does he know male individuals will have vaginal intercourse with HIV infected women? Where logic demands a different conclusion, Professor Short relies on propaganda. He began with his conclusion and grasped for assumptions to build around that to defend what is objectively indefensible.

That's unsurprising because the article is structured to reach one conclusion. Among the arguments offered in favor of circumcision, the article includes "Appearance":

Research by Professor Marvel Williamson from the School of Nursing at Oklahoma City University found women prefer the look of a circumcised penis. "Generally women said it is more sexually appealing," says Williamson. "Ninety per cent of women said it looks sexier and 85% said it’s nicer to touch."

This is a non-medical argument used to excuse surgery on a non-consenting, healthy child. It's also a subjective criterion that will be irrelevant to the 10% and 15% of women, respectively, who disagree with the majority. It will also be irrelevant if the male is gay. This conclusion also demands that we accept an external locus of control for all male sexuality. What the society wants matters more than what the individual wants for himself. Human rights belong to the individual, so we must reject all of this.

But look at what the article explicitly ignored. It's obvious by the location of the research. A quick scan of the study reveals the omission.

This study clearly support the hypothesis that American women prefer circumcision for sexual reasons. The preference for circumcision does not necessarily come out of ignorance nor from lack of exposure to uncircumcised men.

Yeah, noting that the conclusion concerns American women might help Australian parents, except Australian statistics look nothing like American statistics in 2009. Also, this assumes that the mother's preferences - or the father's opinion about his own penis - matters. We're not assuming that because it doesn't matter. Professor Williamson incorrectly thinks it does, as shown in the design of her study:

Of 145 new mothers of sons responding to this survey, ...

Are we really so stupid that a parent's opinion on the sexual aesthetics of a child's genitals is considered a valid reason for surgical alteration? I want to believe we are smarter, but the evidence is very clear that parents can and do use this excuse. That position is indefensible. Remember that all tastes and preferences are subjective, unique to each individual. The choice on whether or not to allow the subjective tastes and preferences of his future sexual partners to influence his decision regarding cultural, medically unnecessary circumcision must be left to him. Ethically, parents may offer proxy consent to circumcision only when medical need exists, and then only when less invasive solutions are insufficient.

Posted by Tony | Permalink | Comments (3)

UNICEF is promoting efforts to end female genital mutilation. This is good. But I'm predictably distracted by the news release.

Female genital mutilation or cutting is the partial or total removal of the external genitalia – undertaken for cultural or other non-medical reasons – often causing severe pain and sometimes resulting in prolonged bleeding, infection, infertility and even death.

Male genital mutilation or cutting is the partial (and sometimes accidental total removal) of the external genitalia - undertaken for cultural or other non-medical reasons - often causing severe pain and sometimes resulting in prolonged bleeding, infection, and even death. I narrowed the reality of total removal and ommitted infertility. Neither of those changes is sufficient to introduce the gender bias that so many demand. Yet, that is exactly what organizations like UNICEF insist upon because (adult, voluntary) male circumcision may reduce the risk of female-to-male HIV transmission during unprotected intercourse. Despite its claims, chasing potential benefits is not a valid medical reason to circumcise non-consenting, healthy individuals - including male children.

Posted by Tony | Permalink | Comments (0)

The "OMG Michael Phelps smoked marijuana" story is still a hot topic, with the general tone thankfully being that this is hardly worth wasting the effort of any brain cells. I concur, but that won't stop the usual idiots from moralizing. The extends a little further to at least the appearance of moralizing, as evidenced by Kellogg dropping its endorsement deal with Mr. Phelps. I regard this as nothing more than a business decision. It's weak and cowardly, but nothing in my support for capitalism suggests that individuals can't be stupid.

Still, this provides a reminder that the company's co-founder, John Harvey Kellogg, endorsed and promoted a radical, not-uncommon opinion for the late 19th century. From Kellogg's book, Plain Facts for Old and Young, here is Kellogg's "cure" for masturbation in children:

In younger children, with whom moral considerations will have no particular weight, other devices may be used. Bandaging the parts has been practiced with success. Tying the hands is also successful in some cases; but this will not always succeed, for they will often contrive to continue the habit in other ways, as by working the limbs, or lying upon the abdomen. Covering the organs with a cage has been practiced with entire success. A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering an anæsthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed. If any attempt is made to watch the child, he should be so carefully surrounded by vigilance that he cannot possibly transgress without detection. If he is only partially watched, he soon learns to elude observation, and thus the effect is only to make him cunning in his vice.

This is one of the contributing arguments that encouraged the establishment of routine, medically unnecessary male circumcision in America. Anyone who denies this origin is misinformed when seeking a gender-based exception to the objective claim that medically unnecessary genital cutting on a non-consenting individual is unethical, whether the mutilated is female or male.

To demonstrate further, this is from Kellogg's writing:

In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will power has become so weakened that the patient is unable to exercise entire self-control.

Victorian-era Americans embraced circumcision because they replaced priests with doctors. They did not replace superstition with science. American medical knowledge of the foreskin accepted a religious foundation for any research, just as American medical knowledge today is ignorant of the foreskin because the circumcised penis is viewed as normal rather than common.

While I think boycotting Kellogg in 2009 because John Harvey Kellogg was despicable in 1888 is melodramatic, the history is worth repeating independent of the company. Boycotting Kellogg in 2009 because of it's business decision regarding Mr. Phelps is a different matter. I support that.

Posted by Tony | Permalink | Comments (0)

Is it ethical to use fertility treatment when the mother already has six children?

How in the world does a woman with six children get a fertility doctor to help her have more _ eight more?

An ethical debate erupted Friday after it was learned that the Southern California woman who gave birth to octuplets this week had six children already.

Large multiple births "are presented on TV shows as a `Brady Bunch' moment. They're not," fumed Arthur Caplan, bioethics chairman at the University of Pennsylvania. He noted the serious and sometimes lethal complications and crushing medical costs that often come with high-multiple births.

So I don't use this solely to leapfrog to my concern, I'll say no, it's not ethical, although I won't go so far as to say it should be prohibited. But if the facts are as they're being speculated in the media, the doctor who administered these fertility treatments acted unethically.

Okay, so to jump to my question. We're talking about whether this is ethical, but not enough people would realize the ethical dilemma this presents for the law. This woman can legally alter the genitals of six of her newborns, for whatever reason or no reason, while her other two newborns are legally protected from unnecessary genital surgery. The general consensus in the American medical and legal community is that this is ethical. No one should be surprised that a ridiculous case of fertility treatment for a woman with six kids can occur.

Posted by Tony | Permalink | Comments (0)

Although I largely ignore Michael Gerson's columns because I know it's going to be feel-good, big government social conservatism, I will defend him on one point from his column today defending ousted PEPFAR coordinator Dr. Mark Dybul and condemning the method of his ouster. Primarily, Gerson states:

A few radical "reproductive rights" groups -- the fringe of a fringe -- accused Dybul of advocating "abstinence only" programs in AIDS prevention. It was always a lie. Dybul consistently supported comprehensive prevention efforts that include abstinence, faithfulness and condom use -- the approach that African governments themselves developed. ...

I conducted a quick search to find proof on what I know about PEPFAR and found this quote from the New York Times, from December 14, 2006:

[Dr. Dybul] also warned that it was only one new weapon in the fight, adding, ''Prevention efforts must reinforce the A.B.C. approach -- abstain, be faithful, and correct and consistent use of condoms.''

So Gerson's point that Dr Dybul is being unfairly attacked on these grounds is accurate.

However, the "it" Dr. Dybul refers derives from the previous paragraph in the New York Times story, an angle I knew I'd find in my research.

Dr. Mark Dybul, executive director of President Bush's $15 billion Emergency Plan for AIDS Relief, said in a statement that his agency ''will support implementation of safe medical male circumcision for H.I.V./AIDS prevention'' if world health agencies recommend it.

From PEPFAR's male circumcision brief, updated January 2009, here is a sample of PEPFAR's work:

In Zambia, PEPFAR continues to support a broad approach to prevention which includes male circumcision. Safe and effective medical male circumcision services are now provided at various sites to reduce new HIV infections and other sexually transmitted diseases. Working with the Ministry of Health, male circumcision is offered at the University Teaching Hospital in Lusaka and the General Hospital in Livingstone, as well as through satellite facilities. PEPFAR is also supporting training, public health evaluation on neonatal circumcision, and the development of comprehensive prevention messages to accompany medical male circumcision services. [emphasis added]

This is an action overseen by an individual Gerson describes as "a great humanitarian physician -- a man of faith and conscience". I have no reason to question the second claim, but one and three are demonstrably false.

I do not expect anything better from the Obama administration's eventual pick to replace Dr. Dybul. Always remember that when public health officials talk about voluntary, adult male circumcision, they never mean voluntary, adult. Never.

Posted by Tony | Permalink | Comments (1)

Last Sunday, The Washington Post published a story about female genital mutilation in Kurdistan. The story is disturbing, as one should expect when dealing with FGM. The pictures - particularly number seven - show the violence involved. I'm going to let most of the story speak for itself, but I have a few comments on the larger topic.

.... In at least one Kurdish territory, 95 percent of women have undergone the practice, which human rights groups call female genital mutilation.

Any regular reader will know that I use the term "female genital mutilation". Rarely will I use any other, and then it's likely to be diminished only to "female genital cutting" if I reference a voluntary action an adult undertakes on her body. But many people incorrectly get caught up in the terms and miss the issue highlighted in the last sentence of that excerpt. Human rights are at stake. It's critical to describe our world as accurately as possible, but it is more important to prevent further violations. To the extent that focusing on terminology helps, let's focus on terminology. But where it prevents us from addressing the correct issue, we need to let it rest.

When I write about male circumcision, I generally prefer to label it "male genital mutilation", its more accurate term. However, I don't use that when I think it will distract from the core message. Being semantically correct helps move the discussion closer to the solution, but being stuck on semantics is stupid if I'm not connecting on the human rights issue.

The Kurdish region's minister of human rights, Yousif Mohammad Aziz, said he didn't think the issue required action by parliament. "Not every small problem in the community has to have a law dealing with it," he said.

This brings up the prominent argument too many libertarians deploy. (Read through the comments on the story at Hit & Run.) Notice the use of an adjective to dismiss the need to protect each individual. This is a common tactic among libertarians and non-libertarians alike. The speaker means to convert the subjective into an objective based solely on the his or her opinion. "Small" problem to whom? Clearly not the 7-year-old now-mutilated girl described in the article, Sheelan Anwar Omer.

But she became more animated when asked whether it was worth it to have the operation so her friends and neighbors would be comfortable eating food she prepared. "I would do anything not to have this pain, even if meant they would not eat from my hands," she rasped slowly.

"I just wish that I could be the way I was before the procedure," she said.

The issue is individual rights. All tastes and preferences are subjective, a core lesson a libertarian must understand. It is not enough to suggest that parents are acting in what they believe to be their child's best interests. Objective standards exist for evaluating parental behavior. The article describes an elderly (mutilated) women describing how genital mutilation makes a woman "spiritually clean so that others can eat the meals she prepares." Our ability to reason suggests that's ridiculous. In the unlikely event that it's true, it is subjective. Each individual should decide for herself.

The struggle against all genital mutilation, female and male, is primarily about the violation of forced cutting where no medical need exists for the victim's genitals. That's a basic human rights concept. It transcends nationality, culture, gender, and degree of harm. Either we defend the principle or we don't. A selective defense based on nationality, culture, gender, or degree of harm is also a selective endorsement of the underlying violation.

From the article, a complication in the flawed "FGM is always perpetrated by men on women" argument:

... The circumcision is performed by women on women, and men are usually not involved in the procedure. In the case of Sheelan, her mother informed her father that she was going to have the circumcision performed, but otherwise, he played no role.

The article stated that one of the reasons it's performed is to control the female's sexuality. Of course. Arguing as I have in the past that FGM is not always performed for this reason is not a denial that control is the dominant excuse in most cases. I merely highlight this fact from the article because the issue is more complicated than what too many anti-FGM activists argue.

From the blog entry at Hit & Run:

As readers of Ayaan Hirsi Ali's memoir, Infidel, can attest, among the most disturbing elements of such practices are the explicit urge to violently control female sexuality (even when the act is mostly symbolic, that's the function it performs) and the way it is enforced by other women. (Read Reason's interview with Hirsi Ali here). Say what you will about widespread male circumcision in the West (and elsewhere, for that matter), but it is not performed as a ritual of punishment defined to rigidify unequal standing in sexual, cultural, economic, and political matters.

I'm only arguing here against the violation of cutting a healthy individual without that individual's consent, not the physical damage caused or the excuses used to justify the violation. The violation is a universal principle. In that context, the argument in that paragraph - particularly its last sentence - is problematic factually and ethically, the latter being embraced with the myopic, haphazard application of individual rights too many libertarians use. (The entry's author, Nick Gillespie, doesn't exhibit that flaw here, in my opinion. But it is pervasive in the comments.)

Circumcision in America has been a tool to rigidify unequal standing in sexual matters, in males and females. (We could debate the other matters, but that's unnecessary here.) The surgery gained its acceptance in America - for male and female children - in the late 19th century as a tool to prevent masturbation. Regardless of how unsuccessful that's been, that is its origin, both medically and theologically. The lingering effect from that is essential to understanding the complete issue.

Then there are the parents who circumcise their sons because mom prefers circumcised partners. Would we accept fathers forcing breast implants on their daughters because dad likes large breasts? The revulsion at the mere hint is obvious. The conclusion with respect to male circumcision is also obvious.

There is little comparison in the degree of inequality typically imposed by male and female genital mutilation. I readily concede the point. But both involve placing the individual's desires below that of another who has physical power over him or her. That is the flaw, the violation of a universal human right.

For reference, Ms. Hirsi Ali states in this documentary that male circumcision is genital mutilation. Again, I'm not equating the typical degree of mutilation. They are different. But the core issue is the violation. That is the same. It's possible to focus on FGM without minimizing MGM.

Posted by Tony | Permalink | Comments (0)

Even though blogging has been sporadic recently, I'm paying attention. I realize I've given far more attention to circumcision than any other topic lately. Rolling Doughnut is not turning in to "all circumcision, all the time," I swear. But the backlog is there right now. So, a little bit more, and then other stuff will return.

Last week I saw news links similar to this article.

It sounds like just another uber-meltable cheese product, but Vavelta is actually miles away from anything you'd want to put in your mouth. It's a radical new treatment for facial pitting, scarring, and wrinkles made out of—what else?—newborns' foreskins.

I didn't write about it because it's just a new example of something I've discussed before. And, while I'm happy an ethical issue appeared in the article...

There are also ethical issues to consider, especially if the folks behind Vavelta start paying parents for their sons' severed sheaths.

... it hints at the wrong ethical issue. Parents do not own their sons' foreskins. That's why they don't have the right to cut them off, much less demand payment for them. If a similar value worked for freshly circumcised adult foreskins, adult males should be free to sell for the highest price. They're not, because the state thinks selling parts of your body is "wrong". But taking healthy, functioning body parts from a child for no objective reason without his consent? That's somehow a valid parental choice. It's madness.

The link came from Hit & Run where I expected to encounter juvenile nonsense, the normal trend of comments there. To my surprise, my fellow libertarians came through in shining glory. Before that, this from commenter Dello:

f I had male children, they'd all get the cut. In the end (of life, that is), it's for their own good.

This is the dumbest excuse I've encountered, although this is not the first time. Dello explains further:

....wait until you're 75, incapacitated, and in a nursing home. Since none of the aides will wash your genitals, having a foreskin means you won't even get fresh water around the head of your penis.

It had to get worse before it got better. The good stuff, from SugarFree:

Yes. Mutilate your penis because you might end up in a crooked rest home. There's a winning argument.

Right. Except, it needs a clarification, provided by Episiarch:

NutraSweet, you have it wrong. It's mutilate your son's penis because he might end up in a crooked rest home. That's even more full of ethical win.

Bingo. Really, how hard is it to understand that most adult males will not end up debilitated in a nursing home that won't care for them properly. Anyway, if it's causing problems at 75, that's a medical necessity. Circumcise then. This is not complicated.

Naturally, someone had to begin the path to logic with an unquestioned regurgitation of simplistic propaganda, as if this dismisses ethical concerns. From J sub D:

A serious note -

Circumcision Gives Men up to 60% HIV Protection; WHO, UNAIDS Urge Adult Surgery

First, condoms. This is not complicated. They're more effective and cheaper. Second, what part of urge adult surgery involves newborn foreskins? The studies used adult volunteers, not infants who can't consent.

Posted by Tony | Permalink | Comments (0)

[Update: I've fixed grammar in the opening sentence. Also, the comments provide a critique and clarification on my point about Islam as it may or may not relate to this proposal.]

I suspect Danish politicians are proposing a ban on male child circumcision because it's an accepted part of Islam. That's the wrong approach, since individual rights achieve the same results without intentionally creating hostility to faith. As long as sanity prevails in the (potential) implementation, the risk is small.

For a thread of comments on this topic, I spent part of my weekend commenting at Amy Alkon's Advice Goddess Blog. I can't say I'm surprised by what's been written there, but Ms. Alkon and a few commenters have been logical and accurate in assessing the issue. I recommend the thread because there are many examples of the thought processes leading to infant circumcision that I've written about.

About the proposed protection of children itself, it would apply to males under the age of 15, the age of majority for bodily decisions in Denmark. It's entirely sensible and consistent with principles of liberty. Naturally, some people oppose it.

While the Social Democrats, Red-Green Alliance and Liberal Alliance have come out in support of a ban, the Danish People's Party called it 'tyranny'.

'It's completely ridiculous to compare the circumcision of girls - which is a barbaric mutilation - with that of boys, where it's just the removal of a skin flap,' said the party's Jesper Langballe.

I don't expect much from any group "People's Party", and this doesn't disappoint. Unfortunately. Ethically, male and female genital mutilation are the same violation. But the issue always gets stuck at the physical results. Anyone who thinks that all FGM is the most extreme version is uninformed, especially if that person doesn't recognize that anti-FGM laws make no such distinctions about results. (Again, correctly, as I've stated many times.) Anyone who thinks that the foreskin is just a "skin flap" is also uninformed. Langballe achieves a perfect score, I suppose.

Yet, the Danish People's Party's health spokewoman, Liselott Brixt, gets it right.

'A lot of parents want it done to their children because they themselves had it done. But we're living in the present and it isn't fair to expose healthy children to religious circumcision.'

Healthy children is a reasoned fact. Religious adherence requires faith. One need not reject faith to recognize that it is not a reasoned approach to medical intervention. The latter must prevail because human rights belong to the individual.

