Category: Logic

Hanna Rosin Is Still Mistaken on Circumcision. Uh Oh.

Yesterday, the New York Times ran an article about a recent study (on a semi-related topic) that suggests the U.S. infant male circumcision rate fell to 32.5% for 2009. This has been floating around for a few weeks. Frankly, I don’t believe it, as much as I’d like it to be true. When the data are fully analyzed, we’ll either see the rate climb or the exclusions will reveal circumcisions that weren’t counted but must logically be assumed (e.g. ritual). I’m aware of my culture’s insanity.

This story has, predictably, brought out the usual folks and their BUT TEH AIDS!!!!1 rhetoric. For example, a year after showing her ignorance and bias¹ for circumcision, Hanna Rosin returns to prove that she’s still willfully ignorant.

The New York Times reports today on new findings that circumcision rates have declined precipitously in the United States, from 56 percent in 2006 to 32.5 percent last year. That’s a phenomenal decline in just three years. …

No kidding. It’s so phenomenal that, were she ever willing to break out her critical thinking skills, she might focus her blog entry on that point. Instead, she regurgitates the same incorrect, irrelevant propaganda.

… The story quotes doctors saying that of course no one in the profession should ever tell a parent to circumcise their child and the Centers for Disease Control declines to comment because they never do on this issue, even though they know full well that the drop in circumcisions is a potentially serious public health problem. …

That quote is this:

“No one is going to tell a parent, ‘You have to circumcise your child.’ That would be foolish,” Dr. [Michael] Brady said. “The key thing physicians should be doing is providing information on both risks and benefits and allow the parent to make the best decision.”

Any doctor who agrees with that is an unethical coward. The key thing physicians should be doing is rejecting the offensive parental request to surgically alter healthy children boys.

As for what they “know full well,” this from the New York Times article:

Some 80 percent of American men are circumcised, one of the highest rates in the developed world. Yet even advocates of circumcision acknowledge that an aggressive circumcision drive in the United States would be unlikely to have a drastic impact on H.I.V. rates here, since the procedure does not seem to protect those at greatest risk, men who have sex with men.

Context matters, a caveat Rosin ignores.

Continuing:

… But circumcision has become like abortion these days, where allying yourself with the Mengele doctors who mutilate infant boys risks bringing a horde protesters to your office door.

Doctors (and non-doctors) who circumcise healthy boys mutilate them:

1 : to cut up or alter radically so as to make imperfect
2 : to cut off or permanently destroy a limb or essential part of

Words have meaning independent of the desired preference of pro- or anti- child circumcision arguments. For mutilation, that meaning is independent of the victim’s gender and the proxy’s intent.

She continues:

It does not really matter if any individual parent decides that circumcision is not for them, as I explained in this New York magazine story, “The Case Against the Case Against Circumcision.” …

This is the crux of her mistake. The (unnecessary) circumcision Rosin defends is not for the parent. It’s imposed on the individual child boy. This is why it’s unethical, regardless of all the unimpressive, incomplete facts she shares. It’s not about what the parents want, but what the boy needs. Proxy consent has objective, logical limits. That our society ignores these does not reduce their validity.

Continuing:

… But it absolutely matters if a whole society turns against the practice. The exact relationship between circumcision and the prevention of certain diseases – from AIDS on down – is not perfectly understood. …

Promote anyway, apparently, since there’s no chance missed factors could contribute to the conclusion.

… But it is absolutely understood that societies in which the majority of boys are circumcised have lower rates of such diseases than other societies.

From AVERT, worldwide AIDS & HIV statistics from 2008 show that North America has an adult prevalence of 0.4%. Most 15-49 year old American males are circumcised. Canadian circumcision rates are declining, but a large percentage in that age group are circumcised. Western & Central Europe, where most males are intact, has an adult prevalence of 0.3%. But it is “absolutely understood” that mutilating societies have lower rates of such diseases. Rosin is entitled to her own facts, apparently. She knows.

