Category: Circumcision

Luckily, I have a forum to grind my axe.

Via Kevin, M.D. I read a recap from a doctor who had to amputate a patient’s finger. It’s an interesting enough story, but something caught my eye in the middle of the story.

… there’s a deeply ingrained taboo that prohibits me from causing permanent damage.

If you read Rolling Doughnut, you won’t be surprised at what immediately popped into my mind. I wonder what this doctor thinks about unnecessary infant circumcision? Based on experience, I guess the answer. I find it, precisely as guessed, here, from three years ago (about a topic I discussed last year):

Note to anti-circumcision trolls: I will ruthlessly delete or negatively alter your screeds about how awful regluar circumcision is, etc. I fully support circumcision done under normal hygenic circumstances. If you desire to grind your axe, do so elsewhere.

I wouldn’t have posted on the entry if I’d seen it in 2004, but I’ve been called an anti-circumcision troll a few times. It’s always a misguided smear offered at the end of a debate by the advocate of routine infant circumcision when his or her only fair response would be to admit defeat in defending the indefensible. The desire to excuse the unnecessary cutting of children is too deep for that, of course.

Wishful thinking about all the possible horrors the child will presumably no longer face – which he most likely wouldn’t have faced anyway, without circumcision, and almost never to an extent requiring surgery – are irrelevant, as are claims about the religious validity of this unnecessary surgery. If anyone should get this, it should be a doctor. Unfortunately, that too often flops in practice. From the 2004 entry, GruntDoc stated this about infant circumcision:

… I believe it is painful to the infant. So is falling down, hitting the coffee table, slamming a finger in a car door. Since I have never read about an infant describing his circumcision, it’s one of those things I think is best done as soon as possible (ask any adult who’s had a circ: it’s like chickenpox, the younger you have it the better off you are).

One painful incident is not like the others in his example.

It’s anti-intellectual to claim that not remembering pain is relevant to the discussion. The surgery is medically unnecessary; no further excuse-seeking is justified. If we factor in the child’s ability to not remember the pain as valid, we may excuse any number of surgical interventions with a potential to prevent future disease. Just look at the prevalence of breast cancer in males. Should we think of the good that can be done for those few men if we remove the breast tissue from the majority of newborn males? They won’t remember it! The thought is absurd, of course. Circumcision is the same. But circumcision advocacy isn’t about facts in context.

As to his last point, I can direct anyone interested to men circumcised as adults who don’t think it’s better. They think they’ve made a tragically stupid mistake. I can also point anyone interested to men circumcised as adults who state that the pain was less than it’s made out to be by the fear-mongers. Are those examples subjective? Of course. But so is the nonsense that all men are happy with being circumcised as infants or that the subjective preference of parents for potential benefits is superior to the subjective preference of the male when there is no medical indication for intervention.

Also, forgive me if I don’t cheer the logic of defending the 100% guarantee of pain imposition on an infant who hasn’t consented, no matter how well forgotten, over the low-single-digit risk that the male would need circumcision later in life, with pain that would be better managed through more effective pain relief techniques. I sympathize with the pain men who need adult circumcision will feel, but life has risks. That’s part of the deal. And the men who merely choose it will get no sympathy because they clearly value whatever benefit they perceive more than avoiding the pain. Yet, I’m supposed to value both equally – to the detriment of infants – through crude analysis implying that delayed pain, however unlikely or unnecessary, is worse than pain now. I will not because I am not irrational. Those few who need or choose adult circumcision should not dictate what happens to healthy infants.

For example:

My main argument for it is hygeine. Yes, many many men take good care of themselves, but you only need to see a couple of men with severe balanitis or penile CA, and the argument gets better. I was once told by a urologist that after a slew of penile cancers / amps following WWI (hard to keep clean in a trench), circ became mainstream more as a preventive med thing than an act of religious faith.

