Flawed Circumcision Defense: Wesley J. Smith (Yet Again)

Wesley Smith is back again in National Review to demonstrate he does not understand genital mutilation. Last week he urged President Trump to sign HR 6100, The STOP FGM Act of 2020, which seeks to resolve the concerns of the federal court that dismissed prosecution in Michigan under the Anti-FGM Act of 1996. Within the bill:

“(a) Except as provided in subsection (b), whoever, in any circumstance described in subsection (d), knowingly—

“(1) performs, attempts to perform, or conspires to perform female genital mutilation on another person who has not attained the age of 18 years;

“(2) being the parent, guardian, or caretaker of a person who has not attained the age of 18 years facilitates or consents to the female genital mutilation of such person; or

“(3) transports a person who has not attained the age of 18 years for the purpose of the performance of female genital mutilation on such person,

shall be fined under this title, imprisoned not more than 10 years, or both.”

A principled individual would read that in its most direct application: non-therapeutic genital cutting on an individual who can’t consent is prohibited, full stop, without exceptions. Alas, like far too many people, Smith believes this applies to only some children, and cites this language from the bill as a foundational defense of discrimination:

It shall not be a defense to a prosecution under this section that female genital mutilation is required as a matter of religion, custom, tradition, ritual, or standard practice.

It shall not be a defense to a prosecution under this section that female genital mutilation is required as a matter of religion, custom, tradition, ritual, or standard practice to impose on a child who neither needs nor consents to surgical intervention. This is so blindingly obvious as a principle that it requires severe mental gymnastics to escape the implication to male (and intersex) children. Smith engages in those gymnastics.

I am a strong defender of religious freedom and the free exercise thereof. But the right is not absolute. The Smith case (which I oppose and hope the SCOTUS will overturn) stripped protection for religious freedom when laws are of general application — as is this bill. In other words, the bill does not single out a particular faith or group in the prohibition.

If the law protects all children, as it should, not a single word of that paragraph needs to change, excluding the parenthetical, which I’ll get to in a moment. Basically, Wesley Smith acknowledges that, under current law and precedent, restricting a religious freedom is permissible when the law is generally applicable and furthers a legitimate state interest. There is nothing more generally applicable than “you can’t mutilate the genitals of a healthy child”. And if that isn’t a compelling state interest, the state literally shouldn’t exist because it will have ceased to defend the rights of its citizens least capable of defending themselves.

Smith’s parenthetical demonstrates that he acknowledges a law prohibiting non-therapeutic genital cutting on boys without exemption for religion is the correct interpretation under current law, or he wouldn’t worry about the case in this context to protect religious “rights” at the expense of human rights he doesn’t value. In America, it’s impossible to argue that circumcision is a strictly religious practice, or that any prohibition would only stop religious parents from circumcising. Every male child can be mutilated at the request of his parents, so a law protecting his right is generally applicable. Thus, everything Smith tacks on after this is special pleading for lawless human rights violations.

That designation certainly applies to a law that prohibits the mutilation of minor girls, which, I should note, is not required by the Koran or any holy book of which I am aware and is done for the express purpose of suppressing the victim’s normal sexual functions. FGM is a direct attack on the equal intrinsic dignity of females and hence, an assault on the human exceptionalism philosophy of our societies.

He just praised the text of the bill that dismisses any claim of a religious requirement, so the fact that he’s not aware of any requirement is irrelevant. Of course, if Smith bothered to look, he’d find interpretations that conclude a requirement exists. I have no doubt Smith would – correctly – dismiss these claims as undermining this prohibition. So, his concern here is, again, special pleading to pretend that a religious requirement matters when he praised the text making it clear it doesn’t.

His belief that parents who cut their daughters always do so with the express purpose of suppressing the victim’s normal sexual functions is also unsupported with even a minimal amount of searching. That is usually the outcome, and it’s always a violation of their body and rights, but Smith assumes his opinion is fact because it’s the narrative, not because he has evidence or has studied the topic beyond a cursory review.

It’s also odd to believe that we need to defend against a direct attack on the equal intrinsic dignity of females by protecting them from what he expressly demands we continue permitting on their brothers. Where is the equality? Where is the dignity? Where is the principle he claims to defend, other than “what we do is good, what they do is bad”? If it’s wrong to cut, it’s wrong to cut.

I anticipate that the “intactivists,” that is, zealots who want to outlaw male infant circumcision, will say that their cause is the same as prohibiting FGM. It is not. First, circumcision is a specific religious requirement of Judaism that brings the infant into the faith, and is also strongly promoted for religious reasons in Islam. Second, it does not destroy sexual function, nor is that the purpose of the procedure. Third, it is not undertaken as a means of oppression. Finally, medical associations believe that the decision to circumcise — regardless of religious issues — should be up to the parents as there is a modest hygienic benefit attained by the procedure.

Of course non-therapeutic genital cutting is one cause, regardless of sex. Non-therapeutic cutting of the prepuce of a non-consenting male violates his bodily autonomy the way such a surgery on a girl’s prepuce would. They both have the same property right in their own body. The only ethical position is that we won’t cut children. This shouldn’t require a law, but it does because people violate their children in this manner. And again, the state has an interest in protecting the rights of every citizen, not just those with the correct cultural favor.

And Smith already demonstrated why his concern that circumcision is a specific religious requirement is irrelevant to whether or not we should protect male minors. Laws of general applicability are generally applicable, not narrowly applicable in blatantly discriminatory ways.

Contra Smith’s opinion, circumcision destroys sexual function. Refusing to acknowledge that the normal anatomical structure of the penis, foreskin included, follows the same biological concepts as every other part of the body, including female genitalia (with foreskin), does not render the removal of the foreskin a non-destructive act inflicting no permanent harm. All surgery is battery. It is harm. The STOP FGM Act of 2020 does not make distinction for degrees of harm or intent to cause harm. The act itself is harmful to the child, and would be prohibited. Some forms of FGM are considerably more severe than a normal male circumcision. Some forms are considerably less severe. All forms will be illegal if Trump signs the bill. There is no “as long as it’s not too harmful” threshold to save male circumcision from ethical rejection.

If Smith actually cared about the complexities in this issue, he’d know that FGM is often undertaken to “improve” the girl, not to oppress her, and at the request of her female relatives over the objection of her male relatives. It still oppresses her, despite any “good” intentions, but we’re talking about the outcome, not the intent, which is what the law explicitly criminalizes.

Smith is correct that parents (generally) do not intend to oppress their sons when they circumcise. It still oppresses them. It is a form of permanent sexual control. “Your genitals will be what I approve of” is control. “You will have this potential benefit through surgical intervention, even if you’d rather just wear a condom” is control.

Having gotten this far in Smith’s shallow analysis leaves no doubt that he hasn’t assessed what “medical associations” say, such as in the APP’s policy statement. It’s an appeal to authority, except the most-often-cited authority’s policy is deeply flawed, misleading, and unethical. The very statement¹ he thinks supports a conclusion that the benefits outweigh the risks ignores the costs (i.e. harms) entirely to reach a conclusion satisfactory to people who will ponder circumcision as superficially as Smith. From the section on ethics, for example, “[r]easonable people may disagree, … how the potential medical benefits and potential medical harms of circumcision should be weighed against each other.” Reasonable people includes the human being who will live with the consequences of others choosing the most radical intervention for him as a prophylactic against mostly minor future risks that can be generally resolved with non-invasive treatments, which is the approach we take with their sisters.

