Flawed Circumcision Defense: Dr. Laura Berman

Posted: October 1st, 2017 | Author: | Filed under: Ethics, FCD, FGM, Parenting | No Comments »

tl;dr version:

Dr. Berman writes:

… Thankfully, [male circumcision] is a choice that we do have here in America, unlike the millions of young girls across the globe who must endure genital mutilation with no option to decline.

Her analysis shifts depending on whether a male or female is cut without need or consent. Male circumcision is “a choice that we do have here in America”. “Thankfully”¹. Her male circumcision argument is about parents, without consideration for the child. She then compares the victims of FGM “who must endure genital mutilation with no option to decline.” When did I have the option to decline my mutilation? When did any boy circumcised without need have the option to decline? Her argument is sophistry. It’s garbage and shows why any defense of male circumcision as ethically different from female genital mutilation is mistaken. Dr. Berman should feel shame for even thinking that sentence.

**********

Dr. Laura Berman posted a question on Facebook, asking:

Men, how do you feel about your circumcision (if you were circumcised)? Do you wish you weren’t, or do you think your parents made the right choice? And women – do you have a preference when it comes to partners who are circumcised vs. uncircumcised?

The replies are roughly in line with what anyone should expect from a circumcision thread. In response to some comments asking her opinion, she followed with a blog post about it, “When You Miss Your Foreskin: The Real Deal on Male Circumcision”. Early on, she writes:

First, as a Jewish woman, I want to acknowledge that there is a cultural legacy behind circumcision which informs many people in my community and their decision to circumcise. While I appreciate and love my Jewish heritage, I realize this is not enough of a reason to perform surgery on an infant without medical cause.

That statement takes courage and is worth commending. Unfortunately, she does not let that inform enough of the rest of her post. She continues:

The pediatric community is still largely in favor of circumcision, as they say that the benefits of circumcision outweigh the risks. What are these benefits?

She links the AAP’s 2012 statement there, which I’m omitting because you can get there here or here, instead. Apart from quoting the AAP’s flawed statement, quoting the AAP as “the pediatric community” is silly. The *American* pediatric community is still largely in favor of (non-therapeutic infant) circumcision. Most of the rest of the world is not in favor, for the reason Dr. Berman touches and then skips. There is not enough of a reason to perform surgery on an infant without medical cause. (There is no reason. There is no medical cause.) That’s the ethical principle applicable here, as in non-therapeutic genital surgeries on female minors. There’s no reason to exclude male circumcision from ethics.

After reviewing some potential benefits of circumcision, including the casual sexism of “for little boys who hate to bathe”, which should be rewritten as “for parents who abdicate their responsibilities”, Dr. Berman gets to some negatives. She writes:

Loss of nerve endings. Removing the foreskin also removes thousands of nerve openings that make sex more pleasurable.

It’s beyond comprehension how someone can write that fact and not end the post there with, “Yeah, this is wrong. We must stop immediately. And we should apologize for every non-therapeutic, non-consensual circumcision performed before now, because we were wrong to perform every one of them.” But she doesn’t, because of the usual consequentialism and moral relativism involved in this debate that predictably appears in her post. She continues:

… Along with physical pain, many men later report that they feel they feel violated as their circumcision was done without their consent.

Although I feel violated, that is a direct result of being violated. My non-therapeutic circumcision occurred without my consent. My circumcision violated me. I know why we avoid acknowledging this as a society, but it’s too blatant to be defensible.

Dr. Berman shifts to something worth repeating:

Last, before I end, I want to address the issue of consent around circumcision. One man on my Facebook post compared circumcision to rape, and while I appreciate his right to anger about his circumcision, we must be very, very careful when we use the word ‘rape’ to describe anything other than rape. Words matter. They are powerful. They shape our beliefs and they inform the way we live in this world. So when we use the word ‘rape’ to talk about a medical procedure performed in good faith, this does a grave injustice to rape victims who have been abused, traumatized, penetrated and dehumanized by a sexual predator(s).

I agree with this, and stand by what I’ve written on it.

However, what is consent, if not the ability to reject something you neither need nor want? It shouldn’t be discussed in the context of calling circumcision “rape”. We must discuss consent, though,
because it’s the crux of the violation. You don’t believe in consent if you believe consent in non-therapeutic genital cutting is sometimes relevant and sometimes not.

She moves on to the comparison of female genital mutilation/cutting and male circumcision. It’s flawed:

Nor do I think it is appropriate to take over a conversation about female genital mutilation by bringing up male circumcision in the Western World. There is a giant difference between FGM which occurs across the globe in places like Africa, Indonesia, and more. There are currently 200 million women living today in 30 countries who have been victimized by female genital mutilation in which these young girls near puberty are held down while some or all of their external genitalia are cut off with a sharp blade or piece of glass or similar cutting instrument.