Typically, we (allegedly) must also factor in that a few men will face some consequence from being intact as an excuse to circumcise. Those many many men who take good care of themselves are not to be rewarded for their common sense and ability with an intact body. They are to sacrifice for the good of the few who will be delinquent or incompetent in their hygiene. After all, parents can’t know in advance if their son will practice good hygiene, and they can’t teach him good hygiene. Why assume that he will figure it out? There’s only so much a parent can do. Obviously. Being the good parents they are, they should opt to have his genitals cut, even though it exposes him to the risk of surgery. They’re responsible in a way he could never be.

From GruntDoc’s entry about amputating a finger:

Only after telling myself several times that this was actually no longer a finger was I able to take the sharp implement and cut off most of a finger.

How similar is the descent from reason that permits a doctor to remove the healthy, functioning foreskin from his patient at the request of his patient’s parents?

Stitches will only heal one of them.

Remember, surgical risk exists in every cut:

Rabbi Yosef Shalom Eliashiv, leader of the powerful Lithuanian religious movement, served as godfather at a Jerusalem brit Wednesday but suffered a deep cut to his hand, apparently when the mohel slipped.

Let’s imagine for a moment that the blade missed the rabbi’s hand and caused a deep(er) cut in the boy. Is it hard to believe that wasn’t possible?

The 97-year-old sage received stitches and was declared well. The baby was unharmed.

The last sentence is not correct. The baby was harmed, but only as intended. That’s supposed to make it acceptable. It doesn’t.

This decision tree stops after the first branch.

The last sentence from this article wouldn’t hold up to any level of logical scrutiny, so I’m assuming it received none.

People against circumcision argue that the procedure is an inhumane thing to do to a child because general anesthesia cannot be used on babies because of breathing risks, and local anesthesia causes inflammation, which makes the surgery much more risky.

That’s nowhere near correct or justifiable. I’d edit it thusly, given the equivalent space constraint and intellectual rigidity to the common, non-thinking approach to excusing imposed surgery on another person as a valid religious practice.

People against circumcision argue that the procedure is an inhumane thing to do to a child. because Also, general anesthesia cannot be used on babies because of breathing risks, and local anesthesia causes inflammation, which makes the surgery much more risky.

Would anyone accept the argument for ritually cutting off a child’s fingers if people for the finger amputation of children argue that we can provide anesthesia? The procedure is an inhumane thing to do to a child because it is medically unnecessary surgery on a non-consenting individual. Inhumane treatment doesn’t become humane through better pain management. The lack of proper pain management is an additional inhumane imposition, not the reasoning to explain why circumcision is unethical.

War is Peace. Freedom is Slavery. Ignorance is Strength.

In response to a brief update by Andrew Sullivan on the Oregon circumcision case (correctly titled “Genital Mutilation Update”), a website called discarded lies tracks back to Mr. Sullivan’s entry with only a link. Obviously that earns a “So what?” but reader “V the K” offers something interesting in the comments, allegedly in defense of parents:

It’s because we’ve created a whole society of busy-bodies. We’ve empowered every Mrs. Kravitz in the world to impose her views on everybody else instead of respecting individual choices.

Allowing an individual child to choose for himself is not “respecting individual choices”? Allowing parents to impose their views onto the body of their child sons is an “individual choice”? Like too many, “V the K” has a very poor understanding of individual and choice.

Just for fun, Gladys Kravitz is an interesting pop culture reference. On Bewitched, she actually saw the strange behavior she claimed. Nobody believed her, but she was always correct. That sounds like a perfect example of what occurs with individuals like me pointing out the violation of routine/ritual infant circumcision. Unintended by “V the K”, I’m sure, but still accurate.

Oregon already denies parents the “right” to circumcise.