So, yes. Male genital cutting is the same as female genital cutting in causing permanent harm, its ultimate violation, and the irrelevance of its religious nature on the prohibition of its imposition on children.

¹ The AAP doesn’t have a policy statement on male circumcision, because the technical report from 2012 explicitly states “[a]ll technical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.” It’s now eight years since this statement, and it has not been reaffirmed, revised, or retired.

Good Riddance to PrePex and Circ MedTech

I’ve written numerous times about PrePex in the past decade. (See: here, here, here, here, and here.) Generally the context involved an advertisement masquerading as journalism, with the source’s reliance on PrePex’s claim that it was non-surgical. As I said in my first post, the ability to limit bleeding does not mean it is non-surgical. Foreskin removal is surgical. Facts weren’t refuted just because the device’s manufacturer said so. “Non-surgical” was always a useful lie.

Now we know the truth.

… After beginning with great success in Africa, a series of events finally led to the company’s closure recently – after 10 years of operations. TheMarker has investigated what happened, using documents and interviews with people from the company, and has discovered that the PrePex device, which was meant to help prevent AIDS, was linked to a number of cases of death from tetanus in Africa.

Removing body parts isn’t risk-free. This shows the tendency of public health campaigners to sell lofty dreams without emphasizing risks and costs. “With this one special action, you can improve your life!” If there’s a “do not taunt Happy Fun Ball” disclaimer, it’s in small print. The effort is to close the sale, not to educate in order to let someone make an informed decision.

… Published studies showed very high levels of satisfaction from those who used it, with the exception of very specific complaints – such as a bad smell from the area of the penis while the device was being used.

Then it turned out that a number of other cases of tetanus has occurred. According to documents Circ MedTech submitted to the WHO in 2016, a total of six cases of tetanus were reported by PrePex patients in Rwanda and Uganda from 2014 through 2016 (including the three already mentioned above). The symptoms began to appear 10 to 13 days after the beginning of the use of the device. Four of these patients, ages 18 to 34, died.

That tetanus risk is significantly higher in Africa was ignored, which is essentially the approach with any confounding factor in the HIV epidemic, as well. “BUT CIRCUMCISION!” And here we are.

Of course, it’s critical to ask if the six patients in the excerpt were informed of this risk. Or that tetanus is mentioned at all in the public health push, since the article states it’s been reported from “surgical” circumcisions in Africa, too. Or that death was a risk, whether from PrePex os “surgical circumcision”, again, as the article reports happened from the push for male circumcision. But at least they won’t get HIV?

The company’s website is still available, despite the company ceasing operations. In a non-shocking discovery, I see that, like the New York Times in its initial advertisement-posted-as-news (see above), Circ MedTech linked to CIRCLIST as a “useful” source of information (along with Brian Morris’ nonsense). This link existed from at least September 6, 2014, according to Internet Archive. At the same time, CIRCLIST included a few fascinating pieces for consideration. These include information on FGC/M (NSFW), in which the distinction is “modifies the female genitalia in ways likely to be accepted by a neutral observer as [enhancing/reducing] the quality of a woman’s sexual experience”. Is there any concern¹ for consent?

CIRCLIST also contained a section on “Women’s Preferences and Experiences” of male circumcision, including a submission from Alexis (Canada) described as “a mother decides to re-circumcise her sons”. The story:

After reading about re-circumcision on the CIRCLIST website I decided to have my two sons re-circumcised. I was never happy with the loose skin that was left over by the doctor at birth. (The same Doctor did both boys). So I arranged it with a urologist and my sons, age 10 and 14 at the time, now have beautifully tight circumcisions. There is absolutely no movement of shaft skin towards the head of their penises, which I just adore and reckon that their future lovers and wives will adore it too and thank me for having it done. Now that the heads of their penises are fully exposed and permanently bared, I can personally say that the appearance is much sexier to look at and cleaner as well. I also encourage my boys to appreciate the look of their newly remodeled penises and to not be shy around girls because, when those girls get a look at their super tight circumcisions they will just go crazy for them.

Obviously there’s no way for the reader to know if Alexis is a real person or that her ode to pedophilia actually occurred. (It seems to have been disappeared from CIRCLIST sometime in 2015.) But publishing it was informative as to both the motive of CIRCLIST and its editors’ standard for what’s reasonable to do to children. And Circ MedTech linked the site as “useful”.

¹ That’s rhetorical, as consent is rarely considered within the pages of CIRCLIST.

Subjective versus Objective in Infant Circumcision

Slate Star Codex’s 2019 Adversarial Collaboration Contest includes an entry called, [ACC] WHAT ARE THE BENEFITS, HARMS, AND ETHICS OF INFANT CIRCUMCISION?. It’s a confusing mess.

It starts with two paragraphs on penile cancer that reveal this collaboration needed more rigor in the analysis. The beginning:

Circumcision greatly reduces the relative rate of penile cancer, a relatively uncommon malignancy in developed nations which kills a little over 400 American men each year. Denmark, while it has one of the lowest rates of penile cancer for a non-circumcising country, nevertheless has 10x the rate of penile cancer as Israel – where almost all men are circumcised. …

First, the relative rate reduction is marketing. The absolute reduction is the important bit. If I play the Powerball, how much better off am I between buying one and two tickets? The odds are 1 in 292,201,338 with one ticket and 2 in 292,201,338 if I buy two. My relative chance of winning doubled but my absolute chance of winning barely budged. I wouldn’t quit my job when I handed over money for the second ticket.

But there isn’t a source for the relative risk reduction, only an assurance that it’s greatly reduced. The link only states that penile cancer is “diagnosed in less than 1 man in 100,000 each year and accounts for less than 1% of cancers in men”. There are four-and-a-half times as many testicular cancer cases and an equal number of deaths each year, for perspective. Would it make sense to consider removing a testicle from each newborn male? Still leaves him fertile, so what’s the objection, right?

In the second sentence, the science analysis switches to a comparison between Denmark and Israel. Mentioning A before ignoring A to compare B and C is odd. It would be better to consider controlling variables, since there’s clear evidence of complexity within the rates in the three countries.

Here’s a statistic for penile cancer in Denmark from pro-circumcision advocate Brian Morris (use Google, I’m not linking him). He states:

Since the rate of penile cancer in Denmark is lower than in the USA other factors besides circumcision are also at work in these climatically, genetically, dietarily and culturally different countries. The statistics for Denmark have been used by anti-circumcision advocates to draw a sweeping and fallacious conclusion about lack of circumcision per se in penile cancer. The Danish themselves have concluded that although their uncircumcised men are at lower risk, this is only 1 in 900 as opposed to 1 in 600 in the USA, as stated above [Kochen & McCurdy, 1980]. …

So, a country with little circumcision has a penile cancer rate lower than the United States, which has a mostly circumcised male population, and the conclusion we’re to draw is that circumcision greatly reduces the risk of penile cancer. Morris’ twisted barb is the mistake he’s making. I’m not claiming there’s no effect on penile cancer with still having one’s foreskin. The risk factors are generally known and accepted: HPV, phimosis, smoking, age, and being intact. Which is to say, get vaccinated for HPV and/or wear condoms, resolve phimosis if it occurs, don’t smoke, and wash your penis regularly.