It’s usually not appropriate to take over a conversation about FGM. The problem arises when the writer changes the analysis used for non-therapeutic female and male genital cutting, as most writers on the comparison do, and as Dr. Berman does here. Is it wrong to alter the healthy, normal genitals of a girl in a sterile operating theatre with appropriate pain management and the best parental intentions, the context assumed for male circumcision? It is still wrong in that context because it harms the girl without her consent. “One is almost always worse” is true and irrelevant to the principled analysis of non-therapeutic genital cutting without the recipient’s consent.

The usual caveats appear to continue the false distinction:

Unlike male circumcision, there are absolutely no benefits to FGM,…

If there were potential benefits to FGM, very few would change their opinion on FGM. Rightly so, because they would look at the costs – the guaranteed harm – and judge it unethical. There is no excuse for distinguishing this violation of males from this violation of females.

… and unlike circumcision, it is not performed to protect male sexual health …

Harming an individual to protect him from harm that can be prevented with lesser interventions is an absurd justification. He may not prefer this “protection” at the expense of his foreskin.

… but in order to erase female sexual pleasure and to lay ownership to a woman’s genitals. …

What did Dr. Berman ask? “And women – do you have a preference when it comes to partners who are circumcised vs. uncircumcised?” Why is that question relevant to the discussion? Dr. Berman doesn’t use the “women prefer” argument, but enough proponents use it to make the comparison. At best, we do not discourage “you prefer circumcision, so circumcise your son”. So, is the argument that it isn’t intended to lay ownership to a man’s genitals or that it doesn’t lay ownership? Even when the former is correct, it’s irrelevant because the latter is always incorrect in non-therapeutic child circumcision. “Son, you should prefer our preference(s), so we’ll make this choice that forces you to live with our preference(s) forever” is the antithesis of self-ownership.

When Dr. Berman later talks about whether “circumcision is the right choice for you and your family”, she implies that the penis belongs to the family rather than the boy. The best intentions don’t change the action. It is permanent control over part of the child’s sexuality.

After more awful facts of FGM, and embedding an Instagram post from WHO (correctly) declaring FGM a violation of human rights, Dr. Berman continues:

FGM is a violation of the human rights of girls and women. There are many who feel that male circumcision is a violation of the human rights of baby boys, and for these people, deciding to keep their baby intact is the correct choice. Thankfully, it is a choice that we do have here in America, unlike the millions of young girls across the globe who must endure genital mutilation with no option to decline.

Circumcision is a violation of the human rights of boys and men. This is true for the same reason non-therapeutic, non-consensual genital cutting violates the human rights of girls and women. There is neither need nor consent. Any cutting in that context violates the individual. Any analysis beyond that is sophistry for one’s preferences and biases.

Re-read the tl;dr above if it isn’t burned into your mind.

And then:

Why am I making this distinction between FGM and circumcision? Because, again, I think it does a disservice to woman who can feel no sexual pleasure, women who endure a lifetime of pain and loss, and young girls who are held down and tortured because their bodies are viewed as dirty and sinful to a medical practice which is performed safely, hygienically and with a baby’s health in mind.

Again, what is done to the genitals of girls and women is horrific, barbaric, and indefensible. Also again, this uses a different standard for assessing what is done to girls and what is done to boys. Would she approve of FGM if it is “performed safely, hygienically and with a baby’s health in mind”? Nope, and to reiterate, correctly. Consequentialism and moral relativism have no place in the analysis of genital cutting, including male circumcision. Genital cutting is wrong for boys for the same reasons it’s wrong for girls. (Especially when we consider “their bodies are viewed as dirty” in the context of “for little boys who hate to bathe” and “I chose to circumcise because I thought it was cleaner.”)

In summary, using the last link in the previous paragraph, Dr. Berman writes:

While nothing can ever undo that man’s circumcision,…

“While nothing can ever undo that man’s *non-therapeutic, non-consensual* circumcision… That’s the whole story. Stop ignoring it.

¹ I’m not thankful male circumcision is a choice “we” have in America, because “we” decided my penis without me.