Still more:

Anti-circumcision activists have convinced us that circumcision is harmful and dangerous and does a lifetime of damage. …

Circumcision is surgery. It removes healthy tissue and nerves. That’s harmful. Every boy suffers some form of harm (e.g. scarring), but some boys suffer far worse. Collectively it is not “dangerous”, but individuals are not statistics. And since this damage is permanent, it certainly lasts a lifetime.

If a male chooses circumcision for himself, that is his right, regardless of his reason. The issue is its imposition on healthy, non-consenting children boys. Their health proves how the science involved is twisted, since only potential benefits seem to count as “science”. Their lack of consent proves the ethical argument against permitting prophylactic circumcision (i.e. ritual, cultural, and “scientific”), unless Rosin wishes to open proxy consent to medically unnecessary genital surgery on female minors.

¹ I also highlighted her ignorance and bias here and here.

Reproductive Rights Include Not Engaging In Sex

The argument that men should have no fiscal responsibility for children they don’t want if the mother refuses to abort the fetus is back in the news.

Greg Bruell and his girlfriend of a year and a half, Sandra Hedrick, had a pact. “We agreed that if we got pregnant, we’d terminate because we were not in a stable family unit,” Hedrick says. Or as Bruell more starkly puts it, “I resumed sexual relations with her on the condition that were birth control to fail, she’d abort without waffling.”

“Resumed,” because nine months earlier Hedrick had conceived a child with Bruell and the couple decided to end that pregnancy. Or rather, he decided, and she went along. Their relationship was too rocky—a series of breakups followed by passionate reunions—for them to become parents together, Bruell argued. Plus, both were still in the process of finalizing divorces, and he was a newly single father struggling to balance his needs against those of his eight-year-old daughter and seven-year-old son. Bruell wanted to steady their destabilized worlds before jumping into fatherhood anew.

This is no less ridiculous than when I first wrote about it four years ago. As I wrote then, “it should be clear that sex can lead to children. Anyone who doesn’t know this shouldn’t be engaging in sex.” And, in the story in this article, it’s as clear as two paragraphs can demonstrate that an unstable, on-off relationship may not be the best place to trust that a partner’s word means much. Engage in sex at your own risk, and accept the consequences of misplaced trust.

Via reason’s Hit & Run.

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Near the end of the article, there’s a resolution and a speculation (emphasis added):

This spring, Bruell informed [Mel] Feit that he didn’t want to headline a lawsuit, after all. He could no longer countenance being pitted against Hedrick and his daughter, and he couldn’t figure out a way to proceed in the courts that wasn’t adversarial. There are any number of lessons that can be learned from Bruell’s withdrawal, one of which is that Libertarians probably don’t make the best activists. “[My lawsuit] would have been a speculative jab at the legal system with low probabilities of success that would have only helped others,” he says. “And given that I’m not an altruist, that was not a sufficient motivation to throw myself on the sword.”

The italicized fragment is preposterous, since one case is anecdotal, and there’s no proof here that libertarianism has anything to do with Mr. Bruell’s decision not to pursue legal theories. This strikes me as the author’s bias creeping into the article.

Education Without Understanding

Here’s a story about a male who decides to have himself circumcised:

“It was a thing I had wanted to do for so long – I work in the health sector so I’d been reading books, discovering the importance of one getting circumcised, that’s why I decided to come.

“Mostly I was interested in the healthier status – the better hygiene, the partial prevention of HIV [in men] and the [possible] lesser chance of infecting your partner [with the human papillomavirus, linked to cervical cancer].

“I talked to my fiancée to say I wanted to get circumcised, because sometimes ladies say, ‘Why?’ I … [explained] why I wanted to go for circumcision and she accepted it.

“I talked to her about [having to wait six weeks for the wound to heal before having sex]. It’s a thing that we needed to discuss, when it comes to that, so that she should not get surprised as to why this thing is not happening – she was expecting to wait.

“It wasn’t difficult to talk to her but, again, this is a girl that I would like to marry. [Also,] we are not in that situation where we are staying together; she stays at her parents’ and I stay at my house … maybe with married couples sometimes it may be difficult.

