Category: Ethics

Hanna Rosin Is Still Wrong On Circumcision, Revisited

Hanna Rosin returns with another apologia showing her determination to remain blind to the ethics against infant circumcision.

… But now that I have done my homework, I’m sure I would do it again—even if I were not Jewish, didn’t believe in ritual, and judged only by cold, secular science.

First, interviewing and/or reading the websites of Edgar Schoen and Brian Morris is not doing one’s homework. They are pro-circumcision advocates who promote bizarre theories. Two of them appear nearly verbatim in Rosin’s essay.

On the larger point, she’s mistaken. Cold, secular science demonstrates that an infant male’s foreskin is healthy. Intervention is not indicated. The cold, secular science she refers to replaces ethics with utilitarian conclusions devoid of any concern for the child’s opinion. This is inexcusable where proxy consent is involved for a medically unnecessary surgical intervention.

There’s a lot of nonsense in this next paragraph, so I’ll unpack it slowly:

Every year, it seems, a new study confirms that the foreskin is pretty much like the appendix or the wisdom tooth—it is an evolutionary footnote that serves no purpose other than to incubate infections. …

No. Every year, it seems, a new study confirms that there is some other potential benefit to be chased for a minor risk. Very few studies have been done on whether or not the foreskin is an “evolutionary footnote that serves no purpose other than to incubate infections.” This is her bias creeping in. She doesn’t value the male foreskin, so it must have no value. This despite the clear evidence that the foreskin contains nerve endings, among the many facts that disprove her opinion. It’s an illogical avoidance of the issue involved. Only the individual can draw a subjective conclusion for himself such as the one Rosin presents.

… There’s no single overwhelming health reason to remove it, but there are a lot of smaller health reasons that add up. …

Again, this is her subjective evaluation because the boy’s health is the only objective fact involved.

… It’s not critical that any individual boy get circumcised. …

She ignores the idea of the child as an autonomous person with basic individual rights. The excuse will be the collective, which I’ll dismantle momentarily.

… For the growing number of people who feel hysterical at the thought, just don’t do it. …

This is the usual trope: If you don’t like circumcision, don’t circumcise your son(s). That dismisses the individual in favor of the notion that his parents’ have ownership interests in this part of their child’s son’s body. For the male who doesn’t want to be circumcised, his opinion is correct for his body. If he was healthy at the time of his circumcision, proxy consent was invalid. He can’t undo his parents’ decision (for their own subjective reasons).

… But don’t ruin it for the rest of us. …

Rosin is digging deeper into her self-absorbed approach to this topic, further proving the ownership mentality necessary for her stance to appear viable.

… It’s perfectly clear that on a grand public-health level, the more boys who get circumcised, the better it is for everyone.

It’s perfectly clear that on a grand public-health level, the more males who get circumcised, the better it is for everyone if our HIV epidemic ever begins to resemble the African epidemic relevant to the randomized controlled trials involving adult male volunteers that showed a reduction in the risk of female-to-male vaginal transmission. But the usual caveats apply. America’s HIV situation differs from Africa’s. STD transmission requires sexual activity, which excludes male minors from the target group. All other potential health benefits from infant male circumcision involve only risks to the individual and are not relevant to the collective public health angle Rosin peddles here.

Twenty years ago, this would have been a boring, obvious thing to say, like feed your baby rice cereal before bananas, or don’t smoke while pregnant. These days, in certain newly enlightened circles on the East and West Coasts, it puts you in league with Josef Mengele. Late this summer, when the New York Times reported that the U.S. Centers for Disease Control might consider promoting routine circumcision as a tool in the fight against AIDS, the vicious comments that ensued included references to mass genocide.

People who suggest mass genocide are idiots, but the ethical point stands. Without ethics, the cold, secular science Rosin presents would permit any number of offensive interventions. What could we study about cutting the genitals of adult female volunteers that we could then apply to healthy female minors at the request of their parents? How is that offensive suggestion suddenly rational when changing the gender from female to male?

There’s no use arguing with the anti-circ activists, who only got through the headline of this story before hunting down my e-mail and offering to pay for me to be genitally mutilated. …

This is ad hominem. I haven’t hunted down her e-mail. I’m not suggesting that she be genitally mutilated. Instead, I’m offering a logical, fact-based rebuttal to her personal opinions about what she wants the facts to be.

… But for those in the nervous middle, here is my best case for why you should do it. Biologists think the foreskin plays a critical role in the womb, protecting the penis as it is growing during the third month of gestation. Outside the womb, the best guess is that it once kept the penis safe from, say, low-hanging thorny branches. Nowadays, we have pants for that.

I’ve seen it before from Brian Morris¹, but I thought Rosin would be a bit less ridiculous. Instead, she repeats it as logic, as her best case, rather than dismissing it for the obvious nonsense it is. If the evolutionary purpose of the foreskin was to protect the penis from, say, low-hanging thorny branches, it’s purpose is not suddenly irrelevant because we wear pants. The foreskin’s purpose is to protect the penis, full stop. What it protects the penis from is a matter of circumstance particular to each male’s life, not the level of civilization of his time.

After rehashing some of the last 140 years of circumcision history, this:

… Circumcision, it turns out, could reduce the risk of HIV transmission by at least 60 percent, which, in Africa, adds up to 3 million lives saved over the next twenty years. …

Condoms, it turns out, could reduce the risk of HIV transmission by nearly 100%.

To the ethics, she omits that the studies involved adult volunteers. She hasn’t made the ethical case for why circumcision should be forced on non-sexually active infants.

These studies are not entirely relevant to the U.S. They apply only to female-to-male transmission, which is relatively rare here. But the results are so dramatic that people who work in AIDS prevention can’t ignore them. Daniel Halperin, an AIDS expert at the Harvard School of Public Health, has compared various countries, and the patterns are obvious. In a study of 28 nations, he found that low circumcision rates (fewer than 20 percent) match up with high HIV rates, and vice versa. Similar patterns are turning up in the U.S. as well. A team of researchers from the CDC and Johns Hopkins analyzed records of over 26,000 heterosexual African-American men who showed up at a Baltimore clinic for HIV testing and denied any drug use or homosexual contact. Among those with known HIV exposure, the ones who did turn ou
t to be HIV-positive were twice as likely to be uncircumcised. There’s no causal relationship here; foreskin does not cause HIV transmission. But researchers guess that foreskins are more susceptible to sores, and also have a high concentration of certain immune cells that are the main portals for HIV infection.

But the results are so dramatic that we must apparently discard our rational minds and circumcise infants to prevent a disease from spreading in the U.S. in a way that it doesn’t generally spread now. We must do this because researchers are guessing, and look, we have self-reported anecdotal data to rely on. She’s proven nothing by citing this.