Ethics Rationalizations, applied to Genital Cutting

Posted: July 8th, 2017 | Author: | Filed under: Ethics | No Comments »

Jack Marshall at Ethics Alarms has maintains a list of Unethical Rationalizations and Misconceptions. It’s a wonderful list for understanding human (mis)conduct and for striving to be better. Much of it applies to the debate over non-therapeutic child genital cutting. (See below.) Recently, Mr. Marshall posted a revision to his list. He added Rationalization #23, The Dealer’s Excuse. or “I’m just giving them what they want!”. This is the rationalization “that conduct becomes justifiable and benign if there is a market for it.” He further explains:

Those who employ the Dealer’s Excuse aren’t providing a service out of altruistic motives, but out of the profit motive. They want the money they can make by doing unethical things that make society uglier, dysfunctional and dangerous, and they really don’t care if their customers come to a bad end or bring miseries to others.

This is true of a subset of practitioners who circumcise infant males, for sure. That it happens is self-perpetuating. “That doctor is doing it, and making quick money doing it, and it makes the parents happy, so there’s no reason I shouldn’t participate.” It’s ugly and harmful.

In my experience from talking to doctors who circumcise (and some who don’t), there is a related factor. They’re cowards. I perceived many of these doctors to be ambivalent or opposed to non-therapeutic infant circumcision. But they feel obligated to appease the parents at the expense of their patient. From Mr. Marshall’s list, it’s Rationalization 15, The Futility Illusion: “If I don’t do it, somebody else will.” If one individual doctor refuses, the outcome for the child is likely no different. But change doesn’t happen if we refuse to speak out and reject what we know to be wrong.

Related, this post from 2015, Ethics Quiz: “Fixing” “Elf Ears”, has relevance. A 6-year-old boy’s ears stuck out like an elf’s, basically. Dr. Tracy Pfeifer, a plastic surgeon quoted in the news article, defended it by saying, “The surgery is relatively simple and it is life-changing in a positive way for these young children.” Someone told me that about circumcision yesterday. Like Mr. Marshall, my response is essentially “so what?”. As he said in his post:

The surgery is also premature, and thus unethical from a medical ethics standpoint, because at six no child’s adult appearance can be accurately predicted. Nor can a six year old make an informed decision about surgically changing his or her appearance at that age, though The Daily News found some dubious experts—as in “flacks for the plastic surgery trade”—to claim otherwise. Except in a case of serious deformity, the choice to radically change a child’s appearance should be made after the child has gained some understanding of the issues involved.

Exactly. Protruding ears, “big” nose, or foreskin, the analysis is the same. Science is necessary and relevant, but the application of that science requires ethics. What we can do is not the same as what we should (be allowed to) do to another.

(See also: The Slippery Slopes of Religious Freedom and Female Genital Mutilation, especially on the potential outcome if Alan Dershowitz’s expected defense strategy in the Detroit FGM prosecution succeeds. I wrote indirectly about the case. The latest version of the complaint is here (pdf).)

********************

From the Ethics Alarms list of Unethical Rationalizations and Misconceptions, at a minimum the following rationalizations apply to the defense of non-therapeutic genital cutting on minors. I’ve encountered each at least once in my activism, some as recently as yesterday:

1. The Golden Rationalization, or “Everybody does it”
1A. Ethics Surrender, or “We can’t stop it.”
2A. Sicilian Ethics, or “They had it coming”
3. Consequentialism, or “It Worked Out for the Best”
4. Marion Barry’s Misdirection, or “If it isn’t illegal, it’s ethical.”
6. The Biblical Rationalizations
9. The Reverse Slippery Slope
13. The Saint’s Excuse: “It’s for a good cause”
13A. The Road To Hell, or “I meant well” (“I didn’t mean any harm!”)
14. Self-validating Virtue
17. Ethical Vigilantism
22. The Comparative Virtue Excuse: “There are worse things.”
23. The Dealer’s Excuse. or “I’m just giving the people what they want!”
24. Juror 3’s Stand (“It’s My Right!”)
25. The Coercion Myth: “I have no choice!”
27. The Victim’s Distortion
29. The Altruistic Switcheroo: “It’s for his own good”
29A. The Gruber Variation, or “They are too stupid to know what’s good for them”
32A. Imaginary Consent, “He/She Would Have Wanted It This Way”
34. Success Immunity, or “They must be doing something right!”
38. The Miscreant’s Mulligan or “Give him/her/them/me a break!”
41. The Evasive Tautology, or “It is what it is.”
42. The Hillary Inoculation, or “If he/she doesn’t care, why should anyone else?”
43. Vin’s Punchline, or “We’ve never had a problem with it!”
44. The Unethical Precedent, or “It’s Not The First Time”
45. The Abuser’s License: “It’s Complicated”
46. Zola’s Rejection, or “Don’t point fingers!”
48. Ethics Jiu Jitsu, or “Haters Gonna Hate!”
49. “Convenient Futility,” or “It wouldn’t have mattered if I had done the right thing.”
50. The Apathy Defense, or “Nobody Cares.”
50A. Narcissist Ethics , or “I don’t care”
51. The Underwood Maneuver, or “That’s in the past.”
57. The Universal Trump, or “Think of the children!”
57A. The Utilitarian Cheat or “If it saves just one life”
58. The Golden Rule Mutation, or “I’m all right with it!”
59. The Ironic Rationalization, or “It’s The Right Thing To Do”
63. Yoo’s Rationalization or “It isn’t what it is”
64. Irrelevant Civility or “But I was nice about it!”
64A. Bluto’s Mistake or “I said I was sorry!”