This is where rote memorization of the biased propaganda surrounding non-therapeutic circumcision is a dangerous problem. This man is engaged, so he’s presumably monogamous with his fiancée. What benefit will he receive from the potential for circumcision to reduce the risk of HIV or HPV transmission? If he and his fiancée are currently free of both, circumcision will have no benefit unless one of them has sex with another individual, one who is infected with HIV and/or HPV. Effectively, he’s surrendered to hysteria. (And his story is being used to sell circumcision on the same grounds.) I don’t wish to imply that this is what advocates of non-therapeutic circumcision want, but it’s the predictable, unacceptable result when relevant facts and context are ignored (or rejected).

Post Script: Given this man’s stated reasons, hygiene is still on the table. In a world with access to running water, this isn’t a concern unless he doesn’t bathe regularly. I assume he does, but if not, then the issue is not with his foreskin.

Expect the Unexpected: Revisited

Our political obsession with identifying Others is potentially as dangerous as it is offensive. Safety is a legitimate role for the government, to the extent it can reasonably be achieved. But we need to uncover the psychopaths (or related variants) who would be murderers, regardless of skin color. Racial profiling is the appearance of safety for political cover. With this week’s news about Colleen Renee LaRose, the Philadelphia woman (Image) suspected of recruiting for terrorist organizations, I want to repost an entry I wrote almost five years ago.

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With a new terrorist threat to the New York subway system gripping the nation, the blogosphere is abuzz. I obviously share everyone’s concern and want our police and security forces to thwart any (potentially) forthcoming attacks. In an effort to accomplish this, the debate seems to descend to an argument simple profiling. When the constitutionality of profiling inevitably arises, the proponent either responds with some variation of “Constitution be damned” or “random” searches. New York implemented a random search policy for backpacks, which was incomplete, at best. (ed. note: Dead links omitted.) Yet, the proponents of profiling continue to advocate ineffective policies. Consider this from La Shawn Barber, who writes extensively and credibly about the threat of terrorism:

Will Islamofascists bomb the NYC subway? Is it all just a rumor? Your guess is as good as the government s. Flip a coin. Draw a straw. Throw it against a wall and see if it sticks.

Are they still searching little old ladies and skipping young men of Middle Eastern descent because it would be racist to search them? Probably.

It would be racist but I’m not against if for that reason. Immediate threats to safety must shake the debate from simple intellectual discourse. But within that intellectual discourse, reason can provide insight into how such a policy could fail, and fail miserably.

I don’t normally agree with Michelle Malkin on much, as evidenced by the posts here where I’ve referenced her blog. But with her reporting on last weekend’s suicide bomber in Oklahoma, she’s doing excellent work highlighting deeper facts in the case. There are indications that the bomber, Joel Henry Hinrichs III, was a Muslim. He attended a local mosque in Norman, OK. His Pakistani roommate hasn’t been heard from since the bombing. Mr. Hinrichs’ bomb included TATP, an explosive compound not commonly used in America, but popular with terrorists. He tried to purchase a large amount of ammonium nitrate. On Saturday, he apparently tried to enter the stadium during the Oklahoma football game before settling on the bench where he blew himself up (intentionally or unintentionally). Etc. I don’t know what story these and other facts will eventually tell, but it seems clear that there is more to the story than just some depressed guy commiting suicide. While I’m not ready to declare this an Islamofascist suicide bombing on American soil, the details of this case should be pursued.

This case also highlights the ineffectiveness of racial profiling in our attempt to prevent further terrorism. Click this picture of Mr. Hinrichs. (Image Source) Ignore the beard; a roommate of mine in college had a beard like that and he was no terrorist, unless you count accidentally killing fish when his hydroponic fish tank failed. So let me ask the obvious question. Say Mr. Hinrichs had tried to bomb the New York subway. Would racial profiling for “young men of Middle Eastern descent” have caught him? Is it reasonable to assume that if we rely on racial profiling, terrorists will switch tactics to include racial (and gender) profiles we’re not looking for?