I’ll leave out “don’t get old” because I don’t think the most radical solution is the best first option, which is the same reason I leave out “circumcise healthy children”. But if an adult wants to get himself circumcised because he’s afraid the above actions aren’t sufficient, I’m not here to judge his decision. I assume his risk will decrease by some amount. That’s his choice, if he concludes the risks and harms from circumcision are less to him than some reduction in the risk of penile cancer, among potential benefits.

In the essay, the authors write about phimosis:

… However, this does raise the question of whether more aggressive future treatment of phimosis combined with HPV vaccination might reduce the rate of penile cancer in uncircumcised men in the future somewhat. Of course, more aggressive treatment of phimosis would require more childhood circumcisions, which carry higher risk than infant circumcision.

More aggressive treatment of phimosis does not require more childhood circumcisions. It requires understanding the difference between normal anatomical development and phimosis, and not letting a condition linger untreated when it appears. The key is to avoid long-term scarring, not to operate at the first hint of a malady.

According to the United Kingdom’s National Health Service on phimosis:

Surgery may be needed if a child or adult has severe or persistent balanitis or balanoposthitis that causes their foreskin to be painfully tight.

Circumcision (surgically removing part or all of the foreskin) may be considered if other treatments have failed, but it carries risks such as bleeding and infection.

This means it’s usually only recommended as a last resort, although it can sometimes be the best and only treatment option.

Alternatively, surgery to release the adhesions (areas where the foreskin is stuck to the glans) may be possible. This will preserve the foreskin but may not always prevent the problem recurring.

We must abandon the notion that the most radical intervention should be used as early as possible.

(Also, a higher risk rate later is not in the criteria for operating on a normal, healthy child now.)

The next section on HIV mostly summarizes the consensus, while once again missing the importance of relative versus absolute risk, as well as comparing populations where the studies took place and the extrapolation of that data to other populations. The AAP did that in the technical report of its (now-expired) 2012 policy statement on infant circumcision.

… Mathematical modeling by the CDC shows that, taking an average efficacy of 60% from the African trials, and assuming the protective effect of circumcision applies only to heterosexually acquired HIV, there would be a 15.7% reduction in lifetime HIV risk for all males. …

That is a 15.7% relative reduction in lifetime HIV risk in the United States. The lifetime absolute risk of HIV is estimated at 1 in 99. That minor reduction of a small risk is the compelling benefit within the context of STIs, according to the article.

How compelling is it as a defense of infant circumcision when you factor in that the studies were conducted on adult volunteers, not children who are more than a decade from sexual activity and can make their own voluntary choice as an adult?

There is an interesting quote within the section:

… Additionally, when considering the benefits and harms of an intervention such as circumcision, there are strong reasons not to consider the benefits that accrue to the patient’s future partners, but instead to focus only on the individual in question.

The article doesn’t directly treat it this way, but that is the beginning of the discussion because the analysis approaches ethics. The same applies to consideration of the cultural benefits that accrue to others (i.e. primarily parents, but also “locker room”, etc). It’s the start of “should we” rather than the “can we”.

For UTIs, the risk reduction is in the first year of life, the risk is already low, less invasive treatments are available (which we use for girls), and while that benefit lasts for the first year, the harm from the surgery lasts a lifetime. Once again, it’s an ethics question, not a “can we” question.

For the risks of surgery, I think there are clear problems in the numbers. The incidence rate of meatal stenosis is telling, for example. This study reviewed meatal stenosis as a late complication, with follow-up assessment of the two groups at 2 months, 12 months, and 16 months. The group with the lower rate of meatal stenosis at 16 months had a rate of 13.8%. The implication seems clear. Infants can’t report complications. Maybe parents are ignorant of complications. Or maybe they’re not reported in a central location to be included in analysis.

And what constitues a complication? Is a poor cosmetic result a complication? What if the parents think their son’s circumcised penis is pretty but he hates the aesthetic? Is that a complication? Is it factored into the “< 0.2%"? Would it be a complication if a 25-year-old man chose circumcision for himself and didn't like it?

Moving on to sensitivity and sexual satisfaction, I’ll note a few things. The study the authors link to for a claim that the glans “does not change in sensitivity” has Brian Morris as a co-author. I find that immediately discreditable, but I acknowledge that’s isn’t relevant to whether any specific work is flawed. It is not evidence.

What’s in their review is evidence, though. Morris and his co-authors generally play “heads I win, tails you lose” when analyzing information about circumcision. For example, in assessing the Meissner’s corpuscles in the foreskin, they write:

… the study concluded that the prepuce is the least sensitive glabrous tissue of the body.

These findings suggest that the prepuce has fewer Meissner’s corpuscles than any other glabrous skin and that the number of these nerve endings decreases significantly after the teenage to young adult years when sexual activity begins. This makes it very difficult to propose any sexual function for Meissner’s corpuscles. A more feasible hypothesis is to regard them as a juvenile phenomenon, perhaps serving to protect the penis until the onset of puberty reveals its sexual function.

The areas in the study were “finger tip, palm, sole, lip, front for forearm, dorsum of hand, dorsum of foot, and preputium of penis”. All had Meissner’s corpuscles. Based on the numbers, concluding that the foreskin is the least sensitive glabrous tissue contains the fact that it is sensitive. There’s no value to this sexually? No one has ever used light touch of fingers, palms, soles, lips, forearms hand, or feet to generate sexual arousal and provide sensation? Is the proper conclusion that some number above the sensitive-but-least area is the threshold above which sensitivity matters for sexuality? This is choosing not to know.

Now ponder a more recent study with a very specific finding about the foreskin. From Brian Earp’s review:

So let me try another analogy. Saying that removing the foreskin “doesn’t reduce penis sensitivity” is a bit like saying that removing the pinky finger doesn’t reduce hand sensitivity. What you really mean is that removing the pinky finger (which is part of the hand) doesn’t reduce sensitivity in the remaining fingers—although, as we’ll see, it’s not even clear that this part of the analogy holds up in the actual study.

…

Again, you will be surprised to learn—I am quoting directly from the paper now—that “Tactile thresholds at the foreskin (intact men) were significantly lower (more sensitive) than all [other] genital testing sites” including the sites in circumcised men (emphasis added).[5]

And if you’re still unsure based on everything above, here’s a quote from Brian Morris, in his own press release:

… Delay puts the child’s health at risk and will usually mean it will never happen.

The child’s health is “at risk”, but if circumcision isn’t imposed early, he’ll usually neither need or choose circumcision in his lifetime.

