Author: Tony

Imagined Social Risks of the Foreskin

I don’t think much of the “Why I decided to circumcise my sons” side in CNN’s point-counterpoint approach to parental choice for circumcision. (“Why I decided not to circumcise my sons” is here. Both were originally published at Parenting.com.) Heather Aimee O’Neill discusses how she and her partner Abbie decided to circumcise their two sons. It’s fairly predictable, with the answer essentially being HIV, a cited benefit that has no significant applicability to her sons in the United States.

My takeaway is from something else:

My other sister, Meredith, an amazing mother of three boys who were all circumcised, agreed. “It’s unsanitary,” she said. “I can barely get my kids to brush their teeth at night. And imagine him in the locker room when he’s a teenager.”

Apart from the hygiene analysis being offensive, compare:

I don’t expect everyone to understand or agree with the choice that Abbie and I made for our sons. When Tommy and Teo are naked at the beach with friends, often they are in the minority because they are circumcised.

People believe many things about the social risks of having a foreskin that are simply not true.

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: Yair Rosenberg, Part 2

In response to the AAP’s pending release of its revised policy statement on non-therapeutic male child circumcision, Yair Rosenberg repeats the mistakes in his prior analysis. He perpetuates appeals to authority, omits relevant information, and ignores inconvenient facts. One might even say he’s being obscurantist.

This isn’t just an issue of religious freedom—it’s a basic question of public health. That’s because according to the National Institutes of Health and the World Health Organization, among others, circumcision is one of the global health community’s best HIV prevention techniques. As Eric Goosby, the U.S. AIDS coordinator, has said, “Male circumcision is a highly significant, lifetime intervention. It is the gift that keeps on giving. It makes sense to put extraordinary resources into it.” To that end, anti-AIDS organizations are partnering to circumcise 20 million African men by 2015. …

Until now, the scientific consensus surrounding circumcision has driven policy in Africa, but not the United States. Today, that changes.

Individual humans make up “public health”. What is – and is not – acceptable to do to individual bodies in the name of public health is the question of ethics that Rosenberg, Goosby, the AAP, and every other circumcision advocate ignores. This is especially true because circumcision is not the least invasive or the most effective method available for reducing HIV (or any other) risk. It’s also still not particularly useful in contexts outside of parts of Africa. As I wrote in my prior post, the risk reduction is in female-to-male HIV transmission in high-risk populations. That isn’t compelling within the scope of the AAP’s focus. Context matters. Obscurantist journalists ignore that.

The importance of this [updated policy] cannot be overstated. …

It can be. Rosenberg’s post is proof.

… The AAP is a driving force behind health policy in America, and the experts involved in its new statement are already going on record in major media outlets to advocate that circumcision be covered on public health plans like Medicaid. The statement solidifies the scientific consensus behind the advisability of infant male circumcision (noting that complications are more likely to arise when the procedure is performed later in life) and places the traditional practice squarely within the realm of sound medical science.

This is only true if ethical considerations are not a part of sound medical science. It’s fine if Rosenberg or others do not wish for ethics to be applied to their own bodies. But not everyone shares that odd, limited view. Some of us appreciate the basic concept of human rights, including those of physical integrity and self-determination, and wish they had been applied to us. It’s too late for too many males, but there is never a bad time to stop violating human rights.

Also, the question of possible benefits and their applicability to any particular individual is separate from the public policy question of paying for non-therapeutic surgical interventions on non-consenting individuals. Non-therapeutic infant circumcision is an irresponsible use of funds in pursuit of subjective goals via unethical means. There is nothing good about it, regardless of how “prestigious” an organization promoting the idea is irrationally perceived to be. An organization that advocates violating human rights deserves no prestige.

