Author: Tony

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

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

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

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

For example, the press release concludes:

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

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

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

The Core of Public Health Circumcision Promotion

From the awful WHO Fact Sheet, “Voluntary [sic] medical male circumcision for HIV prevention” (bold added):

In line with global goals such as Millennium Development Goal 6 to halt and reverse the spread of HIV and the WHO Global Health Sector Strategy on HIV/AIDS, a five-year Joint strategic action framework to accelerate the scale-up of voluntary medical male circumcision for HIV prevention in Eastern and Southern Africa 2012-2016 was developed by WHO and UNAIDS with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Bill & Melinda Gates Foundation and the World Bank and in consultation with national ministries of health. The framework calls for an intensified response by countries and partners to ‘catch up’ with men 15 to 49 years old who were not previously circumcised and to establish sustainable services for infants and adolescents for the longer term. The framework promotes country ownership, a combination of approaches and strategic, coordinated action.

Infants and adolescents don’t consent. This indicts WHO, UNAIDS, PEPFAR, the Bill & Melinda Gates Foundation, and the World Bank. They are all directly complicit in the violation of basic human rights in Africa. They are also propagandists willing to use a word (“voluntary”) that they have no intention of following.

Procedures that Intentionally Alter or Cause Injury

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

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

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

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

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

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

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

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

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

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

There’s also the comparison based on the WHO fact sheet for FGM (emphasis added):

Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.
…

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

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

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

With that stated, she continues (language warning):

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Examples of the Need to Reverse the Approach

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

First:

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

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

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

She continues:

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

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

Next writer:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reverse the Approach

We’ve all encountered the steadfast refusal to consider that male and female genital cutting are comparable and can both be mutilation. The standard closed reaction consists of something along the lines of “the entire penis would be removed” if male and female genital cutting were really the same thing. For example, in response to a brilliant piece by Catherine Bennett in The Guardian, this:

FGM is NOT the equivalent of male circumcision, as an examination of the etymology of the latter word would make clea: O tempora, O mores! An appropriate synonym for FGM might be ‘excision’ or indeed ‘amputation’, were it not for the fact that infibulation is often carried out as well.

The male equivalent of FGM would be a penectomy, followed by a deliberate attempt to make the wound heal with an unnatural form and function.

Bennett might well have a strong personal belief that male circumcision should be left to the particular male to decide, once he is old enough to make an informed choice, and I might well agree; but she has erred grievously in introducing any mention of FGM in her article, thus making it possible for others to draw a preposterous parallel.

Apart from the ludicrous belief that circumcision doesn’t automatically make the penis heal with “an unnatural form and function”, which is not improved by the commenter’s flawed attempt to distinguish deliberate on parental intent, this commenter assumes his answer that there is no valid comparison. He’s wrong, of course. But the explanation for why never occurred to me before. I now think it’s clear.

Opponents of both forms compare male genital cutting to female genital cutting (i.e. mutilation). Opponents of that comparison perceive that we’re comparing female genital cutting to male genital cutting. We start with a different source and target for the comparison. We don’t start with the same gender, so opponents of the comparison think our claim is larger than it is.

We start with male circumcision. Even setting aside the obvious principle (non-therapeutic genital cutting on a non-consenting individual is wrong), removing the male prepuce (i.e. foreskin) is anatomically the same as removing the female prepuce (i.e. clitoral hood). There is a comparison to be made. Society rejects all non-therapeutic genital cutting on female minors, including cutting analogous to male circumcision (and that which is unarguably less damaging). That’s the physical comparison to pair with the principled rights discussion. It is correct.

Instead, notice the approach within the commenter’s words. He starts with female genital cutting/mutilation to then make the comparison to male genital cutting. When doing that, it’s very easy – and understandable – to focus on the more extreme versions of female genital mutilation. When doing that, the commenter’s dismay is easier to understand, and perhaps, to counter. If you start with the worst, yes, the physical comparison does not work, even though the principled comparison always will. But this perpetuates an ignorance to what male circumcision is and how it compares physically to an outlawed form of female genital cutting.

As Ms. Bennett shows in her essay, based on the WHO’s FGM fact sheet (c.f. my genital mutilation fact sheet):

The extent of this cutting, which “has no health benefits”, involves removal of “healthy and normal female genital tissue” and is associated with ideas about “unclean” sexual parts, is immaterial. “It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.”

That applies equally to male genital cutting. The rights involved are human rights, not female rights. Violates the rights to health, security, and physical integrity? That’s the Cologne ruling. The right to life when the procedure results in death? Unless someone wants to argue that male genital cutting never results in death, it’s inexcusable to pretend this doesn’t apply to males in the way that it obviously applies to females.

The commenter includes one more paragraph that further demonstrates my point here, and also cements my belief that opponents of the comparison believe the comparison legitimizes female genital cutting in the way they seem to believe everyone accepts – or should accept – male circumcision as innocuous, at worst. People who get frothy at the comparison think we’re trying to state that FGM is acceptable. That makes no sense, but there’s no other way to interpret this:

Shame on Bennett, for the barbarous torture and irredeemable loss of function she has helped to continue to be inflicted on young girls.