Finally, the discussion of ethics:

The ethics of infant circumcision is a complex topic, and the answers likely depend on one’s ethical system. The benefits of infant circumcision appear to outweigh the risks and harms. Additionally, it is safer to be circumcised as an infant than as an adult, and a significant portion of the benefits of circumcision accrue to infants and children. From a strictly utilitarian perspective, infant circumcision should therefore be encouraged – whether we consider society as a whole or only the boy in question. However, autonomy is an important value, and while a man can become circumcised (missing only some of the benefits of having been circumcised as an infant), it is impossible to effectively restore the foreskin and become “de-circumcised”. An ethical system that heavily values personal choice over cost-benefit analysis may reasonably reject circumcision – especially one that rejects currently-widespread societal assumptions about parents making medical decisions for their children. Furthermore, many of the benefits of circumcision accrue only to men who have sex with women. For men who exclusively have sex with men and for men who do not have sex, the benefits and risks are close to equipose. There is a moral concern with performing a procedure that can thus tend to reinforce heteronormativity and sex-normativity.

The answers on circumcision depend on including the healthy individual in the ethical system for a decision that affects him alone. The benefits of infant circumcision only outweigh the risks and (potential and guaranteed) harms if the individual’s subjective preferences value the benefits more than the risks and (potential and guaranteed) harms. To the extent that there is certainty that infant circumcision is safer, delaying circumcision “will usually mean it will never happen”, and no unnecessary surgery is safer than unnecessary surgery. From a strictly utilitarian perspective, infant circumcision demonstrates the flaw in applying a strictly utilitarian perspective on human rights. That anatomy is an important value is the critical point to dismiss allowing imposing subjective preferences on another forever. The man the boy becomes may not share the preferences of his parents. He can’t be uncircumcised if they impose their will. An ethical system that heavily values the current widespread societal assumptions about the valid limits on the imposition of surgery on a daughter’s normal genitals for the parents’ non-therapeutic preference(s) is reasonable to apply to boys, as well. Furthermore, many of the benefits of circumcision accruing only to men who have sex with women are still of subjective value and can be chosen as an adult. For men who exclusively have sex with men and for men who do not have sex, the benefits, risks, and harms are still subjective to the individual himself. There is a moral concern with performing a procedure that is unnecessary and permanent on an individual who does not actively consent.

Non-therapeutic infant (and child) circumcision is unethical.

Valid Dinner Table Topics: Ethics

When I listen to podcasts discussing circumcision, I’m prepared to sigh and grumble in frustration. Listening to The Dinner Table podcast: Circumcision involved a different experience. I talked pointedly at my radio as I listened, pausing every 30-45 seconds to digest my irritation. It was generally an unpleasant experience because the discussion needed much more reflection and thought in place of the talking-point regurgitation. However, I’m glad I stuck with the episode. It contains numerous succinct examples of both exactly why we shouldn’t circumcise children and how people encounter truth but manage to pick themselves up and scurry off before having to confront reality.

Note: I’ve kept the conversational tics in the transcript from the hosts, Tessa Osborne and Griffin Wiles. (I will do this for their interview with Dr. Joel Greenberg, which I’ll review in my next post). I left them in because they demonstrate the speaker working through the thought in real time, which I think is fairer than editing it. I do not interpret or intend these tics within the transcript to suggest anything else.

Here are some observations:

Wiles: Mmm hmm. And there’s, of course, there’s hygiene. People who are not circumcised as a child, and later on in life, get circumcised, it’s a hygienic reason. If they do it themselves, or if parents circumcise their kids… … or if parents circumcise their kids, it’s for hygienic reasons. Adolescents and young adults are more likely to be circumcised. Social and sexual desirability are also really big social determinants in being circumcised.

Boys should and can be taught to wash themselves. Surgery is neither a replacement for nor an ethical change to this basic life skill.

The next section in the podcast covers some of the perceived medical benefits. I’m not interested in refuting them in detail again here, so I’ll both point to my archives and reiterate that every possible benefit argued for can be achieved and/or treated with less invasive methods and with the consent of the individual himself. That’s the core of the topic, not whether or not imposing it on someone can achieve something.

Anyway, in my experience, the perceived medical benefits are the cloak of respectability placed over the real reason, which is some variation of “I like it, aesthetically”, which Wiles states directly. It’s also, “women prefer it”. Or, more crudely, “women won’t have sex with him if he’s not.” It’s the cultural lie society repeats without questioning whether or not it’s true. If it were true, as people pretend, we don’t stop to consider that maybe the individual male would rather have his foreskin than sexual attention from someone for whom he is not good enough without surgical modification.

After a bit more about the perceived benefits making risks “significantly” lower, a statement that isn’t true in the context of absolute risks (or when compared to less invasive alternatives):

Wiles: … Along with the medical aspect, a lot of people think that circumcision diminishes sexual pleasure, or that it diminishes sexual desire, and there is little evidence that supports the theory that sexual function and sexual desire is diminished. So, really,…
Osborne: Good to know.
W: … the studies are inconsistent in the results that they yield…
O: Mmm hmm.
W: … so there’s really little evidence to suggest that circumcision has an impact on sexual desire and sexual function, period.

There is ample evidence that circumcision diminishes sexual function. Even studies cited favorably by circumcision advocates demonstrate the undeniable truth that the foreskin has nerves (e.g. ridged band and frenulum) and functions (e.g. gliding mechanism). Circumcision removes both. It’s objectively incorrect to conclude anything else with regard to function¹.

Moving to the ethical question reveals a missed opportunity for contemplation on the primary question involved:

Osborne: I want to know, what do you think ethically about circumcision?
Wiles: Alright, well. Personally, I grew up circumcised, was circumcised very early on.
O: Can I go as far as to ask you, are you still circumcised to this day?
W: I am still circumcised, it did not grow back.
O: Ok.
W:
O: Just the way you had made it sound, you were like, “I *was* circumcised. I *was*.”
W: I was at a time circumcised, yeah. So I… … I thought that all penises looked like circumcised. I thought penises were, they just came circumcised, like I didn’t know it was a whole procedure until later on in life. I’m glad I was circumcised, I have to be honest, I am glad, because I think aesthetically, for one circumcision makes the penis look more attractive.
O: Mmkay. Have you ever met a guy that said that he didn’t want to be circumcised?
W: I’ve met guys who are uncircumcised but I have never asked if they want to be.

Ponder that last question more, please. It’s what matters here, as the intact guys can still choose. (If it isn’t obvious, I’m a guy who doesn’t want to be circumcised, but I had no choice in the decision.)

Osborne: Ok. How do you feel about, like, if, you know, if you gave a child that choice, like you decided not to circumcise them, and you said, like, if when they’re an adult, and they want to do it, they can do it. Do you think that’s, like, right, or do you think…
Wiles: I think that’s…
O: …….. or do you think, just do it when they can’t feel it?
W: I think that’s right, umm. I do feel like there are advantages to doing it when they are younger, especially with the disease prevention and the convenience. If you’re already in a hospital, you might as well.
O: Ok, I… I, personally, under the topic of genital… … mutilation, if we could call it that. I wouldn’t… like, if I had a son, I wouldn’t want to make that decision for him. I don’t think that’s fair for me. Umm… I think that might be violating some of his rights. And I think that he can do it when he’s older. I mean, we’ve got good medicine, he can be knocked out, get it done.

“You might as well” is not an ethical argument. It is a pithy shorthand for the abdication of parental responsibility for which so many people justify circumcision.