This is not just good news for the United States, where obscurantist anti-circumcision groups have sought to completely ban this medically beneficial practice rather than allow families to choose whether to perform it. …

Rosenberg’s prior essay was obscurantist propaganda. Unlike his writing, I’ve acknowledged the arguments offered in favor of circumcision. I’ve explained why they’re inferior in the debate as it pertains to individuals. Mr. Rosenberg has not done the same. Instead, he offers condescending evasions:

… It’s also a powerful rebuttal to the flawed reasoning of the German court in Cologne, which ruled that circumcision generally constitutes “bodily harm,” yet made allowances for circumcisions performed for “medical reasons.” Thanks to the AAP, we can now state that all circumcisions are medically beneficial. …

The German court in Cologne ruled that non-therapeutic circumcision on non-consenting children violates their rights to physical integrity and self-determination. There is no flaw in that expression of basic human rights. The are the same rights that form the basis for prohibitions on FGC/M.

The court’s finding that circumcision constitutes bodily harm, no quotes, is consistent with permitting circumcision for medical need. The existence of a problem necessitates considering interventions. Ethically proxy consent will choose the least invasive, most effective solution. That is rarely circumcision when there is a need. But where it is necessary, the goal is an objective net benefit, that the surgery will remedy the problem. The outcome is presumed to outweigh the harm imposed to achieve it. The key is the outcome can be measured immediately and directly. Is the malady resolved?

With non-therapeutic circumcision, there is no objective net benefit because there is no malady. There is only objective harm for subjective benefits. The subjective benefits may not be valued or desired by the individual. In that case it’s objective harm to the individual for the subjective preferences of another. That is unethical. Because surgery on children involves proxy consent, medical need is required. The court was correct and consistent. The AAP is incorrect and encouraging unethical rights violations.

So, can we really state that all circumcisions are medically beneficial? Including the ones where the boy suffers a complication? If he loses his glans, is he still benefited? What about his entire penis? What about the thankfully rare instances where the boy loses his life? At least the benefits accrued over his short lifetime? Since all of these scenarios happen, even if we ignore my focus on individuals who suffer only the expected harm, isn’t it a bit obscurantist to state that all circumcisions are medically beneficial?

… If German courts continue to prosecute Jews and Muslims for practicing circumcision, then we will know that this animus is rooted not in science or fact, but in ignorance and prejudice.

I won’t say I expected his screed to end with something other than a preemptive ad hominem attack. It’s still pathetic.

Update: Walter Russell Mead uncritically endorses Rosenberg’s flawed post and makes a request:

Hopefully anti-circumcision zealots will take a deep breath and rethink their fevered stance on the issue. Beyond the fact that their bans impinge on the rights of Jews and Muslims to practice their religion as they see fit, they ought to consider that there is legitimate science pointing to the practice being beneficial to infant male health.

The only legitimate science involving infants is on UTIs, and possibly penile cancer. The former are uncommon in intact males in the first year (1%) and almost always easily treatable. The latter is more reasonably associated with other causes, with U.S. rates similar to those in mostly intact Europe. Everything else involves adult volunteers. The possibility of health benefits, or even religious benefits, does not render non-therapeutic circumcision on a child ethical.

No court in the United States endorses a right to practice one’s religion as members “see fit”. There are limits that may be imposed based on constitutional tests. Non-therapeutic child circumcision should fail that test because it is physical harm.

One Unremembered Trauma: Emphasize Trauma, Not Unremembered

Here’s a report from Jezebel on the Johns Hopkins study. It’s maddening.

Personally, I don’t give a care what kind of a penis any grown man currently has, because I am not in the business of telling people what to do with their genitals, or judging whether anyone’s genitals are “right” or “wrong.” That said, if I had a boy-baby, I think I would probably circumcise him (not, like, with my bare hands, but you know), because I can’t imagine one unremembered trauma could be more painful than a lifetime of a nasty, unfair, pervasive stigma. But that’s just me.

Did you catch that? She’s not in the business of telling people what to do with their genitals, except she would probably have her son’s normal genitals permanently altered. That is definitely tell someone exactly what he can’t do with his genitals.

That also reads like judging “right” and “wrong” to me. What someone else might say to her son could direct her to parent with a scalpel. Thinking with assumptions like this – that a parent can’t educate their children that the problem rests with the person who would stigmatize – creates the self-perpetuating cycle that parents “have” to cut to make their sons normal common to protect them from possible ridicule. This is especially ridiculous if we’re honest, because children will find ways to taunt, and about anything. If it’s not genitals, it’s hair color or fashion or ears or pimples or freckles or weight or whatever. We don’t expect parents to surgically alter other aspects of their children to avoid this temporary, not-guaranteed harassment. Normal genitals should be no different. Non-therapeutic genital cutting is an abdication of parental responsibility.