If you argue against female genital cutting, but also argue against male genital cutting for the same reasons, you encourage (and possibly support) the mutilation of females? That makes no sense. Everyone making the comparison, at least in the West, states that all non-therapeutic female genital cutting on non-consenting individuals is an unethical mutilation, including those forms that are physically analogous to – or less damaging than – male circumcision. To be clearer: FGM is evil. That point shouldn’t be in doubt. Anyone who reads the comparison otherwise should take a moment to question their conclusion and what they’re implying. The temptation is to see it as a cynical, dishonest ploy to discredit opposition to male circumcision, but it more logically flows from the misguided approach to the comparison I explained above.

The key is to figure out how to improve communication. Those with differing viewpoints on the comparison are talking past each other rather than to each other. As much as the burden of proof should be on those defending non-therapeutic interventions, reality doesn’t work that way. The onus is on us to demonstrate that our view is correct. If we figure out how to make the comparison clear, we have a chance to be more effective.

That Word Doesn’t Mean What Secretary Clinton Thinks It Means

October 1, 2015 update: I changed the word “condemnable” to “commendable” to reflect the intended meaning of a sentence. Additionally, the link to Secretary Clinton’s comments is now here.

The United States government encourages and funds circumcisions. It shouldn’t, of course, if we’re to adhere to the basic principles of human rights. (We don’t on this.) But it shouldn’t be promoted with lies. U.S. Secretary of State Hillary Clinton spoke yesterday at the 2012 International AIDS Conference. (emphasis added)

As of last fall, every agency in the United States Government involved in this effort is working together to get us on that path to an AIDS-free generation. We’re focusing on what we call combination prevention. Our strategy includes condoms, counseling and testing, and places special emphasis on three other interventions: treatment as prevention, voluntary medical [sic] male circumcision, and stopping the transmission of HIV from mothers to children.

Any familiarity with this subject provides a spoiler alert on what voluntary really means. Sure enough, shortly after that paragraph:

On male circumcision, we’ve supported more than 400,000 procedures since last December alone. And I’m pleased to announce that PEPFAR will provide an additional $40 million to support South Africa’s plans to provide voluntary [sic] medical [sic] circumcisions for almost half a million boys and men in the coming year. (Applause.) You know and we want the world to know that this procedure reduces the risk of female-to-male transmission by more than 60 percent and for the rest of the man’s life, so the impact can be phenomenal.

In Kenya and Tanzania, mothers asked for circumcision campaigns during school vacations so their teenage sons could participate. …

Voluntary circumcision requires the consent of the circumcised. Consent from anyone else for non-therapeutic circumcision is unethical.

And, no, it isn’t “medical” circumcision. It’s medicalized circumcision, which merely indicates that it’s performed in a modern, sterile operating theater. That is commendable in its limited focus, but it is not enough to render the non-therapeutic surgery ethical. Consent is also necessary. The perceived benefit of a reduced risk of female-to-male HIV transmission is a speculative pursuit and may not be necessary or desired by the individual.

Achieving the Goal Requires Honesty

The principle against female genital mutilation is obvious and easy to understand. The facts are more complicated, contrary to the simplistic case so often put forth. For example (emphasis added):

Nine women have been sentenced to jail terms for the female circumcision of around 30 young girls, in what the UN said was the first criminal prosecution of its kind in Ivory Coast.

The women, aged between 46 and 91, were found guilty of “female genital mutilation”, or complicity.

From the Orchid Project (italics added):

The person performing female genital cutting differs according to the context. In rural areas, FGC may be performed by traditional birth attendants or cutters. Often FGC will be carried out in unsterile conditions using a basic instrument such as a blunt knife or a piece of glass. In other places, there may be a known cutter, who has high regard within her community. Generally, the person undertaking the cutting is a woman.

This does nothing to excuse this evil, of course. But it shows that it’s more complex than the often-cited narrative that it’s imposed by men on women as a form of control. It is control, and the ignorant preferences of males in those cultures plays a large part. The complicity and responsibility for the violence is far broader, though. Effective measures for stopping it are more likely to develop when we’re honest about how and why it happens.

Always Ignoring Voluntary and Adult

As always, when public health officials discuss voluntary, adult male circumcision, they never mean voluntary or adult. Never:

ZIMBABWE is planning to expand its circumcision campaign to include newly-born babies as part of the country’s fight against the spread of HIV and AIDS, a senior health ministry official has confirmed.

The ministry’s AIDS and TB unit co-ordinator, Getrude Ncube, said a pilot project targeting babies between one and 28 days old would be launched before year end with the full programme likely to be rolled out in 2014.

They dress it up in nonsense.

“Although circumcising neonates will not have an immediate an impact, results will show in 20 years’ time. Our sole aim is to try and reduce new HIV infections.”

No, the sole aim is to implement circumcision. They believe their intentions are noble, a fact I do not doubt. But if their sole aim is to try to reduce new infections, they’d focus limited medical resources on those currently at risk of sexual transmission. They’re not, unless we stupidly assume all males aged 15 to 49 in Zimbabwe have been circumcised. Instead, they’re shifting to males who can’t consent. They still have 500,000 males to circumcise before 2015 to reach their target. The target is what matters, not the individuals being targeted.

Cherished Legal Principle: Freedom from Unwanted Harm

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

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

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

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

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

Reading the Cologne Court’s Words

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

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

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

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

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

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

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

And:

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

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

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

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

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

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

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