Last, while Osborne’s overall approach is strong, I don’t understand the assumption within “when they can’t feel it”. Babies can feel pain, including after the procedure during healing. I doubt she believes babies don’t feel it, and this was a thinking-out-loud shorthand for “can’t remember it”. If so, that has its own problems, as any thought experiment would show we can do all kinds of awful things to babies that they won’t remember. Not remembering them wouldn’t make any of them ethical to impose.

There’s still an interview to analyze, but that will get its own post.

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¹ In the linked study, Bossio found that the foreskin is the most sensitive part of the penis to light touch, which seems clearly relavant to the typical sexual experience. It’s absurd to find this objective fact and then explore subjective explanations valuing only other aspects. Some men will value other aspects more, yes, but some won’t.

Or, as the linked article by Brian Earp explains:

So let me try another analogy. Saying that removing the foreskin “doesn’t reduce penis sensitivity” is a bit like saying that removing the pinky finger doesn’t reduce hand sensitivity. What you really mean is that removing the pinky finger (which is part of the hand) doesn’t reduce sensitivity in the remaining fingers—although, as we’ll see, it’s not even clear that this part of the analogy holds up in the actual study.

In other words, it’s an odd way to frame the hypothesis. To continue the analogy, my guess is that most people—if faced with the claim that removing the pinky finger doesn’t reduce sensitivity of the hand—would say, “But what about the pinky finger itself?!”

Review: Tom Rosenthal’s Manhood

I stood in the corner of the bar attached to a comedy club on a rainy, late September Friday night in central London, alone. I realized I was about to cry. I managed to stop myself, a decision I immediately regretted. I didn’t want to bawl in the bar. I don’t cry, which I do not admit here to brag. It’s a source of frustration rather than pride for me.

I took a deep breath, and centered myself to quickly understand why that moment almost occurred. It was an unthinking reaction sprung from my depths out of the surprise that I wasn’t alone. I’d just seen Tom Rosenthal’s Manhood, his hour-long examination of circumcision where he demonstrated that he feels about it exactly as I do.

Manhood is, first, a comedy show. “Let me lecture you for an hour on the horrors of male circumcision” is a difficult entryway to challenge someone’s preconceived ideas on the topic. I know this because I’ve wanted to give that lecture so many times and seen the glassed-over “Oh, you’re actually against circumcision” reaction from my answer to an initial question. So, I knew going in there was an hour of material. But I was skeptical because circumcision is not funny. I did not expect to be persuaded that it could be.

After the show, it’s still true that circumcision is not funny. However, Rosenthal’s examination of circumcision, the mistaken ideas around it, and how men are treated for speaking out against the practice is hilarious. He understands the humor is in the preposterous, unquestioned ways we perpetuate this violation. Humor offers a path to the necessary realization and knowledge about what is happening. Most critically, unlike much of what passes as humor about circumcision, he understands that the circumcised male and the foreskin are not the butt of the jokes.

Rosenthal’s mastery flowed through the peaks of finding humor in something as basic as the word uncircumcised to the valleys of anger resulting from the discovery of what’s been done to us. I know that feeling intimately. Seeing it expressed with Rosenthal’s talent and perspective fractured me for a moment before letting me put myself back together with more than I had before.

After pondering the show for more than a month and finally writing to this point, I found this review:

Rosenthal has an engaging, energetic manner, and all is brought together by a theatrical ending that’s memorable, silly and ridiculously over-the-top. But none of this overcomes the tonal shifts between the uncomfortable, serious side of the show and the flippant.

The tonal shifts between the uncomfortable, serious side of the show and the flippant are why Manhood works. Again, circumcision is not funny. I knew this before the show, and I know it after. Tom Rosenthal knows that, too. But I laughed and never felt an urge to stop myself because he’d crossed a line. Unlike every ridiculous joke you can find of a comedian making the man or his foreskin the target, Rosenthal hits the laughs by communicating the absurdity of doing this to normal, healthy children.

The show being in the UK added an interesting element for me, since circumcision is not common there. Most of the audience seemed predictably unfamiliar with the facts and ideas in the show. The gasps at some of Rosenthal’s more shocking revelations about circumcision were enlightening for me as an outsider. I appreciated that it’s possible to find a random group of people who don’t think cutting children is reasonable. They were learning, and in a manner conducive to that. Comedy was the perfect entryway.

I’m purposely not repeating any of the jokes, but they’re fantastic. Rosenthal just announced he’s doing more shows in 2020, so I’d much rather people who care about this topic see the show for themselves. Also, I hope one day he can bring the show to the United States. I would love to see it with Americans to discover if there are differences in the reaction among a random group likely to hold only the superficial belief that circumcision is Good(™). But mostly I trust it will get through to audiences here. That’s what we need.

Flawed Circumcision Defense: Wesley J. Smith (Again)

I expect garbage opinions on male circumcision. Too many people don’t think about it, letting the inertia of ignorance fill in the gaps in their knowledge as parents (and humans pondering anatomy). But I don’t expect such trash from a magazine like National Review that prides itself on being smart, honest, and principled. (More on that in a moment.) Here, Wesley J. Smith shows an embarrassing lack of curiosity and imagination. (Again, since Smith has shown he doesn’t understand the subject before.)

“Intactivists”–the nutty name anti-circumcision activists have given themselves–who aim to outlaw infant circumcision, claim that the procedure has no benefits and constitutes child abuse.

Baloney. There are at least mild health benefits for men, to the point that the American College of Pediatricians recommends that the choice of whether to circumcise be left to parental discretion.

He should talk to more people against non-therapeutic male child circumcision, since he doesn’t appear to have met those like me. The procedure has potential benefits. Removing a body part inherently means something that can happen to it can no longer happen. Phimosis, for example, is no longer possible. Or name any potential benefit, real or made up. It doesn’t matter. Smith cites a new rehashing of studies by Brian Morris¹ showing potential benefits to the health of female sexual partners. Fine. I’ll concede it, even though much of the context is often dropped. Male circumcision offers that benefit, whether it does or not.

Here’s the problem: so what? That something is possible does not prove it’s acceptable to do it. Acceptance of science (with disagreement on the veracity of claims) is compatible with rejecting the application of that science to the healthy, normal body of another human being without that person’s consent. Non-therapeutic male child circumcision does not meet the ethical threshold for proxy decision-making. It can be delayed until the male can consent, given that it’s non-therapeutic. There are less invasive prevention methods and treatments available for every potential issue non-therapeutic circumcision seeks to address. The child owns his body, including his foreskin. This is the same human right everyone has over their body and genitals.

That’s all before we even get to preference. What does the individual want for his body? All tastes and preferences are unique. The individual has to live with the decision. If left intact with his choice, he has to live with it for 18 years, at which time he can change it. Or not. If circumcised, he has to live with it for the rest of his life, including the decades he’ll spend as an independent adult. He can’t reject what didn’t need to be forced. The ethical difference in those two scenarios is stark.

Notice, too, that Smith can’t even cite the right organization, calling the American Academy of Pediatrics the American College of Pediatricians. The latter exists, but is not the source² of his link. If he can’t cite them correctly, what is the likelihood he read the AAP’s technical report that fails to support their position?.

Smith concludes:

The utter obsession some have about outlawing circumcision–whether undertaken for religious or health reasons–has always puzzled me.