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Post Script: The predictable chaos ensued in the comments, apparently. I didn’t read them because I don’t read comments sections. But it’s obvious since the first comment addresses it. The Jezebel writer, Lindy West, replied:

Hey, screaming people. First of all, male circumcision and female genital mutilation are not equivalent. …

Ms. West is wrong.

(Advocates for genital integrity should not be screaming, literally or figuratively, in comments sections. I wish that didn’t need to be repeated.)

Infant Male Circumcision and Current Human Rights Disparities

Another focused post for a story on which I’ll have more to say.

In a study published Monday in the Archives of Pediatric and Adolescent Medicine, a team of economists and epidemiologists estimated that every circumcision not performed would lead to significant increases in lifetime medical expenses to treat sexually transmitted diseases and related cancers — increases that far surpass the costs associated with the procedure.

I strongly suspect the study is flawed because it makes estimates. I’ll withhold further comment until I know more. For now, there’s enough to discredit the embarrassingly incomplete approach used to justify the study and its estimates.

That sentiment [that Medicaid should cover non-therapeutic child circumcision] was echoed in an editorial accompanying the study. UCLA health economist Arleen Leibowitz wrote that by failing to require states to cover circumcision in Medicaid plans, the U.S. reinforces healthcare disparities.

“If we don’t give poor parents the opportunity to make this choice, we’re discriminating against their health in the future,” she said in an interview. “If something is better for health and saves money, why shouldn’t we do it? Or at least, why shouldn’t we allow parents the option to choose it?”

We shouldn’t do it or allow it because non-therapeutic genital cutting on a non-consenting child is unethical. Male circumcision on a healthy child violates his basic human rights to bodily integrity and self-determination. It is indefensible, even if it’s possibly “better” for his health in someone else’s subjective evaluation or because it saves money when individuals are considered statistics rather than human beings with their own rights and preferences.

The abstract makes it clear the study is speculative. Yet, we already have rights-based law for females without absurd exemptions we refuse to touch for males, so the idea that rights trump speculative benefits isn’t foreign. The ability to do something or to possibly achieve some population-level result without concern for the individuals involved cannot – must not – be viewed in a bubble that contains only the factors one is interested in (e.g. male circumcision is currently practiced, so it’s acceptable).

There are no doubt many non-therapeutic surgeries we could perform on children that might result in some decreased prevalence of disease x, y, or z. Infant mastectomies to remove breast bud tissue might reduce the risk of breast cancer. Shouldn’t we study that, at least, since it might reduce cancer? Reducing cancer is “good”, whatever the means, right? No one is foolish enough (yet?) to think such a thing, which highlights the flaw in thinking by those making excuses for circumcision, such as Ms. Leibowitz here. Society should stop ignoring the costs to the individual who must bear the outcome of the decision. Ignoring them is unacceptable. The ethics of circumcision are not divisible from any other basic human rights consideration or proper medical analysis based on therapeutic need, or lack thereof.

Finally, that non-poor families can afford to violate their children’s sons’ rights is not a reason to use taxpayer funds to let poor parents violate their children’s sons’ rights. That’s a political question rather than a medical question. It is inexcusable to sacrifice the bodies of male children (only!) because we’re too cowardly to honestly evaluate the mistake of non-therapeutic circumcision on non-consenting individuals. This is the same idiotic approach Dr. Edgar Schoen pushed in his 2005 propaganda book, “Ed Schoen, MD on Circumcision”. Somehow, not using public funds to violate a child’s body and rights is discrimination. It isn’t because circumcision is not a valid parental choice. UCLA health economist Arleen Leibowitz is wrong.

None of this is a surprise, based on the editorial by Ms. Leibowitz and Katherine Desmond, “Infant Male Circumcision and Future Health Disparities”. The first two sentences reveal so much.