It’s shameful how easy it is to demonstrate that the law is wrong, biased, and in dire need of repair. Oregon’s current law on the limit to parental rights over daughters:

Be It Enacted by the People of the State of Oregon:

    SECTION 1. (1) A person commits the crime of female genital mutilation if the person:
    (a) Knowingly circumcises, excises or infibulates the whole or any part of the labia majora, labia minora or clitoris of a child; or
    (b) Is the parent, guardian or other person legally responsible for the care or custody of a child and knowingly allows the circumcision, excision or infibulation of the whole or any part of the child’s labia majora, labia minora or clitoris.
    (2) Female genital mutilation is a Class B felony.
    (3)(a) A person who circumcises, excises or infibulates the whole or any part of a child’s labia majora, labia minora or clitoris does not violate subsection (1) of this section if:
    (A) The person is a physician, licensed to practice in this state; and
    (B) The surgery is medically necessary for the physical well-being of the child.
    (b) In determining medical necessity for purposes of paragraph (a)(B) of this subsection, a person may not consider the effect on the child of the child’s belief that the surgery is required as a matter of custom or ritual.
    SECTION 2. …

Parents do not have the right to make this non-medical decision for their daughters. No one will claim that this law denies parents a right to make medical decisions based on actual need, or to raise their daughters in their religion. We do not care because we know this is the only correct position. It is ethically inconsistent with liberty to allow parents to cut their child’s healthy genitals before the child can consent. It is a larger indictment against our humanity that we see a valid gender distinction.

Still, we fall back on tradition and ignore that boys deserve the same protection of their rights. That must stop. This is a constitutional issue. Any belief otherwise by the Oregon Supreme Court is willful ignorance¹.

¹ The same applies to the United States Supreme Court. Oregon’s text is virtually identical to the Female Genital Mutilation Act (pdf) passed by Congress and signed by President Clinton.

News from the Oregon Supreme Court hearing.

I remain pessimistic about the circumcision case in Oregon. I still hold out hope that the judges will put the boy’s circumcision on hold until he reaches turns 18, a compromise a court reached last year in Illinois. It would be an important step, but that’s the ceiling of my expectations. News reports from the hearing don’t help, although I understand that judges will pursue contrary positions to discover facts and analyze ideas:

A county judge dismissed Mrs. Boldt’s challenge, but blocked the circumcision from taking place until all appeals were exhausted. The mother’s attorney, Clayton Patrick, told the court that the circumcision posed “an unreasonable and unnecessarily high risk to the child.” Mr. Patrick was quickly challenged by Judge W. Michael Gillette, who asked whether courts should step in when a divorced couple disagrees about whether a child should play football.

“More people get hurt playing football than from having a circumcision and a lot more seriously,” Judge Gillette said. He said family court disputes over going out for football were a “necessary consequence” of the mother’s position. “That’s preposterous. I hope you recognize that cannot work,” the judge said.

By conventional thinking, yes, football causes more injuries. But circumcision is physical harm when acknowledging the facts. It is the non-medically necessary surgical removal of healthy, functioning genital tissue. By any definition, that is harm.

However, accepting the judge’s far-too-typical view, football injuries don’t always leave scars, but circumcision leaves at least a scar in 100% of cases. Just as useful to understand, the child hasn’t consented to being circumcised, unlike the child who gets hurt playing football that he presumably consents to playing.

This is about liberty. Judge Gillette’s concern is not the outcome if his questioning pursued the correct constitutional issue rather than the irrelevant family law issue. Playing football and surgically removing healthy portions of a child are hardly comparable. Remember, also, that only male children are legally subjected to this parental decision, which should be the screaming indicator that this is a constitutional issue of the child’s individual rights rather than a squabble over parental “rights”. Hacking at your child’s healthy genitals is not a right.

“The child’s wishes, while of course they should be considered, are not legally decisive or, legally speaking, relevant,” Mr. Boldt, who is a lawyer and has represented himself in the legal proceedings, said. Judges speculated about whether custodial parents had the right to impose genital mutilation or a nose job “on children whose faces are just fine.” “Are there no limits?” one judge asked.

