Category: Law

Progress in The New York Times

The New York Times has a story on prohibitions in Southern California.

Once known for its sunny, freewheeling disposition — a live-and-let-live sensibility rooted in Western ideals and relied upon by generations of surfer dudes and misbehaving Hollywood stars — this region has long been as regulated as anywhere. Lately, however, cities, school districts and even libraries have been outlawing chunks of what used to pass here for birthright at a startling clip.

Most of the examples rightly appear as silly and intrusive, but I’m not focusing on that or the various political aspects involved. Instead, the proposed prohibition on non-therapeutic child circumcision in Santa Monica gets its inevitable mention. Brace yourselves.

A ban on circumcision (“male genital mutilation”) was registered for the Santa Monica ballot last year, then dropped in an ensuing uproar — but not before state legislators got to work on a law banning circumcision bans. It was passed and signed by Gov. Jerry Brown in October. …

That is unbelievable. I expected a mention of the Santa Monica proposal when I read the article. I didn’t expect this treatment. Everything in there is simple fact without further speculations or defenses in favor of circumcision. A prohibition on non-therapeutic child circumcision is not like the others because it’s neither innocuous nor reasonable within a proper understanding of individual freedom. The only birthright is genital integrity. However, the only information that could be questioned is the one piece of information that tells the truth in an unsettling way. Yes, male genital mutilation had quotes, but I still consider that a sign of progress. Remember that prior New York Times reporting on male circumcision hasn’t been quite as rigorous in dealing with facts or relying on credible sources. This is minor but promising.

Flawed Circumcision Defense: Rabbi Shmuley Boteach

Rabbi Shmuley Boteach has an opinion piece in The Wall Street Journal titled, “Germany’s Circumcision Police”. It starts off well.

There was a head-spinning moment in Germany last week: News emerged that a rabbi had been criminally charged for performing his religious duties. Rabbi David Goldberg of northern Bavaria, who shepherds a 400-member community, is the first person to run afoul of a ruling by a Cologne judge earlier this year that criminalized circumcision, a basic religious rite.

There is some precedent outside of Germany for such a ruling. …

Even though we disagree on policy, agreeing on basic facts is always good. But his essay slowly falls off the path.

… In the United States, a San Francisco ballot initiative tried last year to make circumcision an offense punishable by a $1,000 fine and up to a year in prison; it failed to get enough votes. …

That’s not an accurate summary of what happened last year. A court ruled that the local ballot initiative conflicted with an existing state law and struck it from the ballot. It had nothing to do with getting enough votes.

… But the circumcision ban deserves universal scorn.
…

Does the German government really want to get into a public battle over whether they are better guardians of the health and welfare of Jewish (and Muslim) children than their parents?

As long as parents continue to circumcise their healthy sons, I hope so. Obvious physical harm for subjective non-therapeutic benefits is unacceptable without the individual’s consent. Protecting the rights of all citizens is a legitimate role of the state.

The Los Angeles Times recently cited a study predicting that as the number of circumcisions goes down in the U.S., the cost of health care will steadily climb. Eryn Brown reported that “If circumcision rates were to fall to 10% . . . lifetime health costs for all the babies born in a year would go up by $505 million. That works out to $313 in added costs for every circumcision that doesn’t happen.”

I’m not impressed by Rabbit Boteach endorsing the idea that a child’s normal body – and by extension, his rights – has a price beyond which we’ll justify non-therapeutic intervention to remove parts of it. But, more importantly, the key in that is not $313. It’s predicting. Aaron Tobian and his co-authors used a data model to make a guess. There are many factors involved. They are not constant. Cost, availability, and need could be quite different in two decades. For the potential benefits against sexually transmitted infections, circumcision can be chosen later. That would match the ethics of the studies that used adult volunteers. This study seeks to “prove” that a specific, non-urgent solution should be applied now, regardless of ethics.

Why? Because circumcision has been proven to be the second most effective means—after a condom—for stopping the transmission of HIV-AIDS, with the British Medical Journal reporting that circumcised men are eight times less likely to contract the infection.

He gets credit for mentioning condoms, which puts him ahead of the AAP. Still, condoms provide greater protection than circumcision, and remain necessary after circumcision. So, cost-wise, it’s condoms or condoms and circumcision. The former is cheaper and ethical. Infant circumcision is not ethical, including when potential benefits against STDs are cited.

While the Germans decry the barbarity of circumcision for men, they also overlook the benefit to women who are the men’s partners. Male circumcision reduces the risk of cervical cancer—caused by the human papillomavirus, which thrives under and on the foreskin—by at least 20%, according to an April 2002 article in the British Medical Journal.

They overlook the potential benefit to women? Do they? They can agree that (voluntary, adult) circumcision may confer reduced risk to female partners while also finding it unacceptable to impose circumcision on infant males (i.e. not “men”). Rabbi Boteach ignores the ethical foundation for the court’s ruling.

While some attempt to equate male circumcision with female clitoridectomy, the comparison is absurd. Female circumcision involves removing a woman’s ability to have pleasure during sexual relations. …

Not necessarily. Yet, in spite of that, it remains unethical. At some point, the human rights principle(s) involved must factor. Equal protection is a human rights principle.

