Circumcision – Page 2 – Rolling Doughnut

Much Ado About Individual Rights

Timothy Sandefur links to essays by two secular humanists regarding the San Francisco proposal to prohibit non-therapeutic male child circumcision. The essay in favor of the proposal is by Tom Flynn of the Council for Secular Humanism. Mr. Flynn is correct. The essay against the ban is by Ronald Lindsay of the Center for Inquiry. Mr. Lindsay is wrong. I wish to address his essay.

Mr. Lindsay begins:

First, let’s cut through the misleading rhetoric. Some proponents of the ban refer to male circumcision as genital mutilation and equate it with female “circumcision,” the term sometimes used to describe a clitoridectomy, or complete removal of the clitoris. Clitoridectomies are carried out in some cultures, principally in rural Africa. (In some instances, not only is the clitoris excised, but the labia minora and parts of the labia majora are also removed.) Obviously, the removal of the clitoris results in loss of sexual pleasure.

To equate clitoridectomies with male circumcision is nonsense. The latter is a clip job, resulting in removal of the foreskin from the penis. …

It is not nonsense. They are different in degree, not kind. Non-therapeutic genital cutting on a non-consenting individual is wrong. That principle is universal, not gender-specific or discounted if we can figure out some possible benefit. Anything becomes acceptable if we accept possible future benefit as a relevant standard for intervening on healthy children. Of course female ~~circumcision~~ genital cutting is mutilation. Western societies agree on that almost universally. We’ve demonstrated that understanding by enacting laws against any procedures involving the healthy genitals of female minors.

But Mr. Lindsay is incorrect in limiting his point to a comparison of male genital cutting (i.e. circumcision) and clitoridectomies. The latter is an example of FGM, not the definition of FGM. The scope of what qualifies as mutilation mirrors what is illegal in most locations in the United States, including California. The World Health Organization defines female genital mutilation as follows (emphasis added): “Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.” In other words, any surgical intervention less damaging than male circumcision, inflicted for the exact reasons we cite for male circumcision, would still qualify as genital mutilation. Every one of those procedures (i.e. Types I – IV) is already illegal to inflict on healthy female minors. Applying the principle and rights in that accurate definition equally, non-therapeutic male child circumcision is genital mutilation.

After mentioning various possible risk reductions from male circumcision, Mr. Lindsay writes:

The foregoing medical discussion is important because it undercuts the argument made by some secularists that there’s no valid medical reason for this procedure. Granted, the possibility that a newborn boy will experience some avoidable health issues unless he is circumcised is very small. Furthermore, depending on how one evaluates the risks, the potential benefits may be outweighed by the risks of harm. But isn’t this precisely the type of decision we usually leave to parents — and which we should leave to parents unless we want to become even more of a nanny state?

To avoid confusion, any reason for circumcising a healthy male is non-medical. Again, if we are to pretend that chasing potential benefits counts as a medical reason for non-therapeutic surgery, then parents may impose any intervention they wish, unrestrained by society. Protecting children from that is not a nanny state action. It’s the legitimate role of government to protect the rights of all its citizens, including male minors. We shouldn’t need new laws here. But parents shouldn’t mutilate their children.

Mr. Lindsay raises a legitimate question:

Speaking of the state, do we really want to give more power to the government to control what can only be described as a sensitive, highly personal matter? How exactly is this criminal ban supposed to be enforced? Are we going to have special police units to stamp out circumcision? Undercover cops posing as physicians willing to carry out back-alley quick cuts? Will there be search warrants issued based on confidential information that Johnny was seen at the urinal less than fully intact? I don’t know about you, but I don’t care if my junk is scanned or touched at the airport security line, but I do reject the notion that the government can tell us how it should look.

I agree that enforcement is a challenge. That assumes it would be enforced, which I don’t believe would happen in the unlikely event it passes. Still, the question is relevant. What I think it would most likely do is provide better support for circumcised males to sue for the obvious battery inflicted. That’s not everything, but it’s something.

The biggest flaw in Mr. Lindsay’s approach is the conclusion he draws. I care if my genitals are scanned or touched at the airport security line. Do my rights not matter because Mr. Lindsay thinks differently? Are individual tastes and preferences not unique to each individual?