Regarding the study of 28 nations, which 28 nations did Halperin choose? I can pick a group of countries that will show the opposite. The real problem is behavior, not anatomy. Rosin admits as much, indirectly, when she states that the foreskin does not cause HIV transmission. Remember, correlation does not equal causation.

Then there are a host of other diseases that range from rare and deadly to ruin your life to annoying. Australian physicians give a decent summary: “STIs such as carcinogenic types of human papillomavirus (HPV), genital herpes, HIV, syphilis and chancroid, thrush, cancer of the penis, and most likely cancer of the prostate, phimosis, paraphimosis, inflammatory skin conditions such as balanoposthitis, inferior hygiene, sexual problems, especially with age and diabetes, and, in the female partners, HPV, cervical cancer, HSV-2, and chlamydia, which is an important cause of infertility.” The percentages vary in each case, but it’s clear that the foreskin is a public-health menace.

This is the “something may go wrong” theory mixed with the “we can do this, so it must be ethical” non-standard employed in Rosin’s cold, secular science. It’s devoid of any context for how common those risks are, differences between minors and adults, risk factors and possible prevention and treatment options. The whole thing is a diversion, completed with the shameless fear-mongering of “the foreskin is a public-health menace.”

This mundane march of health statistics has a hard time competing with the opposite side, which is fighting for something they see as fundamental: a right not to be messed with, a freedom from control, and a general sense of wholeness. For many circumcision opponents, preventive surgery is a bizarre, dystopian disruption. …

Yes, because the opposite side is grounded in reason and objective facts. I’ve made the case extensively why this is true. Rosin has yet to show why this is false (in any of her attempts).

… I can only say that in public health, preventive surgery is pretty common—appendix and wisdom teeth, for example. …

Remember, she’s established her case for preventive medicine on the idea that the foreskin has no purpose, which is false. There’s also recent evidence suggesting the “unnecessary” appendix has a function, proving that cold, secular science is always learning more. And she’s demanded that we accept infant circumcision as a matter of public health, yet has provided no legitimate public health risks requiring infant circumcision. Phimosis, for example, is not a public health risk in any way. (It doesn’t automatically require circumcision, either.)

Sexual pleasure comes up a lot. Opponents of circumcision often mention studies of “penile sensitivity regions,” showing the foreskin to be the most sensitive. But erotic experience is a rich and complicated affair, and surely can’t be summed up by nerve endings or friction or “sensitivity regions.” More-nuanced studies have shown that men who were circumcised as adults report a decrease in sexual satisfaction when they were forced into it, because of an illness, and an increase when they did it of their own will. In a study of Kenyan men who volunteered for circumcision, 64 percent reported their penis to be “much more sensitive” and their ease of reaching orgasm much greater two years after the operation. In a similar study, Ugandan women reported a 40 percent increase in sexual satisfaction after their partners were circumcised. Go figure. Surely this is more psychology than science.

This paragraph supports my contention that the value of circumcision is subjective to the individual, meaning the decision should be left to the individual who will live with the results, not his parents who invoke their own subjective preferences.

People who oppose circumcision are animated by a kind of rage and longing that seems larger than the thing itself. Websites are filled with testimonies from men who believe their lives were ruined by the operation they had as an infant. I can only conclude that it wasn’t the cutting alone that did the ruining. An East Bay doctor who came out for circumcision recently wrote about having visions of tiny foreskins rising up in revenge at him, clogging the freeways. I see what he means. The foreskin is the new fetus—the object that has been imbued with magical powers to halt a merciless, violent world—a world that is particularly callous to children. The notion resonates in a moment when parents are especially overprotective, and fantasy death panels loom. It’s all very visual and compelling—like the sight of your own newborn son with the scalpel looming over him. But it isn’t the whole truth.

She’s speculating about motive in a way that borders on a return to ad hominem. It all circles back to her self-absorbed, “don’t ruin it for us” mentality. She likes circumcision so I am mistaken in being angry about surgery performed on my healthy infant body. Society would’ve rejected that parental choice on the ethical stance I’ve established, if only I’d been born a girl. By now it’s clear that Hanna Rosin has no intention of doing anything more than working backwards from her conclusion, avoiding the facts that challenge her opinion. That’s something, but it’s not the case against the case against circumcision the title of her essay promises.

¹ I’m not interested in providing Morris a direct link for search engine purposes. Read his speculation here: http://www.circinfo.net/why_are_human_males_born_with_a_foreskin.html

Science Requires Ethics

Intact America ran an open letter, as an advertisement, in yesterday’s Washington Post urging the American Academy of Pediatrics not to recommend that American parents circumcise their infant sons as a strategy against HIV. [Full disclosure: I attended an event hosted by the organization and interact with some of its representatives because I support its cause.] It’s a logical request, based on the necessary combination of science and ethics. A pro-circumcision advocate, Jake Waskett¹, has attempted a deconstruction of the letter, labeling it “propaganda”. His support for that charge is preposterous, as any approach advocating the circumcision of healthy infant males must inevitably be, but his critique fails because he ignores the central issue involved. After a brief introduction, complete with an absurd assumption about Intact America’s motives, Waskett quotes the opening paragraph:

American parents trust their pediatricians and rely on them for the best advice in caring for their children. As a matter of ethics, that advice cannot include neonatal male circumcision – a medically unnecessary, potentially risky surgery that no major medical authority in the world recommends.

I agree with this, although I’m not a fan of appeals to authority. As should be evident with the apparent intention of the CDC to recommend infant circumcision, it only takes one ill-conceived recommendation to distract from the core issue. Despite my misgivings, Intact America structures the argument correctly because it identifies that core: ethics demand not imposing medically unnecessary surgery on normal, healthy children, regardless of gender or potential benefits.

Waskett assesses this with an odd bit of snark about people inventing fire before issuing a parenthetical aside suggesting that the national medical bodies of African nations now implementing mass circumcision programs implies approval. Perhaps this is the case, which circles back to my reservation about an appeal to authority. But assuming it is not a point of fact. Still, if he’s granted the point, what does this prove about Intact America’s ethical argument? The risk of female-to-male HIV transmission through vaginal intercourse is a significant problem in Africa. In America HIV transmission risk through sex overwhelmingly involves male-to-male transmission, from which the (voluntary) circumcision of (adult) males has shown no statistically significant reduction. Even if this wasn’t the case, the ethical issue of applying scientific research to healthy children through surgery centers on infant circumcision, not infant circumcision. That’s the point Waskett ignores. His defense:

So what do we have left? A “potentially risky surgery”. Well, yes, it is. There are risks, of course, albeit small. But these need to be weighed against the benefits: a reduction in the risk of certain conditions.

Finally, “medically unnecessary”. Again, yes, it is. But that’s not an argument against it: something can be beneficial, even advisable, without being necessary. Take vaccinations, for example: they’re not strictly necessary, but they’re certainly advisable.

Their claim that circumcision is unethical seems to be on shaky ground.

