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 at 12:00 PM | 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.

Posted by Tony at 05:00 PM | Permalink | Comments (0)

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 at 04:10 PM | 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?

Posted by Tony at 04:30 PM | Permalink | Comments (0)

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 at 04:15 PM | 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.

Posted by Tony at 03:40 PM | Permalink | Comments (0)

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 at 04:00 PM | 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 at 02:30 PM | Permalink | Comments (33)

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 at 12:20 PM | 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.

Posted by Tony at 07:00 PM | Permalink | Comments (0)

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 at 02:25 PM | 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 at 11:45 AM | Permalink | Comments (0)

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 at 12:30 PM | 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?

Posted by Tony at 12:45 PM | Permalink | Comments (0)

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.

Posted by Tony at 12:53 PM | Permalink | Comments (0)

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 at 02:02 PM | 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 at 03:06 PM | 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 at 02:40 PM | Permalink | Comments (3)

Passed to me by a friend, let's draw the natural comparison on this story:

Thailand's Health Ministry ordered hospitals and medical clinics to temporarily stop performing castrations for non-medical reasons, saying Wednesday that the procedure performed on transsexuals needs stricter monitoring.
...

"As of today, doctors can perform the surgery if there is a medical reason to do so — not for any other reason," ministry spokesman Suphan Srithamma said.

The move came after a leading gay activist, Natee Teerarojjanapongs, called on the Medical Council to take action against clinics that perform castrations on underage boys.

I don't have any knowledge of this topic beyond what this story offers. I assume it's true that some number of males undergo castration to achieve "feminine qualities". Like medically unnecessary circumcision, neither parental proxy nor choice by a legally incompetent individual should factor. Unlike medically unnecessary circumcision, this appears to be at the male's request. But this is important to remember:

"It's a totally wrong perception that castration will make boys more feminine," Natee told The Bangkok Post last week. "These youngsters should wait until they are mature enough to thoroughly consider the pros and cons of such an operation."

Unfortunately the real problem appears to be doctors overlooking the existing rule requiring parental consent for boys until they reach age 18. I don't think there's contention that enforcing this is reasonable.

So, instead, a thought experiment. I would like to assume that parents are rational enough not to sign off on this type of stupidity. I don't assume that, of course, because the evidence proving otherwise is too strong. But apart from the distinction¹ on future reproductive capability from the two procedures, how is it any more reasonable to permit parents to impose circumcision than to permit them to impose castration? We can discuss degrees of violation, but that's a distraction from the truth that they're the same kind of violation. We don't debate the depth to which it's acceptable to stick a knife into someone, even though differences exist in probable outcome from the depth of the assault.

When considering surgery on minors, any intellectual journey towards acceptance after establishing medically unnecessary is unethical and illegitimate. There is no objective justification, so any legal permission granted to parents by society is subjective reasoning devoid of reason. It doesn't matter if the topic is castration, genital cutting, breast augmentation or any other unnecessary intervention a second-party prefers. The individual isn't just supreme, he is all that matters.

¹ Reproduction is not necessary for the individual to live, so its foundation is subjective, exactly like medically unnecessary circumcision.

Posted by Tony at 10:15 AM | Permalink | Comments (0)

Anyone who follows discussion of circumcision on the Internet will encounter regular moments of an overwhelming desire to hate mankind. It's impossible to avoid. People are so devoid of any logic or consideration for the child that disgust is the kindest emotion I can achieve. For example:

But I was also thinking, for all you mummies to be out there, are you thinking of getting your son circumcised? And for those of you with girls or who don't know what you're having, would you get your baby circumcised ? Does anybody know the pros and cons in doing so ?

If you've paid attention to my Circumcision category, you know that actual discussion of pros [sic?] and cons will likely not follow, which is how it plays out. Like here:

It's completely a personal decision ... You cannot make your decision based off of anyone elses opinion. ...

I am here in the US and it is a very common practice. It wasn't even a question for us. Here it is done one day after birth. Neither one of my boys even flinched when it was done. The PlastiBel that they use here takes all of 2 seconds to perform and it's done.

You should really research it so that that you and OH feel that you have made the decision that best suits your beliefs. Good Luck!

Notice¹ that this response ignores the original question. Instead, it's a typical defense of parents making a "personal decision" not based on any other person's opinion, with any other person being inclusive of the healthy child. Whatever suits them is somehow acceptable.

But it gets more blatant:

...

I am not the sort of person to push my views on anyone else but that is what we would do.

Hope you make a decision that you and babies (sic) daddy are happy with.

...

She is mistaken; she is exactly the type of person to push her views on someone else. Her husband is that type of person, too. Neither of them considered that their son might not want to be circumcised. They imagine that only their opinion about his body mattered.