While I also reject the notion that the government can tell us how our genitals should look, that isn’t what this law would do. It would prevent parents from dictating how their ~~child’s~~ son’s genitals must look for the rest of his life. It would leave the individual male himself to say “yes” or “no” to non-therapeutic circumcision. I’m no more mollified that my parents mutilated me than I would be if my government had ordered it. The result is the same.

Later, he inadvertently proves that he misunderstands the issue:

I’m tired of secularists fighting the wrong battles. We shouldn’t care whether Johnny, Joel, or Jamal keeps his hood on.

I don’t care whether Johnny, Joel, or Jamal “keeps his hood on.” I care that he gets to choose whether or not to keep his healthy foreskin. The emphasis is on his and healthy, not foreskin. That’s the debate, not this incorrect view that male circumcision is “a clip job” that may be imposed at the will or whim of parents.

Opposition to Circumcision and Anti-Semitism: Follow-Up

Continuing on yesterday’s post, I’d like to expand a bit with evidence. For context, consider this from a post at Hot Air Green Room on the Foreskin Man comic book:

Note that these circumcision-haters could have addressed the issue as one of science, medicine, personal autonomy, or even just a social issue on which reasonable people can disagree.

My archives demonstrate exactly that. But the issue is obviously larger than me, and currently focused on the proposal in San Francisco. The question is whether we’re going to rightly hammer those involved in the creation of the Foreskin Man material for pushing anti-Semitic filth, or are we going to set aside logic and tarnish everyone opposed to circumcision who favors the plain language of the proposal, regardless of their demonstrated determination to engage the issue only as one of science, medicine, and personal autonomy devoid of anti-Semitism? Do we criticize and ostracize those directly involved or do we simply stop thinking altogether, ignore the issue involved and just self-congratulate?

To demonstrate what I wrote yesterday about my behind-the-scenes efforts, this is an e-mail I sent on December 3rd when I first encountered Foreskin Man issue #2. (I’ve omitted references to the recipient because, as I said yesterday, I don’t wish to embarrass, if appropriate. Those involved rectified the problem immediately.)

To whom it may concern:

I do not believe [you] should be promoting the Foreskin Man issue #2 comic in any forum. The caricatures within this issue suggest that those of us against non-therapeutic infant circumcision can’t see the difference between what is done and why it is imposed on healthy children. We understand the reality of circumcision and how parental intent does not justify or improve its imposition. But we must act against the procedure being forced on children without engaging in stereotypes and ad hominem. Issue #2 isn’t close to being acceptable on those points.

We already encounter mindless accusations of anti-Semitism by people who refuse to engage in any critical thinking beyond the silly notion that challenging circumcision is an attempt to destroy Judaism. This charge is nonsense, but we are able to counter it with our words and deeds. The wording of the various MGM bill initiatives demonstrates this neutrality in seeking only that individuals choose for themselves, not the complete elimination of circumcision. Promoting anything the [sic] depicts “Monster Mohel” wielding machines [sic] guns and stealing children from parents who already don’t consent to a bris for their son is damaging to us.

I am willing to give the benefit of the doubt, although I can only hope this was promoted because no one reviewed it before … . Such an action wouldn’t be acceptable, but it would be a forgivable one-time error. However, I will not be associated with this type of material or anyone who supports it. …

Thank you for your time.

Tony

I should’ve stated rather than implied that Foreskin Man #2 is anti-Semitic. But I think the understanding is sufficiently clear. And in an e-mail I sent to alert someone I knew would be equally furious, I wrote this on December 2, 2010:

I don’t know if you’ve seen it yet, but the 2nd issue is appallingly vile and anti-Semitic. …

I can’t control who creates anti-Semitic filth in a mistaken push against non-therapeutic child circumcision. I can somewhat influence who promotes it after it’s been created, but that’s limited where there is no organizational structure among independent activists. What I can do is expect to be treated fairly based on my own words and actions. If you’re inclined to disagree with me, do so fairly on the principled arguments involved, not because some other guy created something disgusting to ostensibly support the same goal.