… It is a barbarous act of mutilation that has no corollary to its male counterpart. …

This is also not true. Within what he wrote, it is, because he limited himself to clitoridectomy. The scope of illegal female genital cutting/mutilation is much broader than that, including any cutting that is anatomically analogous to (or less harmful than) male circumcision. That’s relevant.

… Judaism has always celebrated the sexual bond between husband and wife. Attempts to malign circumcision as a method of denying a man’s sexual pleasure are ignorant. …

Male circumcision controls male sexuality, with a long history as an attempt to limit sexual pleasure. It is still used to reduce pleasure for males.

… Judaism insists that sex be accompanied by exhilaration and enjoyment as a bonding experience that leads to sustained emotional connection.

If we ignore explicit statements in favor of circumcision as a way to diminish male sexual pleasure, Rabbi Boteach’s claim here is not mutually exclusive from reduced sexual pleasure. Intent does not guarantee outcome.

We Jews must be doing something right in the bedroom given the fact that, alone among the ancient peoples of the world, we are still here, despite countless attempts to make us a historical footnote.

This is evidence that male circumcision does not eliminate male reproductive ability. No one has claimed it does. His statement is a non-sequitor. The ability to reproduce is not proof that circumcision is acceptable or that it does not affect sexual pleasure or inflict harm.

Related: From the Cut Podcast, a debate between Rabbi Shmuley Boteach and Cut director Eliyahu Ungar-Sargon.

The AAP Worsens Its Flawed Circumcision Position

A lot has already been said about the AAP’s revised policy statement on non-therapeutic circumcision on non-consenting male children.

More will be said today and beyond. Much of it will be uncritical regurgitations of the AAP’s revision by news organizations. There will also be analysis from those who recognize and highlight the glaring deficincies and oversights in the policy. I expect to contribute my own thoughts. For now, I’ll highlight one key aspect from my initial read-through before going into what I think is a more important consideration to this apparent-but-not-really temporary setback.

The short version of the statement ends with this (emphasis added):

Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for individual families.

That’s so close to the ethical stance. Remove families and focus on the individual and it would be ethical¹.

The way the promoted portion of the new “finding” within the revised statement differs from this conclusion is the key takeaway to challenge the supposed change from the AAP, which is really more-or-less just an exercise in urging politicians to permit circumcision on Medicaid. Here, the AAP demonstrates that its evaluation of the net benefit, that possible benefits outweigh the risks, is subjective and determined only by individuals. This directly contradicts the supposed proof based on their review of research that the potential benefits outweigh the risks (and the costs – the direct harm in every case – that they ignore). We should repeatedly emphasize that as often as necessary.

My concern is that we’ll get stuck in this low-level, short-term portion of the larger debate. It’s clear from European medical associations and courts that the eventual destination is public policy against non-therapeutic circumcision. The AAP and American society, in general, are (inexcusably) behind. But both will get there. Activists for the rights of children can make that happen sooner than it otherwise might happen.

The key is that we must give people the opportunity to save face, to avoid digging in to protect their egos. The problem is their stance, not necessarily their character. It should be obvious to them that their stance is incorrect. It isn’t. To address that, do we want to express an irrelevant, limited sense of superiority or convince others that we’re correct because facts and ethics demonstrate the case we’re making? If we impugn their motives and/or character by choosing the former, we may extend the period during which this policy statement stands or encourage people who can be influenced either way to choose the inferior stance of the AAP.

Edit note: I changed “it’s” to “their stance” to avoid possible confusion.

¹ The existing societal view treats certain basic human rights – for boys only – as a buffet from which parents may pick and choose for their own reasons. This is the problem merely expressed within the AAP’s policy statement.

Flawed Circumcision Defense: Charlotte Allen

Charlotte Allen has an editorial in today’s Los Angeles Times about circumcision and intactivists. She doesn’t understand either. She begins:

The “intactivists” — anti-circumcision people who are trying to get the practice outlawed in the U.S. and elsewhere — …

This is off to a terrible start. The effort is to prohibit non-therapeutic circumcision on non-consenting individuals. That’s an ethically significant difference. While I suspect she thinks that her words mean what I just wrote, they don’t. Her claim is what’s being repeated, as if this effort is the same as seeking a complete prohibition on religious circumcision for everyone of any age. When arguing against something, the first requirement is to fairly and accurately state the opponent’s position. She fails at that in the first half-sentence.

Intactivism, a movement of the last 20 years or so, got a boost recently when a German judge ruled that non-therapeutic circumcision of children amounted to “bodily harm” and must henceforth be outlawed. …

First: intactivism in its current form has been going on for at least twice as long as she claims. (e.g. Van Lewis)

Re: the court’s ruling. The issue of bodily harm, which is objective, appears only here. She will not directly address this again. She mentions sensitivity, as though that’s the extent of possible harm, and draws an incorrect conclusion by selectively quoting a press release. (More on that in a moment.)

The tagline attached to Ms. Allen’s essay is this:

‘Intactivists’ are trying to get the practice outlawed in the U.S. and elsewhere. But how bad can it be?

There is bodily harm in every circumcision. But to the question, it can be very bad. This bad. Or this bad. Or the worst case scenario. Those are thankfully rare, but they occur. Those males are (or were) individuals with human rights. They are not merely statistics to ignore.