Correlation Still Does Not Equal Causation

Nancy Pelosi’s office blogged about the Department of Labor’s latest jobs report. This graph is included in the brief entry:

Pelosi_jobs.jpg

From this, Rep. Pelosi declares:

Today’s jobs report marks a welcome step in the right direction for our economy and our families: the unemployment rate is going down. The Recovery Act, which Congress passed one year ago to pull our economy back from the brink of collapse, has already created or saved nearly 2 million jobs so far.

Yet our work is far from over. This recession that President Obama inherited has taken the worst toll on our job market since World War II. Too many workers have lost their jobs through no fault of their own. Leaders of both parties must work together to keep our recovery on track by helping small businesses create jobs, investing in our infrastructure and clean energy industries, and keeping police, firefighters, and teachers on the job. Congress will continue to act to build a new foundation for long-term prosperity.

I see the correlation I’m supposed to perceive, but that doesn’t prove what Rep. Pelosi expects me to assume, that the American Recovery and Reinvestment Act is the reason the graph looks as it does. It’s easy to claim success when you establish superficial results as the standards for success. If she’s going to make this claim, she must defend it with specific details about how money was spent and how that improved the jobs situation. Saying it isn’t enough if you’re skeptical of power rather than merely skeptical of your ideological opponents.

(Via Irene retweeting Markos Moulitsas)

Massachusetts Will Debate The Right to Bodily Integrity

The Massachusetts legislature is considering a bill that would make non-therapeutic genital cutting (i.e. circumcision) on healthy minors illegal.

…

(a) For the purpose of this section, the term “genital mutilation” shall mean the removal or cutting or both of the whole or part of the clitoris, labia minora, labia majora, vulva, breast, nipple, foreskin, glans, testicle, penis, ambiguous genitalia, hermaphroditic genitalia, or any genital organ.
…

Reading the bill in its entirety shows that the author(s) shaped it directly from the Federal Prohibition of Female Genital Mutilation Act, while correctly updating the text to remove the federal law’s gender discrimination. It includes protection for females, which is useful (if likely redundant) since Massachusetts does not have a state law prohibiting female genital mutilation. The Massachusetts bill is reasonable and should move out of committee, where it’s scheduled for a public hearing on March 2nd, and pass into law.

It won’t, of course. I’m hopeful it will at least get an honest hearing, but I’ve worked on this topic too long to be that naive. Too many people are unwilling to consider all facts, particularly those detrimental to their status quo preferences.

For example, this editorial from Massachusetts, from Wicked Local, reveals that its authors fail to understand even the actual text of the bill.

Thumbs Down:

Circumcision is a crime? Through state Sen. Michael W. Morrissey, Charles Antonelli of Quincy has decided to waste the Senate’s time with a bill that would ban male circumcision of anyone under the age of 18 in Massachusetts unless medically necessary. The measure would get right in the way of parental rights, imposing a fine and/or up to 14 years in prison on people who violate this ban. Antonelli is the Massachusetts director of MGMbill.org — a group of “we know better than the majority of doctors” nuts working to ban what it calls “male genital mutilation.”

Is it a waste of time to get in the way of parental rights to alter a daughter’s genitals? Because the bill does that, as the excerpt above proves. The federal Anti-FGM act does the same. So, the question here is what is the full list of plenary parental ‘rights’ that require only that the child have a penis?

For what it’s worth, if a doctor believe a healthy child needs surgery, yes, I’m more informed than he or she is. And he or she violates the Hippocratic Oath when recommending genital cutting, regardless of the healthy patient’s gender.

This group shoves aside the belief held by most of the medical community that circumcision reduces susceptibility to HIV and other sexually transmitted diseases as well as urinary tract infections and penile cancer. The anti-circumcision group declares “those findings are not a valid reason to amputate a healthy, functioning body part of a child.”