Opposition to Circumcision and Anti-Semitism

Ken at Popehat has a post today on the proposal in San Francisco to prohibit non-therapeutic male child circumcision. Specifically, he addresses propaganda materials created by individuals associated with MGM Bill, including its founder, Matthew Hess. The charge is that these materials, including a comic book series and trading cards, are anti-Semitic. I’d like to challenge what Ken wrote about it. I can’t, though, because I agree that the materials are anti-Semitic and despicable.

I, and others, have worked behind the scenes to counter this sort of nonsense whenever it’s popped up, including the original release of these materials from Mr. Hess. This will unavoidably appear, since infant circumcision involves religion and not everyone involved in a movement will have the sense to reject the wrong, unethical approach. As I’ve read in a few smart places recently, any movement like this will have its anti-religion fringe, but that should not tar the entire movement. There is a principled approach against circumcision that is easily stated and powerful in a way that anti-Semitism can never be. The words of the proposal are straight-forward. As Ken wrote, “there are many arguments to be made against circumcision that do not depend on denigration of religion.” We should make them, and only them. Those who do shouldn’t be tainted by those who don’t.

So, yes, I’ve encountered anti-Semitism. I do not stand for it when I encounter it, although the only evidence is what I’ve written here. Being a loosely organized movement, at best, chastisement is the only way to counter disagreement on the means of achieving the necessary goal. I prefer to challenge it behind the scenes where possible to educate rather than embarrass. Unfortunately, this example won’t go away, despite behind-the-scenes efforts. And now it threatens to undo any progress principled activists have made. I am furious and powerless, a frustrating combination.

My only hope is that people will not heed this one sentence from Ken, my only objection to his post. He writes: “I hope that it comes to represent the anti-circumcision campaign in San Francisco.” It may. It probably will. But it shouldn’t. There is already too little thinking involved in most decisions to circumcise. We shouldn’t encourage less.

Bob Barr Is Anti-Liberty

I voted for Bob Barr as the Libertarian (rather than libertarian) candidate in 2008. My vote was symbolic, since I couldn’t support either major party candidate. I knew it was a “waste” then, since it wouldn’t amount to anything. I didn’t know I was the idiot. Today, I am ashamed of that vote.

From Barr’s blog at the Atlanta Journal-Constitution, here’s his post on the San Francisco ballot initiative that would prohibit non-therapeutic genital cutting on male minors in the city:

San Francisco, a city that has long been a safe-haven for the liberal elite, …

At least he declares upfront that he wishes to engage in ad hominem rather than logical debate.

… has been on a ban-happy kick of late. But the City by the Bay may have gone a bridge too far with its latest proposed ban . . . on circumcisions!

Don’t think, be OUTRAGED!

After a silly bit about the Happy Meal ban, because banning a food product is somehow no more appalling than banning an unnecessary surgical procedure forced on children, he picks up his mockery:

Now the city may be moving toward an agenda of “genital justice.”

Regardless of whether the city’s Grand Pooh Bahs can defend with a straight face the proposed ban on clipping a baby boy’s foreskin, San Franciscans do appear to be serious about the matter.

San Francisco’s “Grand Pooh Bahs” had nothing to do with this, as his next paragraph demonstrates. It was a ballot initiative led by a private citizen. If it had been proposed to the city council, it would’ve been tossed in the trash can with the same unthinking concern Barr shows here.

The Associated Press reports that local activists have gathered enough valid signatures to place an anti-circumcision referendum on the November ballot. What these activists call “genital mutilation,” would be banned for male children, absent meeting the almost-impossible, “medical necessity” exemption provided for in the referendum. There is no religious exemption. Anyone violating the ban would be charged with a “misdemeanor offense punishable by a fine of up to $1,000 or up to one year in jail.”