The intactivists like to paint circumcision in lurid colors. The phrase they use to describe it — “male genital mutilation” — evokes the barbaric practice of female genital mutilation. But the two have almost nothing in common. …

Mutilation is an accurate description for non-therapeutic male circumcision without the child’s consent. And it has considerably more in common with female genital mutilation than Allen understands.

She continues:

… Female genital mutilation is invasive and ghastly, and results in long-term health risks for women subjected to it, not to mention the diminution or elimination of the ability to feel sexual pleasure. …

Usually, yes, but that doesn’t justify male circumcision. As I’ve said elsewhere, a punch to the face is not acceptable because a knife to the gut is worse. The difference should be in punishment, not prohibition.

Apart from the valid aspects of the comparison of non-therapeutic genital cutting on a non-consenting individual, male or female, male circumcision is unethical on its own.

Male circumcision involves snipping off about three-eighths of an inch of skin. It hurts, briefly, but so do the shots that babies routinely receive. And according to the World Health Organization, it “reduces the risk of heterosexually acquired HIV infection in men by approximately 60%.”

That three-eighths of an inch of skin will grow into a larger structure if left in place. It also removes the nerve endings within that three-eighths of an inch, and leaves a scar. But with that argument, the clitoral hood, or even the clitoris, is a tiny structure in infants. Does that render it ethical to remove either of these from a healthy infant? She’s offering a ridiculous defense of non-therapeutic genital cutting on a non-consenting individual.

For the HIV statistic, she cites this page. She failed to quote pertinent information beyond the first sentence. She should’ve included the part that says “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.” Not one of those three criteria matches a Western nation. It isn’t compelling. Citing it as a justification for infant circumcision is an empty defense, which is worsened by additional arguments against this reason for circumcising infants. (Anything other than circumcision with the voluntary consent of the individual where those scenarios apply is still unethical.)

The notion that circumcision reduces a man’s sexual sensitivity has little basis in fact. Two medical studies, in 2003 and 2007 — one presented to the American Urological Society and the other published in the Journal of Sexual Medicine — found that circumcised and uncircumcised men experienced the same levels of response to touch and pain during sexual arousal. A press release issued by the 2007 study’s chief researcher, at McGill University in Montreal, stated: “This study suggests that preconceptions of penile sensory differences between circumcised and uncircumcised men may be unfounded.”

Suggests is not a synonym for proves. Allen seems to possess a tendency to consider only what is convenient rather than presenting all facts. This press release from McGill University about that study includes the following caveat:

Payne cautioned that though the study’s results are very promising, they are still preliminary and do not necessarily resolve many of the longstanding controversies surrounding circumcision. “This study only measures one sensation, so it questions the held notions, but it does not refute the idea that there may be some differences at some level. No one can deny the anatomical differences between a circumcised and uncircumcised penis.”

To be fair, it’s possible that the version she read didn’t include that caveat. I’m not sure why a press release from these scientists wouldn’t include such a caveat, but I don’t know what her source is. However, a simple bit of thinking reveals the inherent flaw in drawing such a broad conclusion from research like this. This basic fact can be confirmed by reading the study itself:

… It is possible that the uncircumcised penis is more sensitive due to the presence of additional sensory receptors on the prepuce and frenulum, but this cannot be compared with the absence of such structures in the circumcised penis. …

To state the obvious: the foreskin is removed during circumcision. Comparing that in circumcised men is impossible. The study does not demonstrate what Allen claims it demonstrates.

It’s obvious that Allen has not considered anything beyond her limited understanding of circumcision. At best, she presents lazy thinking with minimal research. Or worse, she started with her conclusion and created a fortress around her mind to protect myths and block facts. Whatever the reason, she is wrong. Her defense of non-therapeutic circumcision on children is pathetic.

**********

Post Script: Unsurprisingly, more errors exist in Allen’s analysis. I included them in the original version of this post. I deleted them because they weren’t egregious in the way the above excerpts are. I’ll include one bit in the comments. The above is what I think should be the critical argument against her propaganda.

Flawed Circumcision Defense: Wesley J. Smith

The Norwegian ombudsman for children’s rights recently stated about ritual circumcision:

[Pediatrician] Dr. Anne Lindboe told the newspaper Vart Land last month that circumcision in boys was a violation of a person’s right to decide over his own body. “Muslim and Jewish children are entitled to the same protection as all other children,“ she said. She added that the practice caused unnecessary pain and was medically unbeneficial.
…

The children’s ombudsman is an independent governmental institution entrusted with safeguarding the rights of minors.

Yes. Her statement is similar to the ruling from Cologne that non-therapeutic child circumcision violates the child’s rights to bodily integrity and self-determination.

That logical statement is meeting resistance. Over at Secondhand Smoke, which claims to be a “24/7 Seminar on Bioethics and the Importance of Being Human”, Wesley Smith revealed that he doesn’t much understand how non-therapeutic circumcision involves bioethics¹ or that having a normal anatomical body part is part of being human. In response to Dr. Lindboe, he wrote:

First, circumcision after the start of puberty is far more risky and complicated than infant circumcision. …

Perhaps. It’s also unlikely to be necessary later. The real consideration is between guaranteed pain and harm from the unnecessary surgery on an infant and it being riskier and more complicated as an adult in the unlikely event it’s needed. If a male chooses non-therapeutic circumcision, ritual or not, as an adult, he is expressing that he values the possible benefits more than the risks. Consent is the issue. (There are also advantages to waiting, such as not needing to forcibly separate the foreskin from the glans and having a larger penis to better measure how much skin to remove.)