The whole list is worth reading and understanding, in general, both to notice when you encounter them and to be diligent about not offering them.


Incomplete Progress (v2)

Posted: June 27th, 2017 | Author: | Filed under: "Voluntary", Ethics | No Comments »

Two new examples of circumcision without consent that should be prosecuted, but not for a reason distinguishing it from any other non-therapeutic genital cutting on a child. First, from England.

A 61-year-old man, believed to be the doctor who carried out the procedure, has been arrested on suspicion of grievous bodily harm with intent.

The boy’s mother complained to police, saying her son was circumcised without her consent while staying with his paternal grandparents in July 2013.

If consent from one parent is permitted, it’s still a violation because the healthy¹ boy didn’t consent.

Next, from South Africa:

A police investigation is under way after a group of 27 boys were illegally circumcised in Scenery Park‚ East London‚ the Eastern Cape health department said, writes Naledi Shange.

Spokesperson Sizwe Kupelo said police‚ traditional leaders and health officials raided the initiation school on Sunday afternoon.

They were accompanied by some of the parents whose children had been circumcised without their consent.

The same point on consent applies.

As in my last post, we’ll be making real progress when the meaning of their aligns with ethical principles by referencing the boys, not their parents. Still, any pursuit that raises the issue of consent at all is almost certainly progress.

¹ This key point is why the change we need is more cultural than legal. Doctors who support non-therapeutic circumcision of children – American doctors, in particular – are inclined to believe nonsense about the foreskin, such as what Brian Morris promotes. There won’t be a change in the legal until the culture changes. But if there were somehow a legal change without cultural change, the law wouldn’t matter. The boy’s chart would read “therapeutic treatment for phimosis” or some other offensive lie. Also, having a law no prosecutor will enforce is no better.


Incomplete Progress

Posted: May 14th, 2017 | Author: | Filed under: Ethics | 1 Comment »

I don’t know if the facts mentioned here are accurate or not. I assume so. And for my inclination, obviously, it’s believable. If the facts are as reported, this is progress. But I want to be weary of first reports, always, so that’s what I want to say on the claimed facts.

My focus is the lede of the article.

A British GP is to be prosecuted by an outraged mother for assault after circumcising her baby boy without her consent.

The day that is written as, “A British GP is to be prosecuted by an outraged mother for assault after circumcising her baby boy without his consent” will be better progress.

There’s no complaint about the article for its lede. It mentions the ethical issue of the child’s consent in the next paragraph. We’re getting close to when the framing will finally be right, and people recognize the rights violation is to the child, not his mother and/or father in certain circumstances.


√erifying what you want to believe

Posted: May 4th, 2017 | Author: | Filed under: Ethics, FCD, FGM, Media Marketing, Parenting | No Comments »

WZZM, the ABC affiliate in Grand Rapids, Michigan, has a “verify” article purporting to address the following:

The story of a female genital mutilation case in Detroit has prompted lots of questions from our viewers on what this procedure actually is and how it compares to circumcision in males. So, we set out to Verify this issue by reaching out to the experts.

WZZM “verifies” this in a surprising and predictable manner. There’s a video associated with the article. It’s what I will use as a summary for two reasons. I assume that’s what most people who arrive at the link will use. But I’ll focus on the video because it addresses what WZZM researched, not the comparison the article said they aimed to verify. (Most of the sections of the article are rote talking points. Also, I’m unconvinced the article had an editor for content because it did not have one for grammar.)

First, the on-air reporter, Val Lego, provides a summary of the two procedures.


(Larger size here)

This is the surprising part. It’s accurate. As those of us who recognize the valid comparison have said, both inflict permanent harm for non-therapeutic reasons and without consent. This is where the discussion should end. If this were investigating the correct question, the comparison as posited in the article, Ms. Lego would say, “As you can see, they are comparable. They are both a violation of the child.”

But this wasn’t investigating the correct question. Contrary to the accompanying article, WZZM sought to “verify” the difference between female genital mutilation and male circumcision. WZZM begged the question that they’re different. So, even with the ethical comparison established, the analysis works to provide the flawed, predictable psychological comfort for the viewer. Anyone with even a basic understanding of American culture can predict the outcome:


(Larger size here)

Here’s the completed list. It’s “√erified”. You got it right, didn’t you?