The fact that the exemption is “almost-impossible” to meet demonstrates why Barr is wrong on this. It is permanent, body-altering surgery on a healthy person who can’t consent to the modification’s harms or risks involved. California law already prohibits non-therapeutic genital cutting on female minors. What do the Grand Pooh Bahs of California think of that? What does Bob Barr think of that? Is that “genital mutilation,” or is it genital mutilation? Can only female genitals be “cut up or alter[ed] radically so as to make imperfect”? Barr offers no explanation for why male circumcision is Teh Awesome, just that those liberal elites – center square on the Conservative Bullshit Argument Bingo board – support it. Obviously Barr called every one of those who signed the petition to confirm that they’re liberals and couldn’t possibly argue from any defensible or logical position against non-therapeutic male child circumcision.

Barr concludes:

San Francisco clearly has jumped the shark with this proposal. Even some residents who normally would likely shrug off extreme left-wing campaigns mounted by various activist groups, probably are wondering if things are going a bit too far with this one. They are right to question this proposal. It is about as far off the “Bizarro Scale” as you can get; at least, that is, until we see what San Franciscans come up with next year.

That’s it. He doesn’t include a single word about why parents should be able to continue forcing genital cutting on their healthy sons. There is no argument here. This so-called libertarian doesn’t even attempt the flawed argument in favor of parental “liberty”. The only conclusion is that Bob Barr is not motivated by liberty.

Update: I’ve rethought the title to this post. It was originally “Bob Barr is Unethical and Anti-Liberty.” His mockery within his blog post demonstrates that he does not understand, but it’s something different to state that he is unethical. Hence, my revision.

Dr. Amy Tuteur Is Wrong About The First Amendment (And Still Wrong About Circumcision)

Dr. Amy Tutuer is at it again. She insists on defending circumcision from any rational challenge, and also insists on name-calling. Consider:

The foreskin fetishists have struck again. Those who devote their lives to the preservation of foreskins are hurriedly gathering signatures to put a circumcision ban on San Francisco’s November ballot. The measure would assess fines as high as $1,000 and provide for up to one year in jail for someone who performs a circumcision.

Foreskin fetishists is a term used by someone who has no arguments beyond ad hominem. This isn’t her first time deploying it. But if that’s all it takes to “discredit” an argument, what about this rewrite?

The labia fetishists have struck again. Those who devote their lives to the preservation of labia are hurriedly gathering signatures to put a female genital cutting ban on San Francisco’s November ballot. …

Works just as well, right? Demonize where there is a rational argument to be made against surgical intervention on the healthy genitals of children, and no one needs to think beyond the past. Move on, nothing to see here. It’s stupid and rather pathetic, especially since she refers to herself as “The Skeptical OB.”

The news article she excerpts refers to the current ballot initiative in San Francisco to criminalize circumcisions on healthy, non-consenting male minors. It states:

“We say: ‘Would you like to help protect the children from forced circumcision? This is a human-rights issue,’” [Lloyd] Schofield said.

To which she replies:

Actually, it’s a First Amendment issue, and a ban on circumcision is unconstitutional, because it violates the right to free expression of religion. Circumcision is an integral aspect of Jewish religious practice and is important in the practice of Islam. Of course the foreskin fetishists are not concerned with anything as piddling religious belief.

A ban on circumcision would not violate the First Amendment because it’s an individual right. Male minors possess this same right, even in the face of the obvious point that parents may make religious choices for their minor children.

But I’ll momentarily concede that the parents’ First Amendment right trumps the child’s forever. That right doesn’t trump the child’s right to be free from harm, a fundamental natural right. The courts have already ruled that parents do not possess a plenary right to harm their children in the practice of their religion. The disconnect here is solely that our society does not yet acknowledge the obvious point that circumcision, as surgery, is harm. For example, Tuteur writes in the comments:

Every effort is made to minimize any possible risks and religious circumcision cannot and should not be performed if there is any question that it will harm the infant.

Circumcision removes healthy tissue and nerve endings. It causes scarring. It includes a non-zero risk of complications, ranging from mild to severe, including rare cases of death. It alters the functioning of the penis by removing the gliding and protective features of the foreskin. It is not simply a disposable body part. Contrary to what she stated in the past and clearly still believes, the legitimacy of proxy consent in some cases does not prove that it is legitimate in all cases. The distinction that she misses, which is frightening given that she is an OB, is need. Without medical need, proxy consent is invalid.