I won’t speak for those involved with MGMBill.org, but for me, I shove nothing aside. Prophylactic circumcision has the potential to achieve those results, statistically. So what? Because, somehow, possessing an objectively healthy, functioning body part does not indicate that surgery is not valid for that healthy, functioning body part. There are apparently no ethical considerations involved. There is apparently no need for an objective look at the relative and absolute risks involved. There is apparently no need to question whether or not the child might want his normal, healthy foreskin.

It’s frustrating that Wicked Local defiantly states that circumcision reduces susceptibility to HIV without also noting that every study showing this risk reduction involved only adult volunteers, not non-consenting children. Note, too, that the studies only found a reduction in female-to-male transmission through vaginal intercourse, a significantly smaller problem in the United States than in Africa.

But Wicked Local seems to perceive the issue to be about only potential benefits, no matter how trivial or easily avoided with lesser methods the risks posed by the foreskin. So surely we are failing all children by not proactively removing dangerous body parts from their bodies. To avoid getting in the way of parental ‘rights’, when do we start studies to determine whether or not there is a potential medical benefit to be achieved from prophylactic breast tissue removal? Although, since some adult women are already voluntarily having their breasts removed pre-emptively, we can assume that a plenary parental ‘right’ to remove the healthy, functioning breast tissue from daughters exists. What’s good enough for the parents is good enough for the children. Right?

That’s all intentionally absurd, of course. But without a boundary, there is nowhere to end the madness. The subjective boundary Wicked Local establishes here is arbitrary and based on its editors personal preferences. The law cannot be based on such whim. For proxy consent, the child’s objective needs matter first. Where there is no objective need for intervention, there is no parental ‘right’ to intervene. Surgery must be prohibited. That is a clear standard that applies to males and females, genitals and not genitals.

Also ignored is Jewish and Muslim tradition in which all males are usually circumcised as part of their faith.

Passive voice, males are circumcised. They do not choose. Indeed. But this bill does not seek to prohibit religious circumcision. Adult males may still choose circumcision for themselves if they believe their God demands it. This bill focuses on minors, where civil law must take precedent over religious texts. It codifies that the human rights of every individual exist first, and no amount of parental preference can supersede that in the pursuit of subjective, unprovable spiritual or cultural benefits. Unless we’re opening the law books to strike any law that violates a religious dictate governing what one person may do to another, there is nothing objectionable on this front. Are we opening the law books in this manner for a purge of religiously objectionable civil laws?

The bill has not yet been assigned to committee. It would be best to see this ridiculous waste of government time sniped from the legislative agenda and left discarded on the Senate clerk’s floor. Parents and doctors, not legislators, should decide the merits of whether a male child should or should not have a circumcision.

Parents and doctors, not legislators, should decide the merits of whether a female child should or should not have genital cutting? Again, if we’re saying that parents have a plenary ‘right’ to alter their sons for subjective reasons, the same plenary ‘right’ must exist for their daughters. Or we could consider the importance of the omitted word, a healthy child, and recognize that the answer is irrefutable because it is illegal (and immoral) to discriminate based on gender alone. Either all children have the same right to bodily integrity or no children have that right. The former breaks our current ignorance, while the latter turns children into property.

And here’s a tip for the angry anti-circumcision group — you would do a lot better with an informative public education campaign and debate rather than going state-to-state trying to shove your will on everyone and toss parents who don’t agree with you into jail for up to 14 years — a tact that so far has not seen even one state go along with this nonsense.

I agree, an informative public education campaign and debate is the best way to go. We shouldn’t need to legislate against something unjust. But we do, because the rights
of boys in America (and Massachusetts, in this case) are violated every day. I can explain how male circumcision is egregious because it violates human rights. I can explain how male circumcision is egregious because it is not the least invasive solution for every perceived benefit. But the Wicked Local editors haven’t even bothered to understand the text of the bill. I can overcome ignorance. I cannot overcome willful ignorance.