But now we know that other than emotion and a bizarre belief expressed by some intactivists that sex isn’t as good for the circumcised, there appears no substantial reason to oppose the practice, much less outlaw it.

If he addressed his puzzlement with research rather than cognitive dissonance and confirmation bias, he might understand there’s more than BUT MUH BENEFITS. That Wesley J. Smith can’t think of a reason against non-therapeutic child circumcision is not proof there is no reason against it. The reasons are real and substantial.

For example, he would know the “belief” expressed that sex isn’t as good for circumcised men is an argument that sex isn’t the same, which is a fact, and that it likely isn’t as good, an educated guess based on data and anecdotal evidence. Removal of the foreskin means sex with a circumcised penis is sex without a foreskin. If you change form, you change function. The skin and nerves and functionality there at birth are no longer there. Again, that is a fact. Whether that’s good or not is a different matter. And again, all tastes and preferences are unique.

Anecdotal opinions are easy to find, but you have to be willing to search for and understand the implication of “…[n]ever felt I was too sensitive before circumcision but in retrospect I was.” Will every man think he was “too” sensitive? Does that suggest circumcision changes sex, at least?

Or do you need someone with a few more credentials, such as Dr. Laura Berman, who states “[r]emoving the foreskin also removes thousands of nerve openings that make sex more pleasurable.”

Or do you want a scientist and ethicist who studies circumcision, like Brian Earp, who reads studies rather than headlines to understand what research means. This includes when he read and analyzed³ a study by Jennifer Bossio, writing⁴, “you will be surprised to learn—I am quoting directly from the paper now—that ‘Tactile thresholds at the foreskin (intact men) were significantly lower (more sensitive) than all [other] genital testing sites’ including the sites in circumcised men (emphasis added).”

Or do you want another researcher who studies circumcision and sensitivity, like Dr. Kimberly Payne, who wrote in her study, “[i]t 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.”

Yet, Brian Morris used Payne’s study, which he rated as the highest quality, in another rehash he used to conclude, “the highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.”

The people who seem to care the least about the details of circumcision generalize toward the view they already held going in. Morris is a propagandist, and presumably Smith relies on him because he wants to believe. He’s not unique in that approach, but it’s not something he should put on display as he did.

Which leads me back to National Review’s Credenda. Among their convictions:

A. It is the job of centralized government (in peacetime) to protect its citizens’ lives, liberty and property. All other activities of government tend to diminish freedom and hamper progress. …

Non-therapeutic child genital cutting, including circumcision, violates the rights of the child, who is an individual and a citizen. Removing his foreskin deprives him of his property and liberty.

It is appropriate for the government to prohibit the non-therapeutic circumcision of male minors, as it already does for female minors. Whether or not that’s the fastest path to ending the cultural abomination is worth discussing. I think it isn’t, unfortunately. But it’s an appropriate legitimate action of government, since it would protect the rights of citizens, the substantial reason government exists. The government ignoring this diminishes freedom.

Whatever your opinion of National Review, Smith’s defense of circumcision should embarrass everyone at National Review.

¹ If you want to read the Morris study, follow the link to Smith’s post. If you want to know how to analyze one of the papers Morris cites in this new rehash, which is one of his previous rehashes of prior papers, read here and here. But notice the pattern of Morris rehashing papers over and over for the casual reader like Smith to think, “ahhh, a new study, and look at the volume of past studies showing the same thing!”. Stop being a dupe for his propaganda.

² The American College of Pediatricians has an official statement on Female Genital Mutilation. Its only reference to male circumcision is when it states:

The terminology itself has generated controversy. The World Health Organization emphasizes the fact that there are no medical benefits associated with even the least invasive procedure. Therefore, the WHO uses the term ‘mutilation’ to “establish a clear linguistic distinction from male circumcision, and emphasize(s) the gravity and harm of the act. Use of the word ‘mutilation’ reinforces the fact that the practice is a violation of girls’ and women’s rights, and thereby helps to promote national and international advocacy for its abandonment.“ (source)…

That linguistic distinction is propaganda, in the definitional, non-pejorative context, which the end of the quote acknowledges. There is harm in genital cutting, regardless of the victim. The practice is a violation of the victim’s rights, regardless of the specific genitals of the victim.

Yes, FGM is usually worse than male circumcision. Not always, and the law against FGM in the United States do not permit those harms equal to or less harmful than male circumcision. We treat the issue differently depending on who the victim is, which is logically and ethically flawed. The presence or absence of potential benefits is irrelevant to both. The absence of both need and consent is all that’s relevant.

³ Predictably, Brian Morris mischaracterized this finding in another of his rants.

⁴ Earp also clarifies with an analogy:

“Saying that removing the foreskin ‘doesn’t reduce penis sensitivity’ is a bit like saying that removing the pinky finger doesn’t reduce hand sensitivity. What you really mean is that removing the pinky finger (which is part of the hand) doesn’t reduce sensitivity in the remaining fingers — although, as we’ll see, it’s not even clear that this part of the analogy holds up in the actual study.”

Lazy thinking seems to be a prerequisite for those who advocate non-therapeutic male child circumcision.

Flawed Circumcision Defense: Dr. Laura Berman

tl;dr version:

Dr. Berman writes:

… Thankfully, [male circumcision] is a choice that we do have here in America, unlike the millions of young girls across the globe who must endure genital mutilation with no option to decline.

Her analysis shifts depending on whether a male or female is cut without need or consent. Male circumcision is “a choice that we do have here in America”. “Thankfully”¹. Her male circumcision argument is about parents, without consideration for the child. She then compares the victims of FGM “who must endure genital mutilation with no option to decline.” When did I have the option to decline my mutilation? When did any boy circumcised without need have the option to decline? Her argument is sophistry. It’s garbage and shows why any defense of male circumcision as ethically different from female genital mutilation is mistaken. Dr. Berman should feel shame for even thinking that sentence.

**********

Dr. Laura Berman posted a question on Facebook, asking:

Men, how do you feel about your circumcision (if you were circumcised)? Do you wish you weren’t, or do you think your parents made the right choice? And women – do you have a preference when it comes to partners who are circumcised vs. uncircumcised?

The replies are roughly in line with what anyone should expect from a circumcision thread. In response to some comments asking her opinion, she followed with a blog post about it, “When You Miss Your Foreskin: The Real Deal on Male Circumcision”. Early on, she writes:

First, as a Jewish woman, I want to acknowledge that there is a cultural legacy behind circumcision which informs many people in my community and their decision to circumcise. While I appreciate and love my Jewish heritage, I realize this is not enough of a reason to perform surgery on an infant without medical cause.

That statement takes courage and is worth commending. Unfortunately, she does not let that inform enough of the rest of her post. She continues:

The pediatric community is still largely in favor of circumcision, as they say that the benefits of circumcision outweigh the risks. What are these benefits?

She links the AAP’s 2012 statement there, which I’m omitting because you can get there here or here, instead. Apart from quoting the AAP’s flawed statement, quoting the AAP as “the pediatric community” is silly. The *American* pediatric community is still largely in favor of (non-therapeutic infant) circumcision. Most of the rest of the world is not in favor, for the reason Dr. Berman touches and then skips. There is not enough of a reason to perform surgery on an infant without medical cause. (There is no reason. There is no medical cause.) That’s the ethical principle applicable here, as in non-therapeutic genital surgeries on female minors. There’s no reason to exclude male circumcision from ethics.