But smears are easier than thinking.

Barbara Kay Is Mistaken on Circumcision.

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

She begins:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hanna Rosin Is Still Mistaken on Circumcision. Uh Oh.

Yesterday, the New York Times ran an article about a recent study (on a semi-related topic) that suggests the U.S. infant male circumcision rate fell to 32.5% for 2009. This has been floating around for a few weeks. Frankly, I don’t believe it, as much as I’d like it to be true. When the data are fully analyzed, we’ll either see the rate climb or the exclusions will reveal circumcisions that weren’t counted but must logically be assumed (e.g. ritual). I’m aware of my culture’s insanity.

This story has, predictably, brought out the usual folks and their BUT TEH AIDS!!!!1 rhetoric. For example, a year after showing her ignorance and bias¹ for circumcision, Hanna Rosin returns to prove that she’s still willfully ignorant.

The New York Times reports today on new findings that circumcision rates have declined precipitously in the United States, from 56 percent in 2006 to 32.5 percent last year. That’s a phenomenal decline in just three years. …

No kidding. It’s so phenomenal that, were she ever willing to break out her critical thinking skills, she might focus her blog entry on that point. Instead, she regurgitates the same incorrect, irrelevant propaganda.

… The story quotes doctors saying that of course no one in the profession should ever tell a parent to circumcise their child and the Centers for Disease Control declines to comment because they never do on this issue, even though they know full well that the drop in circumcisions is a potentially serious public health problem. …

That quote is this:

“No one is going to tell a parent, ‘You have to circumcise your child.’ That would be foolish,” Dr. [Michael] Brady said. “The key thing physicians should be doing is providing information on both risks and benefits and allow the parent to make the best decision.”

Any doctor who agrees with that is an unethical coward. The key thing physicians should be doing is rejecting the offensive parental request to surgically alter healthy ~~children~~ boys.

As for what they “know full well,” this from the New York Times article:

Some 80 percent of American men are circumcised, one of the highest rates in the developed world. Yet even advocates of circumcision acknowledge that an aggressive circumcision drive in the United States would be unlikely to have a drastic impact on H.I.V. rates here, since the procedure does not seem to protect those at greatest risk, men who have sex with men.

Context matters, a caveat Rosin ignores.

Continuing:

… But circumcision has become like abortion these days, where allying yourself with the Mengele doctors who mutilate infant boys risks bringing a horde protesters to your office door.

Doctors (and non-doctors) who circumcise healthy boys mutilate them:

1 : to cut up or alter radically so as to make imperfect
2 : to cut off or permanently destroy a limb or essential part of

Words have meaning independent of the desired preference of pro- or anti- child circumcision arguments. For mutilation, that meaning is independent of the victim’s gender and the proxy’s intent.

She continues:

It does not really matter if any individual parent decides that circumcision is not for them, as I explained in this New York magazine story, “The Case Against the Case Against Circumcision.” …

This is the crux of her mistake. The (unnecessary) circumcision Rosin defends is not for the parent. It’s imposed on the individual ~~child~~ boy. This is why it’s unethical, regardless of all the unimpressive, incomplete facts she shares. It’s not about what the parents want, but what the boy needs. Proxy consent has objective, logical limits. That our society ignores these does not reduce their validity.

Continuing:

… But it absolutely matters if a whole society turns against the practice. The exact relationship between circumcision and the prevention of certain diseases – from AIDS on down – is not perfectly understood. …

Promote anyway, apparently, since there’s no chance missed factors could contribute to the conclusion.

… But it is absolutely understood that societies in which the majority of boys are circumcised have lower rates of such diseases than other societies.

From AVERT, worldwide AIDS & HIV statistics from 2008 show that North America has an adult prevalence of 0.4%. Most 15-49 year old American males are circumcised. Canadian circumcision rates are declining, but a large percentage in that age group are circumcised. Western & Central Europe, where most males are intact, has an adult prevalence of 0.3%. But it is “absolutely understood” that mutilating societies have lower rates of such diseases. Rosin is entitled to her own facts, apparently. She knows.