Science Requires Ethics, Part 3

Jake responded to my last entry in our ongoing series. (My first and second entries.) I’ll just jump in. Addressing my view that he is a pro-circumcision advocate, Jake writes:

I find this a rather peculiar statement. I suppose in a sense that any attempt to weigh benefits against risks will have some subjective qualities, and perhaps that can’t be avoided altogether. However, as subjective values are meaningless to another person I would hope that most observers try as objective as is reasonably possible. I certainly try; I can only hope that I succeed.

I am uninterested in convincing or encouraging parents to circumcise their sons, and have been careful to avoid making a recommendation either way. Anyone sufficiently interested (not to mention patient) can verify this by working through the many thousands of my public comments over the years – I use the same name everywhere, so it is not difficult to find them via Google. Indeed, I believe that such advocacy would be contrary to my pro-parental choice position: I genuinely believe that parents should make that decision, not me.

Unlike my perception of many individuals I’ve encountered when discussing circumcision, I believe that Jake advocates parental choice with the intention he states, which is that I think he accepts the decision by parents who do not choose to circumcise their sons. Many parental choice advocates do not believe that decision is valid in their parental choice worldview. In that respect, my saying that Jake “uses his conclusion to encourage parents to circumcise” was incorrect.

Rather, I believe that he is effectively a pro-circumcision advocate because he views his assessment of circumcision as containing some level of objectivity. It can’t, just as my assessment can’t. The difference between our views, I think, is that mine involves the child’s opinion, placing it above that of his parents.

I don’t have an opinion on circumcision, per se. I think it’s an odd choice for a healthy male to make, but that’s the lens of my preferences and experience. Jake has his own opinion, which is clear from his choice to have himself circumcised as an adult. Again, I think that’s odd, but my opinion on that is irrelevant because his choice is valid for him.

On the topic before us, though, the focus of infant circumcision must be infant circumcision, not infant circumcision. I write from the former, while I believe Jake writes from the latter. That difference is why I claim that his conclusion is subjective and incomplete.

Next, Jake considers my take on an appeal to authority:

My first inclination was to agree, but on reflection I think it would depend on the situation. Consider the following hypothetical scenario:

PERSON A: Circumcision is awful because the AAP don’t recommend it.
AAP: [Introduces a recommendation in favour of circumcision]
PERSON A: Oh, the AAP are biased, ignore them.

Here the appeal to authority is utterly invalid. It is quite apparent that it is a sham: the AAP are being presented as an authority merely because the person hopes to gain an advantage by doing so. The person clearly has no integrity, nor any credibility, and can and should be ignored. …

This scenario is close to what I considered. Although I wouldn’t go as far as Jake does in condemning the person’s integrity without more information, it is the response I predict any person to have to the scenario and why I despise appeals to authority.

Even though Jake’s first scenario exemplified my point, his second scenario is instructive:

… Now consider this:

PERSON A: Circumcision is awful because the AAP don’t recommend it.
AAP: [Introduces a recommendation in favour of circumcision]
PERSON A: Okay, the AAP now recommend it, so it’s okay.

In this situation, it seems to me that this is a valid appeal to authority, in that the person is willing to adapt their position once the authority changes theirs.

I disagree, again because the focus of the appeal is infant circumcision, not circumcision. It’s an abdication of judgment in favor of someone else’s conclusion. If Person A is the individual being circumcised, I am indifferent to his acceptance of the authority’s conclusion and judgment. That’s not what’s at stake.

It’s possible to make this too broad. I am not suggesting that expert opinion is worthless or should be ignored. I am saying that, when the focus is on infant circumcision, and specifically the circumcision of healthy infants, citing the authority’s subjective conclusion of a net benefit (or neutrality) is a diversion from the individual child’s lack of need and possible preference for keeping his normal foreskin. The AAP is relatively neutral today, and I contend they’re wrong because they ignore facts (out of philosophical ignorance).

Next, on circumcision versus vaccination:

I see: Tony applies a different standard for surgery and vaccinations. This doesn’t make much sense to me, for several reasons. Firstly, from an admittedly pedantic point of view, is there really that much of a difference? Surgery involves risk. Vaccinations involve risk. Surgery involves cutting the skin. Vaccinations (as delivered by a needle) also involve cutting the skin, albeit in a minor way. So I have to ask, where exactly would you draw the line?