After reviewing some potential benefits of circumcision, including the casual sexism of “for little boys who hate to bathe”, which should be rewritten as “for parents who abdicate their responsibilities”, Dr. Berman gets to some negatives. She writes:

Loss of nerve endings. Removing the foreskin also removes thousands of nerve openings that make sex more pleasurable.

It’s beyond comprehension how someone can write that fact and not end the post there with, “Yeah, this is wrong. We must stop immediately. And we should apologize for every non-therapeutic, non-consensual circumcision performed before now, because we were wrong to perform every one of them.” But she doesn’t, because of the usual consequentialism and moral relativism involved in this debate that predictably appears in her post. She continues:

… Along with physical pain, many men later report that they feel they feel violated as their circumcision was done without their consent.

Although I feel violated, that is a direct result of being violated. My non-therapeutic circumcision occurred without my consent. My circumcision violated me. I know why we avoid acknowledging this as a society, but it’s too blatant to be defensible.

Dr. Berman shifts to something worth repeating:

Last, before I end, I want to address the issue of consent around circumcision. One man on my Facebook post compared circumcision to rape, and while I appreciate his right to anger about his circumcision, we must be very, very careful when we use the word ‘rape’ to describe anything other than rape. Words matter. They are powerful. They shape our beliefs and they inform the way we live in this world. So when we use the word ‘rape’ to talk about a medical procedure performed in good faith, this does a grave injustice to rape victims who have been abused, traumatized, penetrated and dehumanized by a sexual predator(s).

I agree with this, and stand by what I’ve written on it.

However, what is consent, if not the ability to reject something you neither need nor want? It shouldn’t be discussed in the context of calling circumcision “rape”. We must discuss consent, though,
because it’s the crux of the violation. You don’t believe in consent if you believe consent in non-therapeutic genital cutting is sometimes relevant and sometimes not.

She moves on to the comparison of female genital mutilation/cutting and male circumcision. It’s flawed:

Nor do I think it is appropriate to take over a conversation about female genital mutilation by bringing up male circumcision in the Western World. There is a giant difference between FGM which occurs across the globe in places like Africa, Indonesia, and more. There are currently 200 million women living today in 30 countries who have been victimized by female genital mutilation in which these young girls near puberty are held down while some or all of their external genitalia are cut off with a sharp blade or piece of glass or similar cutting instrument.

It’s usually not appropriate to take over a conversation about FGM. The problem arises when the writer changes the analysis used for non-therapeutic female and male genital cutting, as most writers on the comparison do, and as Dr. Berman does here. Is it wrong to alter the healthy, normal genitals of a girl in a sterile operating theatre with appropriate pain management and the best parental intentions, the context assumed for male circumcision? It is still wrong in that context because it harms the girl without her consent. “One is almost always worse” is true and irrelevant to the principled analysis of non-therapeutic genital cutting without the recipient’s consent.

The usual caveats appear to continue the false distinction:

Unlike male circumcision, there are absolutely no benefits to FGM,…

If there were potential benefits to FGM, very few would change their opinion on FGM. Rightly so, because they would look at the costs – the guaranteed harm – and judge it unethical. There is no excuse for distinguishing this violation of males from this violation of females.

… and unlike circumcision, it is not performed to protect male sexual health …

Harming an individual to protect him from harm that can be prevented with lesser interventions is an absurd justification. He may not prefer this “protection” at the expense of his foreskin.

… but in order to erase female sexual pleasure and to lay ownership to a woman’s genitals. …

What did Dr. Berman ask? “And women – do you have a preference when it comes to partners who are circumcised vs. uncircumcised?” Why is that question relevant to the discussion? Dr. Berman doesn’t use the “women prefer” argument, but enough proponents use it to make the comparison. At best, we do not discourage “you prefer circumcision, so circumcise your son”. So, is the argument that it isn’t intended to lay ownership to a man’s genitals or that it doesn’t lay ownership? Even when the former is correct, it’s irrelevant because the latter is always incorrect in non-therapeutic child circumcision. “Son, you should prefer our preference(s), so we’ll make this choice that forces you to live with our preference(s) forever” is the antithesis of self-ownership.

When Dr. Berman later talks about whether “circumcision is the right choice for you and your family”, she implies that the penis belongs to the family rather than the boy. The best intentions don’t change the action. It is permanent control over part of the child’s sexuality.

After more awful facts of FGM, and embedding an Instagram post from WHO (correctly) declaring FGM a violation of human rights, Dr. Berman continues:

FGM is a violation of the human rights of girls and women. There are many who feel that male circumcision is a violation of the human rights of baby boys, and for these people, deciding to keep their baby intact is the correct choice. Thankfully, it is a choice that we do have here in America, unlike the millions of young girls across the globe who must endure genital mutilation with no option to decline.

Circumcision is a violation of the human rights of boys and men. This is true for the same reason non-therapeutic, non-consensual genital cutting violates the human rights of girls and women. There is neither need nor consent. Any cutting in that context violates the individual. Any analysis beyond that is sophistry for one’s preferences and biases.

Re-read the tl;dr above if it isn’t burned into your mind.

And then:

Why am I making this distinction between FGM and circumcision? Because, again, I think it does a disservice to woman who can feel no sexual pleasure, women who endure a lifetime of pain and loss, and young girls who are held down and tortured because their bodies are viewed as dirty and sinful to a medical practice which is performed safely, hygienically and with a baby’s health in mind.

Again, what is done to the genitals of girls and women is horrific, barbaric, and indefensible. Also again, this uses a different standard for assessing what is done to girls and what is done to boys. Would she approve of FGM if it is “performed safely, hygienically and with a baby’s health in mind”? Nope, and to reiterate, correctly. Consequentialism and moral relativism have no place in the analysis of genital cutting, including male circumcision. Genital cutting is wrong for boys for the same reasons it’s wrong for girls. (Especially when we consider “their bodies are viewed as dirty” in the context of “for little boys who hate to bathe” and “I chose to circumcise because I thought it was cleaner.”)

In summary, using the last link in the previous paragraph, Dr. Berman writes:

While nothing can ever undo that man’s circumcision,…

“While nothing can ever undo that man’s *non-therapeutic, non-consensual* circumcision… That’s the whole story. Stop ignoring it.

¹ I’m not thankful male circumcision is a choice “we” have in America, because “we” decided my penis without me.

Ethics Rationalizations, applied to Genital Cutting

Jack Marshall at Ethics Alarms has maintains a list of Unethical Rationalizations and Misconceptions. It’s a wonderful list for understanding human (mis)conduct and for striving to be better. Much of it applies to the debate over non-therapeutic child genital cutting. (See below.) Recently, Mr. Marshall posted a revision to his list. He added Rationalization #23, The Dealer’s Excuse. or “I’m just giving them what they want!”. This is the rationalization “that conduct becomes justifiable and benign if there is a market for it.” He further explains:

Those who employ the Dealer’s Excuse aren’t providing a service out of altruistic motives, but out of the profit motive. They want the money they can make by doing unethical things that make society uglier, dysfunctional and dangerous, and they really don’t care if their customers come to a bad end or bring miseries to others.