When Mr. Boldt said he thought a custodial parent could do anything that wasn’t illegal to a child, Judge Rives Kistler replied, “That seems a real broad claim. What if they wanted to have tattoos put on the child’s face?”

Mr. Boldt said some actions might be so outrageous that they called into question a person’s fitness as a parent. A tattoo on a child’s shoulder that says “Mom” would be a different matter than “a swastika on the forehead,” he said.

Mr. Boldt’s moral relativism is obvious, but unfortunately, it’s not surprising given how willing people are to engage in moral relativism when it comes to male circumcision. It’s useful to bring it into the debate, if only the court wisely smacks it down in favor of gender-neutral individual rights.

Mr. Boldt insisted that the court should not single out circumcision for greater scrutiny than other parenting choices. “There’s no principled, intellectually defensible, legally supportable reason to extract that one category,” he said.

How did Mr. Boldt pass any state’s bar exam?

To demonstrate more reason for pessimism, those on the correct side of liberty and facts aren’t helping.

“We’re not talking about an infant circumcision here,” said Clayton Patrick.

Remember, Mr. Patrick is Lisa Boldt’s attorney. When does Mr. Patrick believe the individual right to remain free from unnecessary genital surgery at the whim of another begin? With friends like these…

And now the core claim that I hear too often:

The parents dispute whether the boy wants to be circumcised. The trial judge did not interview the child or appoint an attorney to represent him.

But James Boldt said that legally it doesn’t matter what the boy wants. Custodial parents get to make medical decisions for their children, he said.

The law is wrong because it treats children like parental property. Circumcision is not a medical decision when it is not medically indicated (i.e. routine and/or ritual circumcision). That’s what the court needs to acknowledge.

Circumcision: The Ongoing Class War

From a Time article on circumcision:

Medicaid no longer covers the surgery routinely, leaving many poor children without the option.

Poor (and rich) children, when left with the option, choose to do nothing to their foreskin. The author meant to imply that poor parents are less likely to have it done because they can’t afford it. But it is not legitimately their choice.

The article quotes pro-circumcision propagandist Dr. Edgar Schoen¹ on a separate, no less stupid point beyond the scope of this entry. Still, Schoen is a useful figure in the quote from above. He put these nuggets into the circumcision debate, from his book² Ed Schoen, MD on Circumcision:

Since the anti-circumcision groups have been unsuccessful in decreasing circumcision among the general public in the U.S. they have turned their frustration and desperation into an attack on the most vulnerable and defenseless part of the population – poor children. Parents on welfare have no political or economic power, and are at the mercy of State bureaucracies and legislatures for decisions on the medical care of their children. …

Schoen is either intellectually incompetent or intellectually dishonest. He’s graduated from medical school, so he’s clearly not stupid. And he’s been involved in this debate long enough to have encountered more than enough opponents of routine infant circumcision to know that the economic class of the child’s parents is irrelevant. (It is not irrelevant to Schoen, as he’ll demonstrate in a moment in one of his many nods to non-medical excuses.)

Regarding his second statement, children – regardless of economic class – have no political or economic power, and are at the mercy of their parents and medical professionals for decisions on their medical care. That demands that we act conservatively on their behalf. Yet Schoen doesn’t advocate such reservation. Instead, he attempts to score cheap sympathy through blatant mischaracterization.

Some have spoken out against this disregard of the wishes of poor parents. An editorial in the St. Petersburg Times criticized Florida legislators who “never stop boasting about an agenda they say promotes families and “more personal freedom.” Then they halt Medicaid coverage for newborn circumcision – a surgical procedure that the nation’s most respected medical professionals say should be a decision left to families and their doctors.” In quoting one state legislator who said that halting funding for circumcision was a “no-brainer” the editorial went on to say: “This is a terrible message – that poor people don’t deserve the right to make a medical, cultural, and religious choice that is available to everyone else.” So much for the claim of the anti-circumcision groups that they are out to protect the rights of the child.