Secondly, does it make sense to create multiple standards? To my mind, no. But I may be biased: I’m trained as an engineer, and when I observe lots of different little rules I see a situation in which there ought to be one, more general rule. Special cases are usually an indication that the general rule needs some more attention. Maybe one shouldn’t apply engineering principles to ethics. I don’t know, but I can’t see any reason why one shouldn’t…

Yes, there is a difference. Surgery removes a healthy, functioning body part. Vaccination does not. I draw the line between them for that primary reason. So, yes, it makes sense to create multiple standards.

In turn, it doesn’t make sense to create multiple standards for boys versus girls for the same parental activity and justifications. Later, in response to my view that anti-FGM laws would not be overturned if female genital cutting was shown to have potential benefits, Jake writes:

In an ideal world, I wish I could say that anti-FGC laws would indeed be overturned if scientific knowledge changed significantly. However, I’m sorry to say that Tony is probably right in that they wouldn’t be. I don’t think that this has anything to do with rights, though: it’s a simple case of collective prejudice. The notion that FGC is horrific is deeply ingrained into modern, Western society, and it takes an awful lot to dislodge that notion. I know this from personal experience: I have to make a conscious effort to think about FGC objectively, and have to fight the knee-jerk reaction. And I consider myself very open-minded.

I accept that circumcision can have potential benefits. I am opposed to prohylactic¹ infant genital cutting because pursuing these potential benefits for an individual who can’t consent is unethical. It is unethical because there are real and potential harms. Jake is wrong in his view because he is valuing science in a manner that leaves it insufficiently tethered to ethics. It’s a view that, because we can achieve something, it is ethically valid to pursue it. I find that approach abhorrent. It gives parents the choice to pursue an option that is not theirs to pursue. Their opinion must be subordinate to the objective facts of their child’s healthy body.

To my point that adults can choose condoms and that parents can’t know if their sons will be irresponsible
, Jake replies:

To both points, I agree. Nevertheless, it seems difficult to deny that if it were performed during infancy, circumcision would help to reduce this risk when the child became an adult.

I’m not denying that it might help reduce this risk, but it requires a specific, low-risk, low-probability situation to be effective. The choice of surgery to chase a miniscule benefit must be left to the individual.

Of course, it’s worth a reminder that the studies in Africa involved adult volunteers. Leaving aside the ethical difference, declaring that circumcision would help males (especially Western males) circumcised as infants is speculation. There are more variables involved, including the foreskin’s adherence to the glans in infants and the prevalence of HIV in the society.

In response to my review of his opinion on “most effective/least invasive”:

Here I believe Tony has misunderstood, or at least has not considered the issue with sufficient care. If there is a medical problem to address, then the physician’s responsibility is to solve that problem while exposing the patient to the least risk. That’s the essence of the “most effective/least invasive” standard. But if there is no medical reason for considering circumcision, then it is meaningless to even consider the “most effective” solution. If circumcision is being considered for non-medical reasons then it is in all probability the only solution to the problem (that being that the child is not circumcised). So it is the wrong standard to apply.

I believe I’ve understood him correctly. He is wrong. If there is no medical reason (i.e. need) for circumcision, it’s unacceptable to permit it on children. Normal genitals are not a “problem,” no matter how opposed the boy’s parents are to his normal genitals. I repeat my earlier criticism: Jake is begging the question he wants to answer. Medical need is the standard for proxy consent to surgery. Without medical need, the process stops. No intervention is valid.

Next:

At this point Tony declined to list ‘”surgeries we recognize as offensive” that are valid when benefits and risks are properly weighed’, stating:

I am not citing any particular science or surgeries because that was not my point.

This is a shame. I had hoped that Tony would at least try. I cannot think of any, and my suspicion is that this is because none exist. And if none exist, then Tony’s earlier objection that “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” seems a rather empty objection.