This is true of a subset of practitioners who circumcise infant males, for sure. That it happens is self-perpetuating. “That doctor is doing it, and making quick money doing it, and it makes the parents happy, so there’s no reason I shouldn’t participate.” It’s ugly and harmful.

In my experience from talking to doctors who circumcise (and some who don’t), there is a related factor. They’re cowards. I perceived many of these doctors to be ambivalent or opposed to non-therapeutic infant circumcision. But they feel obligated to appease the parents at the expense of their patient. From Mr. Marshall’s list, it’s Rationalization 15, The Futility Illusion: “If I don’t do it, somebody else will.” If one individual doctor refuses, the outcome for the child is likely no different. But change doesn’t happen if we refuse to speak out and reject what we know to be wrong.

Related, this post from 2015, Ethics Quiz: “Fixing” “Elf Ears”, has relevance. A 6-year-old boy’s ears stuck out like an elf’s, basically. Dr. Tracy Pfeifer, a plastic surgeon quoted in the news article, defended it by saying, “The surgery is relatively simple and it is life-changing in a positive way for these young children.” Someone told me that about circumcision yesterday. Like Mr. Marshall, my response is essentially “so what?”. As he said in his post:

The surgery is also premature, and thus unethical from a medical ethics standpoint, because at six no child’s adult appearance can be accurately predicted. Nor can a six year old make an informed decision about surgically changing his or her appearance at that age, though The Daily News found some dubious experts—as in “flacks for the plastic surgery trade”—to claim otherwise. Except in a case of serious deformity, the choice to radically change a child’s appearance should be made after the child has gained some understanding of the issues involved.

Exactly. Protruding ears, “big” nose, or foreskin, the analysis is the same. Science is necessary and relevant, but the application of that science requires ethics. What we can do is not the same as what we should (be allowed to) do to another.

(See also: The Slippery Slopes of Religious Freedom and Female Genital Mutilation, especially on the potential outcome if Alan Dershowitz’s expected defense strategy in the Detroit FGM prosecution succeeds. I wrote indirectly about the case. The latest version of the complaint is here (pdf).)

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From the Ethics Alarms list of Unethical Rationalizations and Misconceptions, at a minimum the following rationalizations apply to the defense of non-therapeutic genital cutting on minors. I’ve encountered each at least once in my activism, some as recently as yesterday:

1. The Golden Rationalization, or “Everybody does it”
1A. Ethics Surrender, or “We can’t stop it.”
2A. Sicilian Ethics, or “They had it coming”
3. Consequentialism, or “It Worked Out for the Best”
4. Marion Barry’s Misdirection, or “If it isn’t illegal, it’s ethical.”
6. The Biblical Rationalizations
9. The Reverse Slippery Slope
13. The Saint’s Excuse: “It’s for a good cause”
13A. The Road To Hell, or “I meant well” (“I didn’t mean any harm!”)
14. Self-validating Virtue
17. Ethical Vigilantism
22. The Comparative Virtue Excuse: “There are worse things.”
23. The Dealer’s Excuse. or “I’m just giving the people what they want!”
24. Juror 3’s Stand (“It’s My Right!”)
25. The Coercion Myth: “I have no choice!”
27. The Victim’s Distortion
29. The Altruistic Switcheroo: “It’s for his own good”
29A. The Gruber Variation, or “They are too stupid to know what’s good for them”
32A. Imaginary Consent, “He/She Would Have Wanted It This Way”
34. Success Immunity, or “They must be doing something right!”
38. The Miscreant’s Mulligan or “Give him/her/them/me a break!”
41. The Evasive Tautology, or “It is what it is.”
42. The Hillary Inoculation, or “If he/she doesn’t care, why should anyone else?”
43. Vin’s Punchline, or “We’ve never had a problem with it!”
44. The Unethical Precedent, or “It’s Not The First Time”
45. The Abuser’s License: “It’s Complicated”
46. Zola’s Rejection, or “Don’t point fingers!”
48. Ethics Jiu Jitsu, or “Haters Gonna Hate!”
49. “Convenient Futility,” or “It wouldn’t have mattered if I had done the right thing.”
50. The Apathy Defense, or “Nobody Cares.”
50A. Narcissist Ethics , or “I don’t care”
51. The Underwood Maneuver, or “That’s in the past.”
57. The Universal Trump, or “Think of the children!”
57A. The Utilitarian Cheat or “If it saves just one life”
58. The Golden Rule Mutation, or “I’m all right with it!”
59. The Ironic Rationalization, or “It’s The Right Thing To Do”
63. Yoo’s Rationalization or “It isn’t what it is”
64. Irrelevant Civility or “But I was nice about it!”
64A. Bluto’s Mistake or “I said I was sorry!”

The whole list is worth reading and understanding, in general, both to notice when you encounter them and to be diligent about not offering them.

Incomplete Progress (v2)

Two new examples of circumcision without consent that should be prosecuted, but not for a reason distinguishing it from any other non-therapeutic genital cutting on a child. First, from England.

A 61-year-old man, believed to be the doctor who carried out the procedure, has been arrested on suspicion of grievous bodily harm with intent.

The boy’s mother complained to police, saying her son was circumcised without her consent while staying with his paternal grandparents in July 2013.

If consent from one parent is permitted, it’s still a violation because the healthy¹ boy didn’t consent.

Next, from South Africa:

A police investigation is under way after a group of 27 boys were illegally circumcised in Scenery Park‚ East London‚ the Eastern Cape health department said, writes Naledi Shange.

Spokesperson Sizwe Kupelo said police‚ traditional leaders and health officials raided the initiation school on Sunday afternoon.

They were accompanied by some of the parents whose children had been circumcised without their consent.

The same point on consent applies.

As in my last post, we’ll be making real progress when the meaning of their aligns with ethical principles by referencing the boys, not their parents. Still, any pursuit that raises the issue of consent at all is almost certainly progress.

¹ This key point is why the change we need is more cultural than legal. Doctors who support non-therapeutic circumcision of children – American doctors, in particular – are inclined to believe nonsense about the foreskin, such as what Brian Morris promotes. There won’t be a change in the legal until the culture changes. But if there were somehow a legal change without cultural change, the law wouldn’t matter. The boy’s chart would read “therapeutic treatment for phimosis” or some other offensive lie. Also, having a law no prosecutor will enforce is no better.

Incomplete Progress

I don’t know if the facts mentioned here are accurate or not. I assume so. And for my inclination, obviously, it’s believable. If the facts are as reported, this is progress. But I want to be weary of first reports, always, so that’s what I want to say on the claimed facts.

My focus is the lede of the article.

A British GP is to be prosecuted by an outraged mother for assault after circumcising her baby boy without her consent.

The day that is written as, “A British GP is to be prosecuted by an outraged mother for assault after circumcising her baby boy without his consent” will be better progress.

There’s no complaint about the article for its lede. It mentions the ethical issue of the child’s consent in the next paragraph. We’re getting close to when the framing will finally be right, and people recognize the rights violation is to the child, not his mother and/or father in certain circumstances.