No, these risks need to be weighed against the need, or rather, the lack of need. The ethics of proxy consent require parents to choose a balance between the most effective and least invasive solution to remedy their child’s malady. But there is no malady when the boy is healthy. Setting the ability to chase potential benefits as the ethical standard opens the range of allegedly valid parental interventions to include any number of surgeries we recognize as offensive. The science becomes ungrounded by any concern for the individual child as an individual.

Invoking the topic of vaccinations does not change this evaluation. There are similarities between circumcision and vaccination, based on potential benefits. However, the difference rests on how the problems the interventions are meant to prevent occur. For example, becoming infected with measles requires no effort other than participation in society, while acquiring HIV from an HIV+ female through vaginal intercourse requires a very specific action, an action not undertaken by infants. Comparing the two solutions as comparable for parental consent fails.

Add to this the fact that parents treat the same maladies circumcision is supposed to prevent with less invasive, non-surgical methods when they affect their daughters, and Waskett’s argument misses the ethical case against infant circumcision because he’s making the case for circumcision devoid of context and ethics. That’s a case that works only if it’s a voluntary decision by the adult male himself.

Next, Intact America requests that the AAP defend the ethics against infant circumcision rather than considering a revision in favor of the surgery since science necessarily involves ethics when applied to a person’s body, particularly via proxy consent. Waskett calls this request “bizarre,” despite having failed thus far to address the ethical argument made by Intact America.

Continuing:

[sic] still, more than one million American babies undergo the surgery every year driving one billion dollars in health-care spending.

And, no doubt, saving comparable figures in disease prevention.

Waskett’s claim is based on speculation. Perhaps his analysis is correct, but he does not provide proof for his assumption here. We have statistics from other western nations demonstrating the incidence rates for the diseases to which he refers. Since we can analyze circumcision on these terms, “no doubt” is insufficient.

Regardless of the cost, the issue is still the ethics of circumcising healthy infant males. The individual matters, not America’s males as a collective.

Continuing:

Most European nations, with circumcision rates near zero, have lower HIV/AIDS rates than the United States.

Are Intact America really so naive about epidemiology that they think that between-country comparisons constitute a decisive answer to such a question? Evidence-based medicine requires use of the best available evidence (usually randomised controlled trials), not the least (ecological analyses such as this are considered one of the weakest methodologies, and for good reason).

First, the “best available evidence” is that the infant male is healthy. No surgery is indicated or, therefore, justified. But that’s nit-picking facts when it’s as correct to stick with ethics.

Waskett seems to think that Intact America ignores the randomized controlled trials showing risk reduction in female-to-male HIV transmission from voluntary adult circumcision. The letter noted this fact in an earlier paragraph. Still, as I read the letter, Intact America is not making an argument about epidemiology. Rather, it is making an argument about populations and risk factors. The risk factors among America’s population are similar to those of European nations, not African nations. Our risk is male-to-male transmission and shared needles during IV drug use. Circumcision protects against neither. Is that complete proof that infant circumcision in America, unlike the randomized trials involving adult volunteers in Africa, is irrelevant to the United States? No, and I don’t think Intact America is suggesting otherwise. It is simply working from the central fact, which is that it is unethical to circumcise healthy infant males – who are not sexually active – to prevent a disease for which most of them will face minimal lifetime risk and for which less invasive, more effective prevention methods exist. Europe is an appropriate anecdo
tal case study that (infant) circumcision is not necessary to achieve the results health officials desire.

Continuing:

Furthermore, circumcision has significant risks, including infection, bleeding, impairment of sexual function, and even death. Earlier this year, an Atlanta family was awarded $2.3 million because a physician accidentally amputated much of their infant son’s penis during a “routine” hospital circumcision. A Canadian baby bled to death in 2004, after being circumcised in a British Columbia hospital. In 2008, a baby from South Dakota bled to death, and his parents have filed suit against the hospital where he was circumcised, as well as the doctor who performed the surgery.

Yes, accidents happen, and of course they’re tragic. But let’s be sensible. If we’re going to consider the risks associated with circumcision, we also have to consider the risks associated with non-circumcision. Babies die of urinary tract infections – and circumcision reduces the risk. Adults die of penile cancer (again, the risk is reduced) and of HIV (and again).

The complications of circumcision affect individuals. Those individual have rights. We recognize this for female minors, legislating against parental proxy consent for medically unnecessary genital surgery on daughters for any reason. The ethical argument against infant male circumcision involves the equal rights concept that the same protection should be applied to males. Waskett hasn’t yet made a coherent case for denying these rights to male minors.

But on his demand that we include the “risks associated with non-circumcision,” to an extent these must be lumped into the risks associated with living. That’s sufficient since it’s how we treat female minors, but it’s worth noting that Waskett’s argument is flawed because he ignores the context of those ailments, thereby avoiding the ethical issue of proxy consent. He ignores that alternate solutions exist for those risks associated with normal genitalia. Most infections are not life threatening and can be treated with interventions less severe than surgery. The other risks, such as HIV and penile cancer, involve causes (i.e. behavior) not directly related to the foreskin. This is the approach we take with female minors. It is the approach an ethical society would take with male minors.

¹ This is an assumption. I have interacted with Jake Waskett on previous occasions. The language, tone, and approach to the topic match what is found here. As added support, an excerpt in the entry quotes “…in favour of the surgery…” from the Intact America letter, which is a British spelling not found in the original letter. At least one other British spelling appears in the entry. Waskett is British. I leave open the possibility that I am mistaken and will correct if it becomes clear that I am.

Is There Any Choice Parents Can’t Make?

I haven’t written on Roman Polanski’s arrest because everything worth saying is so blindingly obvious that those who need to hear are likely devoid of any capacity for understanding it. Still, one point thrown around bothered me most. The following excerpt from a New York Times article discussing cultural changes since the rape of a 13-year-old sums up the point I witnessed in more than one excuse for Polanski (emphasis added):

A 28-page probation officer’s report completed in September of that year presented a broadly sympathetic portrait of Mr. Polanski and his behavior, even while acknowledging that the victim, Samantha Geimer (who has since publicly identified herself), had offered grand jury testimony of forcible rape.

Submitted by the acting probation officer Kenneth F. Fare, and signed by a deputy, Irwin Gold, that report, which recommended against further jail time, said “the present offense appears to have been spontaneous and an exercise of poor judgment by the defendant.”

In a further conclusion that appeared to shed blame on the victim, it said, “There was some indication that circumstances were provocative, that there was some permissiveness by the mother,” who had allowed Ms. Geimer to spend time with Mr. Polanski. And, in a conclusion that might particularly jar readers today, it pointed toward evidence “that the victim was not only physically mature, but willing.”

I do not want to meet the sort of person who would suggest that parents may consent to the rape of their children. Anyone who suggests such a right exists is a barbarian. It doesn’t, because children are not property.