Still more:

Anti-circumcision activists have convinced us that circumcision is harmful and dangerous and does a lifetime of damage. …

Circumcision is surgery. It removes healthy tissue and nerves. That’s harmful. Every boy suffers some form of harm (e.g. scarring), but some boys suffer far worse. Collectively it is not “dangerous”, but individuals are not statistics. And since this damage is permanent, it certainly lasts a lifetime.

If a male chooses circumcision for himself, that is his right, regardless of his reason. The issue is its imposition on healthy, non-consenting ~~children~~ boys. Their health proves how the science involved is twisted, since only potential benefits seem to count as “science”. Their lack of consent proves the ethical argument against permitting prophylactic circumcision (i.e. ritual, cultural, and “scientific”), unless Rosin wishes to open proxy consent to medically unnecessary genital surgery on female minors.

¹ I also highlighted her ignorance and bias here and here.

The Facts, Although Interesting, Are Irrelevant

When I wrote about the American Academy of Pediatrics’ revised policy statement on ritual genital cutting of female minors, I sensed some misunderstanding of what the policy says. Then the story hit the New York Times, among many outlets covering it, confirming what I suspected.

In a controversial change to a longstanding policy concerning the practice of female circumcision in some African and Asian cultures, the American Academy of Pediatrics is suggesting that American doctors be given permission to perform a ceremonial pinprick or “nick” on girls from these cultures if it would keep their families from sending them overseas for the full circumcision.

Saying that the AAP now supports female genital cutting grabs attention, but it’s not an accurate summary of the policy statement. The AAP’s conclusion:

The American Academy of Pediatrics:

Opposes all forms of FGC that pose risks of physical or psychological harm.

Encourages its members to become informed about FGC and its complications and to be able to recognize physical signs of FGC.

Recommends that its members actively seek to dissuade families from carrying out harmful forms of FGC.

Recommends that its members provide patients and their parents with compassionate education about the physical harms and psychological risks of FGC while remaining sensitive to the cultural and religious reasons that motivate parents to seek this procedure for their daughters.

I stand by my original interpretation that the AAP left itself room to appeal to both sides of the argument. It brought up a ritual ‘nick’ for ceremonial blood, but avoided anything more declarative than hinting that it should be discussed. But it did not endorse female genital mutilation, unless one defines genital mutilation as any blade-to-genitals. (If that’s your definition, I agree from my rights-based perspective, but the same applies to male genital cutting.) If the goal is to reduce and eliminate harm to children, it’s stupid to suggest that we factor anything other than harm from non-therapeutic genital cutting and sexist to suggest the victim’s gender matters, somehow.

So, to be clear, I don’t have much respect for the AAP, for multiple reasons. It’s revised statement is cowardly. And I’m angry that the story has careened in a manner that requires me to defend an organization unable to reject non-therapeutic male circumcision, a practice it admits¹ is harmful. But here, with this statement, the AAP did not recommend that doctors perform female genital mutilation, nor did it initiate discussion of anything other than the least harmful forms of Type IV as a substitute for Types I, II, and III in a context where some form of genital cutting is likely.

To its credit the New York Times called the AAP:

A member of the academy’s bioethics committee, Dr. Lainie Friedman Ross, associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, said the panel’s intent was to issue a “statement on safety in a culturally sensitive context.”

Dr. Friedman Ross said that the committee members “oppose all types of female genital cutting that impose risks or physical or psychological harm,” and consider the ritual nick “a last resort,” but that the nick is “supposed to be as benign as getting a girl’s ears pierced. It’s taking a pin and creating a drop of blood.”

I don’t accept that ear piercing is benign, but for the purposes here, Dr. Friedman Ross shows that the AAP did not say what many now hysterically claim it said. The now-accepted misunderstanding of its revision is unfortunate because there’s a relevant, necessary path for the discussion to take now that it’s opened:

Dr. Friedman Ross said, “If you medicalize it and say it’s permissible, is there a possibility that some people will misunderstand it and go beyond a nick? Yes.”

But she said the risk that people denied the ceremonial procedure, usually on the clitoris, would opt for the more harmful one was much more dangerous.