Posted by Tony | Permalink | Comments (8)

I finally figured out how to explain the flaw in the thinking I challenged last week, the flaw that believes male and female genital mutilation are not morally equivalent. The path to missing the truth is clear. The blogger who claimed that gender is a valid surgical distinction assigned his entry to a category - "Medicine" - that misses the point. It's a category that he would explicitly refuse to assign any discussion of female genital mutilation. He would file any such post to "Ethics". That's where he should've posted Wednesday's entry.

In his mind, and in every encounter I've had on this topic, the assumption informing the lapse in reason always rests on the mistaken notion that the claimed potential benefits from male genital mutilation inform the ethics of imposing the procedure on another. It can be helpful, so it is acceptable. Obviously it's desirable for the patient. Obviously. Also obvious, because it's now acceptable and presumptively desirable, it must be desired by the patient. We assume that every male who can't consent would consent if given the option, so there's no need to bother with waiting. Waiting only increases the likelihood that one of the scary possibilities from being intact will affect the male.

But that misses the subjectivity of potential benefits and the evaluation each individual might undertake if he retains his normal choices. There is no medical need at the imposition of the surgery. Ethics must dictate a refusal to impose unnecessary surgical procedures, which is most often nothing more than tradition and conformity masquerading as medicine. The key word is impose. That requires legitimate ethical consideration, a test that cultural and ritual male child genital mutilation fail.

With female genital mutilation, our society recognizes no potential medical benefits. We do not consider the silly idea of chasing any. We assume no benefit and understand the obvious harm. We invoke only ethics, rejecting any hypothetical encroachment of speculative, preventive medicine into the ethics. Everyone in western society accepts that it is morally objectionable to impose unnecessary genital modification on a healthy individual who can't consent, if the healthy individual is female. We know females would not consent to genital modification. Yet, we have evidence that seems to contradict this in societies that practice FGM. In the United States some adult females willingly choose cosmetic surgical alteration of their genitals. We refuse to accept the former and willfully ignore the latter.

This adherence to a gender-based relativism is the ethical myopia that leads to the mistaken belief that male and female genital mutilation are not the same immoral human rights violation. They are morally indistinguishable because humans possess human rights, not just female humans. Society errs every time it sanctions parents imposing surgical genital modification on their healthy child. We've reasoned our way to the proper understanding of female genital mutilation. We need to stop rejecting reason the same proper understanding of male genital mutilation.

Posted by Tony | Permalink | Comments (1)

I want to add a thought to last night's post on whether or not male genital mutilation is morally equivalent to female genital mutilation. (It is.)

Is domestic violence perpetrated by a woman against a man morally equivalent to domestic violence perpetrated by a man against a woman?

The latter occurs far more frequently. Men are generally stronger than women. These do not matter in judging the immorality of the violence because the attack violates the individual. The outcome informs the decision on punishment, but it does not change the original fact that a crime occurred.

What's the difference with male genital mutilation, if not gender and tradition? Neither are effective counter-arguments against facts and individual - human, not just female - rights. Each person owns his or her body from birth. We must permit proxy consent to maximize liberty. Liberty isn't much good if the child dies. But the possibility of future medical problems is not the existence of a medical problem warranting the exercise of proxy consent to surgical intervention.

Any claim that current and future religious/cultural problems may result from normal human genitalia fails the test for permitting the exercise of proxy consent to surgical intervention. Fails it miserably.

Posted by Tony | Permalink | Comments (1)

Last week I saw both of these Tom Toles editorial cartoons, but never together.

And:

The second cartoon, from Friday, is much more effective because it's correct. The first cartoon, from Tuesday, is full of sentimentality but devoid of truth. (To be fair, we moved closer to truth, although not as much as everyone believes.) The success of California's Proposition 8 demonstrated that "All men are created equal" isn't fully realized yet. Maybe it will never be. And there are many issues where our society falls short of the ideal. Denying those because we want some warm, fuzzy feelings for a day is unproductive.

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A post at denialism blog claims that male and female genital mutilation are not morally equivalent. After some buildup, the gist of the entry:

Independent of how you may feel about male circumcision, it does not normally, or even more than very rarely, lead to long-term medical consequences. FGM nearly always does. FGM is not usually as "simple" as a pinprick. And who performs it is irrelevant. If women are co-opted into torturing each other by the dominant male culture, that is most emphatically not a mitigating factor, but a sign of how deeply disturbed gender relations in the culture are.

There are many long-term medical consequences that are discounted or ignored. Scarring is a long-term (permanent) consequence. An asymmetrical incision is a long-term consequence. But those are not what the author implies, so I'll consider it on his strict terms that those should be ignored. Would the removal of too much skin constitute a long-term medical consequence, since it leads to painful erections? Or are we just considering a negative result such as loss of the glans and other extreme outcomes?

Regardless of the answer, the ethical question looms larger. Who decides which medical consequences matter? Risk aversion and personal preferences are subjective to the individual. If the decision-maker is someone other than the individual whose body is altered, the intervention must be medically necessary. Otherwise, the surgery is immoral. Gender is irrelevant.

Notice, too, how the margins are ignored. Some male genital modification results in devastating consequences. Some female genital modification is physically insignificant. Those cannot be tossed aside as irrelevant. They inform the discussion. Why is it that the latter is legally prohibited under all non-medical circumstances, yet the former is considered an acceptable risk in the same non-medical circumstances? We do not get to dismiss inconvenient details.

The last part about who performs the mutilation flows into the author's next paragraph, which I'll break into segments:

Male circ is not a method of controlling males and their sexuality.

This is incorrect. Genital mutilation - of males and females - began in America as a method to prevent masturbation, among many grand claims by its advocates. Today we have the constant defense of the practice for males¹ based on a reduced risk of female-to-male transmission of HIV. What is the justification for modifying the genitals of infant males if it is not an attempt to control their sexuality? The undeniable assumption is that they will not be competent enough to practice safe sex. Remember that the studies from Africa involved only voluntary, adult circumcision. Transferring such findings to infants requires assumptions.

Also consider two very common defenses given for mutilating infant boys in America. Proponents claim that circumcised men take longer to orgasm than intact men. First, consider what that suggests about the long-term consequences on male sensation from the foreskin and the loss of the foreskin. Although I am not making the claim here that this is true, advocates of circumcision always deny this logical conclusion. But it is very clearly meant as the preferred expression of male sexuality. And it is most often imposed on infants. Second, the assumption is that he wouldn't last long enough, however long that might be, without the removal of his foreskin. Another decides for him. I refuse to redefine the concept of control.

The other common claim is that women prefer the circumcised penis. A male's future partner's assumed preference matters exclusively, even though he may prefer to be intact and might choose to reject any woman who would reject him for having the body he was born with. Think of the corrollary. If men prefer large breasts and we forced breast implants on females, would we view that as an attempt to control female sexuality? What is this, if not control?

Continuing:

In nearly every culture that has ever existed (and one might argue that this is even more true of cultures that circumcise), males are dominant. FGM is always---always---a method of controlling women and their sexuality.

If we're establishing that societal attempts to control an individual's sexuality through surgical alteration is immoral, and we are, then we're done. We can wrap potential benefits around the procedure for males, but it is not the least invasive option for any of its claimed benefits. The conclusion is the same. The surgical alteration of a healthy, non-consenting individual's genitals is immoral. Gender is irrelevant to the fundamental moral claim. The extent of the damage is irrelevant to the fundamental moral claim. We may decide that legal punishment should differ based on actual results (including the uncommon extremes for each, which means minimal punishment for lesser forms of FGM), but the act itself is immoral. Every victim - female or male - is a victim.

For a similar analysis applied to religious male genital mutilation, see this entry from my archives.

Posted by Tony | Permalink | Comments (1)

I wish I could send a memo to every newspaper headline writer. It would be brief, saying only "This headline is not clever."

The kindest cut — AIDS-ravaged Swaziland rolls out male circumcision to prevent AIDS

First, notice how - once again - voluntary and adult are left out of the headline. The studies in Africa that have caused the world to lose its capacity to think rationally researched voluntary, adult male circumcision, not forced circumcision of boys. That's an entirely different study, with impossible-to-overcome ethical hurdles.

Next, most dangerous complaint: the studies did not find that male circumcision prevents HIV infection. They concluded that male circumcision reduces the (short-term) risk of becoming HIV-infected. There is a significant difference, clearly lost in the current marketing. Somehow the correct interpretation appears in the story. I suppose the truth isn't sexy enough for the headline. Marketing, folks, marketing.

Finally, regarding male circumcision being "the kindest cut", the implication clearly implies that it's kind on the part of the cutter. Shouldn't the concern be for what and why the individual chooses for himself? For the cutter, it's should be nothing but an objective medical procedure. Hacking away at the body of another for your reasons is unreasonable.

I allegedly have a reduced risk of being infected with HIV through sexual intercourse. I don't engage in risky behavior, so my risk is zero. I do not care about any potential HIV risk reduction. For that reason, and many others, I do not consider my circumcision to be "kind". It's the rudest, most inhumane act as yet committed against me. My opinion is all that matters.

Or, all that should've mattered.

Posted by Tony | Permalink | Comments (0)

I don't know the intricacies of Finnish law. I don't need to know them to know that this is obscene.

A circumcision performed on a Muslim boy in Finland was not a penal offence, Finland's Supreme Court (KKO) decided Friday in a precedent setting case.
...

However, according to the Supreme Court a circumcision done for religious reasons helped the son in the development of his identity. The operation also helped him to become attached to his religious and social community.

How does the court know it helped him in his identity? What they mean is that they assume it will help him develop his identity as a Muslim because Muslim's circumcise. That is an appeal to subjugating the individual to the group. It is anti-liberty. At some point, preferably sooner, tradition must be analyzed for what it is, not how long it has been around, or which non-legally-binding books demand it.

It gets much, much worse:

The court decided that the child's parent was allowed to decide on the operation as it was not against the interests of the child. The boy's bodily integrity was violated only a little and as the operation was conducted under local anaesthetic, it did not cause the child unnecessary suffering.

Why not say it's okay to rape women, as long as the rapist wears a condom? I mean, it's not like he'll get her pregnant or give her a disease. It only violates her bodily integrity a little. Some counseling, a bit of time, and voila, the problem disappears.

Just like circumcision only removes a few thousand nerve endings and some tissue. So what if he's healthy and surgery imposes objective risks. He¹ will be thankful, as long as his parents' subjective opinion demands it. It's minor, really. It's not for the individual to complain. It's merely his body, and what is that, really?

The only valid precedent set by the Finnish Supreme Court is that its judges are insane anti-liberty cretins. Demonstrated by Finland's existing prohibition on female genital mutilation, they're also disgusting hypocrites.

¹ Or she? Her opinion is also irrelevant, subject to whatever whim her parents hold, right?

Posted by Tony | Permalink | Comments (3)

Here are three stories to demonstrate that media reporting on male circumcision borders on propaganda. First, from Aidsmap:

A meta-analysis of studies of circumcision in gay men and men who have sex with men (MSM) has not found sufficient evidence to show that being circumcised reduced their risk of acquiring HIV. Although it finds a small reduction in the risk of HIV infection in circumcised men, this is not statistically significant - in other words it could just be a chance finding. Furthermore, the study, published in the Journal of the American Medical Association, found that although circumcised men who were exclusively insertive for anal sex had a lower risk of infection with HIV, the difference with uncircumcised men was still not statistically significant and could have been chance.

Fair enough, and there are further possibly-relevant nuances in the article. Those aren't my focus here (nor do they overcome my principled objection to forced circumcision). Rather, consider how the editor titled this news:

Jury still out on whether circumcision protects gay men against HIV

What would it take for the jury to finally be in? We see how quickly it's in on unstudied results assumed from a study that appears to give the results the researcher wants. (The answer? Six days.) When the jury gives an answer you don't like? Deliberate further. I don't wonder why.

Note: We can debate the semantics of scientific investigation of the hypothesis and findings, but pro-circumcision researchers use only a very loose application of either.

Second, from Time (emphasis added):

Circumcision is believed to lower H.I.V. transmission in several ways. The inner surface of the foreskin is rich with cells that are more vulnerable to H.I.V. than cells on other parts of the penis; because they are also closer to the epithelial surface and at higher risk for tears during intercourse, they increase susceptibility to infection. Removal of the foreskin further lowers men's odds of developing genital ulcers (from diseases such as syphilis), which in turn lowers their vulnerability to H.I.V. during intercourse. In theory, circumcision should be protective for all men who participate in insertive sex, including heterosexual men and men who have sex with men.

Believed to lower is accurate, because all studies involving (voluntary, adult!) male circumcision and HIV risk reduction look at results. None of them have shown what generates the results researchers claim. There are theories, but nothing concrete. It could be nothing more than flawed methodology, right? Yet, Time reported male circumcision's claimed role in reducing HIV risk as its 2007 medical breakthrough of the year. Has the magazine changed its opinion to one of logically-defensible caution?

Third, from the Jerusalem Post:

Almost a third of male immigrants from the former Soviet Union are uncircumcised, according to a survey by the Geocartography Institute commissioned by the Jerusalem AIDS Project.
...

The survey also found that 2.2% of women who immigrated from the FSU "didn't know" whether their partner was circumcised, and 72.8% of female partners of uncircumcised new immigrants would prefer that they don't undergo ritual circumcision.

That 72.8% figure is interesting. It's subjective, a point I actively make, even when it benefits me. But this is the type of irrelevant statistic pro-circumcision propagandists like Dr. Brian Morris love to spew when their carefully-chosen studies suggest that women prefer circumcised partners. We mark anyone who would argue in favor of compulsory breast implants for teen girls because their male partners prefer large breasts as intellectually ridiculous. The same applies here. What women prefer only matters if the male choosing circumcision for himself wants it to influence his decision. For the anti-intellectuals who don't get this, the propaganda can work against them. They'll never notice, of course.

Continuing, with emphasis added:

Research carried out abroad shows incontrovertibly that circumcision reduces by 60% the risk of a man being infected with HIV by a female carrier. In many African countries with high HIV rates, men are lining up for circumcision, and Israel's experience in circumcising thousands of adult males has aroused interest in the UN and among African governments.

How does incontrovertibly reconcile with believed to lower? In the same way that "six in 10 circumcised men are immune to HIV infection"?

Posted by Tony | Permalink | Comments (1)

I'm always curious to see how our biases encourage us to frame reality. It can be something as simple and unimportant as complaining that the umpire squeezed the strike zone on your team's starting pitcher instead of admitting that each pitch consistently passed the plate over the batter's box. Or it can be something more, as this entry demonstrates in referencing the U.S. Supreme Court's refusal to hear the Oregon circumcision case, which I mentioned yesterday.

UPDATE - My good friend Rabbi Zalman Berkowitz at miyan this morning reminded me that a conversion is in almost all cases not complete without the bris. In other words, the Supreme Court is preventing the kid from his religious aspirations by not ruling in favor of the father. It is not going too far out on a limb to come to the conclusion that this case prevents freedom of religion, and is an invasion of privacy. The case now goes back to an Oregon judge to determine whether the boy wants to undergo the procedure.

That's an interesting way of analyzing the Court's decision that is self-evidently wrong. The blogger assumes that the boy wishes to convert and have himself circumcised. The Oregon Supreme Court concluded that it did not know the answer to that question, only the stated claims of the father (for) and mother (against). The Supreme Court is merely saying that procedural paths short of its consideration have not been exhausted. The Court did not close the option for the boy to undergo circumcision if he indeed wishes to convert and undergo circumcision. But assuming the boy wants the circumcision is (at least) one assumption too many.

It's worth remembering that the Oregon Supreme Court established two tests for the lower court to use in its evaluation. If the boy wants circumcision, the case is over. Fair enough, you will hear no complaints from me. His body, his choice.

But if the boy does not want circumcision, the case continues, with the lower court instructed to determine if the father's imposition of circumcision would cause irreparable harm to his relationship with his son. The court essentially ignored that this would be the imposition of medically unnecessary genital surgery on an individual who objectively denies consent. One person is granted property rights over another if the court rules using a subjective test. Apart from being ethically wrong, that is hardly a precedent for arguing that the state is preventing freedom of religion.

This is also a good time to again state my position on ritual child circumcision. The problem with ritual child circumcision is not its religious aspect. The age - and by extension, ability to consent - of the circumcised is the sole issue. The child can't consent. He might not consent when he can decide for himself. The surgery under consideration is not medically indicated, making this solely an issue of self-ownership. Each person has an exclusive liberty interest in his (or her) body. No one has an option for proxy consent that can ever legitimately overcome this natural right. Claiming a First Amendment protection is no help because the child retains his right to - and from - religion, independent of his parents' opinion. Government also has a legitimate interest in preventing the imposition of objectively identifiable physical harm on another who can't consent.

I've written in the past that the age of majority should be the legal standard for non-medically-indicated surgery. However, I am not opposed to a competent minor deciding for himself that he wants to be circumcised, for whatever reason he prefers. A 12- or 13-year-old may have developed sufficient maturity to decide this for himself. Perhaps the child in this case fits that, and if so, again, you will hear no complaint from me about his decision or his father's willingness to grant that request.

Disclosure: I would not consent to the procedure if my (hypothetical,) healthy 13-year-old son asked to be circumcised, if that matters in considering my analysis. Saying "no" to a child's wish for non-medically-indicated surgery is a legitimate parenting choice. Saying "yes" over a child's objection is not. The former is a temporary denial of a liberty interest based on the parents' subjective judgment. The latter is a permanent denial of a liberty interest based on the parents' subjective judgment. The subjectivity of parental judgment is the crux of this case, as well as the general topic of child circumcision.

Posted by Tony | Permalink | Comments (0)

Here's an update to the ongoing circumcision case in Orgeon, confirming my expectation from May:

The U.S. Supreme Court has rejected an Oregon dispute between a father who wants to circumcise his 13-year-old son against the wishes of the boy's mother.

The case now goes back to an Oregon trial judge to determine whether the boy wants to undergo the procedure.

Of course. I'm not an attorney like the father, but even I could figure out that the Supreme Court would refrain from addressing the issue because the lesser options to resolve the case haven't been exhausted. This is the correct course of non-action.

From a different angle, it will be wonderful when sentence two in the news report is not relegated to an afterthought. It's the question that matters.

Posted by Tony | Permalink | Comments (0)

Hi, I run an active blog here. You may not know it because the top of the main page changes so rarely these days. There are now only 5 posts, including this one, on the 21-day-history main page. But I'm still here, still pondering the world and figuring out what to say about it. Normally that's easy: read news, sit in front of computer, type, publish. Easy.

Yeah, I wish. Really, it takes motivation and creativity. I've had little of the former lately and the latter takes effort. I'm to blame.