The health benefits of male circumcision (MC) have been extensively documented in observational studies and by randomized controlled trials in Africa showing that MC reduces heterosexual transmission of human immunodeficiency virus (HIV) infection from women to men by 55% to 76% …

The trials showed that voluntary, adult male circumcision reduces female-to-male HIV transmission in high risk populations with a heterosexual epidemic and a low rate of circumcision among adult males. That’s quite different, since it doesn’t describe the United States. It also fails to describe the circumcision they’re advocating. Children are not adult volunteers. That’s the ethical flaw in their analysis.

… and provides significant protection against human papillomavirus infection. …

Gardasil is approved for girls and boys. Circumcision is unnecessary for this possible benefit, as it is for nearly every possible benefit.

… Male circumcision is negatively associated with prostate cancer in men and with cervical cancer in female partners of men infected with human papillomavirus.

Negatively associated. Correlation is not causation. The study’s authors acknowledged this when they stated that it was an observational study. “Negatively associated” is not sufficient.

Doctors Aren’t Cultural Actors

I may have more to say on this story about circumcision as “the ultimate parenting dilemma. Understood, it isn’t a dilemma. But we have to deal with reality, not the world we should have. For now, this:

“You are doing a procedure on someone who cannot make a decision for himself – it’s a difficult choice for both parents and physicians,” says Dr Marvin Wang, co-director of the Newborn Nurseries at Massachusetts General Hospital, who has conducted hundreds of circumcisions.

It is, he says, more a “cultural decision” than a medical one, and therefore, for parents to decide, while he advises on the pros and cons.

Wang says most parents come in with fervent beliefs – and what a doctor says makes little difference.

“The bottom line is… they stick to their guns. They choose the pieces of information that bolster their argument and run with that.”

What a doctor says makes little difference. Having conversed with people who support circumcision for irrational reasons, I am not surprised. However, what a doctor does can make all the difference. Or, rather, what a doctor does not do. There is no obligation to participate in non-therapeutic circumcisions on minors. There is an ethical duty to not participate. If doctors refused to perform the surgeries, the numbers would decline. Not to zero, but it would signal a critical truth to parents who intend to make their son’s choice.

I Haven’t Forgotten

I 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. I intend to write more on them in the near future.

I’m working on that post. I want it to be as honest and clear as it can be.

In the meantime I know of at least one response to that. Lilli at Moralogous offered a thoughtful treatment of the issue. I like it because it’s not the approach I’m writing. The different perspective is useful in encouraging debate and consideration of the many aspects involved in circumcision.

Anyway, I haven’t forgotten.

The Marketing Changes Again

Hospital Male Circumcision has been sold with evolving euphemisms in an attempt to hide the ethical flaw in the associated public health policies. First, it was Voluntary Medical Male Circumcision, which never meant voluntary or even medical. The only requirement was a penis with a foreskin. Then it changed to Medical Male Circumcision. That involved 50% less pretense, while retaining 100% of the ethical omission. Now, it’s changed again:

Health facilities across the country have run out of supplies for Safe Male Circumcision kits, an HIV expert has said.

It’s better that they dropped medical, but replacing it with safe is little better. First, males will suffer complications beyond the guaranteed loss of the foreskin. Most of them will be minor. Some of them will be significant. Safe will be false.

It’s also possible the word’s meaning will be misconstrued.

The medical practice is intended to prevent HIV infection but it is not 100% safe, medical experts claim.

According to World Health Organisation and United Nations AIDS (UNAIDS) trials in Uganda, South Africa and Kenya have shown that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%.

I can’t fathom a scenario in which the public health officials intended safe to describe HIV after circumcision. Yet, that’s what this reporter took from it. That does not bode well. That’s a danger of propaganda. It’s inexcusable because there are lives at stake.

The premise of the article is worth addressing, too. They’ve run out of supplies. The article implies that they’re not circumcising while they lack supplies. That’s the right answer, of course, so I hope that’s what is happening. But I’m also concerned by the description of the kits as containing “reusable and disposable supplies”. Are they adhering to that distinction? And are the reusable supplies being sterilized properly?

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.

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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.