I’d like to see research to back that claim, but for some (probably significant) percentage, I have no doubt she’s correct. Unfortunately, the hysteria now present in the debate involves people who either have not read the revised policy statement or have poor reading comprehension skills, so we can’t approach that topic. (Remember, too, that I wrote that I favor of zero tolerance on this if you wish to accuse me of anything for pursuing the discussion.)

Instead, we’re left with people preening about an existing, incomplete (or inaccurate) narrative. The sentiment seems to be a determination to show that one cares about the issue in the correct way rather than figuring out how to minimize harm to children. I’m not saying that people who exhibit the former are uninterested in the latter, but they’re inadvertently working against the legitimate goal.

Post Script: I’d planned to include examples from other sources. Since they generally raise issues that are tangential to my objective in this post, I will address them separately.

¹ The AAP exhibits its cowardice by admitting this indirectly. It engaged in obvious moral relativism as it acknowledged that male circumcision is more harmful than what it proposed we discuss and that causing harm violates the physician’s “principle of nonmaleficence.” But the proper conclusion that non-therapeutic male circumcision is harmful and should therefore be prohibited on male minors is unavoidable from the bioethics committee’s statement on female genital cutting.

A Request

Seeing how the AAP’s revised policy statement on female genital cutting is inducing mass outrage, I think I need to revisit the issue. My initial analysis is very different from the basic, solidifying narrative. I’d planned to follow-up during lunch today, but there’s too much information to adequately address in this short time. I’m going to clarify my thoughts over the next day or so.

My request: I know people read what I write here about circumcision. If you read my blog entry on the AAP’s policy statement, let me know if you think there are any flaws in what I wrote, or if there are areas that I wasn’t clear. I want to make sure I get this right, but I’m perplexed that my take is so much different than what’s being said elsewhere. I don’t think I’ve misread the policy statement, but I want you to tell me I’m wrong if you think I have. Thanks.

A Universal Standard of Basic Human Rights Isn’t Divided By Gender Or Culture

UPDATE:I corrected a word from the original entry to clarify my intent. I understand that the AAP is not a government organization. I’ve corrected the poor wording.

The American Academy of Pediatrics’ Committee on Bioethics issued a new policy statement on female genital cutting, titled “Ritual Genital Cutting of Female Minors”. It updates the organization’s previous stance. Mostly it’s predictable statements against all female genital cutting (FGC), which won’t be controversial in the United States. But there are a few bits of odd reasoning included.

From the abstract:

… The American Academy of Pediatrics opposes all types of female genital cutting that pose risks of physical or psychological harm, counsels its members not to perform such procedures, recommends that its members actively seek to dissuade families from carrying out harmful forms of FGC, and urges its members to provide patients and their parents with compassionate education about the harms of FGC while remaining sensitive to the cultural and religious reasons that motivate parents to seek this procedure for their daughters.

This is unobjectionable without focused reading. But it explains what is coming in the policy statement. Most Americans will read “opposes all types of female genital cutting that pose risks of physical or psychological harm” to mean no cutting should be permitted on healthy girls. The policy statement doesn’t refute that because, as it acknowledges, all non-therapeutic genital cutting on female minors is prohibited in the United States. In the body of the statement, this:

Protection of the physical and mental health of girls should be the overriding concern of the health care community. Although physicians should understand that most parents who request FGC do so out of good motives, physicians must decline to perform procedures that cause unnecessary pain or that pose dangers to their patients’ well-being.

Reading what isn’t being said demonstrates that the committee fails to endorse complete opposition to FGC, either. For example:

… Most forms of FGC are decidedly harmful, and pediatricians should decline to perform them, even in the absence of any legal constraints. However, the ritual nick suggested by some pediatricians is not physically harmful and is much less extensive than routine newborn male genital cutting. There is reason to believe that offering such a compromise may build trust between hospitals and immigrant communities, save some girls from undergoing disfiguring and life-threatening procedures in their native countries, and play a role in the eventual eradication of FGC. It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm.

I think there’s merit to this argument. It fits the details of proposed accommodations at Harborview Hospital in the ’90s for Somalian immigrants. From a practical standpoint, a ceremonial nick to draw a drop of blood is better than an excision. Discussion without invectives would be helpful.