More interesting - hopefully - is the reason behind the lull. I didn't know what it was. I just knew that diverted attention left this page stale. The Phillies are still in the playoffs and winning. That takes some. I've also rediscovered my Xbox 360, only to get the Red Ring of Death. And so on.

That was my explanation until Friday night. Driving home, I listened to music rather than talk radio or podcasts. Time to not think actively freed me to figure out my the explanation. Apathy. I've been at this long enough to realize how consistent the themes are. Too few care much about liberty, choosing instead to structure the world according to their own lives.

Ranting here about the bailout bill, for example, would accomplish so little. The narrative is set. Morons like Harold Meyerson rule the day. It won't last forever, but while it does, the anti-intellectuals won't be stopped. I did not favor the bailout, nor do I favor the corporate welfare so many misinterpret as free market capitalism. The story will remain free of facts as long as there is an outcome-determined agenda. The socialist is no different than the corporatist.

I won't change the world. So what? I don't write to change the world. I write because I like it. It helps me process the world. It helps me learn. It helps me teach. And I'd rather focus on individuals. If I convince one person to refrain from circumcising a child, it's worth it. If I provide an insight that helps someone convince someone else, it's worth it. I won't change the world. So what.

In other words, I'm back. The pace probably won't pick up immediately. The Phillies are still in the playoffs, remember. But I've decided to stop being angry that people continue to harm others, be it with the state or the scalpel. I'll write instead. And I'll get angry again. I'll just direct it rather than allow it to fester.

Pathetic? Meh.

Posted by Tony | Permalink | Comments (3)

Here's a story that taps my two main interests:

A MEMBER of the Bagisu Cultural Board has proposed that the retirement age for the circumcision surgeons (Bakhebi) be set at 60 years if their sight is still good.

He said this would minimise the accidents that occur during the operation. John Musila made the remarks at a consultative workshop on the promotion of safe male circumcision in the era of HIV/AIDS, held at Communications Centre hall in Mbale town on Saturday.

I'll take the paragraphs in reverse order. As for reducing accidents during circumcision, clearly not performing circumcisions would be most effective. Again, I do not care what an adult chooses for himself (or herself). But that's not what we're ultimately discussing with this story. When introducing the HIV topic, we inevitably move from voluntary, adult circumcision to involuntary, child circumcision. Making the latter safer is better, but it is barely an ethical improvement.

Now I'll assume only that we're talking about voluntary, adult circumcision. In considering the libertarian implication of the age restriction, I'll also assume the legitimacy of the state licensing the medical profession¹. Obviously it's irrational to have a blind doctor. But what does age have to do with it? A 30-year-old doctor can go blind and a 75-year-old doctor can retain all of her capabilities. The test is competence, not arbitrary lines the may or may not lead us to a good result most of the time.

This is similar to suggesting that we must prohibit medically unnecessary circumcision, unless it's imposed on children to meet their parents' religion. There is no principle involved. In the scenario in the story, if the doctor is competent, no needless limits should be placed on him to prevent him from engaging in his profession. He must be free to trade his services to a willing customer.

¹ My default position on this low-priority issue is an endorsement of something close to our status quo.

Posted by Tony | Permalink | Comments (0)

When I say that the introduction of single-payer healthcare would not lead to the en - or even a significant reduction in - the circumcision of infant males in the United States, I do not hope I'm right. But I still see no reason to think I'm wrong. My analysis includes the evidence that countries with nationalized healthcare don't pay for ritual/cultural circumcision. I also understand that claiming any particular market is somehow different is dangerous. But it's quite clear that Americans have an irrational affinity for cutting the genitals of male children. That is a political rather than economic factor in this debate. Our politicians have never shown an ability to say "no" when confronted with a choice of excessive spending or the potential loss of votes. Wrap in religion and it's a perfect combination for everyone to ignore facts (and the child).

There is one fact in the above narrative that is not accurate. If you've guessed that countries with nationalized healhtcare pay for ritual circumcision, congratulations, you understand politics at the expense of economics. From England:

... medical opinion has swung against it, and the procedure is now mainly carried out here for religious reasons.

As such, according to NHS guidelines, it should only be carried out, and paid for, privately.

But an investigation by More4 News has found an increasing number of health trusts are bowing to pressure, and offering circumcisions free on the NHS.

I'd normally embed the video here. I do not like the still image presented before the video plays. You can find it at the link above, or directly here.

Take note that no one in the report mentions what the boys might want. It's a religious requirement for the parents to impose on their children. That's enough for everyone to ignore the obvious questions beyond the cost, even though unnecessary circumcision is unjust, both morally and legally. But even in a culture like England that generally does not circumcise, mix the parents' religion with an inability to pay and the state pays. America will be different how?

The bit about "unscrupulous circumcision practitioners" is particularly fascinating. The doctor interviewed in the beginning of the report operates in a glass house. No, he's not a mechanic circumcising an infant with a soldering iron. Yet, he is a professional sworn to an oath placing the patient's health as his first priority. As long as his child patients are healthy when he mutilates them, he is nothing more than an unscrupulous circumcision practitioner with training. The physical results may be less troublesome, but those children will still carry the mark of his criminal lack of ethics for the rest of their lives.

Post Script: I still detest the idea of single-payer healthcare because of the inevitable deterioration in health and care before we get to any discussion of rights.

Posted by Tony | Permalink | Comments (6)

I'm curious about the facts behind this arrest, because I can assume several different scenarios:

On 8/26/08 at 6:50 p.m., Victoria Marmontello, 37, of 4224 Aurora Path, Liverpool, NY, was arrested for Endangering the Welfare of a Child, a class A misdemeanor. Released on an appearance ticket, Ms. Marmontello is scheduled to answer the charge before Town of Parish Court on 9/09/08. She is accused of talking about sex and circumcision to minors on 8/07/08 and demonstrating what a circumcision looked like by showing the circumcised penis of another minor to the children while at a campsite located in the Town of Parish.

Hmmmm, what to make of this? There are necessary details missing from this report to get an accurate understanding, so I'll fill those with assumptions. I'll try to make those clear while speculating with my experience-influenced guess.

Probably the problem with talking about sex and circumcision to minors is more problematic to prosecutors because of the sex, not the circumcision. When I speak to minors, I keep the emphasis on circumcision because the kids don't need discussion of sex to grok the angle I take. Sure there are sexual consequences, objective and subjective. Those aren't necessary. Children have rights, and their healthy bodies don't need surgery. Minors of a reasonable age - teen-ish? - will make the connection based on their own knowledge, so I leave it out until they ask questions. And, while I find it hard to pass judgment on discussing sex with minors without the specifics of this case, I err to more knowledge is better than less knowledge. If the allegation is factually correct, I doubt Ms. Marmontello used tawdry terms intending to titillate.

More likely the problem on this point was teaching children about circumcision. I've witnessed parents and chaperons pull children away after realizing that the protest they've stumbled upon is not "innocent". I've heard the comments, usually some variation on "it's your parents' right to decide and they do it when you're a baby". The objection is always about the adults trying to continue their own willful ignorance and forcing the same on their children. Educate children properly and they tend to question. Parents who circumcise don't like that. If our protests weren't at the steps of the Capitol, with police support, I suspect some parents would challenge our rights with a bit more vigor.

None of that is to suggest it's impossible to cross a line when discussing circumcision with minors. It is. But there needs to be more than being factual and anatomically correct.

The thornier question is the latter charge. Again, there are relevant facts left out here. "Showing the circumcised penis of another minor" is not enough to know what happened. I suspect she showed a picture rather than had a boy drop his pants. That's what I'll assume. Such pictures are certainly widely available on the Internet, many of them in the context of the numerous possible complications from circumcision. I don't use them for the same reason I think anti-abortion advocates are stupid to throw around pictures of aborted fetuses. It's counter-productive. And with children other than your own, it's especially stupid. Probably more stupid than showing them pictures of a circumcised adult penis because of the obvious child porn implications.

In agitating against forced circumcision, it's painfully clear that our society is insane about anything related to sex. Medicalized unnecessary genital cutting - male and female - began in America as a solution for masturbation. As much as it's undeniable that I am not the one with flawed thinking on this topic, dancing around society's insanity is just smart strategy. We can and must address it, but trampling on it is dumb. It's possible to teach about circumcision with nearly the same efficacy with a long sleeve shirt.

To be clear, I'm not endorsing Ms. Marmontello's alleged actions. I've assumed the most innocent explanation for the latter charge. There could be more. If there isn't, I don't think that scenario should be a crime. Thoughts?

Post Script: I made it all the way to here without making a remark about circumcision endangering the welfare of a child. So there it is. Cutting your male child's healthy genitals: not a crime. Someone explaining to your children about cutting your male child's healthy genitals: a crime. Yeah, that makes sense.

Posted by Tony | Permalink | Comments (1)

In the sense that the term is used to imply a moral obligation and chosen desire to provide and care for children, I have no objections to discussing parental rights. To some extent that's what I read as the goal in this editorial by Thomas Bowden of the Ayn Rand Center for Individual Rights. I just wish the correct use was the basis of the discussion rather than the caveat. Mr. Bowden introduces the topic in response to the recent ruling in California affirming the legality of homeschooling.

But where’s the real victory for parents’ rights? Rights identify actions you can take without permission. A true victory would have been a judicial declaration that parents have an absolute right to control their children’s upbringing--and that they therefore don’t need government permission to educate their children as they see fit.

There's much more verbiage in the essay taking that same lazy approach. But absolute should not be accepted as a stand-in for nuance. Is this particularly libertarian?

To give parents a permanent victory, California would need to make its law consistent with America’s founding principles. Parents are sovereign individuals whose right to life, liberty, and the pursuit of happiness includes the right to control their child’s upbringing. Other citizens, however numerous or politically powerful, have no moral right to substitute their views on child-raising for those of the father and mother who created that child.

We know that rights are ignored far too often, but that doesn't provide us justification to fling the word about as if expanding its definition and application are all that matter. That justification doesn't exist, nor is that approach to rights correct. Where the individual is concerned, yes, but children are also individuals. Sharing DNA is not a contract capable of converting an obligation into a right. Creating the child is the parents' right as individuals. Raising that child is better approached as an obligation with important qualifications. (I use obligation as an objective term not meant to imply a burden.)

Mr. Bowden gets closer later in his essay:

Of course, there are certain situations in which government must step in to protect the rights of a child, as in cases of physical abuse or neglect. ...

Education, like nutrition, should be recognized as the exclusive domain of a child’s parents, within legal limits objectively defining child abuse and neglect. ...

The qualification is key to advancing liberty first, for each individual. How best to do that, and on which principles, is next. Parents are the correct answer. But setting limits using objective standards should never be lost in the issue. Parents must be free to homeschool their children because they are best positioned to respond to the child's positive right to an education. That is not a concession that the child may be held in a perpetual state of ignorance that will inhibit or prevent her from becoming a functioning, independent adult. Bowden succeeds where he makes that point. I wish he'd gotten there earlier so he'd have more time to defend this proper view of liberty instead of retreating on exaggerated claims.

For discussion: How likely is it that children will respect liberty when they become adults if they're only granted their basic, fundamental liberties at the discretion of their parents? Where liberty is denied, is it really better if parents deny it rather than the state?

Posted by Tony | Permalink | Comments (2)

It's been too many days. Blah, work, blah. More on this sometime this weekend. Moving on.

Many, many circumcision stories have popped through lately. I'm aiming for a quick hit to clear them out. First up:

“In our study we found gay men who were circumcised at infancy didn’t report having some kind of negative or positive impact on sexual dysfunction.

“However, nearly all men who were circumcised after infancy reported some sexual dysfunction, erectile problems or premature ejaculation, and one in five reported some complication as a result of the circumcision. ..."

We all see the obvious flaw, I think. Didn't report. Is it too difficult to extrapolate that self-reporting is subjective, and therefore inferior, to objective considerations. How about I theorize that all circumcision results in some form and degree of sexual dysfunction. Those circumcised at infancy just don't realize it. I can't (and won't) say that's true, but it's no worse than the above.

Next, there was an international conference on HIV/AIDS in Mexico City recently. Of course all discussion of circumcision seemed to focus entirely on the allegedly miraculous power of circumcision. I encountered very little consideration of ethics. I found an example of this indifference in the New York Times, which is almost always reliably bad in this respect.

There was no question about the ethical need for an early stop of the trials. ...

But there was a question about the ethical need to constrain the implementation of voluntary, adult circumcision to adults volunteering to undergo circumcision. Public health officials ignored that ethical need within six days. They've continued to ignore it since.

For example, in an article titled "Not such an unkind cut, after all":

Modern techniques make the risks associated with circumcisions insignificant.

Insignificant according to whom? Not necessarily the person facing those risks, yet that gets ignored in favor of propaganda.

Brisbane doctor Terry Russell, who has performed about 19,000 circumcisions, says he has never had a case in which a blood transfusion was required, or a systemic infection ensued. "We see minor local infection in about 2 per cent of the boys that we do, but most are treated without putting them on antibiotics."

Russell uses the PlastiBell for his procedures, which is a small ring that fits inside the foreskin, over the head of the penis. The foreskin is compressed between the ring on the inside, and a string which is tied to the outside of the foreskin. The clamping cuts off circulation in the area, reducing the risk of bleeding and infection. The PlastiBell accurately defines how much foreskin should be removed, "so you can't take off too much or too little", says Russell.

Too much or too little according to whom? Not necessarily the person losing the (functioning, healthy) foreskin, yet that gets ignored in favor of propaganda. And where there's propaganda, we can almost always find one of our cadre of propagandists. This time, it's Brian Morris:

An unequivocal advocate of circumcision, Morris notes that men who have the procedure enjoy better hygiene."Just general, day-to-day, run-of-the-mill hygiene is so much better in circumcised males. This is something that washing with soap just can't fix, because the bacteria return quite quickly in uncircumcised males," he says.

And female genitals? Other parts?

... Morris claims that the medical benefits of circumcisions are such that the procedure should always be considered a direct medical need.

Morris needs a dictionary that will properly define need, preferably in a medical context.

Morris says one in three uncircumcised males will suffer an illness that will require medical assistance for a disease directly related to not getting circumcised. From this perspective, Morris argues, it is unethical not to routinely circumcise given the relatively simple and painless nature of the process and the harm that can be avoided.

Do women who get breast cancer suffer a disease directly related to not getting a mastectomy before cancer strikes? Morris is playing very loose with logic, yet he gets featured as if he's the reasonable voice. The best¹ the reporter can apparently do to counter Morris is this:

That both pre-pubescent boys and adults can undergo circumcisions might support Mason's contention that the matter should be left until the child can decide for themselves.

It's not "now or never" for circumcision and all its allegedly wonderful benefits. That's a large caveat in favor of considering ethics and human rights, no? And maybe it suggests a more vigorous examination of the bit where Morris equates potential benefits to direct medical need than the reporter attempted?

Finally, via Religion Clause, an article from World Net Daily about a lawsuit in Italy over infant baptism. This particular aspect stood out.

[Alliance Defense Fund senior counsel Joseph] Infranco said, "All parents have the right to raise their children in their religious tradition, which obviously includes participation in the historic rituals associated with that religion."

We could discuss baptism, and I'd probably agree with this statement. But it's far too broad. If we can judge psychological harm, then no, I won't concede the point without a debate. If we can judge physical harm, then I will never concede the point. Historic or not, ritual or not, there is no defense for permitting parents to impose physical harm. Children have individual rights - particularly to their bodily integrity - that can't be ignored in favor of imagined, non-existent rights to treat individuals as collective property.

I didn't really stick with the quick hits, did I?

¹ For those who wish to mix issues and push for nationalized healthcare as a strategy to reduce infant circumcision, the reporter dropped this into its own paragraph as a defense for the clear intention of the article. I think America would see this emphasis on long-term costs more than an emphasis on short-term costs. Or rights.

Reducing the burden of diseases later in life would also save money in the already over-stretched health budget.

When the choice is between hubris and rights, central planners will always choose hubris.

Posted by Tony | Permalink | Comments (5)

In three minutes, this video neatly summarizes much that is wrong with the American mindset surrounding infant male circumcision.

After a bit about "what is circumcision", we have this exchange:

Teen: "Does it hurt the baby?"
Adult: "It doesn't feel good, but they don't remember it."
Teen: "Yeah, but it doesn't matter the memory of pain, it matters the pain or not."

The teen has a natural, reflexive push for simple logic. She gets it entirely correct. As I've argued before, following the "he won't remember it" angle could justify anything short of murder. Something else (ethics, medical need) must get in the way, rendering "he won't remember it" irrelevant. He will experience it. That matters.

Continuing on through the video, the adult pushes to replace logic with emotional conditioning. One of the teen girls asks why all (circumcised) men have "an awkward scar around their penis". After laughter and a bit of disbelief, the adult responds:

"He's talking about probably the separation from the shaft and the head, okay?"

This is ignorant. A scar results from every circumcision. It may be at the separation of the shaft and the glans, although it's usually further down the shaft than that. (Not much, unfortunately, since there are nerve endings in the now-excised foreskin.) But there is a scar. No circumcised male is unique in being free of this inevitability. Any person who's seen a circumcised penis, or even the result of another surgery, knows this if he or she is willing to acknowledge reality despite its interference with preferred fantasy.

Next comes the low point of the discussion from the adult:

"You want your husband or boyfriend or whoever... your husband, yeah, there we go, to be circumcised."

If I told my (fictional) son that he wants his wife or girlfriend or whoever to be large-breasted, implying that he shouldn't be with a smaller-breasted woman because their natural bodies are defective, you would consider me a piggish ass. Rightly so. Forcing one person to conform to the opinion of another is wrong. Including when it involves surgery. Especially when it involves children.

We all remember our economics, right? All tastes and preferences are subjective. Even if I ignore the preferences of the male subjected to circumcision so that he will presumably please his future partner's aesthetic preference, as this woman does, what about the subjective tastes and preferences of these females? They're entitled to their own opinion, as long as it's the adult's opinion that foreskins are gross? Conformity for all? That is wrong.

Apart from witnessing how the development of a young mind is perverted by an adult's careless lack of curiosity, this video is instructive of how males are not the only people injured via circumcision. We expect conformity among females. They just get less unlucky in this debate. We achieve their conformity through manipulation rather than mutilation.

Posted by Tony | Permalink | Comments (0)

This article about serious side effects possibly related to Gardasil is mostly speculation. Point conceded, so I won't use it as fact. Instead, it's worth considering the ethical questions. The (doctor) father of one teen believes Gardasil caused the medical problems his daughter now faces. (Correlation is not causation, of course.) He said:

One thing that's different about Amanda's case than some of the others is that both of her parents medical doctors who didn't think twice about having their daughter get the shot – but are now second-guessing themselves. They call their daughter's illness after Gardasil "a very sobering experience." Amanda's dad says, "as the father of three girls, I've had to ask myself why I let my eldest one get an unproven vaccine against a few strains of a nonlethal virus that can be dealt with in many more effective ways. It's not like they are at high risk. It was the regrettable acceptance of the vaccine party line that [mis]led me."