He continues:

… But more fundamentally, religious liberty is one of the world’s most important freedoms. …

Yes, but there are other freedoms, such as the rights to bodily integrity and self-determination. They’re also important. And children possess their own individual right to religious freedom.

… For you secularists who don’t care, it seems to me that means that you only care about liberties you want for yourselves–which isn’t freedom at all.

First, that’s ad hominem. Second, he’s wrong. It’s possible to care about many freedoms at the same time, and for all people equally, including children. It’s possible for secularists to care about religious liberty possessed by parents while recognizing the ethical flaws inherent in non-therapeutic child circumcision that place the surgery outside the scope of individual religious liberty for parents.

The attack he perceives is misunderstood. (See also.) An attack on religious freedom would require an effort to prohibit religious circumcision, full stop. The current facts have been presented that way, which is incorrect (for whatever reason that misrepresentation occurs). The effort here is to prohibit non-therapeutic circumcision on a child who can’t consent. It aims to leave each child with his choice. He retains his right to have himself circumcised for religious (and/or non-religious) reasons. He may exercise his freedom of religion rather than having it exercised for him by his parents.

This necessary change will require religion to accommodate a different understanding of religion’s interaction with individual civil rights. That can and should be debated. As evidenced by Mr. Smith’s words, he hasn’t engaged that debate yet.

But if we believe that religious liberty is fundamental–it is, after all, a core part of the Universal Declaration on Human rights–then Jews and Muslims have a right to circumcise their children. [ed. note: males only?] Indeed, it is a religious imperative. …

It’s consistent to believe that religious liberty is fundamental and that no one has a right to circumcise their healthy children. It may be an imperative, but that alone grants no right.

Here is another core part of the Universal Declaration of Human Rights (emphasis added):

Article 1.

  • All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.

Article 2.

  • Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.

Article 3.

  • Everyone has the right to life, liberty and security of person.

Mr. Smith writes as if other rights aren’t implicated by the exercise of religious freedom. The rights expressed earlier, and clearly, in the Universal Declaration of Human Rights are strikingly similar to those expressed by the District Court of Cologne and Dr. Anne Lindboe. It is clear that he is wrong rather than those with whom he disagrees.

To close he cites this essay by David P. Goldman, which deserves a post of its own rather than an analysis here. After the excerpt, Smith writes:

It doesn’t matter whether the Norway ombudsman or any of us agree. Circumcision is a sacred duty for Jews, a rite that brings the infant into the community. I assume the same is true for Muslims. In the name of freedom, government must leave it alone.

In the name of freedom, a legitimate government must protect the rights of all citizens equally. Because non-therapeutic child circumcision violates various rights of the child and inflicts permanent physical harm in every instance, prohibition is the only means to promote individual freedom. That is the proper role of government.

¹ The issue is more complicated than parental intent or imperative because there are competing rights. It’s further complicated because very few advocates of circumcision acknowledge what the surgery does to the (healthy) child.

Flawed Circumcision Defense: Waxman, Lowey, Berman, et al.

Twenty members of Congress sent a letter (PDF) to German Ambassador to the United States Peter Ammon. It’s a standard pro-circumcision talking points effort without any thought and without any acknowledgement that a (better) counter-argument exists. It’s the view of people living in a fantasy world. From the press release (emphasis added):

The letter, which was sent to German Ambassador to the United States Peter Ammon, objects to a June 26, 2012 decision in the District Court of Cologne as an affront to religious freedom because Jews and Muslims consider circumcision a fundamental rite of passage and affirmation of faith. …

It should be an affront based on objective criteria. In addition to the issue being a fundamental rite, circumcision is harmful to the recipient in objective ways. Prohibiting its imposition on a non-consenting individual (e.g. a child) would be an affront if the second issue were not involved. It is. This is an issue of competing rights. The District Court of Cologne ruled on that basis. These members of Congress, incorrectly meddling in the legal and policy affairs of another country, do not address the court’s ruling in their letter. They do not engage the facts.

For example, the press release concludes:

“A not so veiled assault on tenets central to religious expression is underway in Europe’s courts and legislatures,” added Rep. Berman. “We must let it be known to our friends in a clear and unequivocal voice that such measures are harmful assaults on religious freedom and should not continue.”

An attempt to regulate an activity is a “harmful assault” on an idea. I can accept that as a possibility, although the idea can’t be injured. It isn’t happening with a prohibition on non-therapeutic child circumcision. There is no assault on a valid freedom, just a child being injured during a non-therapeutic surgery. That is the only harmful assault involved. The Representatives are pushing empty platitudes as public policy at the expense of the rights of citizens.

For the letter itself, it’s linked above. I urge everyone to write a letter in response, especially if one of the twenty members is your representative. But we must remember to be respectful. Stick to the ideas. Do not engage in ad hominem or insinuation based on superficial factors. Focus on their words and how they contradict logic and equal human rights.