Letting parents remove their son’s healthy foreskin promotes more personal freedom. For whom, the parents and their non-existent “right” to circumcise or children and their valid right to remain free from harm? And note the quoted editorial’s opinion that denying state funding is “denying the right” to circumcise. I admit I seek to deny this “right”, but I can only pray it gets that easy some day. Refusing to finance circumcision is not the same as prohibiting circumcision.

Also note Schoen’s dishonesty in his last sentence. The child has a “right” to be circumcised. I’ve witnessed more intelligent taunts on an elementary schoolyard, but this nonsense appears every so often under the belief that parents are denying the boy the chance to grow up circumcised, with all the subjective benefits. Frankly, I think this is idiocy because anecdotal evidence that intact men almost never choose circumcision supports the principle the every individual should be free from harm. The right to grow up with the healthy body you’re born with is easily defended. The alleged right to grow up with less of the healthy body you’re born with is not, absent parental psychic powers.

With the great majority of mainstream, middle class boys in the U.S. being circumcised, an uncircumcised [sic] boy in this country is marked as either an immigrant, a son of recent immigrants or a child of poverty (with the exception of a few middle class followers of the anti-circ movement). To cope with this social disadvantage of the foreskin, some poor parents, sadly and courageously, have scraped together enough money to pay for newborn circumcision from their meager assets, in order to giver their sons the appearance of mainstream American boys. The cost of newborn circumcision for middle class boys is covered by health insurance but in 13 states poor parents will have to raise the money themselves if they want their sons circumcised.

Of course, the locker room teasing theory. It’s “American” to circumcise, except for the few middle-class followers who reject circumcision. The “appearance of mainstream American boys” is a goal worth pursuing, so much that poor families should spend their meager assets on medically unnecessary surgery for a child who can’t consent. I can see the advertising now: “Can’t afford a BMW? Don’t worry, your kid’s circumcised penis can show that you’re upwardly mobile!” The mind reels at such stupidity.

But look past the supposedly distasteful class warfare he so readily uses to bludgeon infant circumcision opponents, he undermines his arguments by admitting that poor parents can and do circumcise their children, in spite of not having government funding. The debate becomes a legal/political/economic issue. He’s moved beyond medical facts – those he acknowledges – yet is unencumbered by the absurdity of the doctor as sage mentality. He thinks parents should choose, but there is only one correct choice. He’d be more honest if he advocated for mandatory circumcision of all infant males.

The anti-circumcision groups have argued unsuccessfully that by agreeing to have their newborn sons circumcised, parents are robbing the infants of their human rights. In a brazen example of hypocrisy apparently they feel that newborns should have the right to choose or refuse circumcision, but not poor people. The opponents of circumcision have met with some success in punishing the weak and helpless, but have had no effect on the general American public.

I didn’t understand it when I first read Schoen’s book, and I don’t understand it now. How are opponents of infant circumcision hypocritical? Schoen inserted class into the discussion.

This “infant circumcision opponents hate poor people” canard is a classic straw man, but it’s so pathetically transparent that even a moment’s thought destroys it all. Yet, he’s quoted as an expert in Time magazine and anyone who believes children should keep their choice when surgery isn’t medically necessary must defend the normal against the common, as if we’ve lost our minds and might come back to the “reasonable” view that parents have a right to surgically alter their healthy children if we’re humored long enough.

¹ I will not link to his website, where, like he does in his books, he selectively omits any information damaging to his maniacal pursuit to have all boys circumcised.

² Schoen, MD, Ed. Ed Schoen, MD on Circumcision. Berkeley: RDR Books, 2005, pp. 82-84.

If tradition and parental preference mean more, the Constitution means nothing.

The Oregon Supreme Court is now hearing the case where the (custodial) father wants his 12-year-old son circumcised as part of conversion to Judaism against the wishes of the (non-custodial) mother and, possibly, the wishes of the boy. I wrote about it previously, although there are many issues to consider beyond what was in that entry. NPR’s Day to Day recapped the story in a concise 4:32 (Real Player audio here). I recommend it to anyone interested in principles of self-ownership.