**********

Posted without comment, I agree with every word of this assessment of the case (and the NYT article) by author Lauren McLaughlin, titled “She Was an Eight Grader.” A choice excerpt:

They don’t mention the drugs he gave her, drugs with very specific muscle-relaxing properties, mind you. They don’t mention that she said no repeatedly. They don’t mention that, after fleeing his sentence, Polanski immediately took up with another minor, Nastassja Kinski. If there’s a clearer case of unrepentant pedophilia, I’m not aware of it.

Nor is Polanski’s pedophilia in anyway mitigated by the fact that he seems to think that everyone wants to have sex with young girls. Rather, it’s a sign of the decrepit company he must have kept. And, perhaps, of the decrepit leniency with which sexual assault used to be treated.

For this reason, it irks but does not surprise me that people like Martin Scorsese, Woody Allen, and Terry Gilliam signed that petition. But why did Tilda Swinton, Darren Aronofsky, and Alexander Payne sign it? Are they aware of the actual crimes they’re so anxious to pardon? And if so, what exactly would Polanski have had to do to this eighth grader to disqualify himself from their forgiveness?

Nancy McDermott Is Wrong On Circumcision

In replying to an essay against infant circumcision by Ethan Epstein at Spiked, Nancy McDermott attempts to defend parental proxy consent for routine infant male circumcision. She is mistaken.

The main problem with The Circumcision Discussion in general, and with Ethan Epstein’s article in particular, is the appeal to Science with a capital S to validate what is essentially a personal decision for parents. There isn’t really overwhelming evidence for or against infant circumcision, which makes this issue quite unambiguously a matter of preference, and more so than some other issues such as breastfeeding or vaccination where the scienctific research is abundant.

There is overwhelming scientific evidence against infant circumcision: the boy is healthy. Surgery on that healthy person is only unambiguously a matter of preference if the healthy person makes the decision for himself. It is not a valid personal decision for parents to make for their healthy children, male or female.

A good blogger would stop here because McDermott’s case is already refuted. But there’s more to say. Effectively, McDermott advocates using science without the capital E of Ethics. Would we entertain a discussion of whether or not removing the breast bud’s of female minors is a valid parental decision because it might reduce her risk of breast cancer? Of course not. Yet, we abandon such critical thinking because circumcision has a long history. We ignore that science without ethics encourages us to choose the science we prefer while ignoring objective reality. Again, the child is healthy. He needs no intervention. Therefore, the child’s human rights are involved, even when medical intervention is indicated. As discussed here it is the primary sole issue because the child is healthy. McDermott’s argument is the usual sophistry unleashed to defend genital cutting on male children as a parental right, despite the lack of need and demand that we only extend this right to their children of one gender.

She continues:

But that hasn’t stopped Epstein from trying to use Science to support what is essentially his own particular set of prejudices. In the end, his attack on infant circumcision is not based so much on evidence but rather on a degraded notion of personal autonomy that is contemptuous of parents and reduces the whole parent/child relationship to the matter of a few inches of skin.

Defining the foreskin down as “a few inches of skin” indicates a particular set of prejudices. Defining surgery as a relationship tactic indicates a particular set of prejudices, as well.

As for being contemptuous of parents, I am. When parents engage in contemptible behavior, I will call their behavior contemptible. Since it’s always worth repeating in this discussion, the child is healthy. Performing surgery on him (or her) for the parents’ subjective reasons is unethical because it violates a basic human rights principle: Performing medically unnecessary surgery on a non-consenting person is wrong. Where facts differ from any of the conditions involved in that principle, the discussion changes to proxy consent. But circumcision as understood in this essay involves all of the facts involved in the principle. Proxy consent is not valid.

Referring to Epstein’s essay, McDermott continues (footnote removed):

Take for instance his attempt to establish – or rather to assert – that male infant circumcision is on a par with ‘female circumcision’. It’s a comparison that defies even a basic familiarity with human anatomy. ‘Female circumcision’, or Female Genital Mutilation (FGM) as it is usually called, involves the removal of some or all of a woman’s external genitalia and is associated with side effects like intense pain, infection, haemorrhaging, infertility and urinary incontinence. Comparable surgery in a man would involve the removal of most of the penis and the scrotum. But male circumcision as it is currently practiced consists of the removal of the foreskin and nothing else. Statistically it is a very safe procedure with few complications (in some cases, there may be minor bleeding or a local infection).

The moral equivalency exists because medically unnecessary surgery on a non-consenting person is wrong. Gender is irrelevant. Extent of damage is irrelevant. The World Health Organization defines female genital mutilation as “procedures that intentionally alter or injure female genital organs for non-medical reasons.” The intent is generally different between male circumcision in America and female genital cutting in other cultures, but a well-intentioned act can still be objectively harmful. Outcome matters. And male circumcision meets the definition applied to female genital cutting, since the male child’s genitals are intentionally altered for non-medical reasons.” There is usually a difference in degree, but there is no difference in kind.

Given that male genital cutting matches the definition applied to female genital cutting, it’s crucial to explore how McDermott is under-informed about FGM. As it’s typically practiced, it involves removal of some or all of a female’s external genitalia. But FGM is defined to include “all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.” These (less commonly practiced) forms are similar in enough ways to male circumcision to make the point. Parents who force it on their daughters often give similar subjective reasons for both procedures. Yet, our anti-FGM laws make no distinction for extent of cutting or personal preference involved in the parents’ decision. The focus is on the autonomy (and health) of the minor, which is where the focus should be.

Yet, it’s easier to explain why McDermott is wrong. How does she arrive at the implied conclusion that removing a male child’s foreskin is not “the removal of some or all” of his external genitalia? Implicitly (and incorrectly) positing that the foreskin and its removal are trivial isn’t enough. She ignores the truth that, as surgery, circumcision is harm. Instead, she relies on self-reporting studies that she believes support her stance (footnote omitted):

Epstein doesn’t do much better when he tries to show evidence for psychological trauma and sexual dysfunction as a result of circumcision. He relies on a 2002 paper written by self-proclaimed ‘intactivists’ which indicates that some men enjoy sex less after circumcision. Had he more objectively investigated what he says is ‘quite evidentially true’, he might have come across any number of studies that show the opposite. My favourite is a large-scale study from 2008 (with over 4,500 participants) in which an overwhelming majority of Kenyan men reported no difference in sexual satisfaction or function after their circumcisions.

What is incompatible in comparing a study that indicates some men enjoy sex less after circumcision and a study that shows an overwhelming majority of men reported no difference? “Some men” and “overwhelming majority” are both synonymous with “less than 100%” for the purposes of the ethical discussion of medically-unnecessary child circumcision. Some males will not be happy being circumcised. I am not. Some men will suffer more than the standard, “acceptable” damage. The issue is about an individual right, not a right based on parental desires.