Procedures that Intentionally Alter or Cause Injury

In Reverse the Approach, I had in mind the numerous blog posts like this I’ve encountered:

In this installment of things that should not be compared as equal, we’ll discuss how female circumcision is not the same as male circumcision. …

There’s the subtle difference I discussed. When I make the comparison, it’s to compare male circumcision to female genital cutting. That method allows for the relevant comparison, as well as the opportunity to discuss how the comparison is limited. Trying to compare FGC/M to male circumcision hinders the goal, which should be an accurate analysis of male circumcision. Society has already assessed the ethics against FGC/M. No one wants to re-open or challenge that when using the valid, limited comparison of the two interventions.

The blogger, Lindsay Marie, finishes her introduction with more fence-sitting than her post demonstrates before moving into the comparison:

How they’re similar:
For one, they’re both called circumcision (this isn’t entirely accurate… I’ll get to that in a bit). For another, both involve cutting off a part of the person’s genitals.

Basically, yes. I wouldn’t start with the name, though. It’s semantically inaccurate for females, but it’s hardly a point to compare the two acts. They can both be mutilation while calling one mutilation and the other anything else. A consensus on nomenclature tells us something without proving anything on its own.

I would start with the principle, which she gets almost complete. Non-therapeutic genital cutting on a non-consenting individual is more accurate for what we’re describing. That applies to both females and males. There is no reasonable way to make a gendered distinction on that principle. The distinctions, which exist in practice, are relevant to punishment rather than prohibition.

She incorrectly moves on to differences at this point. As I argued, I think this results from comparing female genital cutting to male circumcision. It’s too easy to start with the most common forms, which are unfortunately also the more extreme forms. Again, that matters, but for the comparison, the validity of state intervention on male circumcision is the question for the comparison. Is there a comparison to be made between male circumcision and what the state prohibits with respect to female genital cutting? There is.

(a) Except as provided in subsection (b), whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years …

Any cutting, even that equal to (i.e. hoodectomy) or less destructive than male circumcision, is illegal. Those forms exist, although they are not the common forms. They are illegal. The comparison works on that limited scale, and points to other legal questions about the right to physical integrity and equal protection.

There’s also the comparison based on the WHO fact sheet for FGM (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.
…

… It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.

There is no reason to exclude males from that protection of rights, even though FGC/M is almost always more physically damaging, and to a significant degree. Males suffer injury in every case, and worse in some cases, including extremes such as amputation and death. The implicated rights are the same.

There are differences, of course. I’ve acknowledged them here, to some extent, but I’ll reiterate that most female genital cutting is more extensive, with more extreme and lasting consequences. It is evil and should be eradicated as much as possible.

With that stated, she continues (language warning):

How they’re different:
In every other fucking way. Male circumcision is practiced widely in developed countries as a way of preventing specific health issues in both men and women. Male circumcision is usually performed by a trained professional (almost always a doctor, but some religious parents ask a trained Rabbi to perform the procedure) in a sterile medical setting with the latest tools and effective healing techniques to eliminate infections and reduce pain. Male circumcision is performed on days-old infants who will not remember or even realize what happened and almost always with anesthetics to reduce pain. Pardon the comparison, but breeders clip dog tails at the same age and in a similar way, and zoo keepers clip bird wings at the same age and in a similar way. I don’t agree with clipping dog tails, but if it’s going to happen it might as well happen when they’re too young to realize.

First, I don’t want to put too much emphasis on widely, but it’s confusing. If it should be attached to “as a way of”, which is how I read it upon a second pass, I disagree because most circumcision is cultural. The science is a pretty way of making people feel better about doing something indefensible they wish to do for their own subjective reasons. If widely is meant to describe “in developed countries”, that’s inaccurate. It’s widely practiced in the United States and Israel. It’s been widely practiced at some point in the past in the UK, Australia, and Canada.

To the point, where it is intended as a prophylactic, it is practiced as an attempt to prevent specific, unlikely health issues. Statistics show that most circumcisions in the developed world prevent nothing for most males because most males will not develop a foreskin-related problem. When they do, it’s usually associated with some other corresponding behavior. (e.g. Does he get HIV because he has a foreskin or because he didn’t wear a condom?) People get incorrectly impressed by the relative risk differences between intact and circumcised when the absolute risk of foreskin-related issues is small. Even the most dedicated propagandist, Prof. Brian Morris, only claims that the risk of a foreskin-related issue requiring some form of medical attention (i.e. not just circumcision) within the male’s lifetime is 1 in 2 or 1 in 3, depending on where he’s writing. (I will not provide links to his propaganda. Use Google.) Imposing the most invasive solution on a healthy individual is unethical.

As for the sterile operating theater with modern techniques and equipment, I’m unconvinced. As her post makes clear later, she wouldn’t support female genital cutting conducted in a similar setting. That’s the correct stance, but if it’s not support for one, it isn’t support for the other. As the WHO’s fact sheet states, “more than 18% of all FGM is performed by health care providers, and this trend is increasing.” Defending it for male circumcision will likely lead to further justification from proponents of female genital cutting because they’ve modernized a cultural ritual.

The “he won’t remember it” defense is also not compelling. We wouldn’t be any more convinced that a little female genital cutting would be okay if inflicted on girls too young to remember it. We must judge the act on its own. Would we excuse a punch to the face of a child who won’t remember it? It is unlikely to leave a permanent alteration. Corporal punishment for children even has a biblical basis. At some point, the rights of the individual must matter more than peripheral arguments.