Don't get distracted by "unproven vaccine" or "nonlethal virus". They're important in both the medical and ethical evaluation, but "can be dealt with in many more effective ways" should be the focus.

Merck, which makes the vaccine, the CDC and the FDA all say it is safe, effective, and important. Speaking of more than 8,000 adverse event reports and more than a dozen deaths, the CDC told CBS News, "we have found no connection between these deaths" and Gardasil. "We still recommend the vaccine and feel it is an important vaccine for the health of women. There are about 20 million people currently infected with HPV. Women have an 80 percent chance of developing HPV by the time they are 50. HPV is most common in people in their late teens and early 20s. Because the vaccine is a preventative and not a cure, it is important that the vaccine be given prior to beginning sexual activity. About 11,000 women will be diagnosed with cervical cancer and 3,600 will die. This vaccine prevents four viruses that account for about 70 percent of cervical cancers." [emphasis added]

The CDC ignores the necessary caveats. It is important to give the vaccine prior to beginning sexual activity if the female will engage in risky sexual behavior and/or weighs the risk of infection greater than the risk of possible adverse reactions to Gardasil, among many factors in the decision. Parents can't know the answers. They can assume, but assuming involves risk greater than they should impose. The threat of HPV is serious but infection is neither automatic nor inevitably deadly. Waiting involves additional risk. But risk involves rights. That can't be forgotten.

Posted by Tony | Permalink | Comments (0)

I'm a libertarian because maximizing individual liberty is the primary goal of collective human action. Whatever the means, achieving maximal individual liberty is the end.

The question is, of course, by what means? I've toyed with the idea - to be honest, not seriously - of no government. I understand and accept the idea that private processes would develop in the absence of a formalized government. The protection of rights present¹ in our current system of government would largely remain. However, given human nature, there is too great a threat to individual liberty inherent in no formal government. A monopoly on force is dangerous, but no such monopoly is not automatically better for the individual. A government with limited, stated powers designed to protect the rights and liberty of all its citizens is, I believe, the ideal.

That is the ideal. We don't live in libertopia, though. Such a government must exist with its limited powers explicit and limited only to protecting rights. I use the term collective human action above to express this narrow, rigid concept of legitimate government. We act together specifically so that we may be free from each other generally.

Since a government's objective is to maximize liberty, I'm interested in minimal restrictions on individuals. The valid test for restricting an individual's free action is objective, unrequested harm. Where an action causes such harm, a government's power to restrict the action is legitimate. Beyond that boundary, any government action is a violation of the powers granted to it by its organizers.

(There is a large, important gray area concerning subjective harm. Although it must be explored to develop a complete political philosophy, I leave that discussion alone for my purposes here. It's pointless to consider the subjective before settling the objective. It is also unnecessary because I wish to consider only objective harm here.)

So, circumcision.

A recent string of Free Talk Live episodes discussed circumcision in the context of how far states should go in preventing child abuse. The show's hosts generally take an anti-state position, relying instead on the expectation that private systems will fill the void if we dismantle the state. In many cases I'm sympathetic to this view. Particularly with economics and all the ways in which our government seeks to improve our world, the state makes obvious, large mistakes because it must plan rather than rely on ever-changing needs to direct the market. But in matters of protecting rights, I am not sympathetic to this view. The state is a means to protecting rights and achieving individual liberty. This function is necessary in any society, and the properly-constrained state is the least bad option. "Properly constrained" is the key, of course. I do not foresee a private market in force being any more properly constrained than the state yet still undertaking the necessary task of protecting citizens.

From the June 11, 2008 episode (approximately 1:26:45 in):

Mike (Caller): So I think we've all agreed that at three or four years old, a child cannot make a rational decision.
Ian: I would certainly agree with you. No doubt about it. And here's what I would suggest. You should go and live on a piece of property that has deed restrictions or private law, whatever you'd like to call it. You can call it deed restrictions, you can call it private law. Then, you know, in that world of private law, you can construct and create whatever sort of rules you want to as far as the behavior of your neighbors is concerned. And if you want to ban things like mutilation, or hitting children, or whatever it is that you consider anathema to your belief system, it would not be allowed by punishment of whatever it is that you determine the punishment should be.
Mark (Host): And before one moves to that community, they have to agree upon those rules.
Ian: Right. Then you wouldn't have anyone around you that was doing those awful things and you wouldn't have to be concerned with it. And then those who wanted to mutilate their children, or whatever, could go and live together in their own little, you know, their own little society.

Being anti-state is the wrong way to approach this issue as a libertarian. Certain rights are inherent and universal to all humans. Do the children in the latter community not have the same rights they'd possess if born in the former community? Children would not choose these community rules as adults would, so the protection of rights become merely the will (or whim) of the strong. Suggesting this as a viable option towards maximizing individual liberty treats children as property. What is it worth to be free of force from the state if you are not free of force from your parents?

Maximizing individual liberty requires limiting an individual's liberty to the extent that his unfettered actions would infringe on another individual's liberty. Doing so in that limited manner protects individual rights. We can argue whether the state or some other method is the best way to maximize individual liberty by protecting the rights of all individuals, but there is no valid argument that this should not be the primary goal of any society.

On June 16, 2008, a caller continued the discussion on circumcision (approximately 17:40 in):

Dan (Caller): Hi, Ian. Umm, a couple weeks ago, or maybe it was last week, I'm a podcast listener, so I get times mixed up.
Ian (Host): Okay.
Dan: There was a gentleman who called in, actually, a couple Christians who called in talking about how they don't want to force their morality on people but, you know, if people are, you know, abusing their kids and you've got to do something, you've got to have the government around to do something. And I just wanted to submit that in a totally free society where you have, you know, where people have the liberty to basically do what they want as long as they're not hurting anyone else, you're still going to have people hurting each other, but it's no different than today. My point was going to be that, uh, why can't the kids, if they have a case that they've been abused, uh, why can't they just sue in retrospect?
Ian: They should be able to.

That continued after a commercial with a restatement (approximately 20:04 in):

Dan: Ok, um, I was talking about how there have been some Christian libertarians who have been calling in talking about how, you know, they they just can't accept the idea that we have to allow everyone full liberty to raise their children how they want to, you know, because, you know, what if, well what if they're, you know, doing something like, you know, they brought up female circumcision or something like that.
Ian: Yeah.
Dan: And what I was saying is why, you know, the burden of proof should be on the accuser. So why don't we allow people to do, to, you know, to raise their kids as long as there's no clear signs of abuse, and if the children are damaged by it, sue in retrospect. That rather than having the burden of proof constantly on the parents so they have to prove to this government that we have constantly that they're not abusing their children.

Proposing a post facto process for recourse in the event of harm is a no-brainer. (What system of mediation, if not the state's legal system?) We have a system for this today that covers all sorts of offenses that are also a crime. Obviously harmed individuals have a claim to compensation against those who harmed them. Offering that as a substitute for prohibition avoids the real issue of rights violations. We prohibit certain assaults despite having options for restitution after the assault because protecting the right of every individual to be free from harm is at the core of liberty.

Unfortunately the typical libertarian approach to hypothetical questions seems to revolve around the assaulted being able to pull out his concealed weapon and stop the assault, hence no need for the state. I exaggerate wildly, even though my hyperbole is useful in hypotheticals because adults have some ability to defend themselves, whether through brains, muscles, or technology. There is merit to the argument of self-defense. But we're not discussing adults. Many, if not most, minors lack sufficient resources in these defense mechanisms. Infants lack all resources. Yet, as citizens with equal, natural rights, all minors must be treated as more than inconvenient obstacles to extending hypotheticals into real world rules. The notion that children complicate libertarian political philosophy - or worse, that libertarianism does not apply to children - is a failure of application, not the underlying principles of liberty and rights. The reasonable concept of proxy consent matters because parents are the proper decision-makers where necessity demands it, but proxy consent does not matter most. No adult has a legitimate claim to violate those rights merely because he or she is the child's parent.

Permitting parents to surgically alter the healthy genitals of their (male³) children grants them an illegitimate liberty interest in altering - and harming - the body of another at the expense of his legitimate liberty interest in self-ownership, a right that includes his foreskin. Endorsing that because it precludes state involvement, even with a post facto compensation system in place, turns antipathy for the state into a fetish, at the expense of individual liberty. Being oppressed in private is still oppression.

The debate continues (I've omitted an inconsequential bit):

Mark: Ok. Yeah, absolutely true. Umm, I think that, uh, people that have been, you know, harmed by their parents in some way should be able to sue and umm, I would think in the case of a female circumcision that likely they would, uh, you know, a jury would find for them. Umm, male circumcision, maybe not so much. You know, pervasive morality matters in a, in a society, and if you're going to get a jury of your peers, you know, they're probably not going to find that you were harmed significantly by a male circumcision. Maybe they will, I'm not sure.

It's a strange kind of libertarianism that places the "pervasive morality" of the majority before the protection of individual rights and objective standards of harm.

Continuing, with omissions for space:

Ian: You mean Dan's idea?
Mark: Yeah, Dan's idea would be, would take care of it relatively quickly because, well, people don't want to be sued.
Ian: Well, right, because, uh, if there was a judgment against the parents in that particular case then, uh, then the other parents that were considering doing that would have to think twice.
Mark: Absolutely. And of course social ostracization would, uh, keep these types of things from really cropping up within private, voluntary societies so you'd have private arbiters, you'd have parents who, and uh uh and new new parents who would already have signed on to the rules. And, uh, man, if they broke those rules, they would not be able to prosper, and they would be hit pretty hard financially.

There is some merit in this argument, but as it applies to doctors, not parents. That's already starting in the U.S. It will have more impact as the courts become more sympathetic to the proper inclusion of medical ethics into unnecessary genital cutting.

With parents, we're back to being stuck with the pervasive morality of the majority at the time of the circumcision, and parents already ignore what their son may or may not want in favor of what they think he wants, or worse, what they want. That misses the point. A male can later make the case that he was harmed, but this solution relies on two faulty assumptions. First, it assumes the male minor's (obvious) rights aren't worth protecting while he is a child, perhaps merely because his parents circumcised him rather than a stranger. Their liberty is more equal than his liberty. This can never be correct.

Second, it assumes that money will sufficiently compensate him for his lost foreskin. Not all men would accept that trade-off. Not all parents will be able to fund a judgment against them. And if they don't expect to have the resources in the future, would the parents be concerned enough about a possible future judgment to not circumcise? Nor will all parents with the financial means to fund a jury's punishment value the lost dollars more than whatever value they place on the act of circumcising their sons. Remember, all tastes and preferences are subjective. Just as the evaluation of the foreskin's worth will vary by individual, the evaluation of the worth of a dollar (or a million or a billion) relative to pleasing God/a perceived reduction in HIV risk/avoiding the "ick" factor/etc. will vary by parent(s). There simply is no reliable way to predict what individual's will do. Incentives matter, but not everyone responds the same way to the same incentives.

This hypothetical system also ignores the extreme cases where the harm to the boy is greater than the typical circumcision outcome. It seems reasonable to suggest that the rare boy who dies from circumcision will not be satisfied by the possibility of money he can't collect.

We're left with individual rights as the only defensible guide for what system should be in place. I can't make this point enough. Every individual, regardless of age, has the same natural rights. An age-based inability to defend one's own rights does not render those rights subject to the will of another, even a parent. What system will protect those inherent, equal rights? If you value liberty, that is the discussion. If you value only the dismantling of the state, understand what your position entails. Don't wrap it in talk of liberty and pretend you've found an intersection that bypasses the state. You haven't because compensating the violated after an identifiable, predictable violation rather than protecting before the violation has nothing to do with liberty.

I'll end with a concise statement of the philosophical consideration at hand, from D.A. Ridgely at Positive Liberty (from a different context):

The quintessentially libertarian position, in any case, is that the burden must fall on the state not before it permits some exercise of individual freedom but before it prohibits it. It is, by contrast, the quintessentially conservative position (of the Burkean variety) that tampering with long established traditions and institutions is so inherently risky that we must apply the social equivalent of the precautionary principle before proceeding.

I'm arguing the quintessential libertarian position. I'm not willing to concede that parents have an absolute right to make medical decisions for their children. Such a right assumes the option to make objectively stupid medical decisions for another. I'm thinking of parents who let their children die while waiting for prayer to save them. Still, parents deserve at least first - and great - deference to their judgment. The burden falls on the state to prove that it may prohibit the circumcision of minors. Where direct medical need is absent, as it is absent in ritual/social circumcision, the objective infliction of harm on the child to achieve subjective benefits valued by the parents, however well-intentioned, is sufficient proof that state prohibition is not only legitimate, but a requirement to protect rights and maximize individual liberty for everyone. Imposing routine/ritual circumcision is not a medical decision, so the decision deserves no deference. Whatever system is in place must recognize that and protect the child. The private system proposed by Free Talk Live is unacceptable because it fails to embrace liberty for all.

¹ Admittedly, our representatives disregard this duty. This is a flaw in execution, not design. But it's presence in our government is a significant, complicating issue.

² By force, I mean objective harm. The state does not have the constitutional power to cut your genitals at the discretion of its representatives, at least not without due process. (Also, see footnote ¹.)

³ The distinction permitting only the circumcision of male children demonstrates our unprincipled, unequal understanding of the rights of children.

Posted by Tony | Permalink | Comments (2)

When public health officials say voluntary, adult, ...

The soldiers in the Rwanda Defence Force (RDF) will be the first men to benefit from a government policy to use male circumcision as a tool in the fight against HIV/AIDS, according to senior health officials.

... The voluntary circumcision programme is expected to start in August.

"We will use the military as role models for the rest of the population – they are adult enough to give consent, and if young men see that soldiers are willing to suffer the pain of circumcision, they will also get the courage to do it," said Dr Agnes Binagwaho, executive secretary of Rwanda's national AIDS commission (CNLS).

... they never mean voluntary, adult. Never.

"After the military we will concentrate on students and, finally, on the general population; eventually we hope to move on to circumcising new-born babies, as long as research proves that it is advantageous and cost-effective to do so."

Want to bet research will prove that infant circumcision will be advantageous and cost-effective, in spite of reality that Rwanda has "only one doctor for every 50,000 people"? Should it skew the analysis against infant circumcision that the rate of HIV infection in Rwanda is higher in circumcised men than in intact men? Of course, but it won't. It's so much easier to blame the foreskin than the male attached to the foreskin.

Also, should we put trust in Dr. Binagwaho when she couldn't pass a basic statistics class?

"People must be made aware that although circumcision is beneficial, there is still a 40 percent risk of HIV transmission, so they must know that it must be used in conjunction with another HIV prevention method, such as condom use," she said.

I expect those unfamiliar with statistics to make such a mistake. Is it too much to expect a doctor to be familiar with statistics?

Post Script: Based on the article's closing paragraph about funding for Rwanda's circumcision plan, I feel confident that I will eventually be able to remove my updated qualification from this entry. The plan outlined in the article is stated in Rwanda Fiscal Year 2008 Country PEPFAR Operational Plan (COP). We will continue throwing money at this ignorance.

Posted by Tony | Permalink | Comments (1)

There is much to commend in this article, but like all attempts to be unbiased on a topic where introducing subjectivity is the only method for achieving balance, the conclusion veers into scare tactics.

[Opponents] declare [circumcision] mutilation.

But there is another side to the story.

Dave, who didn't want his full name used to protect the privacy of his circumcised 19-year-old son, objected to the practice after his son's birth.

"I went through it, and I didn't want him to go through it," said the 48-year-old electrical engineer from Chantilly in Northern Virginia. "They cut millions of nerve endings that would be nice to have." [ed. note: thousands of nerve endings]

But, as his son grew, he couldn't pull the foreskin back far enough to clean it without significant pain. He stopped cleaning, and infection after infection of the penile head and foreskin ensued, turning his penis beet red.

"We ended up doing the circumcision when he was 5," Dave said. "It was awful. For years after, he got into the bathtub only gingerly, putting his hand over those parts the whole time."

Now, Dave advocates having the procedure done as soon as possible after birth.

"My son suffered by not being circumcised early," he said. "And I wonder what long-term impact that has had on him."

This is not another side to whether or not it's appropriate to circumcise healthy male infants/children. This is an emotional appeal to a child's ability to remember surgery and the unlikely-but-possible risks of life. Even a cursory look at circumcision statistics in other Western countries will confirm this article's anecdote to be devoid of any merit as a defense in favor of imposing surgery on healthy children to avoid risks later.

It should be clear that I understand some males will need medical intervention on their genitals if left intact. (And if circumcised.) That is not then justification to circumcise children. Many females (and some males) will eventually need some kind of medical intervention for breast cancer. We do not see that as a defense for removing the breast tissue from infants because we are not irrational on that front. Apply a speck of reason and the similar excuse for male child circumcision fails.

To the anecdote directly, I can only speculate. It is not unusual for the foreskin of a five-year-old boy to at least partially adhere to his glans and inner foreskin. Pulling the foreskin back further than it can easily retract is bad and can cause pain. (Almost as bad as forcibly separating the foreskin from the penis prior to circumcision.) Perhaps that occurred here. I've certainly heard of parents being aggressively determined that the foreskin should retract fully before it naturally separates. This can lead to problems.

But, again, I'm only speculating. Speculating is pushing limited facts into a preferred narrative. Dave speculates to the reporter. (Circumcised males get infections.) I'm speculating here to illustrate the process. I don't need speculation to defend my position. I'm willing to concede that Dave's anecdote is exclusively an example of the risk of being intact. It happens, unfortunately. But where his stance needs speculation and anecdote, I have reason and evidence:

"... And, urinary tract infections are so rare in baby boys that the increased risk of it isn't significant," [pediatrician Roxanne Allegretti] said.

Anecdote of the "my best friend's cousin's first-grade teacher's next-door-neighbor's driving instructor once had <insert problem here> with his foreskin, leading him to get circumcised at <insert age here>, and he definitely remembers the horrible pain" is not a compelling reason to perform surgery on healthy children. Healthy and surgery are mutually exclusive for those who can't consent.

Posted by Tony | Permalink | Comments (1)

Ignorance can speak truth, even when ignorance doesn't intend something so broad (emphasis added):

... I feel that "female circumcision" gives this practice a veneer of respectability to hide behind. Uninformed people likely know that male circumcision is done mainly for hygienic or religious reasons and has nothing to do with sexual pleasure or causing other problems down the road, as mutilation may cause with menstruation and childbirth. Circumcision is pretty much the opposite of mutilation as far as having an effect on a person.