Continuing:

It is striking that midway through Epstein’s article the CDC’s proposal to ‘promote’ infant circumcision mysteriously transforms into a plan to ‘m
andate’ infant circumcision. This is not a slip and it’s not just that Epstein has got his facts wrong (although he has). …

I’ll pause here to make the point that I am not defending Epstein’s article. Were I to write about it, I’d call out the same flaw McDermott notes about the CDC’s intentions, as I wrote when the CDC news stories broke in August.

… Rather he makes this change in terminology because he isn’t really talking about the CDC at all any more. He’s talking about parents. For anti-circumcision activists, all infant circumcision is mandated in the sense that infants do not consent to it.

Exactly.

In what seems an attempt to defend her indifference to what the boy doesn’t need and may not want, her next paragraph demonstrates how she’s failed to grasp this fundamental aspect of the ethical case against infant circumcision.

On one level Epstein is right. It is of course impossible for an infant to consent to anything, and parents make decisions large and small on behalf of their children all the time. Some of these decisions affect their future and many are far more difficult than the question of whether or not to have your infant circumcised.

That some decisions parents make are “far more difficult” does not validate parental proxy for infant male circumcision.

In the second excerpt above, McDermott mentions the parent/child relationship. This inevitably leads to a mistake that advocates of infant circumcision, or at least of parental choice, make. McDermott is no different:

Many of the choices we make as parents profoundly affect our children. But when we look back at our own lives it is often things that didn’t concern us directly at all that had the greatest impact – things like parents’ decision to divorce, to change jobs, or to emigrate. As children we rarely have any say and yet we manage to adapt and often to flourish. One of the major reasons we are able to develop this resilience is because we can depend on our parents. It is the parent/child relationship – each one unique and dynamic, a complex mix of love and trust, and mutually crazy-making – that creates the sense of inner confidence that helps us learn shape our own destinies.

By counterpoising the ‘personal autonomy’ of an infant to the judgment of his parents, Epstein and others who campaign against circumcision reduce the relationship between parents and their sons to one moment; a moment that forever defines the child as victim and the parent as victimiser regardless even of what the boy himself thinks about it later in his life. Once a victim, always a victim.

McDermott’s shift from discussing the parent-child relationship to the parent-son relationship reveals the flaw in her thinking. There’s a key distinction because she talks in generalities to establish parental authority before shifting to a specific case in which she omits a gender from consideration to reach her preferred outcome. If parents have a right to choose that is superior to the personal autonomy and health of their sons, that same right exists superior to the personal autonomy and health of their daughters. She rejects objective health and risks in favor of subjective decisions by parents for their sons, yet accepts objective health and risks as a defense against subjective decisions by parents for their daughters. That right doesn’t exist, but if it did, she’s being contemptuous of the parents of daughters because she refuses to let them exercise their right. She’d deny that, but regardless, it’s clear she started with her preferred outcome and worked her way backwards to find only the relevant facts she needed.

She concludes:

There are all sorts of reasons why parents do or don’t circumcise their sons. For some it is the embodiment of their faith, for others it is simply custom. For some the thought of subjecting their child to any unnecessary pain or alteration is unacceptable. The important point is that the choice takes place within the context of the parent-child relationship. ….

Again, the choice she’s defending takes place between the parent-son relationship. She’s established this separate category, incorrectly as I’ve shown, without offering an explanation for why this is legitimately a separate category beyond an incorrect assumption that the removal of some or all of a female minor’s external genitalia is offensive in a way that removal of some or all of a male minor’s external genitalia is supposedly not.

…The CDC is not, as Epstein implies, planning to circumcise every male infant in the United States, but the change in its recommendation, just like every other official pronouncement about the right way to raise children, should be greeted with scepticism. Not because, as Epstein argues, it might lead parents to make a wrong choice, but because it questions their right to make choices in the first place.

Somehow I suspect she doesn’t believe we should be skeptical about the official pronouncement (i.e. a law) from the United States Congress criminalizing the parental “right” to choose female genital mutilation. But we are not to question the parental right to make that choice for sons, with circumstances and reasoning explicitly rejected for female minors. Her essay is a self-absorbed excuse for parents and their made-up right to impose their whims based on irrational traditions and willful ignorance.

Matt Steinglass Is Mistaken On Circumcision

In the interest of context for this post, Chris Bodenner did what Hanna Rosin didn’t, which is to apply critical thinking to the circumcision question. He wrote:

Studies are a red herring, however, when it comes to the ethical part of the debate. Even if there are no discernible differences between cut and uncut on average, there are still many individuals who are better or worse off from a procedure their parents imposed. As one reader puts it:

It’s my dick. It’s my dick. It’s my dick. It is no one else’s dick but my dick. And I should have the choice to circumcise it when I am old enough to make that decision.

Matt Steinglass reacts:

Let me reassure this guy: no one is planning to do anything to his dick. Assuming, that is, that he is more than 8 days old. But with respect to the practice of circumcision, the important point is this: he’s my son. Not yours. Parents have the right to decide on medical treatment for their children, presuming such medical treatment is not actively harmful. And parents have the right to include their children in cultural rites and practices, again presuming no harm is done.

Proxy consent is valid where medical treatment is indicated (i.e. necessary). Parents do not have a right to impose medical treatment – in this case, surgery – because they like that medical treatment, for whatever reason they value it. This is precisely because it fails the test Steinglass establishes: it causes harm. Circumcision is surgery. It removes healthy, functioning tissue. There is scarring. There is an inherent risk of further complications, starting with “excessive” bleeding and infection and extending all the way to death. The more extreme complications are, of course, rare, but the risk itself is a form of harm. Parents cannot know if their son will be the statistic. Good intentions are not a substitute for objective criteria.

He continues:

What, then, of female circumcision? Well, I understand, perhaps wrongly, that there are some forms which are not particularly medically invasive, and which do not entail significant medical consequences. I think that such forms of female circumcision are a matter of cultural practice that should be left up to parents to decide. The more invasive forms of female circumcision entail serious negative medical consequences. Obviously that’s not cool. And female circumcision is carried out on girls aged 7 to 12 or even older; at that age, the child gets a vote, too. In any case, this doesn’t have much to do with anything, because we’re talking about a medical recommendation.

I’ll address his strange tangent on female genital cutting in a post script. For now, I’ll point out that his criteria fail because the cultural genital cutting is not a medical recommendation backed by need, regardless of the child’s gender. Medically unnecessary genital surgery on an unconsenting individual is unethical. Again, it causes harm in 100% of cases for no objective benefit or attempt to correct a genital malady. The intervention is indefensible.