With male circumcision, it’s not “going to happen”, as her defense of “too young to remember” implies, unless we take the validity of parental choice as a given. I don’t. There is a risk, as with all normal body parts, male or female. But the chance of needing circumcision are very low. Most males left with their choice never need or choose circumcision. The “he won’t remember it” defense requires an assumption that he will either need or choose circumcision eventually. If it merely assumes he wants circumcision but will be too afraid of the pain, then he values not experiencing pain more than he values being circumcised. There is no reason to assume an infant thinks differently. This is related to female genital cutting more than it may seem. Like father, like son, so like mother, like daughter?

Next, she links to a comment on Reddit that discusses the issue of intent.

… One of the best explanations for the difference between male circumcision and female genital mutilation comes from a user called superdillin:

I think the intent and damage differences between male and female genital mutilation does need to be pointed out. What we do to our baby boys, often with no medical reason, is bad. Very bad and we should stop. BUT, what was done to OP’s girlfriend was done to take away her sexuality, and to control her. It has put her life at risk at worst, and at best has taken away her most sexual pleasure organ, and it was done with the intention of her becoming a breeding cow to be used for a man’s needs for the rest of her life.

What we do to our boys is due to misinformation about health and hygiene, combined with unhealthy aesthetic expectations and tradition. What some cultures do to their girls is deliberate, controlling, life-threatening and inherently sexist. [Her emphases.]

I agree with that, which differs somewhat from the blogger’s post. And I’ve already acknowledged the damage differences in the most common forms. Beyond that experience of the mutilated women described in the Reddit thread, there is evidence that some mutilated females retain some ability to orgasm, which just suggests that the issues and how they relate are more complicated than the idea that male circumcision somehow isn’t bad because female genital cutting is usually worse. (That evidence changes nothing on the ethical question. FGC/M remains evil.)

It is not clear that the intent for each exist as polar opposites. The motivations can have certain similarities. For FGC/M a (possibly overwhelming) majority of the cutting seems to be motivated in the way the West perceives. Sometimes it’s more complicated. But even with the best intentions, which apply to almost every male circumcision, they still aren’t enough. The act matters first. Non-therapeutic genital cutting on a non-consenting individual is wrong. We can’t get past that, ethically, so everything else is important but irrelevant to the validity of prohibiting unnecessary surgery on a child, regardless of gender.

The first key fact in the WHO’s fact sheet states that FGM “includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.” (See footnote¹.) The intent that matters is the intent to act, not the intent to act for good or bad reasons. “Good” and “bad” are subjective, to some extent, anyway. Do the parents intend to alter the child’s normal, healthy genitals? Yes. It’s about the act and the objective harm that results.

Back to the word circumcision: I’ve noticed an increase in groups publicly opposed to male circumcision (part of this was seen during our recent Gay Pride parade), and some argue that male circumcision should be called male genital mutilation, to more closely align itself with female genital mutilation. Although circumcision in both sexes involves the cutting of the genitals, and both procedures can be unnecessary at best, only female circumcision can actually be called butchering because of how it’s performed and what its purpose is. It’s called “circumcision” to make it seem more acceptable and to hide what it really is. (Hell, even the Wikipedia page for female circumcision is titled “female genital mutilation.”)

I don’t believe use of the term male genital mutilation is primarily meant to more closely align the two. It does that, but the intent is to stop pretending that circumcision is so innocuous that it should remain a parental choice for the parents’ subjective, preferred reasons. Some forms of female genital cutting don’t reasonably constitute “butchering”, yet we still outlaw those forms. When does the individual who will live with the modified genitals get to offer input on whether it constitutes mutilation?

From this brief interview with Sister Fa (Fatou Diatta), a musician from Senegal who is a victim of genital mutilation.

Rebellion is in the words. You are dealing with issues such as forced marriage, female genital mutilation. How important is this for you?
“It’s more than important. But my struggle is not against Female Genital Mutilation (FGM, ed.). Me, I do not even use the word “mutilation,” because mutilate means cutting with the intention to hurt. I say ‘cutting’. I’m campaigning so that people would know that it is important that we can educate a child without going through certain practices that may harm his/her health. I’ve been a victim of this practice and I know its effect. It hurts.”

Again, this is so much more complicated than the world so many imagine we live in. The word mutilation is definitionally accurate for both genders, tied to outcome, regardless of parental intent. Whether to use the term or not is a marketing question, not an applicability question.

I wouldn’t publicly advocate one way or the other for male circumcision because there are benefits and consequences of the procedure that must be taken into consideration. I can, however, speak from the only experience I have, which is as a woman who has had sex with both circumcised and uncircumcised men. My experience taught me that male sexual pleasure has absolutely nothing to do with having been circumcised as an infant and that my own sexual pleasure had nothing to do with whether or not my partner was circumcised. However, if asked my opinion I might point out that even the cleanest of males can be less hygienic and more likely to spread a disease or infection with their foreskin intact, which from a female standpoint is a huge concern since an infection inside the vagina can be much worse than a topical penile infection. It seems to me like male circumcision has more benefits for a male’s sexual partner than for the male himself.

Perhaps, but that isn’t a defense for circumcising children. It’s a defense for encouraging and empowering women to stand up for themselves in sexual relationships and to choose their sexual partners and practices consciously. Ask the male to shower. Refuse to have sex if he won’t wear a condom. It’s also a defense for voluntary adult male circumcision.