So "female circumcision" sounds kind of like a benign minor medical procedure, while "female genital mutilation" tells it like it is. I don't think calling the practice circumcision will fire many people up against it - it almost sounds like a P.R. phrase for genital mutilation, designed to mask what really happens.
This practice has also made its way to the United States, through immigration.

I don't think calling the practice circumcision will fire many people up against it - it almost sounds like a P.R. phrase for genital mutilation, designed to mask what really happens. Indeed. It's almost as if Americans embrace that mentality with our treatment of male children. Almost, of course, because only They™ engage in immoral actions. We™ are always correct, never to be questioned again.

I will be using that quote frequently in the future.

Posted by Tony | Permalink | Comments (1)

I wonder if these two Ugandan MPs have ever spoken to each other. First:

THE parliamentary food forum has asked the Government to provide funds for the a campaign against female circumcision. Addressing journalists at Parliament on Friday, Bukwo Woman MP Everline Chelangat urged the Government to establish vocational institutions for girls to fight the custom.

Second:

THE chairman of the parliamentary HIV/AIDS committee has appealed to men to embrace circumcision to reduce the risk of contracting the virus.

“There is nothing to lose when you remove the fore skin of the penis. Men who are not circumcised are more prone to HIV/AIDS,” Dr. Elioda Tumwesigye said on Saturday.

Dr. Tumwesigye is wrong about what a man loses from circumcision, and he is too broad in his declaration of the benefit against HIV because he ignores the necessary contributing factor, an HIV-infected female partner and condom-less sex. But where he accepts the distinction of choice in losing his perceived nothingness, these statements on male and female genital cutting are reasonably congruent, if slightly tone-deaf. As I've always advocated, I do not care what an adult - male or female - chooses to do to his/her genitals. Leave it alone or hack away. MP Chelangat is clearly arguing against forced cutting. I just wonder whether or not that distinction of choice exists in Tumwesigye's intent:

Tumwesigye noted that attempts to make circumcision compulsory for men had failed because of the misconception that it was a practice only for Muslims.

I won't read that as a statement that Tumwesigye isn't interested in choice, although I think such an inference makes sense. Where are those attempts originating? If that's what he's saying, I'm not surprised. Respecting the science makes many doctors forget the ethics. I don't know why, but it does. I think I'll have more on that idea in the near future.

There isn't much more to say than, from a marketing perspective, it's fascinating that these two articles appeared on the same day in the same news outlet.

Posted by Tony | Permalink | Comments (0)

In response to the Jeremy Kuper essay I criticized yesterday, Laura MacDonald writes an excellent rebuttal demonstrating how little attention Kuper gave the topic beyond the superficial evidence that he believes supports his decision to circumcise his son. This is excellent:

Specifically, let's talk about the foreskin itself. Its function is – bizarrely – one thing you'll find absent in most of the discussion articles written about circumcision.

... Often presented as a "tiny" vestigial flap of skin, most particularly by women and by men who haven't got one, a male foreskin measures around 10-15 square inches when unfolded, some 50% of his overall penile skin system. ...

Right, then. Next time they'll try harder, I'm sure.

For the sheer giggle factor of proving how extreme and indefensible circumcision is when compared to other interventions (i.e. condoms), this:

There is no convincing proof that circumcision reduces sexually transmitted infections in developed nations, and its effect on penile cancer rates is similar to that of soap.

I know. Soap, the preposterous suggestion we needn't bother offering to men. Especially since they won't need soap after circumcision. Or does that not make any sense? Whatever. As long as parents get to cut their children in the end, every absurd justification is logical.

Posted by Tony | Permalink | Comments (0)

In an attempt to defend the indefensible (i.e. circumcising his healthy son), Jeremy Kuper writes a rambling, disorganized essay at Comment is Free that skims only the surface on each aspect of the debate. Moreover, he includes the euphemism "member", so the weight of his position automatically suffers according to my rule on penis euphemisms. You can read the essay, if you're interested, but I already wasted enough time for all of mankind. Consider it not worth your time. And as proof, Kuper writes this near his conclusion:

Possibly the worst effect of circumcision for Jewish people, is the accusation that it is a form of mutilation, and cruelty to a small baby who is unable to give his consent.

Merriam-Webster defines mutilation as "to cut up or alter radically so as to make imperfect" or "to cut off or permanently destroy a limb or essential part of". Someone takes a blade to a child's healthy genitals and removes a functioning part of the body. Are we going to quibble over "essential", because in the context of the foreskin, the clitoris holds no greater objective essentiality. I am not making an accusation that circumcision is a form of mutilation. I am stating the obvious truth that all forms of genital cutting on healthy, non-consenting individuals is mutilation.

Some uninformed critics even appear to confuse it with the horrendous practice of female circumcision, and the removal of the clitoris in some cultures, which is now largely banned. Dr Nahid Toubia argues that the term female circumcision "implies a fallacious analogy to non-mutilating male circumcision".

Kuper is the uninformed individual in this debate. I "confuse" male and female genital cutting because they are the same act: medically unnecessary genital cutting on a non-consenting individual. That's not a complicated analysis to arrive at. A few minutes spent objectively considering the act of circumcision could get to that understanding, even if he was unwilling to accept the comparison.

A few more minutes spent researching female genital cutting would demonstrate that removing the clitoris is FGM, but FGM is actually a spectrum of offenses that involve surgical alteration of the female genitals. A quick trip to Google reveals the four recognized types. At least one type is no more damaging than male genital cutting, yet all non-medically-indicated female genital cutting is illegal in Western societies. If I am to be the person who is wrong in this debate, then Kuper must defend the position that legislative bans on all female genital cutting are too broadly defined.

He must also reject the Western liberal tradition of gender-neutral equality under the law, but I'll accept one concession to facts and modernity if his ego can't handle an honest, complete exploration of the topic.

Posted by Tony | Permalink | Comments (1)

I'm still catching up on some of the circumcision-related news items form the last few weeks. Sometimes, I step away from the topic for short periods to recharge my tolerance for the inevitable frustration that arises when considering the various ways the rights of the circumcised are ignored, and the manner in which every breathless proclamation seems to instill even more determination that every male will just love being surgically altered shortly after birth. Stepping away eliminates reduces the number of verbal tirades I feel compelled to unleash. I always come back, though.

This story, forwarded to me by a loyal reader who forwards me useful material that I too often fail to translate into entries, is worth mentioning. Now that I'm looking, I can find a few references to it, but most media seems to have ignored it. Probably because it directly challenges the cheerleading for infant circumcision in the recent past. Anyway, the gist:

A quarter of a century after the outbreak of Aids, the World Health Organisation (WHO) has accepted that the threat of a global heterosexual pandemic has disappeared.

In the first official admission that the universal prevention strategy promoted by the major Aids organisations may have been misdirected, Kevin de Cock, the head of the WHO's department of HIV/Aids said there will be no generalised epidemic of Aids in the heterosexual population outside Africa.

This is the appropriate point to remind everyone - the unethical scientists at WHO specifically - that the recent research we've been bombarded with repeatedly for the last two years suggests that voluntary, adult male circumcision reduces the risk of HIV transmission from female-to-male through heterosexual intercourse. Those infants who've been circumcised in the mad rush to embrace fear unsupported by at least the anecdotal evidence any mildly observant individual in a Western society could pick up? Ooops. But, hey, women will dig it, so there's that.

In case you think this might cause the media to apply any critical thinking to the way they've reported on circumcision, fret not, they're fully prepared to let you down if you get optimistic. In the same article, this:

Critics of the global Aids strategy complain that vast sums are being spent educating people about the disease who are not at risk, when a far bigger impact could be achieved by targeting high-risk groups and focusing on interventions known to work, such as circumcision, which cuts the risk of infection by 60 per cent, and reducing the number of sexual partners.

Interventions known to work. Process that for a moment. It's known to work¹ at reducing the risk of HIV transmission from female-to-male through heterosexual intercourse! Isn't the point of this story to report on the possible exaggeration of an epidemic among heterosexuals? I can imagine the editorial review of this article. "Everyone, shake your pom poms with me. Give me a "C"! Give me an "I"! Give me an "R"! Give me a "C"!

I won't put it in print, but I'm swearing right now.

¹ There is room to debate this, primarily on methodology. Another time, perhaps.

Posted by Tony | Permalink | Comments (1)

Via Amy Alkon, a story with some relevance to my stance that medically unnecessary male circumcision of all minors should be prohibited (and enforced, where necessary) by the state. From Canada:

A Canadian court has lifted a 12-year-old girl's grounding, overturning her father's punishment for disobeying his orders to stay off the Internet, his lawyer said Wednesday.

The girl had taken her father to Quebec Superior Court after he refused to allow her to go on a school trip for chatting on websites he tried to block, and then posting "inappropriate" pictures of herself online using a friend's computer.

In the case of cultural circumcision, which includes medicalized circumcision that seeks potential health benefits, the obvious first standard for what to prohibit is objective harm. Circumcision is surgery, so it always involves objective harm to the body. When there is no medical need for the surgery, forcing it on another person is an assault, regardless of the intent. Preventing this type of harm to one by another is a legitimate function of any state. Prohibition of medically unnecessary circumcision forced on minors is valid. QED.

Discussing the male circumcision issue within the libertarian community is an interesting process. Strangely, many libertarian males seem displeased, however mildly, about their parents circumcising them. Yet, in an odd consideration of limited government and individual liberty, they also seem reluctant, often vehemently, to consider state involvement. This is more a misdirected focus on minimizing the state as the ends than on maximizing liberty with the best, possibly necessary means. (More on this to come in a detailed post I'm working on.)

But there is a limit to legitimate state intervention. Always, the first response I get in the libertarian discussion is that parents make all kinds of decisions for their children that the child may not like, should we legislate those? I think that logical leap is lacking in logic, but it's not (generally) offered with malice, so it's worth considering. I usually discuss some combination of objective harm and the permanence of choices. Unless one is being intentionally ridiculous, it's worthless to advocate an exact comparison between requiring your child to take piano lessons and requiring him to undergo unnecessary surgery that removes portions of his healthy, functioning anatomy. "Requiring" is a key word in considering intervention, but "unnecessary" is the much more important word as it ties directly to objective harm. Surgery causes objective harm in a manner that piano lessons do not. The difference, to some degree, is parenting. I do not favor state intervention in normal parenting, nor have I written anything that could be construed as favoring limitless intervention. I offer specific guidelines for legitimate state intervention.

Which brings us to this case from Canada. I guess it's possible that there's more to the case than the reports I've read. It seems hard to believe that, so I will assume there is nothing more. So, this judge made an egregious error. The state's intervention is illegitimate.

It's not controversial to accept that, which gets us back to the more fundamental issue. What is the legitimate boundary for state intervention? It's somewhere short of this case, we all probably agree. It's at least as far as prohibiting the assault of children, however well-intentioned. We don't all agree, or I wouldn't be writing this. But I've made an argument in favor of my stance that outlines criteria for deciding how to limit or condone state involvement in parenting decisions. This case shows that my effort is an attempt at an objective standard that aims to protect the rights of all individuals, regardless of their power within society based upon having not reached the objectively arbitrary age of majority.

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I only know the facts to the extent that the article states:

School board members voted 5-0 to fire Mount Vernon Middle School science teacher John Freshwater. Board attorney David Millstone said Freshwater is entitled to a hearing to challenge the dismissal.

Freshwater denies wrongdoing and will request such a hearing, the teacher's attorney, Kelly Hamilton, told the Mount Vernon News.
...

Freshwater used a science tool known as a high-frequency generator to burn images of a cross on students' arms in December, the report said. Freshwater told investigators he simply was trying to demonstrate the device on several students and described the images as an "X," not a cross. But pictures show a cross, the report said.

I stand firm on innocent until proven guilty. Until he has a hearing, I'm not interested in saying much more than anyone who would teach religion in a science classroom is not qualified to teach science. I hope it's obvious that anyone who would burn an image on a child's arm, be it an "X" or a cross, is fit only to wear a prison jump suit.

That said, is this about violating the First Amendment rights of the children or violating their human rights? Change the scenario: would we allow parents to burn an image of a cross on their child's body? Many will reflexively offer some variation of "of course not". But that's not accurate. We already allow parents to "burn" a (permanent) religious mark on their (male) child's body through genital mutilation. And that doesn't disappear in three or four weeks, as the burned image of the cross/"X" disappeared. Why is the less damaging, less permanent assault reprehensible and the more damaging, more permanent assault considered a reasonable parental choice?

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Still catching up from the last two weeks, this was in the first draft of my last entry. It got a bit too long, so it became a stand-alone entry.

Via Andrew Sullivan, this quote from UNAIDS on travel restrictions placed on HIV-positive individuals by the United States (pdf):

UNAIDS recognizes that States impose immigration and visa restrictions as a valid exercise of their national sovereignty. However, in imposing any restrictions on entry and stay relating to HIV or health, UNAIDS calls upon States to adopt non-discriminatory laws and regulations which rationally achieve valid objectives through the least restrictive means possible.

UNAIDS would like to take this opportunity to reiterate that HIV-related travel restrictions have no public health justification. It is also our view that, where such restrictions are based on HIV status alone, they are discriminatory. There is no need to single out HIV for specific consideration as an exclusion criterion. ...

Etc, etc. Exactly how much hypocrisy is allowed before principled becomes merely a mish-mash of preferred outcomes? How long ago did UNAIDS pass that point? A non-discriminatory recognition of human rights would be an excellent start, as opposed to something like this (pdf):

7.3 Since neonatal circumcision is a less complicated and risky procedure than circumcision performed in young boys, adolescents or adults, such countries should consider how to promote neonatal circumcision in a safe, culturally acceptable and sustainable manner.

Now compare with this, from the same link:

The message that male circumcision is very different from female genital mutilation also needs to be emphasized.

Or this:

Female genital mutilation, also called female genital cutting and female genital mutilation/cutting, violates the rights of women and girls to health, protection and even life as the procedure sometimes results in death.

Which can be said about male genital cutting. Still, UNAIDS doesn't discriminate because it puts this in its report on "Safe, Voluntary, Informed Male Circumcision and Comprehensive HIV Prevention Programming" pdf:

Governments that introduce or expand services for male circumcision will have a responsibility to
launch public health campaigns that:
...

(iii) emphasize the voluntariness of male circumcision;

(iv) clearly distinguish male circumcision from female genital mutilation, which is a violation of the human rights of women and girls, is illegal in most countries where it still takes place, has no health benefits and carries considerable physical and psychosocial risks for girls and women;
...

The male genital cutting UNAIDS pushes is hardly voluntary, which makes it a violation of the human rights of men and boys. But we can't say that because then we'd have to question what's been done to so many. Instead, UNAIDS needs to silence criticism by drawing odd, strained attention to only the outcomes that fit its narrative. (It is hardly alone in this, of course.) For example:

How is male circumcision different from female genital mutilation?

While both male circumcision and female genital mutilation are steeped in culture and tradition, the health consequences of each are drastically different. Female genital cutting or mutilation comprises all surgical procedures involving partial or total removal of the external genitalia (type I) or other injuries to the female genital organs. ...

And on it goes, willfully missing the obvious truth that the more than one million cases of "voluntary" male genital cutting or mutilation performed each year on infant males in the United States comprise surgical procedures involving partial or total removal of the external genitalia or other injuries to the male genital organs. The inherent human right to be free from that without consent does not disappear simply because cutting a boy's genitals might reduce his risk of HIV in the future if he has unprotected sex with an HIV-positive female.

Infant male circumcision: ethical, legal and human rights considerations

Studies have shown that the circumcision of infants is simpler and carries fewer medical risks than circumcision of older people. Parents considering circumcision of an infant boy should be provided with all the facts so they can determine the best interest of the child. In these cases, determining the best interests of the child should include diverse factors—the positive and negative health, religious, cultural and social benefits. Because the HIV-related benefits of circumcision only arise in the context of sexual activity, and because male circumcision is an irreversible procedure, parents may consider that the child should be given the option to decide for himself when he has the capacity to do so.

And given the irreversible nature of circumcision, what happens when a male decides that having his normal, healthy foreskin would be in his best interests? Setting aside the topic of (potential) health benefits for the moment, parents may argue for positive religious, cultural, and social benefits for female genital cutting. UNAIDS recognizes that none of those are legitimate, so it rightly dismisses them. Yet, because it's a penis, those same religious, cultural, and social benefits, as determined dictated by the parents suddenly matter? No.

So, yeah, UNAIDS is right on the U.S. denial of entry to HIV-positive individuals. But UNAIDS does not practice what it preaches.

Post Script: See the section of the report titled "Protecting Women in the Context of Male Circumcision" for an understanding of this entry's title.

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I've known about this for a little bit, but I hadn't planned to blog it because I don't think it will initially amount to much. But it's in the press now, so here's an update on the Oregon circumcision case:

A divorced father who wants to circumcise his 13-year-old son against the wishes of the boy's mother is trying to take his case to the U.S. Supreme Court.

James Boldt, who converted to Judaism, argues that preventing him from circumcising his son violates his constitutional right to practice his religion.

The U.S. Supreme Court accepts a small fraction of the appeals it receives. A decision on whether it will take the case is not expected until the fall [sic]

Earlier this year, the Oregon Supreme Court ruled that the trial judge should determine what the boy wants.

Obviously the mother, who is trying to prevent the circumcision, must approach this as if the Supreme Court will consider the father's request. I think she'd achieve the same short-term outcome if she ignored it because, until the trial judge determines what the boy wants, there is no reason for the U.S. Supreme Court to consider intervening.

That said, it might be interesting to speculate that the father is signaling something about the boy's wishes if he's wants to bypass his incomplete-but-favorable victory granted by the Oregon Supreme Court. But that would be speculation, so I will go no further until I know more.

To his claim that "preventing him from circumcising his son violates his constitutional right to practice his religion," every necessary piece of information you need is in that brief statement. His constitutional right, as an individual, can never legitimately include the option to surgically alter another person. That the other person is healthy is relevant but not necessary for consideration. That the other person is his child is irrelevant. "His child" is properly stressed as "his child". He is the child's guardian, not the child's owner. The child has his own individual rights that negate¹ his father's assertion that his religious requirement permits him to remove his son's foreskin.

Additionally, if the court is to recognize that a parent may circumcise a male child under the U.S. Constitution because a religious text tells them to circumcise, the court must also overturn the Female Genital Mutilation Act as an unconstitutional infringement upon this same alleged First Amendment right of parents to inflict genital surgery on their daughters because the law specifically excludes any parental claim to religion. If the parents have this right, it is plenary over all of their children, not just their children who were born with a penis.