Immediately following my objection, I wrote that “I am attacking a way of thinking,” which is to say that I reject the notion that because we can achieve a potential benefit, it is ethically valid to pursue it. At its core, prophylactic infant circumcision is about chasing potential benefits. I reject that for the multitude of reasons I’ve presented. Speculating that I did not cite any because none exist is a straw man.

Citing “surgeries we recognize as offensive” is a pointless diversion. However, I’ll play along briefly. I nominate removing the breast buds from infant females to reduce their risk of breast cancer. I have no idea if this would work or it’s been studied in any manner. It doesn’t matter, because my point was to reject the thinking that believes a potential benefit may be chased. I suspect this would be offensive to most parents, as it almost always is when I raise it in debate. Non-essential, healthy, functioning breasts are different from non-essential, healthy, functioning foreskins, somehow. My guess is that Jake’s approach to this would be his utilitarianism, which would assess whether removing breast buds has a potential benefit. (Unless he has some objection I haven’t determined.) If it does in his evaluation, it is a valid choice for parents, even if only chosen by those few parents who don’t find it offensive. I reject that because the healthy girl may not want the intervention.

Next:

It is meaningful to compare female genital cutting to male genital cutting because, ethically, they involve the same issue. Unnecessary surgery on a non-consenting individual is wrong.

If you take that last sentence as axiomatic, then you will probably see the two issues as similar (although, presumably, there’s no reason to focus on genital surgery in particular). Those of us who adopt a different ethical principle – something like “harmful surgery on a non-consenting individual is wrong” see no problem with circumcision, and a problem with female genital cutting.

(I realize that I’m about to object to an issue of semantics in his axiom, but I’m certain I’ve gotten the gist of any future clarification correct.)

All surgery is harmful, including circumcision. It’s meant to achieve some benefit greater than the harm. Jake concludes that circumcision is, at worst, neutral. But that is his subjective evaluation. It is as irrelevant as my opinion that it is a net harm. Proxy consent is not valid for prophylactic infant circumcision because circumcising healthy infants is objective harm pursuing subjective benefits. Jake writes:

… Evaluation of potential benefits should not be dismissed as mere opinion. The literature contains a relatively large amount of data, which can be summarised in the form of objectively quantifiable data.

Potential benefits are based on objectively quantifiable data. Determining the value of applying those objectively quantifiable data to the objectively healthy penis of an infant male is subjective, mere opinion. Deriving an opinion is only valid for the male himself as applied to his body.

Finally:

There is an obvious double standard. Girls may not have their healthy genitals cut for any reason. Boys may have their healthy genitals cut for any reason. That’s the valid comparison.

That’s not even correct. Try getting a surgeon to perform a glansectomy on a healthy boy. Or castrate him. Or perform any number of other surgeries on his genitals. He or she will refuse. Most such surgeries are a net harm (except when actually needed, in which case the benefits are considerably greater, thus making them a net benefit), and cannot therefore be ethically performed. Circumcision is unusual precisely because it is a surgery which is neutral or (depending who you ask) a net benefit. And that’s why the reason for a specific circumcision doesn’t really matter.

I think it’s obvious that my declarative statement about genital cutting implied “as it’s commonly practiced in Western society,” which would preclude intentional glansectomy, for example. Moving on.

What Jake omits here is telling. Circumcision is neutral or a net benefit, according to him. He’s ruled out that prophylactic infant circumcision can be a net harm, the glaring mistake in his analysis.

A male who suffers a serious complication from circumcision would unquestionably qualify as experiencing a net harm. That risk is inherent in every circumcision. But leaving that aside, a “normal” circumcision has results. Evaluating those results, even if just on a cosmetic level, is a subjective process. There is no correct, objective way to evaluate a change, which is what circumcision is. All tastes and preferences are subjective to the individual. Even a preference regarding the potential health benefits of circumcision. The possibility of “No, thank you” is why infant circumcision is unethical.

¹ I am no less opposed to ritual infant circumcision. Discussing it in depth here would be a distraction. For a primer on my opinion, see here.

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.

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.

**********

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.