However, I don’t want to imply that I endorse this strategy. I reject it as a matter of law and practice because children possess the same basic, natural human rights as adults. (There’s no distinction for the gender of the child, which I’ll address shortly.) Legislating such an exception, or refusing to prosecute such violations of existing law, legitimizes ritual and cultural genital alteration. It moves the discussion from should it be allowed to how much should be allowed. It dismisses the child, the individual whose genitals face the scalpel.

Related to that, the statement includes this:

There is also some evidence (eg, in Scandinavia) that a criminalization of the practice, with the attendant risk of losing custody of one’s children, is one of the factors that led to abandonment of this tradition among Somali immigrants.

There are options and paths to pursue before we embrace moral relativism.

Predictably, the statement avoids acknowledging American hypocrisy on the topic of male genital cutting. This is particularly worth noting as some seek to move the AAP’s (and assorted governmental bodies) official stance on non-therapeutic male child circumcision from its relative neutrality to deliberate advocacy. In the introduction of its updated FGC policy, it states:

The language to describe this spectrum of procedures is controversial. Some commentators prefer “female circumcision,” but others object that this term trivializes the procedure, falsely confers on it the respectability afforded to male circumcision in the West, or implies a medical context. …

Any fair, honest treatment of its words would recognize that male minors have the same rights. That excerpt should be rewritten to state that referring to female genital cutting as circumcision “confers on it the false respectability afforded to male genital cutting in the West”.

This follows the last excerpt:

… The commonly used “female genital mutilation” is also problematic. Some forms of FGC are less extensive than the newborn male circumcision commonly performed in the West. …

This is from the same organization that “opposes all types of female genital cutting that pose risks of physical or psychological harm.” The newborn male circumcision commonly performed in the West imposes objective physical harm in every case, yet the AAP refuses to reject it, preferring platitudes about parental choice. From the abstract of its policy statement on male child circumcision:

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.

According to the AAP, parents may impose physical harm on their sons, violating the “principle of nonmaleficence” cited as a reason to reject FGC. Yet, in its revised FGC policy statement, the committee writes:

Parents are often unaware of the harmful physical consequences of the custom, because the complications of FGC are attributed to other causes and are rarely discussed outside of the family.

Changing “FGC” to “MGC” in that statement makes it no less accurate. Briefly perusing almost any news article or essay discussing male circumcision will reveal this.

Near its conclusion the committee writes:

The American Academy of Pediatrics policy statement on newborn male circumcision expresses respect for parental decision-making and acknowledges the legitimacy of including cultural, religious, and ethnic traditions when making the choice of whether to surgically alter a male infant’s genitals. Of course, parental decision-making is not without limits, and pediatricians must always resist decisions that are likely to cause harm to children. …

Including cultural, religious, and ethnic
traditions when making the choice of whether to surgically alter a male infant’s genitals is not legitimate. It is unethical, immoral and offensive to anyone who alleges to respect universal principles against causing harm. The committee’s second sentence shows its hypocrisy. It tells pediatricians to respect and aid parents who (ignorantly but unintentionally) wish to harm their sons. It’s moral relativism instead of clear principles respecting individuals. It’s unworthy of a civilized society.

Contrary to my initial concern, the revised policy statement does not explicitly advocate acceptance of lesser forms (i.e. Type IV) of female genital cutting. But it hints that it’s willing to look the other way if anyone wants to substitute Type IV for a type that won’t be practiced in the United States. Discussing such substitutions is a reasonable approach, but the committee cowardly avoids taking a stance, choosing to introduce the topic while letting others draw conclusions. It attempts to straddle both sides of the FGC debate to let each side read into its statement what it wants, if they’re unwilling to question or acknowledge anything that contradicts their preferred, limited viewpoint. Anti-FGC advocates are (correctly) upset, but the appeal of this approach is to those who believe that a potential benefit is science but the objective current health of a child is not. The AAP can plausibly say it opposes all female genital cutting, while also plausibly saying it recognizes the complexity of FGC as it’s practiced and is sensitive to the people who practice it on their children.