He concludes:

… Men who are circumcised don’t complain about it. There may be some vanishingly small number of guys who are upset about the fact that their parents circumcised them. It’s a weird thing to be upset about. The whole issue of treating this as some kind of mutilation of a rights-endowed human being who should be allowed to decide for himself seems to me like an insane metastasis of the American fixation with individual rights-based ideology. Children are born into families. Those families have cultures and beliefs, and are entitled to make decisions about how their children will be treated, shaped, and raised.

He perceives no harm and thus dismisses the individual making the rights-based claim against something he, Matt Steinglass, thinks is a “weird thing to be upset about”. That tells us nothing because it’s about Matt Steinglass, not circumcision. He writes only of culture and family without considering that the male may not value that culture or that circumcision is objective harm.

Yet, he’s not in favor of families deciding how their children will be treated, shaped, and raised without limits. He stated that he believes parents have the right to make decisions as long as it’s not actively harmful to the child. He is making a rights-based argument that centers on the child possessing certain individual rights. There are limits to how much culture may play a role. This makes the role and influence of the family and culture irrelevant here; his claim hinges first on the merits of circumcision as surgery on a healthy child. It fails for the reasons I’ve stated, which prevents moving to cultural considerations. It’s important to remember that he implicitly agreed to that test because of his caveat. He probably disagrees that circumcision is objective harm. He is wrong, if he does, but he hasn’t bothered to attempt the defense. Instead, he is essentially proposing that subjective preferences are valid for parental decisions as long as the parents believe them to be culturally valid. That’s madness.

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Post Script: To his credit, I suppose, his paragraph on female genital cutting shows that he is consistent in his error. But I’m not sure why he thinks that girls aged 7 to 12 or even older get a vote. Is he saying they do or that they should? If it’s the former, he is mistaken. If it’s the latter, we limit the rights of children to the extent that we deem them capable of consenting. In this “ideal” world where children are asked before their parents surgically alter their healthy genitals, is a 7-year-old competent to make that permanent decision without undue influence? More importantly, do we believe parents will refrain if the child rejects it? Is the child to be considered potentially opposed to genital cutting only if she’s old enough to voice opposition, whether or not she could reasonably be expected to comprehend the full implications? Is there a similar age for male minors?

The shorter version here is that I don’t think he thought that paragraph through before he posted the entry. It’s incoherent.

Hanna Rosin Is Still Mistaken On Circumcision

Hanna Rosin summarizes the responses to her circumcision post from yesterday “into three basic categories”:

1. How can we do this to a child without his consent? There are so many things we do to children without their consent – change their school, banish their friends, give them drugs, abandon and neglect them. Removing a foreskin should not even fall in the top 20 ways to ruin your child’s life.

Right, ethics. She again fails to address this valid concern. Stating that “X is worse than Y” grants no legitimacy to Y.

2. “Foreskins are, well, fun,” writes one gay reader. My authority here is obviously limited. That said, all that research of specific areas of male sensitivity (Andrew cites some here) has always struck me as dubious. Erotic pleasure is a rich and complicated thing. Specific percentages of sensitivity can’t possibly sum up the experience.

Those last two sentences are true. Yet, she’s said nothing in defense of infant circumcision with either statement. Even if she’d explained why the research of specific areas of male sensitivity strikes her as dubious, what would that prove about infant circumcision? An extension of the ethical argument she’s failed to confront involves each individual deciding what constitutes preferred pleasure and sensitivity from and for his normal body. Erotic pleasure is a rich and complicated thing unique to the individual. Specific percentages of sensitivity evaluated by another can’t possibly sum up the experience for the individual.

3.Preventative surgery is a “bizarre notion.” This is somewhat more convincing. But for one thing, “surgery” is a bit of an exaggeration. We certainly cause infants minor pain for the greater public good many times, in the form of vaccines. It depends, I suppose, whether you consider HIV and STD’s a widespread public health crisis, or something affecting only a very few. I could get into the specifics of the research here, but I won’t.

Why is surgery in quotes? It is not an exaggeration to call circumcision surgery. Even her source from yesterday’s article, WebMD, defines circumcision as “the surgical removal of the foreskin, the tissue covering the head of the penis.” If there is a risk of death, no matter how small, circumcision is surgery. Her statement suggests a lack of curiosity on the subject for anything beyond what she wants to believe.

The vaccine argument is interesting and related. However, circumcision is the (surgical) removal of healthy, functioning tissue. The associated pain is a separate, secondary aspect for consideration. Our ability to control pain and its temporary presence are not defenses for performing the offending surgical procedure. Controlling pain does not render the intervention humane.

Nor are a boy’s genitals subject to the alleged needs of the public good. STDs require specific, individual actions. Those are actions that infants will not be undertaking for many years. When they begin engaging in those actions, they must use condoms, regardless of whether or not they still have their foreskin. Conveniently, a condom’s effectiveness is considerably higher than that of circumcision.

On the specifics of the research, it would be useful for her to state them. I’ll probably agree with her. It’s not necessary, though, because the discussion must circle back to ethics because she’s advocating circumcision on healthy infants, not adult volunteers. What we can do is not synonymous with what we should do.

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I didn’t include this in my objection yesterday because it disappears as an issue once we get the question of infant circumcision correct, but it’s an interesting point to pursue because a willingness to comprehend circumcision from perspective of the child’s rights is essential to ultimately grasping why circumcision is wrong. From her entry today:

…, my post defending circumcision taps into the current fears about “big government trying to mandate certain types of medical procedures,” as one reader wrote in.

As a circumcised male, why do I care whether circumcision is mandated by the government or merely by my parents? The result – forced circumcision – is the same for me. Basically, Rosin engages in the “if you don’t like circumcision, don’t circumcise your son” defense. This is wrong. The case against circumcision centers on the boy as a (healthy) human being, not the boy as a son of parents making a choice.

Where does the comparison fail?

Consider:

Police say 26-year-old Enrique Gonzalez held the boy while another gang member tattooed his right hip. …

Gonzalez has been booked into the Fresno County Jail on suspicion of child abuse, mayhem, false imprisonment and a host of crimes with gang enhancements.

The (alleged) actions of the father are wrong, a conclusion virtually everyone will agree upon. Society is correct in prosecuting this as child abuse.

Yet, society’s laws also allege that parents have an unquestionable right to circumcise their (male) children – a permanent change to the child’s body – based only on a parental conclusion that some social benefit might exist for the child. We are not to judge those family decisions (on boys only, remember) made for subjective reasons.

Joel Stein satirized this mentality in a recent issue of Time when he wrote that “circumcision is something the U.S. does and Europe doesn’t and is therefore awesome.” Stein used this as a tongue-in-cheek way to introduce his skepticism on the issue. It wasn’t funny because he recognized the violation of circumcision and still forced it on his son, but the attempt at humor was obvious. Someone like Dr. Edgar Schoen uses this same faux-patriotism in his books as an excuse to continue parental choice on infant male circumcision for social reasons without noticing the absurdity of this forced inclusion. The law sides with Schoen’s stupidity on infant male¹ circumcision, which raises the question: How is tattooing a child any different than forcing unnecessary surgery on him?