Some inject a little sanity into the discussion, saying it should be illegal. But then comes the inevitable softening to saying it should be a personal decision for the parents based on good reasons. Why? Has one parent on this board who chose to circumcise given any indication that common sense intervened? It should be illegal. That is the only reasonable stance based on more than one analytical approach. Why step away from that? To avoid offending? The legally-permitted violation will continue for some time. There is no reason to enable it longer. Don't be afraid to call people out on their selfish delusions².

<sarcasm> With all of these arguments for and against the procedure </sarcasm>, I can't say I'm surprised by the original commenter's decision:

yeah I think I'm going to get my boy circumcised, seeing as it protects him from all sorts of infections and sexually transmitted diseases, but I heard a story about a man who lived here in winnipeg
He got circumcised when he was a baby and they 'accidentally' cut his penis off! Can you believe it ?

It protects him from UTIs in the first year of life, but the risk is minute without circumcision. (Girls suffer more than intact boys.) And the data on STDs is equivocal, at best. (Condoms? Bueller? Bueller?)

The man she speaks of is David Reimer. His circumcision was attempted using cauterization, which is not an accepted method. While he is important to remember because he was a victim of a botched, unnecessary circumcision, there is (unfortunately) at least one recent example from Canada. The child died.

To the first response I quoted above, the circumcising doctor used a PlastiBell ring on the child.

¹ Notice also that the (unverifiable) claim that it didn't hurt the child is irrelevant. The ability to make a surgical intervention pain-free could justify any number of barbaric procedures. Need matters first, which didn't exist here. Then, when need exists, a scientific conclusion that the most extreme intervention that is circumcision is warranted because no lesser interventions will correct the malady.

Also, did the child suffer any during the healing period?

² From one mother's rambling comment excusing her selfishness:

I am happy with my decision, and I am sure my sons will never come to me saying they wish they still had their foreskin.

I've heard this so many times. No parent ever thinks it will happen to them. I know she's psychic enough to know what her son will want, but what if he asks? And what if he asks because he's not happy about it? Or is he not allowed an independent thought?

Posted by Tony at 11:47 AM | Permalink | Comments (4) | TrackBacks (1)

On Monday the Los Angeles Times offered a typical analysis of infant male circumcision. There are many points to address from this story, so I've broken them up into multiple posts. (Posts 1, 2, and 3.)

Point four:

FOR nearly all of Nada Mouallem's pregnancy, she and her husband, Tony, had a running argument. She wanted to have their son circumcised. He didn't. "Many days, I'd go off and research all the pros. He'd go and research all the cons. Then we'd get together at night and fight," she says.
...

For the Mouallems, family tradition and religion were not factors. "We kept those separate and focused only on the scientific reasons," says Tony Mouallem, who was against circumcising his son because he didn't think it was necessary. Plus, he's not circumcised. "You have to work a little harder to keep it clean, but that's not a big deal."

His wife, Nada, however, worried about the responsibility of keeping her newborn's penis clean. She thought circumcision would help reduce the risk of infection and disease. "I wasn't keen on my baby having a surgical procedure, but then I thought, why not if we can offer him more protection?"

In the end, Tony sided with his wife. Their son was born Feb. 10, and was circumcised the next day. Tony held him during the procedure. "There was no bleeding and he didn't even cry," he says. "I'm still not convinced it was medically necessary, but I didn't want to burden my wife with the worry of cleaning it. And maybe it will be easier for him in the locker room."

Choosing surgery over responsibility is the abdication of an obligation when having children. No one states that an intact penis can't be kept clean. Even ignoring the absurdity that it's more difficult to clean in his early years when his foreskin adheres to his glans and shouldn't be retracted, keeping your children clean and eventually teaching them to care for themselves is parenting. Anything else is the selfish subjugation of the child's needs to the parents' whims. In this case, that whim is further discredited because the father presumably understands how to keep an intact penis clean.

Post Script: This most fits the "typical" analysis. These "balanced" articles always contain a couple who can't decide. And the couple always chooses "yes".

More analysis of this article and the CDC's obtuse approach can be found here and here at Male Circumcision and HIV.

Posted by Tony at 01:10 PM | Permalink | Comments (0)

On Monday the Los Angeles Times offered a typical analysis of infant male circumcision. There are many points to address from this story, so I've broken them up into multiple posts. (Posts 1, 2, and 4.)

Point three:

Robert and Cara Moffat of Los Angeles, who are expecting their first child, a boy, in May, had no trouble deciding, and plan to have their son circumcised. Robert, who is 30 and circumcised, said, "I grew up with it, and my wife has a preference for it, so that's what we'll do. We're doing what the family is comfortable doing."