Thankfully they do not have this right, so eventually this nonsense will lose its inexcusable credibility. Unfortunately, I expect the U.S. Supreme Court to botch this horribly on the barely non-zero chance that it takes the case. It will rule that the child has rights, but tradition makes this practice reasonable. (The Court will, of course, dismiss the truth that female genital mutilation is performed to adhere to tradition and social expectations.) The Court will also cite subjective benefits to male circumcision while ignoring the objective harm because the risks and inevitable outcome are "minor". Everyone but the boy's opinion matters. So, the most achievable path to Destination Sanity is clear, but arrival is probably not imminent.

¹ Much analysis in the news and blogosphere considers the importance of the child's age. At 13 he can make his wishes known. Yes, but the default presumption in our society - as shamefully demonstrated in the Oregon Supreme Court's ruling - is that we must decide whether the child's age overcomes the parent's wishes. That is incorrect. The default must be that the child would want his healthy foreskin because the alternative is permanent. Only medical need would allow the parents to make the child's decision until he can state that he wishes to be circumcised.

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From John McCain's speech to the NRA:

Real activists seek to make their case democratically -- to win hearts, minds, and majorities to their cause. Such people throughout our history have often shown great idealism and done great good. By contrast, activist lawyers and activist judges follow a different method. They want to be spared the inconvenience of campaigns, elections, legislative votes, and all of that. Some federal judges operate by fiat, shrugging off generations of legal wisdom and precedent while expecting their own opinions to go unquestioned.

Is there an upper bound on how many individuals may have their rights violated before we conclude a constitutional solution is better than a democratic solution? If so, what's the number? Is there a distinction marking which rights are sacred and which may be violated at will by a majority? Is there any reservation worth considering to limit this complete trust in The People that might acknowledge those hearts and minds that are either incapable or unwilling of being won?

Like every politician, John McCain is a propagandist unworthy of being in a position of leadership. He will not behave as a leader.

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As a thought experiment, consider:

LASIK surgery in children.

AIMS: To report success in the treatment of high myopia in children with LASIK. To report the visual results, complications and postoperative management of children with high myopia. METHODS: Six children (seven eyes) with high myopia were included in this series. Preoperative and postoperative refraction, visual acuity, and pachymetry were compared. RESULTS: Six children with high myopia ranging from -5.00DS to -16DS were treated. There were three males and three females. Five children had improved refraction and visual acuity post-LASIK. Age ranged from 2 to 12 years. Five of the children had unilateral amblyopia preoperatively. One had bilateral high myopia. CONCLUSION: High myopia in children may be treated safely and effectively with LASIK.

Now consider this story, via Amy Alkon:

Most Lasik recipients do walk away with crisper vision, and the American Society for Cataract and Refractive Surgery reviewed studies showing about 95 percent of patients say they're satisfied with their outcome.

But not everyone's a good candidate, and an unlucky fraction do suffer life-changing side effects: poor vision even with glasses, painful dry eyes, glare or inability to see or drive at night.

How big are the risks? The FDA agrees that about 5 percent of patients are dissatisfied with Lasik. How many struggle daily with side effects? How many are less harmed but unhappy that they couldn't completely ditch their glasses? The range of effects on patients' quality of life is a big unknown — and the reason the FDA help a public hearing Friday as part of its new move.

"Clearly there is a group who are not satisfied and do not get the kind of results they expect," said Dr. Daniel Schultz, the FDA medical device chief. The study should "help us predict who those patients might be before they have the procedure."
...

Doctors advise against Lasik for one in four people who seek the surgery, said Dr. Kerry Solomon of the Medical University of South Carolina, who led a review of Lasik's safety for the ASCRS. Their pupils may be too large or corneas too thin or they may have some other condition that can increase the risk of a poor outcome.

Solomon estimates that fewer than 1 percent of patients have severe complications that leave poor vision.

Should parents have an unchallenged option to choose Lasik surgery for their children for any reason?

Bonus question: Should they have that unchallenged option for only their children of one gender, with the exclusion based on a societal belief such as the (non-)desirability of glasses?

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Obviously I think the California Supreme Court's ruling on same-sex marriage is the correct outcome. I'll leave the legal analysis of how the Court got there for others to judge. Still, this is an interesting, positive development.

I wish to comment on one factor that will appear in the coming weeks, and will probably quickly grow within the presidential election. Many will claim judicial activism, as if that's a valid claim. Our courts do not exist to rubber stamp any and every rule a legislature can dream up. Enforcement is the Executive's job. The Judiciary must interpret. Bowing to the mythical "will of the people" gets us no closer to the truth than waiting for a new constellation to appear in the sky with the correct outcome spelled in the stars.

An Andrew Sullivan reader wrote this to Mr. Sullivan:

...

The decision is an arrogant, impatient one. My gay friends are impatient, and I understand their impatience. But the Court should have trusted the people.
...

It was only a matter of time. A democratic consensus, based on reason and persuasion, is much better for everyone, in all the states, in the long run.

Mr. Sullivan responds with the perfect rebuttal:

Yes, and it has been building. But a republic is not just a democracy. It is a confluence of constitutions, laws, legislatures, executives and courts. In 1948, the California court ruled against miscegenation bans. It took three decades for that act of "judicial activism" to gain consensus nationally.

Exactly. And constitutions are first. Where the laws of the legislature violate that, the courts must reject the laws. Anything else is mob rule.

This fits into the discussion on how civil law should treat medically unnecessary circumcision of male children in America. The procedure is ethically and scientifically flawed. It should not be permitted. Legislatures have already shown an willingness to exclude male children from this protection acknowledged for every other American. Democracy (i.e. mob rule), with a nod to social and religious justifications before individual rights protected by constitutions, should prevail, some say. What parents want is worth defending because altering the healthy genitals of their male children is their choice. It is a right that supersedes the rights of the child, both in individual religious freedom and bodily integrity/freedom from harm.

The political side of the issue is an unprincipled, anti-constitutional mess in America. The concept of individual liberty is lost. The court's role is to uphold constitutional protections for every individual. It is critical to defend the rights of the minority against the tyranny of the perceived majority. Where tradition and social expectations conflict with individual rights, tradition and social expectations have no merit. The role of the court is to set these legal excuses aside in favor of individual rights. This is not activism.

Courts are not infallible. Yet, as Mr. Sullivan's example shows, society has a way of catching up to the "activism" of courts, with an eventual understanding that wisdom and logic demanded the outcome. History will show that with same-sex marriage. It will show that with medically unnecessary child circumcision. The former before the latter, but the day for both will arrive.

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I don't know which is more frustrating, stupid "science" articles or the reporting on those articles. Last week, my news world was filled with various regurgitations of this nonsense:

According to a new policy analysis led by researchers at the Harvard School of Public Health (HSPH) and the University of California, Berkeley, the most common HIV prevention strategies-condom promotion, HIV testing, treatment of other sexually transmitted infections (STIs), vaccine and microbicide research, and abstinence-are having a limited impact on the predominantly heterosexual epidemics found in Africa. Furthermore, some of the assumptions underlying such strategies-such as poverty or war being major causes of AIDS in Africa-are unsupported by rigorous scientific evidence. The researchers argue that two interventions currently getting less attention and resources-male circumcision and reducing multiple sexual partnerships-would have a greater impact on the AIDS pandemic and should become the cornerstone of HIV prevention efforts in the high-HIV-prevalence parts of Africa.

Hold off on assessing the validity of such claims. Wouldn't it be appropriate if they put the two key words - voluntary, adult - in front of male circumcision? That's all that the studies being cited as gospel looked at. The press release does later invoke voluntary, so I wonder if the omission of adult implies that children consent. Perhaps a look back at past writings from one of the studies authors, Daniel Halperin, might reveal anything:

As Holbrooke noted, circumcision has indisputably been proven to prevent HIV. It reduces the risk of male infection during intercourse by at least 60 percent and, unlike a condom, cannot be forgotten during a moment of passion. Nearly all of 15 studies conducted throughout Africa found that most uncircumcised men would want the service if it were affordable and safe, and even more women prefer it for their partners and children.

Excerpted from Halperin's essay referenced in my original entry.

How convenient. Even more women prefer it for their partners and children. Regarding the former, I don't care what influences or reasons adult males use if the decision to undergo circumcision is voluntary. But with the latter, that simply isn't the case. And how is it sexually relevant to (male) children what their mothers prefer regarding their genitals? (Also notice how nearly all of the studies revealed that most intact males would want circumcision. Contradictory evidence is still evidence.) Obviously I don't come to this report with any pre-established respect for circumcision promoter Daniel Halperin. But continuing from the new article.

The AIDS pandemic continues to devastate some populations worldwide. In most countries, HIV transmission remains concentrated among sex workers, men who have sex with men and/or injecting drug users and their sexual partners. In some parts of Africa, HIV has jumped outside these high-risk groups, creating "generalized" epidemics spread mainly among people who are having multiple and typically "concurrent" (overlapping, longer-term) sexual relationships. In nine countries in southern Africa, more than 12% of adults are infected with HIV.
...

For example, condom use is widely promoted as an HIV prevention measure and is effective in countries such as Thailand, where the epidemic is spread primarily through sex work. However, studies have found no evidence that condom use has played a primary role in HIV decline in generalized, primarily heterosexual epidemics, such as those in southern Africa, the authors note. This is mainly because most HIV transmission there occurs in more regular sexual relationships, in which achieving consistent condom use has proved extremely difficult.

I want to pound my head on my desk until I can't think any more. Where HIV transmission occurs, it occurs because the couple is engaging in unprotected sex where one partner is HIV-positive. If a condom is not used, that is not an indictment on condoms as a prevention technique. It's not even about condom use in a relationship. It's obviously about unsafe promiscuity. It does not take a genius to figure out that, if behavior remains consistently immune to logic, circumcision will not matter. HIV will spread. The only potential difference under discussion is the rate at which the disease spreads. Have unsafe sex with HIV-positive partners and you will become infected. It may take an extra encounter, but it will occur.

Circumcision also has the potential to encourage "just this once" disregard for safe sex practices. "I'm circumcised, so just this once, I'll ignore the condom." How many times will be "just this once"?

Under this focus on the rate, though, the true implication becomes clear. This is best shown in the poor reporting regurgitation of articles like this. For example:

In western Africa, were male circumcision is high for cultural and religious reasons, the prevalence of HIV is low and controlled trials have shown that the operation can stem the rate of infection, said Professor Malcolm Potts, of the University of California, Berkeley. "It is tragic that we did not act on male circumcision in 2000, when the evidence was already very compelling," he said. "Large numbers of people will die as a result of this error."

Because we didn't implement mass circumcision of males in Africa, large numbers of people will die. As opposed to saying that, because many individuals¹ aren't engaging in safe sex practices, large numbers of people will die? Which is more accurate at portraying a direct cause? Which advocates speculation that can't be verified? Which is scientific?

Individual actions matter. If We™ are going to intervene, we must provide nothing more than the tools for individuals to choose for themselves. Where individuals ignore known risks and engage in dangerous behavior, there will be consequences. Suggesting that we shift from truly voluntary prevention techniques such as ABC (Abstinence, Be Faithful, Condoms) and voluntary, adult male circumcision to involuntary male child circumcision is little more than an indication that We will save Them. Because They do not partake of the known methods to protect themselves as individuals, we must do it for them.

Of course, there's the giant elephant in the room. "Reducing multiple sexual partnerships" sounds a lot like Be Faithful. So we're left with only one different approach the authors believe should receive more funding. New articles and studies like this always have the goal² of pushing mass male circumcision, voluntary and involuntary, adult and child. Always.³

¹ I know that the issues of consent in sexual relations are more complicated than assuming every sexual encounter is voluntary and free from any pressure. Conceded. But that does not change the point that involuntary circumcision is not an answer to this problem. Correcting a wrong with a wrong is not valid. Individuals have rights, not collective groups.

² If you look at what the article is saying, you'll also note that the validity of ABC instead of a collectivist, utilitarian perspective on male circumcision applies to the United States. Our HIV problem is not caused by what circumcision is supposed to protect against. That hasn't stopped circumcision advocates from promoting (infant) male circumcision in the United States as a way to reduce the risk of female-to-male HIV transmission.

³ It would require its own blog entry, but I don't think any of this is some mass conspiracy by any group or profession. A mindset closed to a full set of facts, maybe, but not groups. Still, the point remains: it's always about circumcision first, even if the stated justification is "public" health or some other goal perceived to be noble.

Posted by Tony | Permalink | Comments (1)

Heartland Regional Medical Center in Marion, Illinois had a problem recently where two babies were mixed up after being circumcised. Both sets of parents consented to violating their sons, so there wasn't much to blog about beyond the obvious point that no one should be surprised at any incompetence found in a hospital that routinely performs unnecessary surgery on the genitals of healthy male children. That alone is sufficient proof of incompetence.

Still, the hospital felt the need to implement solutions to prevent the mistaken identity. If you're going to violate a child, you should do it as few times as possible, I suppose. Part of the solution:

• Only one baby, one doctor and one circumcision at a time. ...
• The RN whose mother/baby couplet requires a circumcision will be the same RN who does the time out, accompanies the baby to the surgery and assists the physician with the surgery. That RN is also responsible for band verification and the time out.

Concerning operating room policies, Lang said surgical services must be consistent with needs and resources. Policies governing surgical care must be designed to assure the achievement and maintenance of high standards of medical practice and patient care.
...

Thirty circumcisions a month will be observed for the next four months to insure time outs are performed according to the hospital's policy and procedure.

Concerning patients' rights, Lang stated that the patient has the right to receive care in a safe setting.

All that attention, and the only concern for the actual patient's rights is that the patient has the right to receive care in a safe setting. How about the more fundamental right to receive "care" only when it's medically necessary and indicated? Is that not a right? Would it be okay to amputate a child's arms, as long as it's done in a safe setting? Have rights really regressed to the point that we view a clean scalpel as the ceiling of a patient's rights?

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Last week I wrote about baby tossing, making a comparison to infant male circumcision. Today, via Kevin, M.D., here's a story that includes a debate among doctors.

"Of course there is risk of injury in this practice. Missing the stretched cloth might be fatal and even landing on it wrong might cause a limb fracture," said Dr. Joseph R. Zanga, past president of the American Academy of Pediatrics and a professor at the Brody School of Medicine, Greenville, N.C.

Objectively identifiable risk for a subjective, perceived benefit. End of discussion. Yet:

"I would not suggest that we try it in the U.S., but if they have been doing it for 500 years without any injury I'd be wary of stopping them," Zanga said.

When faced with a tradition of stupidity, it's best to focus on the stupidity, not the tradition. Science over superstition.

Dr. Michael Wasserman, of the Ochsner Health System in New Orleans, felt the same pull toward cultural sensitivity. "It is hard for one to disagree with religious rituals, as they are private choices, at the same time, there is a real danger?" Wasserman said.

This is not about disagreeing with religious rituals. If people want to toss themselves over a building's edge in a "controlled" manner, have at it. This is not that. This is people intentionally endangering another person - a child - for no objective gain to the person being tossed. Jumping and being tossed are quite distinct. The former is a ritual. The latter is madness.

However, some doctors thought the health risks trumped cultural sensitivity in this case.

"The idea that parents would participate in such a harmful practice and that no one would point out the dangers to them seems inconceivable," said Dr. Astrid Heppenstall Heger, professor of clinical pediatrics and executive director of the Violence Intervention Program at the University of Southern California, Los Angeles.

While this sentiment is based in logic, it's not really inconceivable. American parents participate in a harmful practice that disregards risk in favor of cultural sensitivity more than one million times each year. The parents have "rights", you know. As long as the tosser¹ finds value in the act, the tossed is merely the necessary pawn assumed to value the subjective gain more than the objective risk. He or she² isn't completely worthy of individual protection because the group finds some benefit.

¹ No derogatory pun intended.

² Except for genital cutting, of course. There the comparison allegedly breaks down. Cutting healthy boys is valid tradition, but cutting healthy girls, that's barbaric, even when it's tradition. Half of that rationale is wrong. Would doctors suggest it's okay to toss only male children from a building?

Posted by Tony | Permalink | Comments (1)

I don't generally listen to what parents claim when they circumcise their sons. By nature of the act, they treat their son's body as their property. They would deny it if confronted with this logic, and most aren't willing to listen to even that. It's mostly fruitless fodder for philosophical discussions.

Sometimes, though, parents come out and make it nakedly obvious. From this thread on cloth diapering after a circumcision, which descended into defensiveness and ad hominem. (To be fair, the original question asked for an answer independent of whether to circumcise or not.) Select quotes:

# 10: first off, ignore any "hate responses" as you are the parent and it is YOUR choice. Don't listen to scare tactics. ...

YOUR choice. Also, only those opposed to circumcising non-consenting, healthy children can use scare tactics, of course. A focus on HIV, UTI, penile cancer, STDs, hygiene, and social rejection aren't fear-based tactics?

# 19: ... What ever choice you make mamma is the right one. It is your son and your choice [sic]

There can be no objective truth, as long parents wish hard enough with good intentions.

# 37: ... Dont [sic] worry about the anticirc posts, he's your baby, it's your decision. ...

She's your baby, it's your decision? Nope.

I expect every single mother quoted here would deny that their words mean they consider their sons their property. But the logic just doesn't hold up. It's always the self-absorbed obsession with how circumcising affects them, without consideration for the how it affects the boy negatively or what objections he might one day raise. It's their (capitalized for emphasis) decision.

This is interesting to me since I've encountered the hysteria that arises the moment anyone hints at a comparison of performing genital surgery on female minors. No woman would want that done to her. Duh. But every boy will be perfectly content if it's done to him. He'll applaud his parents. Again, duh. Except I can't figure out how to get from "medically unnecessary" to "duh", intellectually or emotionally. It will never compute because it requires willful ignorance.

For fun, here are two comments in response to the links offering information against the circumcision of children:

# 15: ... she [sic] asked for ADVICE on CARING for an INFANT, not if you thought the reason behind that special care was/is warranted. ...

And:

# 27: And that pertains to cloth diapering after a circ how? ...

The links pertain to cloth diapering because, at its core, if you don't engage in a surgical violation of the healthy boy's body, the debate over what to do to protect his sensitive penis is moot because nature's already provided the protection. If you ask me what's the best way to diaper a girl whose parents surgically altered her healthy genitals, I'm going to question the validity of the action that makes the question allegedly defensible. There is no difference because the cutting occurs on a penis rather than labia or a clitoris. None.

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Do unto others, or something like that:

During spring break, [University of Florida quarterback Tim] Tebow added a new facet to his fame. In an impoverished village outside General Santos City in the Philippines, Tebow helped circumcise impoverished children.
...