The law permits parents to have no reason, but “like father, like son” is among the non-medical excuses most commonly provided. The medical community pushes this and few question it. Presumably the child in the news story above would’ve experienced greater acceptance and status among his father’s peer group² by having the tattoo. Why is one ethical framework applicable in one scenario and inapplicable in an analogous scenario, if not to cherry-pick for outcome? Because one violation is uncommon and the other is practiced more than one million times each year? Because one leaves a mark accepted by most while the other leaves a mark shunned by most? I’m curious to know because the answer isn’t logical.

None of these possible exemptions satisfies the primary ethical flaw in either violation. The act is forced upon the child without his consent. Necessity requires an acceptance of limited proxy parental consent for infant male circumcision that does not exist for tattooing because the probability of a medical need for circumcision is not equal to zero. But when the surgery is unnecessary to the child’s health, circumcision is the same violation, a permanent change to the child’s body without his consent. The disparity in protecting the rights of children is obvious and inexcusable.

¹ The law explicitly forbids this nonsense for female genital cutting, which is informative and worth exploring until the law changes. But it is beyond the scope necessary for this blog entry.

² It’s also possible to make a reasonable comparison here to the locker room theory used to justify circumcising male children.

Families Consist of Individuals

Via KipEsquire’s Twitter feed, here’s an interesting case about the power of the government to overrule medical decisions made by parental proxy.

A Minnesota judge has ruled a 13-year-old boy with Hodgkin’s lymphoma, a highly treatable form of cancer, must seek medical treatment over his parents’ objections.

In a 58-page ruling Friday, Brown County District Judge John Rodenberg found that Daniel Hauser of Sleepy Eye has been “medically neglected” and is in need of child protection services. Rodenberg said Daniel will stay in the custody of his parents, but Colleen and Anthony Hauser have until May 19 to get an updated chest X-ray for their son and select an oncologist.

Going only this far into the story, I’m inclined to believe that this is wrong because other reports I’ve read state that the boy understands his condition. Thirteen is not objectively too young for the child to consent or refuse. There must be a sufficient standard (the details are difficult and beyond the scope of this entry) to judge the child’s competence in the matter, but if the child passes that, I see no reason to interfere.

Rodenberg wrote that Daniel has only a “rudimentary understanding at best of the risks and benefits of chemotherapy. … he does not believe he is ill currently. The fact is that he is very ill currently.” Because of that and other evidence in the case, Rodenberg ruled there is a “compelling state interest sufficient to override the minor’s genuine opposition.”

Parents act irresponsibly if their child is incapable of deciding and they choose treatment (nutritional supplements and other alternative treatments) with no scientific basis instead of treatment (chemotherapy) with a high success rate. There are no perfect decisions in something as complex as cancer. Still, some level of objective comparison is possible, and success rates show this isn’t close. Doctors say he has a 5 percent chance of survival without chemotherapy and up to 90 percent with it.

A court-appointed attorney for Daniel, Philip Elbert, called the decision unfortunate.

“I feel it’s a blow to families,” he said Friday. “It marginalizes the decisions that parents face every day in regard to their children’s medical care. It really affirms the role that big government is better at making our decisions for us.”

Government has a role to play when people make decisions for another person. Pick a scenario where that qualifier isn’t involved and I will defend an individual’s right to make subjective, possibly fatal decisions for himself. But within that scenario, which applies to medical (and non-medical) decisions parents make for children, the government’s role is legitimate. It must protect the child from neglect and abuse, regardless of parental intention.

This case is similar to the case of Abraham Cherrix. My entry is here.

Do Children Have Any Rights?

Any point in the long line of events leading to the Supreme Court hearing a case on the strip search of students by school officials demonstrates that we’ve collectively lost our minds. It’s easy enough to shout “Will no one think of the children,” and I will. Will no one think of the children? Not as an emotional plea, although that is valid. This is a demand for recognition that children are individuals, as well, with the same complement of rights protected by the Constitution. We can debate the degree to which they are fully vested versus held in “trust” (e.g. free speech), and that’s a useful debate. This is not that.

None of the lawyers had a particularly easy time of it. Matthew W. Wright, representing the school district, said that intimate searches should be allowed even for the most common over-the-counter drugs.

“At some point it gets silly,” Justice David H. Souter said. “Having an aspirin tablet does not present a health and safety risk.”

Mr. Wright did draw the line at searches of students’ body cavities, but only on the practical ground that school officials are not trained to conduct such searches. Mr. Wright said there was no legal obstacle to such a search.

Mr. Wright, and the government, may have a legal point on this topic using strict semantics. But the moral question is clear. These children own their bodies. They are due the same respect and dignity we offer to adults. (We violate the rights of adults. The point is that we violate the rights of children more.) Anyone who would propose that school officials could legitimately perform a body cavity search on a student if properly trained has lost his way.

I know enough to understand that the questions asked by Justices are not necessarily indicative of the eventual outcome. With that caveat:

Without intimating a view on the ickiness of what Mr. Wolf had described, Chief Justice John G. Roberts Jr. suggested that the law might treat different undergarments differently. “The issue here covers the brassiere as well,” he said, “which doesn’t seem as outlandish as the underpants.”

Not as outlandish, perhaps, but according to whom? The student, or does her (or his) opinion not matter? I know, DRUGS!@#$!@!!!. But, is there any room for the consideration that the person searched might find exploring her brassiere outlandish? If we extend this to even younger students, as a ruling in the school’s favor surely would over a short period of time, would a female student who develops breasts earlier than her classmates be self-conscious of this fact? Could it be mortifying to have her brassiere searched? Is there a “breast-no breasts” exception to the Fourth Amendment, or just a general view that children have no rights?

“My thought process,” Justice Souter said, “is I would rather have the kid embarrassed by a strip search, if we can’t find anything short of that, than to have some other kids dead because the stuff is distributed at lunchtime and things go awry.”

Notice that Justice Souter states what he would rather have when comparing the strip search of a minor and an event that has no verifiable examples. This is the same idiocy that states that pre-emptive, legalized torture is acceptable because there might be a ticking time bomb. What is done is subservient to why the actor does it because DRUGS!@#$!@!!!.

Radley Balko sums it up best:

It’s a little troubling to see how comfortable these old men (Ginsburg isn’t quoted in the article) seem to be with allowing school administrators access to the genitalia of school children based on nothing more than a hunch that they might be “crotching” some ibuprofen.

At this point, the drug war really can’t be parodied, can it?

This is madness.

John Cole offers a good summary of this case, titled “I’m Not a Lawyer or a Constitutional Scholar”:

And as such, will probably not understand the legal intricacies of this case that was debated in the Supreme Court yesterday. However, I can state that as someone with an IQ over room temperature, the fact that we are debating whether it is appropriate for school authorities to strip search kids is a sure sign that something has gone horribly, horribly wrong with this country and our sense of perspective, and I blame the war on drugs.