I truly believe, when performed by a surgeon or urologist in a hospital with the proper tools, that male circumcision should be an option and that parents of sons should educate themselves on whether or not to do the procedure. But I also believe that even if female circumcision were to be performed in the exact same situations as male circumcision (on infants, by medical professionals in a sterile setting) that it would be genital mutilation. The intent automatically makes it wrong and the way a female’s body is designed opens the poor girl up to dozens of complications, many of which are life threatening. Male circumcision and female genital mutilation are not the same thing.

She’s wrong. Intent matters, but outcome matters first and most. An individual’s healthy body is permanently altered without the individual’s consent. The invasive act violates the individual’s right to physical integrity (and right to self-determination). In that core analysis, female genital cutting/mutilation and male circumcision are the same. They are both indefensible.

¹ Non-therapeutic “medical” male circumcision is a misnomer. It’s medicalized circumcision, which merely indicates that it’s performed in a modern, sterile operating theater. That is condemnable in its limited focus, but it is not enough to render the non-therapeutic surgery ethical. The patient’s consent is also necessary. The pursuit of possible benefits (i.e. reduce risk of UTIs or female-to-male HIV transmission in high risk populations) is speculative and may not be necessary for – or desired by – the individual himself. There are all sorts of interventions we could perform that might reduce the risk of some future malady. Society does not open those up to parental choice because they’re also harmful. They’re ethically wrong. Circumcision is the same.

Examples of the Need to Reverse the Approach

Following on yesterday’s post, The Guardian posted four letters from readers about Catherine Bennett’s excellent essay against non-therapeutic male circumcision. Three of the letter-writers believe they’ve found a weakness in her argument. They’re mistaken, and in odd ways. (I’m omitting points that are mistaken but beyond the comparison.)

First:

Female genital circumcision implies the removal of the clitoris, sometimes with the inner labia, sometimes infibulation. It is often practised with blunt razors or knives and without anaesthetics. The risks: fatal haemorrhaging, cysts, urinary and vaginal infections, chronic pain, obstetrical complications.

This supports my last post. This writer didn’t figure out how the comparison might work. She assumed it doesn’t. She started with FGM and worked back to discredit it.

The larger question is the relevance of the remaining facts in that paragraph. If those didn’t happen, and FGM occurred in a clean hospital room, I don’t believe her objection to it would change. She’s arguing for a distinction that doesn’t matter to the initial ethical question or the fundamental comparison. (It only matters to individual practices, which is still important to understand and change.)

She continues:

… There is no evidence whatsoever to support the notion that it affects function, sensation or satisfaction.

It’s incorrect to claim that there is no evidence that circumcision affects function, when the form changes. There is more to function than the ability to orgasm and impregnate. On that crude basis, an argument could be made that FGM doesn’t change function. Just limit “function” to whatever begs the question. (The latter two are subjective to the individual, which is also on the ethical point.)

Next writer:

Catherine Bennett is incorrect in describing female genital mutilation (FGM) as the “equivalent” of circumcision. Granted, both procedures involve a surgical modification of the external genitals of a non-consenting child. Both are, in my view, unacceptable.

That’s the key comparison. I don’t understand why this bizarre tangent follows:

There are, however, great differences: female genital mutilation is illegal in the UK and in many other countries worldwide, including in Africa. Circumcision is lawful. So campaigners against circumcision need to get into dialogue with the Jewish and Muslim communities and press for a change in the law.

Of course. But how is that relevant? The legality of an action doesn’t speak to its validity. Here, numerous historical examples could disprove that “correlation equals causation” mistake. Ms. Bennett made no error in comparing the acts.

This writer provides another paragraph, but it’s more helpful to move on to the next writer:

With reference to Catherine Bennett’s polemic on male circumcision, she should give more attention to the WHO’s statement that male circumcision can be a positive boon in relation to sexual cleanliness. …

This comment demonstrates the idea that one’s own subjective view should somehow be everyone’s objective view. It’s the idea that anyone against circumcision simply hasn’t considered some aspect allegedly in favor of circumcision. If the opponent would just think of benefit X valued by someone else, it would all be clear.

It doesn’t work that way. Much of the debate is subjective to the individual affected. That’s a reason the choice belongs only to the male himself. Me, I prefer to bathe properly and engage in safe sex practices. The so-called “positive boon” to “sexual cleanliness” is irrelevant to me. Ethically, we’re left with the objective facts from a non-therapeutic surgery.

… That hidden space underneath the flap of foreskin is indeed a fertile breeding ground for bacteria and disease. …

That just as accurately describes female genitalia. I don’t imagine the letter-writer thinks that’s a ringing endorsement for female genital cutting.

… The German court’s ban on male circumcision has rightly been overturned by its parliament. …

They did not overturn the court’s decision. They passed a resolution showing support for circumcision as a parental choice. The resolution is essentially a promise to address the issue in the legislature in the fall. The letter-writer erred on a simple, verifiable fact.

… Babies and young children are not able to make rational decisions as to their welfare: their parents have to decide how they are fed; what names they shall be known by; what schools they will go to; to which religion they will be directed; all of which decisions have a significant effect on their later life. …

Parents make decisions for their children. Circumcision is a decision. Therefore, parents may circumcise their children. That’s flawed logic. It assumes that a decision is just merely based on parental choice. Surely the letter-writer sees the negative implications of that. One such implication would be that parents may also cut the genitals of their healthy daughters. The silliness of the argument is that parents may make many decisions, and they all apply to their children, except this one so-called parental right that only applies to their sons. If they make this decision for their daughters, we incarcerate them. It’s incomprehensible in a rational analysis.