His father is happy being circumcised, so the boy will be happy with it. This is an unverifiable assumption at birth. His mother prefers having sex with circumcised partners. This is irrelevant because I presume she does not intend to have sex with her son. So it leaves the conclusion that his future sex partner(s), who they apparently know will be female, will prefer that he be circumcised. This is an unverifiable assumption at birth. Finally, "what the family is comfortable doing" is hardly a principle of ethics, liberty, or science.

Also note that the parents have said nothing about (potential) medical benefits in forcing this on their son. Yet, they're allegedly qualified to decide that their son will want this. And legally we're all supposed to think this is reasonable.

As parents and task forces sort through the variables surrounding this intimate decision, [Dr. Andrew] Freedman offers parents in turmoil this comforting advice: "Rest assured. No matter what decision parents make for their son, most men think whatever they have is just fine."

There are four potential realities for an adult male when he is finally legally protected to make his own genital decisions the way females are protected from birth. He can be intact and happy. He can be circumcised and happy. He can be intact and unhappy. He can be circumcised and unhappy. In the first scenario, he could do something but he wouldn't. In the second, he can't do anything but he doesn't care. In the third, he can do something and he will choose either the perceived benefits of circumcision he seeks or not facing the drawbacks from adult circumcision. In the fourth, he can do nothing and society rejects his opinion as an individual.

In the first two scenarios, we conclude that the child validates the parents' decision. We mistake an unrelated outcome for causation. In the third scenario, whatever we conclude, we've achieved the minimum standard of liberty that the male retains his right to choose (or reject) medically unnecessary procedures. In the fourth scenario, we either deny its validity or babble on about the rights of the parents. This generally involves some hand-wringing about parents making lots of tough choices while actively missing that none of the other choices involve removing parts of his anatomy. (You didn't forget that parental rights are greater when speaking of sons, did you?)

Dr. Freedman's opinion tells every man in scenario four his parents' opinions about his penis matter more than his own. Anyone who argues this refuses to reconcile the complete lack of medical need with any notion of ethics and individual rights. Just because science can (allegedly and potentially) achieve an outcome does not mean it should try to achieve that outcome. That is a slippery slope unbounded by any consistent rule or principle.

More analysis of this article and the CDC's obtuse approach can be found here and here at Male Circumcision and HIV.

Posted by Tony at 01:08 PM | Permalink | Comments (0)

On Monday the Los Angeles Times offered a typical analysis of infant male circumcision. There are many points to address from this story, so I've broken them up into multiple posts. (Posts 1, 3, and 4.)

Point two:

In the first year of life, 1 in 100 uncircumcised [sic] boys will develop a urinary tract infection. Only 1 in 1,000 circumcised boys will. "While that's a tenfold reduction, you have to keep in mind that the risk was only 1% to begin with," says Dr. Andrew Freedman, pediatric urologist at Cedars-Sinai Medical Center. Proper hygiene can prevent most infections.

When considering potential benefits, context matters more than an isolated statistic. For example:

The downside of letting the child make the decision later is that adult circumcision is more expensive, painful and extensive. During an infant circumcision, practitioners numb the site with local anesthesia, then attach a bell-shaped clamp to the foreskin and excise the skin over the clamp. The clamp helps prevent bleeding. In adults, the procedure involves two incisions, above and below the glans (tip of the penis), stitches and a longer recovery. The cost is about 10 times that of a newborn procedure.

Let's ignore the rights of the individual for the moment. I don't, but the hypothetical does, so I'll stick with it. The cost is about 10 times that of a newborn procedure. So what? As a fact on its own, it means nothing. How likely is it that an intact male will need circumcision in his lifetime? If it's less than 10%, and it is, then a basic cost-benefit analysis shows that we will spend less overall by circumcising only those males who medically require circumcision. The "ten times more expensive" meme is worthless upon minimal inspection.

Dr. Freedman seems to understand this:

"The HIV data is the most compelling to date that circumcision can help prevent the transmission of the virus in male-female sex," Freedman says. "While this is important to sub-Saharan Africa, the question is how many infant boys need to be circumcised in the United States to prevent one case of HIV transmission 25 years from now? Factoring in even the rare complication that can occur with circumcision may render this study insignificant."

No kidding. Aside from not being able to predict who (or if) circumcision will help prevent HIV, we can also not predict who will suffer a complication. I seriously doubt the few children who suffer a significant mutilation of the penis care that most circumcisions are "successful". Nor do I suspect the few boys who die from circumcision care about the general outcome. Of course, this should matter now, even before reducing a child to his (unknown) place in the statistical herd.

But he might not get it:

If parents do opt for the procedure, Freedman advises that they do it when the baby is a newborn, have someone trained and experienced perform the procedure, and use pain control. "The older a child gets, the less benefit there is, and the greater the risk," he says. "I would ask parents of an older child to strongly reconsider if the only reason they're doing this is cosmetic."

The parents of a newborn