"The first time, it was nerve-racking," he said. "Hands were shaking a little bit. I mean, I'm cutting somebody. You can't do those kinds of things in the United States. But those people really needed the surgeries. We needed to help them."
...

Others saw [Richard] Moleno, who after a crash course from the Filipino professionals, circumcised 10 boys and removed six cysts, some the size of tennis balls. Tebow helped with the last few circumcisions, growing more comfortable with each one.

"I got a kick watching him," [Tim's father] Bob Tebow said. "He did a great job, and he didn't look really nervous. I wouldn't let him cut on me, but he did well and helped where there was a need."

Before I comment, circumcision in the Philippines is generally not like what we think of as circumcision. It is more an opening up of the foreskin through a dorsal slit than anything. It's also a ritualistic transition from childhood to manhood, although it's still forced on children. And the social pressure to circumcise is even more intense than it is in the United States.

Also, I have no idea if the boys in this story needed circumcision or not. I assume they didn't, but the conditions they live in don't exactly suggest that as an obvious assumption. The number of child circumcisions suggests, though, that there was more of a ritualistic "need" than a medical need. Obviously I oppose the former entirely, with condemnation for the latter only when less invasive treatments are ignored when treating a child.

To the story... This is something to joke about? "I wouldn't let him cut on me...", but it's acceptable to cut on a child? One doesn't have to grasp the ethical problem with the medically unnecessary circumcision of children to grasp that competence gained through extensive education should be a prerequisite for performing any surgery. There is a reason we won't allow it in the United States. There are actual human - with rights - beings involved. Complications occur. What would someone have said if Tebow had made a mistake? Not that this story implies Tebow performed flawlessly on these people, but would an accidental amputation of the glans earned anything more than an "oops"?

I like to run with my intellectual curiosity, like most people. Yet, I'm capable of understanding that getting my jollies should still recognize the rights of others.

Posted by Tony | Permalink | Comments (0)

Via Boing Boing, I thought baby dropping had to be a hoax.

Muslims in western India have been observing a bizarre ritual - they've been throwing their young children off a tall building to improve their health.

The faithful have been observing the ritual at a shrine in Solapur, in western India's Maharastra, for more than five hundred years.

They believe it will make their children strong and say no accidents have ever happened.

The video accompanying the article suggests it is not a hoax, although I remain skeptical. But it does raise an obvious question. Is this a parental right similar to the claimed right to circumcise male - and only - male children? The child doesn't need to be tossed from a building. There is an objectively identifiable, if hard to quantify, risk of injury, both minor and severe. There are benefits stated by parents that are subjectively identifiable, objectively unprovable for the child being tossed, and hardly guaranteed to be preferred by the child as an adult. Would he or she choose, as an adult, to be dropped from a building into a sheet below? (Note: The one child whose face we see closely in the video appears to be rather not enjoying the process.)

Compared to infant (male) circumcision, should baby dropping be treated ethically and legally different?

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It's pretty pathetic when Conservapedia is more accurate on female genital mutilation (link) than most other Internet debate on the topic.

The procedure may range from a simple cut in the pubic region to the complete removal of parts of the female reproductive organs.

There's very little else there, and there's no source for the specific claim. (That could be here, as an example.) But it's accurate, in a simplistic way that's almost always missed.

Unfortunately, that sentence follows a statement that's inaccurate because it's partially refuted by the statement above.

Female circumcision, practiced in parts of Africa, is a much different procedure that can have lasting effects on a girl's health.

That's all there is. It's not possible to argue the accurate claim that a form of FGM involves only a simple cut and still adhere to a claim that male genital mutilation is a "much different procedure". I'm sure many would defend this by going into intent. I don't accept that because the claim that FGM is strictly imposed to eliminate the ability to feel sexual pleasure is often wrong. There's also the core human right to remain free from harm. Genital cutting on a healthy individual without the individual's consent is wrong. It's ethically and legally incorrect to discriminate in judgment against this practice based on gender.

Not that the UN and World Health Organization understand this core stance. WHO defines gender discrimination in its glossary:

Gender discrimination refers to any distinction, exclusion or restriction made on the basis of socially constructed gender roles and norms which prevents a person from enjoying full human rights.

There's the irrelevant claim that women prefer circumcised partners. There's the more vehement dismissal of any (equally irrelevant) claim that men in certain cultures prefer women with surgically altered genitals. Etc. etc. (c.f. this entry.)

Lest you think I give any actual credibility to Conservapedia, I quote this statement from the circumcision entry:

The procedure lasts only ten minutes and ...

No source supports that statement in the entry's footnotes. If, as the site's About page suggests, this is the sort of thinking meant "to educate advanced, college-bound homeschoolers", my low opinion of the site should be obvious.

Posted by Tony | Permalink | Comments (0)

A common defense used to justify continued legal indifference to the clear rights violation of male child circumcision in the United States is tradition. The sometimes-blurry distinction between ritual and social tradition is mostly irrelevant. The argument is that humans have been circumcising male children for thousands of years. In the United States, the tradition approaches 150 years. Tradition relies on "if it ain't broke" without questioning whether or not it's broken. I reject this, obviously, but I'd like to offer a hypothetical scenario:

A family gathers every Thanksgiving at the home of the family matriarch. This has continued for decades, and now includes children, grandchildren and a few great-grandchildren. Every year, the menu remains constant. The festivities start at the same time. Afterwards, there's football in the yard before watching football on television.

One family member does not participate because he chooses to spend the holiday at with his wife's family.

Those who defend tradition seem to argue that an opposition to male child circumcision rejects this. Reject tradition-inspired circumcision and you reject a family's ability to decide. This is not the case, because the correct equivalent includes one additional piece of information not yet expressed in the hypothetical.

The man who chooses not to participate is physically forced by his blood relatives and barred from leaving the family's holiday celebration. When he objects, he is restrained. At the end of the festivities each year, he is permitted to leave.

If he sought state intervention, would he have a valid claim of false imprisonment? Does the family's claim of tradition supersede his right to be free in his movements and activities? The answers are undeniably "yes" and "no", respectively.

Obviously the age of the individuals is an essential variant in the discussion. Let's consider it. If the family refused to circumcise a son in childhood, when do they lose the right to circumcise him? At age 18? If at 18, is it not contradictory to permit them to circumcise him without need before that age? In doing so, they are effectively granted the right to choose circumcision for him at 18, 28, 38, 48, etc. He can't unchoose what they've imposed. The permanence of the decision separates it from every other parental responsibility claimed as an equivalent. Those alternate claims involve life-sustaining needs (food) and/or objective benefits (education). Circumcision fits neither category, while also lacking the affected individual's ability to overcome poor choices by his parents contained in legitimate choices based in parental responsibility.

That returns the defense to tradition. Children may be forced to attend the family gathering for Thanksgiving. Conceded. But the logic - defined loosely - needed for forced circumcision of minors based on tradition requires a familial right to override an adult's liberty to refuse attendance at all present and future gatherings. No such right exists. There can be no consistent rule based on tradition. Thus, tradition can't be an acceptable defense for a permanent reduction of another's future bodily choice, barring objective medical need. We must rely on principles rather than tradition. Principles center exclusively on the individual and his natural rights.

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One more for today (and one more for tomorrow, then there will likely be a lull in the circumcision posts). In a comment to this anti-circumcision essay, commenter "MizMoxie" wrote this:

... I would have sex with anyone with one not "cut". [sic somewhere in there, as you'll see] Too much waste and bacteria and gunk. Yuck. Besides, women have to go through a bunch just because we are women. I personally think that a male child should have to suffer a little. I've never heard a grown man say he remembers the pain of his circumcision! ...

I hope that's meant as a lame effort at humor. I've encountered that argument in the past, so I don't think it is. I assume it's real, if only for my purpose here. When dismissing principle in favor of subjective defenses like tradition and fear, this will occur. The law currently permits this justification as much as any other, even though the intent is clearly harm (among multiple poor excuses) to the child.

Is permitting harm to male children to balance the harm females suffer a legitimate trade-off to protect the perceived rights of parents to decide what is anatomically in the best interest of their children sons? If not, what is the consistent, objective rule of law to prevent this harm that doesn't also prevent "good" reasons (that still lack medical need)?

Posted by Tony | Permalink | Comments (1)

A few days ago, in the context of the current FLDS story, Timothy Sandefur posted a principled defense of children and their rights against the (religious) claims of their parents. It's very similar to what I've written about circumcision generally, and ritual circumcision specifically. The parents' religion is not enough to justify the objective harm under civil law, regardless of the sanctity and tradition of the action. Still, Mr. Sandefur's wonderfully stated words are worth posting here. (Note: I have no idea whether he would apply this to the medically unnecessary circumcision of minors. I suspect he does, but I do not know.)

The starting point of the analysis must be the principle that children have rights valid against parents, including the right not to be raised in an abusive or neglectful environment. The state has the legitimate authority to enforce these rights against parents. The state obviously has the legitimate power to take a child away from parents who beat him, or from a family of homeless alcoholics who neglect him. The fact that parents act abusively or negligently because they believe that God wants them to does not change the analysis. It cannot change the analysis, because it would, of course, create an easy route around laws that validly protect the rights of children: just assert that abuse is part of your religion. Heaven knows that’s been tried many, many times.

We do not allow parents to beat their children, yet that almost always leaves no permanent physical damage, unlike circumcision. Of course the psychological damage of physical abuse is undeniable. But is parental intent really enough, which is what seemingly allows circumcision while prohibiting other abuse? (cf. this post) Since one excuse used in favor of infant circumcision is that the boy won't remember it, I say no. If a parent punches an infant, the infant will not remember it. But the act itself, separate from other considerations, is antithetical to the child's individual rights. The motivating intent we assume (or discover) of the parent is irrelevant. As Mr. Sandefur's statement declares, we shouldn't excuse abuse just because parents claim God made them do it.

Mr. Sandefur continues:

... —and the state has the legitimate authority to defend that right [not to be imprisoned in an asylum], again, within certain (often vague) boundaries set by a parent’s right to direct the upbringing of a child. The latter right, however, must yield to a child’s objective welfare. In other words, while a parent has broad discretion to direct the education and upbringing of a child, that discretion exists within boundaries which the state may police, and keeping children away from education, medicine, &c., are things which—at least at some level—exceed those boundaries. ...

The surgical alteration of a healthy child's genitals exceeds those boundaries. We already recognize this for female minors. The Female Genital Mutilation Act explicitly denies parents the option to cut their daughters for non-medical reasons. The 14th Amendment, among other Constitutional claims, implicitly requires us to prohibit genital mutilation of male minors.

Perhaps more succinctly, Mr. Sandefur clarifies his point in a follow-up to his original post. Discussing the implications of two court cases, Yoder and Pierce, and the constitutional limits imposed on parents, he writes:

... The fact that some communities claim that God wants them to abuse or neglect children is just not a good reason for allowing them to do so, and the state is and ought to be more concerned with ensuring that children’s rights are protected than with whatever excuses parents give—mystical or otherwise—for violating those rights or for neglecting those children. ...

I can make no comment on the validity of his legal analysis; I am not an attorney. But his reasoning is logical and based in individual liberty. The family is not society's building block, with parents acting as property holders of their (male) children until the children reach the age of majority. What's in the best interest of the family is collectivist, anti-liberty nonsense. Cutting is objective harm. The absence of medical need demonstrates that there is no corresponding objective benefit to be gained that would permit a discussion of parental proxy after applying the child's individual rights. So, while I certainly adhere to a libertarian deference to parents and a suspicion of extraneous laws, legislatively prohibiting medically unnecessary genital surgery on minors is well within a libertarian framework of appropriate and necessary state use of power.

It would be nice if we didn't have to do this. Maybe we can even justify not having a specific law prior to the beginning of child circumcision, if we lived in an alternate world without the historical tradition preceding the United States. (Assault laws would still be applicable, I think.) But approximately 3,000 male minors have their healthy genitals surgically altered every day in America. Rights are being violated. Not only may the state intervene, the state must intervene.

Caveat: I am not claiming that religious circumcision of minors proves the religion is harmful. I am claiming that religious circumcision of minors is a blind spot against individual rights that can't be overcome through claims of parental "rights". This must be prohibited in civil law. Civil law applied to the individual must trump any and all concerns of religion, particularly since the to-be-circumcised individual retains his own freedom of - and from - religion. He alone must decide if he wishes to express his faith in this manner.

Posted by Tony | Permalink | Comments (34)

Via A Stitch in Haste, ABC News ran a social experiment in two cities, Verona, N.J. and Birmingham, Ala.

Two years ago, ABC News hired two actors, a man and a woman, to publicly display their affection for each other by kissing in public at a restaurant. Reactions from other restaurant-goers varied; some onlookers enjoyed the sight of young love, while others lost their appetite.

This year, we once again decided to explore how the public responds to public displays of affection -- but this time, our couples were gay.

911 "hilarity" ensued in Birmingham, as Kip highlighted. Shameful, but not my point here. Instead, this:

... A topic that did come up repeatedly was children. "I don't really find it inappropriate, especially during the day when schoolchildren aren't running around. They might get confused and want an answer for what's going on," bystander Mary-Kate told us. The majority of the people who spoke about children seemed to echo Mary-Kate's feelings. They are indifferent to gay PDA but did not want to, or know how to, address homosexuality with children.

People wilt under the pressure of addressing "tough" issues with children. (Some to a greater extent than others.) But when children get confused and want an answer for what's going on in the world, the proper response is to treat them like human beings who deserve respect. Adults must apply tests to decide what information is appropriate to censor or finesse, but shielding children from information solely because the question makes the adult uncomfortable is not a rational response to reality.

Obviously I'm drawing a comparison to circumcision, so I'm not going to dance around the topic. When I've protested on the lawn of the U.S. Capitol against infant male circumcision¹, children approach to discuss the topic. I discriminate based on age. Without a good qualifier, it's best to let the child ask. This generally leads to self-selection among the children who are capable of understanding and discussing. The youngest child I've spoken to is probably 10 or 11. And I still limit the discussion away from the anatomical function of the foreskin during intercourse and masturbation. However, those children are capable of understanding the core of the issue. They know when they're being lied to. I've witnessed parents offering excuses to children while shielding them from any consideration. The children rejected these excuses by asking further questions.

I'm dismayed at how many people, even when not rejecting that same-sex relationships exist, fear that children can't understand love if it's not packaged in a specific, safe manner. Safe, of course, refers to the perceptions of the adult, not the child.

¹ Here's a writing tip for you. The first edit of the footnoted sentence read:

When I've protested against infant male circumcision on the lawn of the U.S. Capitol ...

There are no circumcisions occurring on the lawn of the U.S. Capitol, to my knowledge. Clarity demands that the writer group "on the lawn" with what occurred on the lawn.

Posted by Tony | Permalink | Comments (0)

Here's an interview (part 2 of 3) with Stephen Lewis¹, a former diplomat now involved in HIV/AIDS issues. Here are a few curious excerpts (italics added):

What do you think should be done [to fix PEPFAR]?

People should demand more – much more. No one denies that when you pump several billion dollars into a response it will mean something. Of course it will; millions of people will be treated. That's terribly important.

But that's what we deserve to expect from the United States. You don't kneel down before a country because it's doing… something that the world has a right to receive. The American administration is so discredited, George Bush is such a lamentable president, that when anything of a positive kind happens people are prostrate at the unlikelihood of it and they shouldn't be.

It gets worse from there, but it's most important to focus on the key assumption. The world has a right to receive American funding for its problems. I'd like to know the socialist theory Lewis is using to arrive at the conclusion. Presumably we're only allowed to call our giving "charity" if we need to feed our American egos. The world will acquiesce with that concession, but the dollars must continue to roll in to satisfy the world's right to receive.

I don't have anything else nice to say about that, so I'll move on to the next interesting bit. (Again, italics added.)

How about the response of the United Nations to HIV/Aids in Africa?

There is just so much more to be done. Frankly, one of the things that is inadequate is the United Nations agencies. Some of it is bewildering.

For example, you get the Minister of Health in South Africa (Dr. Manto Tshababala-Msimang [sic]) attacking and dismissing circumcision as a preventive technology. Here you have three determinative studies, definitive studies, we have UNAIDS and WHO encouraging male circumcision as a way of reducing transmission and you get an attack on it by the minister of health in South Africa. Where is the United Nations' voice? Why haven't they taken on the minister? Why haven't they said what should be said, which is that she's effectively dooming people to death and it need not be done? You have to have a much stronger voice of advocacy from the United Nations in dealing with disease and related matters.

Dr. Manto Tshabalala-Msimang is nuts is HIV, yes, but Lewis' rant against the United Nations is bizarre. Whether it's pushing circumcision through UNAIDS with breathless calls-to-action, issuing press releases touting the latest hype on the original story from WHO, or endorsing gender-based human rights violations through its remaining organizational reach, I'm not sure it's possible to do more for the organization to insert its reach any further into this debate on the wrong side of human rights. But that's defensible. Instead, let's complain that they never criticized Dr. Tshabalala-Msimang for being stupid and dangerous.

Except, they did.

The United Nations special envoy for Aids in Africa has closed a major conference on the disease with a sharp critique of South Africa's government.

Speaking at the end of the week-long gathering in Toronto, Canada, Stephen Lewis said South Africa promoted a "lunatic fringe" attitude to HIV/Aids.

Mr Lewis described the government as "obtuse, dilatory and negligent about rolling out treatment".

Hey, wait a minute. Stephen Lewis? Stephen Lewis, working as special envoy for AIDS in Africa, attacked Dr. Tshabalala-Msimang's comments in August 2006. Denouncing idiotic statements is necessary, but move on. Leave the grudge match to the WWE. Instead, every microphone is dead horse meets Stephen Lewis' stick.

I did thoroughly enjoy this, in an "I'm disgusted" way:

"It really is distressing when the coercive apparatus of the state is brought against the most principled members of society," he said.

Clearly Lewis is exhibiting a textbook case of Kip's Law. I would challenge Lewis' assertion that he is principled, since the UN's Declaration of the Rights of the Child clearly forbids medically unnecessary genital cutting, without exceptions for gender or potential disease prevention. Nor am I particularly moved by his claim of oppression. Are infants subjected a coercive apparatus when they are circumcised, in part based on the rantings of individuals like Stephen Lewis?

¹ The following biography accompanies the article:

Formerly the special envoy for HIV/Aids in Africa for United Nations Secretary-General Kofi Annan, [Stephen Lewis] is now chairman of the board of the Canada-based Stephen Lewis Foundation, which endeavors to ease the pain of HIV/Aids in Africa by funding grassroots projects. Lewis is also co-director of Aids-Free World, a new international Aids advocacy organization based in the United States.

This will be important later in the entry.