… The only effect of male circumcision on their later life is enhanced cleanliness and hygiene.

Taking the statement at face value, because the male still has to bathe, the claim is rather silly. The only basis on which it works as support for non-therapeutic child circumcision is with the assumption that the male will not undertake the minimal additional effort to bathe himself properly if left with his normal foreskin. Without that (offensive) assumption, the choice must be left to the male to decide whether he values his foreskin or saving a tiny bit of effort in the shower.

The larger problem is that this posited benefit isn’t the only effect. The male loses a normal, functioning part of his anatomy. He loses his foreskin, and suffers the damage to the nerve endings that remain. He is left with a scar that he may not find aesthetically appealing. He is left without the mechanical gliding action of his foreskin, so sex becomes a matter of friction rather than pressure. That’s not a valid parental choice.

Cherished Legal Principle: Freedom from Unwanted Harm

Remember, never trust politicians to protect individual rights, even rights so basic as physical integrity. (e.g. Mike Gatto)

The German government says Jewish and Muslim communities should be able to continue the practice of circumcision, after a regional court ruled it amounted to bodily harm.

Chancellor Angela Merkel’s spokesman said it was a case of protecting religious freedom.

Steffen Seibert said: “Circumcision carried out in a responsible manner must be possible without punishment.”

Non-therapeutic circumcision carried out in a responsible manner requires the consent of the circumcised. The Merkel government is wrong. It is endorsing the violation of a child’s rights to physical integrity and to self-determination.

Reading the Cologne Court’s Words

Since the recent ruling against non-therapeutic child circumcision by the Cologne district court, many have spoken out against it and claimed various and potentially extreme results that will flow from it. Some of these complaints are legitimate. As I previously wrote, there are issues offered by proponents of ritual child circumcision that deserve to be taken seriously. Asking people to let go of something they intensely value is asking them to bear costs, even if it should be clear that avoiding objective harm to the child must be stressed more. (That post is coming.)

Still, what I haven’t seen yet is the opposite view. I haven’t seen a single example of someone who supports legally-protected ritual child circumcision accurately acknowledge the court’s ruling as it was written, rather than using a selective reading, to defend the practice. (If someone has seen an example of a proper acknowledgement, please link it in the comments.) The closest I’ve seen comes from Chief Rabbi Lord Sacks, but he only built and defeated a straw man. Near his conclusion, he wrote:

That is what the court in Cologne has done. It has declared that circumcision is an assault on the rights of the child since it is performed without his consent. It ignored the fact that if this is true, teaching children to speak German, sending them to school and vaccinating them against illness are all assaults against the rights of the child since they are done without consent. The court’s judgement was tendentious, foolish and has set a dangerous precedent.

The issue of consent is only part of the court’s ruling. The child’s lack of consent factored because of what was being done to him. The court evaluated the act first. From an English translation of the ruling, found here:

… since the parents’ right to religious upbringing of their children, when weighed against the right of the child to physical integrity and to self-determination, has no priority, and consequently their consent to the circumcision conflicts with the child’s best interests. …

Circumcision violates the child’s (right to) physical integrity. Consequently, parental consent conflicts with the child’s rights, including his right to consent or to refuse. Contrary to Chief Rabbi Lord Sacks’ statement, the court did not imply parenting is now illegal. It made the necessary distinction to limit the ruling to non-therapeutic child circumcision.

… There was consent by the parents, but this was not capable of justifying the commission of the elements of bodily harm.

And:

… The parents’ fundamental rights under Article 4 (1), 6 (2) of the Basic Law (Grundgesetz, GG) in turn are limited by the fundamental right of the child to physical integrity and self-determination under Article 2 (1) and (2) sentence 1 GG. …

There are two rights involved. The right to physical integrity and the right to self-determination (i.e. consent). A complete attempt at a rebuttal requires acknowledging both.

An insufficient response such as that by Chief Rabbi Lord Sacks is not unique. Consider:

Muslim leaders joined the Jewish groups in their condemnation of the ruling. Ali Demir, chairman of the Islamic Religious Community in Germany, described circumcision as “a harmless procedure that has thousands of years of tradition and a high symbolic value.

There are also Christian (and probably secular) advocates who mistakenly defend circumcision as a parental right based on, but not limited to, their religious freedom. However, they all ignore, minimize, or fail to understand that circumcision, like all surgery, is not physically harmless to the child.

As the court stated, “the child’s body is permanently and irreparably changed by the circumcision.” Harm and its link to consent are the issues. Circumcision¹ inflicts harm, despite the presumed good intentions of parents. Only the individual directly affected can evaluate whether or not this objective physical harm is good, bad, or neutral for himself, permanently. Only he can decide whether or not he consents to this intrusion on his physical integrity. That is what the court ruled, not the convenient straw men floating around as a defense against the equal rights of children.

¹ Here I refer only to ritual and non-ritual non-therapeutic circumcision. Proxy consent for therapeutic circumcision requires further analysis and can be justified, although it also inflicts harm.