That’s succinct to the point of perfection.

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I got the Balloon Juice link from Doug Mataconis at Below The Beltway. I no longer read Balloon Juice, even though Mr. Cole provides excellent commentary like the quote above. His update to the post reminds me why I no longer read. After an excerpt from a linked summary he introduces with “Government by old men afraid of advil is disgusting”, Mr. Cole writes:

Where is the outrage? Oh, yeah. They are too busy protesting the fact that Bill Gate’s taxes are going to go up 3%! Tyranny!

Link to examples, if they exist. I’m sure they do. But it is shrill and unfair to mock – out-of-context – someone’s opposition to another issue and imply that agitating for one issue makes having a coherent position on another topic is impossible. This is common, as I’ve experienced, but it’s a pathetic tactic in any context. If someone has made up his mind on a topic, that’s okay. I have, for example. But that person should be prepared to defend himself if he brings up the topic. If not, don’t bring up the topic. Doing so is the sign of an incurious, closed mind.

If You Can’t Beat Them, Resort to Name-Calling?

There’s a new meme popular among advocates of routine infant circumcision referring to those who oppose routine infant circumcision as “foreskin fetishists”. It’s not a surprising strategy because it’s the type of tactic deployed when one is on the wrong side of logic and facts. It’s been deployed against me, and I’ve seen it deployed as a general tactic. It’s unwise to the point of being odd, since it’s so easy to dismiss with a simple observation. But it’s clear those who use it do so because they realize that most people believe what they’re told if it fits their opinions, not what fits with reality. Smear your opponent and some will buy it.

So, the claim itself. I support the right for each male to choose for himself. If he chooses circumcision for any reason, that’s his right. If he chooses against circumcision for any reason, that’s his right. My only concern is that each healthy child be left his choice for when he can consent or refuse.

Circumcision advocates believe that parents should choose. They are wrong, for the many logical reasons I continue to write about. This isn’t the place to rehash most of those directly. However, there is one that is relevant. I’ll point to a claim by Professor Brian Morris, linked in the entry I posted yesterday.

Getting circumcised will result in:
…

• A penis that is regarded by most as being more attractive.

And what about Dr. Edgar Schoen?

Women’s Preference, Sexual Activity, Psych Effect:

Sexual function is not adversely effected by NC. On the contrary, published evidence shows that circumcised men have a wider variety of sexual activity, and women prefer circumcised men, mainly because of better genital hygiene.

I can find any number of further examples, but the point should be clear. If there are fetishists, which side contains the fetishists? Is it those who advocate for each male to choose for himself for his reasons or those who believe that parents may impose unnecessary surgery on their son’s genitals because they believe his future partner(s) will find his circumcised penis more sexually appealing?

Anyone who tosses this meme around is engaging in propaganda.

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For an example, consider this entry from Dr. Amy Tuteur. She labels herself “The Skeptical OB”, but it will be clear that she is hardly skeptical in any meaningful way on circumcision. She opens:

A visitor from outer space might be forgiven for concluding that the most important part of the human body is the foreskin. It is, after all, the only part of the body that has multiple organizations devoted to its preservation in the natural state. The visitor might get the impression that the choice of circumcision is a fateful choice with profound implications for the rest of life.

It is the only part of the body that has multiple organizations devoted to its preservation in the natural state because it is the only body part we regularly remove from non-consenting individuals in its natural (i.e. healthy) state.

… Foreskin fetishists also employ inflammatory language to express their judgmentalism. Circumcision is “mutilation” and parents who choose to circumcise their sons are “mutilators”.

Does fetishist qualify as “inflammatory language”?

The foreskin fetishists are so obsessed with the foreskin that they actually dare to advance the misogynistic claim that male circumcision is analogous to female genital mutilation, in other words, that the foreskin is the analogue of the clitoris. The male analogue of clitoridectomy is is amputation of the penis. Comparing circumcision to clitoridectomy is like comparing ear piercing to having your ears cut off.

My claim is that unnecessary genital cutting on a healthy, non-consenting individual is wrong. Gender makes no difference to that principle. That is a different, and more fundamental, claim than what Dr. Tuteur puts forth for people who state (accurately) that female and male genital cutting are comparable.

She adds to this in the comments:

The comparison is essentially misogynistic. FMG exists specifically to prevent female sexual activity by permanently removing the possibility of sexual enjoyment. Male circumcision is performed for religious reasons or for medical benefits. It has nothing to do with sexual satisfaction, and is certainly not meant to interfere in any way with male sexual satisfaction.

Every claim in that comment is incorrect. There is no misogyny in stating that males and females possess equal human rights. FGM exists for many reasons and in different forms, not all of them intended to permanently remove the possibility of sexual enjoyment. (They may still do that, and probably do in most cases. But that’s obvious because parental intent does not guarantee good outcomes, another point not specific to the gender of the recipient.) Male circumcision is also performed so that parents don’t have to learn how to care for a normal penis or so that the son will look like the father or so the mean kids won’t pick on him in the locker room or because his parents think women won’t sleep with him if he has his foreskin. The latter point is clearly about sexual satisfaction. And whether or not it is meant to interfere is subordinate to the truth that it interferes with male sexual satisfaction. That interference could be positive, negative, or neutral, but only the male himself can make the relevant determination to that subjective question.

Anti-circ activists like to claim that there only risks and no benefits to circumcision, but that is not true.

Dr. Tuteur links to zero sources making this claim. I don’t doubt that some people are making that claim. People on both sides make ridiculous claims. Still, if one wants to make a sweeping claim, defend it with evidence.

Yesterday, I wrote that “[t]he reduction in UTI risk is likely real. The reduction in HIV-infection risk is likely real, at least in the short-term. And so on. I accept this.” This is not complicated, but as I added after that statement, it is not enough to dismiss the fact that the child is healthy at the time of the surgery. That makes the ethical evaluation the primary focus. Non-therapeutic circumcision fails this test. Yet Dr. Tuteur seems uninterested in anything more than potential benefits as an excuse to permit parents to make the decision.

She defends this opinion in the comments:

Parents have the right to consent to ANY surgery, brain surgery, heart surgery, so consenting to removal of the foreskin is hardly a big deal. Moreover parents have the right to consent to piercing, removal of birth marks and other forms of body modification.

Do parents have the right to consent to non-therapeutic brain or heart surgery for their healthy children? A heart stent for a 2-year-old because he might have problems at 50?

The core evaluation is very simple. If the child is healthy, no surgery is indicated or justifiable. Chasing benefits for children is an illogical path that can be pursued to other irrational avenues and on both genders. It has no place in the proxy decision-making of parents for the geni
tals of their male children, as we already understand clearly for female children.