Here are my thoughts on the report, for anyone interested. If the boy wants to convert as the father contends, I have no specific qualms with him choosing circumcision for himself, beyond some basic expectation that he is competent to understand the permanent ramification. Self-ownership is the issue here.

Contrary to the implication early in the report, opposition to circumcision is not synonymous with anti-Semitism or a desire to oppress Jews. I do not care if someone chooses to have himself circumcised, for a religious reason or for no reason. I oppose medically unnecessary genital cutting on a non-consenting individual. Although routine infant circumcision dominates the discussion in America, I am opposed to medically unnecessary genital cutting on a non-consenting individual whether the individual is male or female, child or senior citizen. Proxy consent is reasonable only when a) immediate medical need exists and b) the patient is not legally competent to make the decision. But when a) is absent, b) is irrelevant. Until a) is satisfied, proxy consent is invalid and can’t justify the permanent removal of healthy, functioning genital tissue.

I think the law professor quoted at the end of the report is correct in assuming the case will be decided on family law rather than Constitutional law. The “right” of the parent will trump the right of the boy, regardless of which parent prevails. If that happens, it will be wrong.

From the Female Genital Mutilation Act (pdf):

“In applying subsection (b)(1), no account shall be taken of the effect on the person on whom the operation is to be performed of any belief on the part of that or any other person that the operation is required as a matter of custom or ritual.”

How does family law trump extending that protection to a gender-neutral guarantee (i.e. Constitutional) of the same rights to male minors in the United States?

Quote of the Day

The article is a few days old, but actor Alan Cumming offers an insight:

Cumming, an endearingly puckish type, is really rather proud of his foreskin. “During interviews in America, I have made a point of talking about it,” he says. “I think it’s insane that an entire nation is ignorant about a part of their body they have lost. When I take my pants off in America, people gasp, which is kind of nice, until I realise that they’re actually staring at my penis as if it’s some kind of National Geographic photo come to life. Nobody has a foreskin there. They’re, like, ‘Wow! What do you do with that? How does it work?’ ”

Worse, the ignorance is perpetuated intentionally.

Science is cool. Don’t reject it in favor of fear.

Via Jason Kuznicki at Positive Liberty, this interesting story:

A physicist and his biologist son destroyed a common virus using a superfast pulsing laser, without harming healthy cells. The discovery could lead to new treatments for viruses like HIV that have no cure.

“We have demonstrated a technique of using a laser to excite vibrations on the shield of a virus and damage it, so that it’s no longer functional,” said Kong-Thon Tsen, a professor of physics at Arizona State University. “We’re testing it on HIV and hepatitis right now.”

Knowledge is awesome.

Now, an obvious question. If it’s possible that this will work and cure HIV – still a long shot given the apparent early stage of this research – how is it reasonable for parents to circumcise a son today to reduce his risk of becoming infected with HIV after he becomes sexually active?

Many parents seem determined that we can’t presume there will be a cure/vaccine before their son becomes sexually active. The more rational position is that we can’t presume there will not be a cure/vaccine in the decade-and-a-half before he becomes sexually active. Science involves a never-ending process of learning more. Anyone who doubts it needs only to observe the drastic improvement in HIV/AIDS treatment and prevention in the last two decades.

Circumcision is not a now-or-never surgery at birth. If the boy is left intact, the overwhelming likelihood is still that he will not become HIV-positive. And that’s before a reminder that researchers only looked at circumcision’s possibility to reduce the risk of HIV in adult males undergoing voluntary circumcision. The effect on males from forced circumcision as an infant remains unstudied, although anecdotal evidence in the United States suggests that condoms would be a much wiser strategy. It’s more effective to teach him to protect himself than to surgically remove parts of his genitals.