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Advocates for Youth is

... dedicated to creating programs and advocating for policies that help young people make informed and responsible decisions about their reproductive and sexual health. Advocates provides information, training, and strategic assistance to youth-serving organizations, policy makers, youth activists, and the media in the United States and the developing world.

Helping young people make informed and responsible decisions about their reproductive and sexual health is a noble goal. This is not that:

• Human rights—Planners must take an approach to offering male circumcision that acknowledges the human rights of the client:
  • Every adult male who is considering circumcision for himself should be able to give informed consent.[1]
  • Where a minor is the prospective client, counselors must take extra time to ensure that the minor and his parents understand the procedure and that the young male consents to it.[1]
  • When an infant is to undergo the procedure, his parents must be fully informed.

If he is an adult, the male must consent. If he is young, the male must consent. If he is an infant, no human rights principles apply to him. That is a pathetic view of human rights. Anyone who accepts that view is not an advocate. At best, he is a propagandist who does not believe in principles, only principals who may act on another according to an undefined criterion.

What is the delimiter indicating when a male ages out of "pre-young" and into young, conferring a human rights requirement for consent before his healthy genitals may be surgically altered? I reject the answer in advance for reasons I've explained in detail. Still, I want to know because I do not understand the magical powers wrapped around the penis that reduces mankind's ability to think when applying principles to its anatomical sanctity. So, advocates of the "pre-young" qualifier within human rights, when do "pre-young" males get the (ahem) equal right to consent - or refuse consent - to the surgical alteration of their healthy genitals that young and adult males possess?

Post Script: The footnote attached to the young and adult requirements points to an excuse from the usual suspects in infant male genital cutting advocacy. I will not provide a link to that report here.

Post Post Script: I addressed a similar, gender-based ethical lapse in a previous entry challenging nonsense from UNAIDS.

Posted by Tony | Permalink | Comments (0)

This article on adult circumcision was the companion piece to the recent Los Angeles Times article on infant circumcision. It would've been easy and proper to focus on consent, here and in the article on infants, but instead it's mostly fluff seemingly intended to prove that men really, really like circumcision. The facts don't support the article's implications, although you have to know the facts because they weren't provided in the article. I suspect this is mostly because the reporter lazily relied on urologists, who will inevitably see only men with an issue. Healthy, happy intact men don't generally visit a doctor to say everything's fine.

Still, I found one useful nugget (emphasis added):

Dr. David Cornell, a urologist who runs the Circumcision Center in Atlanta, sees men who want a circumcision because they prefer the appearance and because they want to feel more comfortable socially.

"I hear a thousand times a year from men who don't feel that they look like most other men in the locker room. In our society, there's an overriding preference for circumcision," says Cornell, who performs 250 procedures a year on men who, for cosmetic reasons, want a circumcision or a revision to one they don't think looks right.

Even where the male eventually agrees with his parents and/or society's subjective judgment that circumcision is more aesthetically appealing, what is specifically appealing is also subjective. Dr. Cornell surgically alters (consenting¹) circumcised men toward the body they want. This part of his practice demonstrates that even when parents guess correctly, there is no guarantee that this will be sufficient.

Of course, men could also choose this if left intact, with a better chance of getting exactly what they want² because they have everything to work with, rather than the remnants of the original circumcision.

¹ Also from the article:

Though frequently attacked by anti-circumcision activists, [Dr. Cornell] says, "I'm doing a cosmetic operation on a consenting adult. Why he's doing it is his business."

He's correct. Those activists damage the legitimacy in this debate. Circumcision is only the expression of the real issue, the lack of consent from healthy minors whose genitals are surgically altered.

² Or what they think they want. I know at least one man whose parents did not circumcise him. He chose it for himself as an adult to conform to societal expectations. He hates the results and regrets his action.

Posted by Tony | Permalink | Comments (1)

I used to feel some reservation about quoting parents when they've said something stupid about circumcision. You've probably figured out that I shed that a long time ago. When someone says something stupid to a reporter, I highlight it solely to point out that people are using stupidity to justify imposing permanent, medically unnecessary surgery on their child. (Doctors are complicit in this nonsense, which will also be obvious.) From an article out of St. Louis:

"I tell people there's not a real medical reason for them to have [ed. note: Have? Force.] a circumcision," said Dr. Jack Klein, chief of obstetrics at Missouri Baptist Medical Center, where 1,873 of the 2,144 boys born in 2007 were circumcised. "I will tell you the majority reason that people get circumcised is because they want their kid to look like other kids."

That social conformity is reason enough, say some parents concerned about future locker room comparisons and sexual relationships.

"I really didn't want to be faced with a teenage boy asking me why I didn't do this and not have a really good reason for him," St. Louis resident Amy Zimmerman said of her 2-year-old son John.

Notice who she is concerned about. Her concern was about her own feelings, her own desire to avoid the potential for (allegedly) tough questions from her son. That was enough for her to justify unneeded surgery on her son. She seems to wish to parent her son only in ways that do not exceed her level of comfort with potential issues. If it might be uncomfortable for her, her fear is enough to dismiss the healthy, intact (i.e. normal) individual he was, as well as the preference he may one day hold for having his genitals intact. Ms. Zimmerman fails to understand what it means to "not have a really good reason".

Not that he would've complained if she didn't have him circumcised. That's speculation. But even if he would eventually complain, it's an easy position for parents to say "We didn't cut your healthy penis because it was healthy." That's rather simple. If he's not placated by that, it would still have been possible for him to choose circumcision. But if she's faced with a teenage boy asking why she did this, and he is not happy about it, what then? Oops?

If an individual does not want to parent his or her children, that person should not have children. Cosmetic surgery on healthy children to avoid future questions is a coward's solution.

Unfortunately, doctors are complicit in this abdication of parenting. Dr. Klein's statement above makes this clear, since the surgery is objectively not indicated. But they cede this point in the name of parenting, a very poor conception of that responsibility.

Ultimately, it's a personal decision, said Dr. Joseph Kahn, chief of pediatrics at St. John's Mercy Medical Center.

"Like every decision for every surgery on every child," he said, "it really needs to be something that's discussed with the parents."

Ultimately, we don't treat it as a personal decision. The male choosing or rejecting circumcision for himself would be a personal decision. And like every other decision for every other surgery on every female and male child, it really needs to be something that's medically necessary. That's the first principle that's ignored. Or can parents just order any cosmetic surgery for their child son(s)?

Female genital cutting is prohibited, of course, regardless of the "personal decision" parents might wish to make. We don't listen to nonsense about parents deciding what's best for their family, the newest mantra I see developing around male genital cutting. What's best for your family, when you decide to have a family, is that each person's bodily integrity is respected. You decide to have children. When they arrive healthy, you do not then have a special veto power over the form of that child's body just because he is a he and not a she.

Where medical need is absent, intervention is illegitimate.

Posted by Tony | Permalink | Comments (1)

In an essay discussing a magazine article reviewing the origin of circumcision, the author demonstrates - parenthetically - why it continues.

(The most logical explanation is simple. The male organ [sic] simply looks better post-circumcision than it does pre-circumcision. And looks matter: Consider how visual an animal the human male is and just how much time he spends gazing at himself.)

That's not logic. That's a subjective preference rationalized from an ex post facto analysis fueled by cultural conditioning, as well as a refusal to accept that what is common is not necessarily normal and may, in fact, be harmful.

(For my own parenthetical, the last sentence of the excerpt warrants a response, but it is beyond the scope of my more fundamental argument. If you understand my objection to the first two sentences, my critique of the third sentence is obvious.)

Then, this:

I put the magazine back on the stack, fishing for my handkerchief to deal with the chilly sweat now covering my forehead. [ed. note: There is slightly more context to this excerpt, before and after, but excluding it does not alter the meaning.]

I will never understand how circumcised men react to discussion of the topic this way, only to defend imposing on infant boys what would be so objectionable to them now. What makes a man express relief because he doesn't remember rather than disbelief that something so objectively offensive could be forced on him? And where is the empathy, the moment of thought for other individuals that might make us ask whether or not he wants his healthy penis cut?

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This article appeared in the Boston Globe last week. It's a discussion of efforts to train new mohels in Massachusetts. Two particular passages are relevant to my focus. First:

Be flexible and compassionate, [Dr. Bob] Levenson told the doctors. ... Gently tell the truth when a tearful, post-partum mother asks if babies can feel pain. (The answer is "yes, but I'll be as quick as possible"). And it is perfectly OK - recommended, even - to anesthetize the infant with a little kosher wine dabbed on the lips.

Beyond wanting to see evidence that wine dabbed on the lips of an infant male will anesthetize him from the pain of surgery, this issue raises a large ethical red flag. There must be an objective reason to inflict pain on another, particularly a child who can't offer (his) consent. And does the infant male's soon-to-be-removed foreskin serve a purpose? The answer is "yes," no parenthesis necessary or appropriate.

Second:

But for doctors, the work is not considered particularly lucrative. Mohels must secure their own malpractice insurance, spend significant time counseling families, travel, perform the ceremony on the eighth day of a child's [sic - male] life, all for a fee of $350 or $400.

If a religious observation requires medical malpractice insurance, it is only legitimate to perform on consenting adults. The individual right of minors to be free from (medically unnecessary) harm must remain the exclusive standard, superior to any religious requirements, because risk is objectively inherent. The evaluation of that medically unnecessary risk against unverifiable religious benefits is subjective. The conclusion is only legitimate from the individual giving up his foreskin.

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The Kenyan government is rolling out a plan that overlooks a few key issues.

The Kenyan government has embarked on an ambitious national programme to fast track the national rollout of male circumcision as a means of preventing HIV.
...

According to the new policy document, circumcision will be rolled out for males of all ages in a culturally sensitive way and in a clinically safe setting.

I searched for the policy document but haven't been able to find it. Still, this says everything. Males of all ages. And they're more worried about culturally sensitive ways than they are about human rights or common sense. These children aren't having sex. And there are other, more important (the only?) reasons for the HIV epidemic in Kenya (italics added):

Why is there more AIDS in some parts of the country than in others?

Infection levels are generally higher in urban areas than in nearby rural areas, and some parts of western Kenya have the highest recorded rates in the country. HIV is still spreading in Kenya, so that many rural and urban areas that had low infection levels in the past are now experiencing higher infection rates. Many factors may contribute to these differences, such as high population density, more movement of people because of trading and migration routes, non-practice of circumcision, sexual networks within communities, and cultural practices such as wife-sharing and widow inheritance.

Fixing the "non-practice" of circumcision will solve nothing as long as the last two remain in practice. If, at the very least, the last two are properly compensated for with condoms, fixing the "non-practice" of circumcision will be unnecessary.

Worse, this mentality:

"Our pilot is a free mobile outreach, where a team of five members - a doctor, clinical officer, care assistant, nurse and driver - goes into various communities and sets up camp in a room at a local medical centre or in a tent, and invites people to come or bring their children for circumcision," said George Obhai, monitoring and evaluation manager at Marie Stopes Kenya.

Before the mobile team arrives, the local hospital or clinic is contacted to conduct community mobilisation, and on the day every man getting circumcised receives counselling from a trained member of staff before the procedure is carried out.

"Interestingly, many of the ideas people have about male circumcision work in our favour, even among the Luo; for example, people believe that it improves the sexual experience and that ladies prefer circumcised men," he added.

I respect the idea that moving from traditional circumcision to clinical circumcision will improve the situation for boys, however small the improvement. But to willingly embrace subjective nonsense because it works in your favor is absurd. Medical procedures on children must be based in science alone. There is medical need or there is not. Everything else is irrelevant and should be explained and disregarded as such when it appears.

This plan - as will all similar efforts around the world - will be properly seen as worthless failures when we analyze the long-term results many years from now.

In somewhat related news, this bit of genius (link via by way of Male Circumcision and HIV:

It is now illegal to encourage the use of condoms in southeast Nigeria’s Anambra State. The state government has also banned the advocacy and distribution of other forms of contraceptives including IUDs (intrauterine device) and any other “un-natural” birth control.

“Instead of teaching children how to use condoms to enjoy sex they should be taught total abstinence,” the state commissioner for health, Amobi Ilika said when announcing the measures in late March at the state capital, Awka. “The use of condoms has greatly encouraged immorality,” he said.

The question of proper governmental role aside and an understanding that condoms are still available, what could possibly go wrong?

Posted by Tony | Permalink | Comments (7)

Following on today's earlier entry, how many pro-circumcision myths does this short essay, "The Debate Over Circumcision," inadvertently expose as flawed?

My first son had what can only be described as a bad circumcision. While he was still in diapers, the skin at the tip of his penis started to get sticky and when we changed him, we were unable to pull the skin back to do an adequate cleaning. "It's a problem," the pediatric urologist explained. I am sure there is some medical term for the condition, but all I can remember is that it required a trip to Boston's Children's Hospital where, in the office, my little boy had to get "re-snipped."

This was very, very difficult to for me watch. Despite receiving a local anesthetic, my son cried a lot. So did I. When I found out I was expecting another boy, I did more research on circumcision and stumbled across countless websites arguing both for and against the procedure. Given that my husband and I are not of the Jewish or Islamic faith, where circumcision is customary, there was no real reason to choose circumcision other than family tradition. The medical arguments don't really hold all that much weight, in my opinion.

The complications the author's son experienced are easily explained. At birth, the foreskin adheres to the glans thanks to synechia. The inner foreskin is mucosal tissue, just like the nose, mouth, and female genitals. It doesn't magically stop being mucosal tissue after circumcision. It only stops acting like mucosal tissue through years of keratinization. Until that occurs, any loose foreskin will tend to re-adhere because it is moist mucosal tissue. As the author discovered, this can require further surgical intervention. It can also lead to complications (NSFW - graphic images).

This is objective harm. Even when parents understand some of the risks - through the experience of their previously healthy sons - from medically unnecessary infant circumcision, they're willing to proceed again. The risk of it becoming reality for the boy is inherent in every infant circumcision. No one has the right to impose this risk on him without medical need. No one should have the legal option to impose this risk on him, either.

Posted by Tony | Permalink | Comments (0)

Mark, who writes the excellent Publius Endures, left an excellent (and appreciated) comment over the weekend. Normally I would reply there, as I do with most comments. But Mark included one point that I'd like to discuss (emphasis added).

I must say that the circumcision debate (to the extent it can even be called that) has made me feel relieved that my wife and I are having a girl since we don't even have to consider the issue. Circumcision is frequently done almost without thought, essentially as a ritual. Until Andrew Sullivan started blogging about it in the last few years, it was an issue that I didn't even consider - I thought it was something that was just what was done. People like you and Sully are starting to open eyes that the practice largely lacks any kind of basis other than as a cultural norm.
The main reason to perform circumcision, as far as I can tell, is that it may create some awkwardness when the child becomes a sexually active adult. The thing is that by the time that becomes an issue, the child will be more than capable of making the decision on his own.
If we had our child a year ago (and it was a boy), I think I would have opted for circumcision just based on the fact that it is a social norm and that there is little publicity about the arguments against circumcision. Were the decision to come up now, I would almost certainly not circumcize.
I'm not sure the procedure should be made illegal, though, but only because I'm generally opposed to adding new laws. However, parents need to be better informed about the risks and generally nonexistent benefits of circumcision.

Before I respond, allow me to clarify that this is in no way meant to condescend on this (or any) point. Although I'm certain that I'm right in all facets of my approach, I've thought about this every day for many years. I've read a lot of bad arguments on both sides. Reading through them can be tiresome, and without self-monitoring, my response can fall into frustration. (I try to avoid outright disdain, even though there are places where it's richly deserved.) Mark's comment is none of that. He shows an open mind that demonstrates genuine intellectual curiousity. He grasps the fundamental argument against male infant circumcision and is willing to act based on that new knowledge. Or to not act, based on that new knowledge. I wish more people had that kind of integrity.

Nor am I suggesting that he does not understand any of the libertarian approach I advocate here. Allow me to reiterate, if you're not reading Mark's blog, add it to your RSS feed today. His libertarian credentials are well written in his entries. Here, I'm only offering how I think a libertarian approach must be applied. I've read that libertarian arguments don't apply to children. I find that strange, so this is at least tangentially a refutation of that.

To his comment, though, I think there's an easy libertarian argument that demands legal prohibition. The Female Genital Mutilation Act of 1995 exists. As long as it is valid law, restricting all medically unnecessary genital cutting on female minors, even at the request of parents, the 14th Amendment demands that the government treat citizens equally. The only choices are to repeal the FGM Act or make the law gender neutral. Since we all agree that the former is unacceptable, we're left with the latter. (Take a look at the work Matthew Hess is doing to achieve an MGM Bill.)

Beyond that, viewing government through a libertarian goal of maximizing liberty, I'm against any law that would restrict people from making that decision for himself (or herself). I can form whatever opinion I want about someone's decision, but it's irrelevant to what he should be able to do to himself. Weigh the benefits against the harm with whatever consideration makes sense. But the issue at hand is that medically unnecessary surgery is objectively identifiable as harm. There is cutting. There is an inherent risk of complications, both minor and severe. And infants do not have their choice. Objective harm is forced on them without their consent with no medical need or objective benefit.

Statistics demonstrate that, when left with their choice, males almost never choose or need circumcision. Any reasonable person standard must side with not removing healthy body parts from children. They have the same individual rights that every adult has to the extent that a right is inherent and inalienable. For minors, those rights should be viewed as held in trust rather than created upon reaching the age of majority. Since the first legitimate purpose of government is to protect the rights of each citizen against infringement by other citizens, there is no reason to overlook that just because the person imposing the harm is a parent who views the imposition as beneficial in some (subjective) manner.

Again, I don't think Mark's comment indicates that he's willing to overlook anything. He's not rejecting a law. But as he points out there is a societal norm in the United States that male circumcision is just an inconsequential snip. As I've demonstrated throughout my circumcision category, it's not true that it's inconsequential. Even though most American men are content to be circumcised, we are a nation of individuals before any other examination. Adding a new law to include boys protects them as individuals in the same we already protect girls. It is a law that actively advances individual liberty, while actively rejecting an incoherent narrative of liberty dressed in parental "rights".

We shouldn't need a law to protect against infant circumcision. But in a perfect world, parents wouldn't remove healthy body parts from their children out of fear, superstition and conformity. We must legislate for the world we have, with the foundation of individual rights that we know is valid. I could make an argument that existing assault laws cover unnecessary infant circumcision, but no prosecutor is going to pursue that in the common circumstances of male infant circumcision in America. So, barring a sudden shift to rational action by parents, this is an area where the government must legitimately exercise its authority in defense of rights.

Post Script: There's a little more to Mark's comment than what I posted here. I left an additional response there, but it was more anecdotal.

Posted by Tony | Permalink | Comments (3)

Passed to me by a friend, let's draw the natural comparison on