(Larger size here)

While accurate in the merely factual sense, none of it is relevant to the question of whether child genital cutting is acceptable. The comparison established before this list demands equal protection for everyone based in the ethical principle¹, whether female or male, adult or child. Everyone has the same human rights. There are no exceptions in the right to bodily integrity for “rooted in parents’ religion”, “potential health benefits”, or “only lifelong consequences we care about”. Religious rights belong to the individual, including the choice to reject genital cutting. The potential health benefits are of subjective value² because the child is healthy. Only he may decide if he values them more than his foreskin. And permanent removal of normal body parts is harm, always. That harm occurs in varying degrees, but harm is guaranteed with every cut.

Going back to the article, it ends with this:

Dr. Megan Stubbs, sex and relationship expert, says that there is a distinct intent to curb a woman’s sexual desire when she undergoes FGM/C – women and girls may face serious, lifelong medical and sexual dysfunction.

“Men who have been circumcised typically lead happy, health lives. Circumcised men still enjoy sex, with or without a foreskin,” Dr. Stubbs states.

Again, FGM is evil in all its forms. “May face” is true here because some less-common forms of FGM do not inflict serious, lifelong harm (or inflict harm similar to circumcision). Those forms are still illegal, as they should be. Good so far.

Dr. Stubbs then counters objective harm to a female victim with “still enjoy sex” for male circumcision. It’s a ubiquitous attempt at a distinguisher, the psychological comfort to parents of boys. But Dr. Stubbs changed the criterion, going from factual statements about FGM to a subjective statement about male genital cutting. Changing form (i.e. cutting away genital parts) changes function (e.g. loss of foreskin’s gliding mechanism). Whether that’s good or not depends on the individual recipient’s opinion. Outcomes vary for every individual. Preferences for or against those outcomes differ for every individual.

The issue is proxy consent for non-therapeutic genital cutting. The first picture above makes it clear how this should be answered. It is not a separate analysis for female versus male patients. (There is perhaps a separate analysis of punishment for what is inflicted on the victim.) Without need, inflicting permanent harm on an individual via proxy consent – with unknown severity and long-term consequences – is indefensible.

No individual’s experiences (or rights) are less valid than another’s because his or her outcome isn’t typical or as severe as another’s, or because his or her parents had the perceived right intention. “Still enjoy sex” is not a Get Out of Violating Human Rights Free card. Nothing in that video or article makes me think those who oppose FGM and defend circumcision would accept FGM if potential health benefits were discovered. (It wouldn’t be ethical to research the question on children, anyway.) That’s correct because FGM/C violates the girl’s body and rights. Thinking the items in the “√erified” column excuse or differentiate male circumcision in a meaningful manner is wrong and hypocritical.

¹ Non-therapeutic genital cutting without consent of the recipient is unethical.

² Science isn’t stagnant, either. It’s realistic to imagine a future with even better ways than our existing less-invasive-than-genital-cutting options to respond to the problems prophylactic male circumcision might address.


Discomfort Them So They Won’t Be Discomforted?

Posted: May 1st, 2017 | Author: | Filed under: Ethics, FCD | No Comments »

In the comments to the article in yesterday’s post, Bryan Swilley wrote the following:

This article is another example of the media using sex to generate readers when no real controversy exists. Sure, a few detracters exist to circumcision but they are a small minority. In my medical career I have counseled virtually no one concerning any mishaps during the procedure or any mental anguish from having it done and can remember only 1 american parent in 30 years who was steadfast against it, but I do remember the discomfort some men faced following an elective circumcision performed when they were adults. The procedure tends to help when it comes to cleanliness and I remember senior physicians during my training discussing cancers that were hidden under a foreskin later in life when no circumcision was performed.

We could easily play a game of “Whack the Fallacy”, but there are only so many hours in each day. I want to make rhetorical points instead.

Why is it difficult for people to recognize the absurdity in citing the “discomfort” of elective adult circumcision as a justification for infant male circumcision? It’s elective, so do they value the circumcision or not being in discomfort more? Do people believe an infant doesn’t experience “discomfort” during his elective elected circumcision? Why is the issue of consent not shining in their minds?


False Distinction, Not False Equivalency

Posted: April 30th, 2017 | Author: | Filed under: "Voluntary", Ethics, FGM, Law, Logic, Science | 2 Comments »

Note: I’m not going to write about the charges directly here. Anything involving a cursory glance of my work here will let you know I understand, abhor, and reject FGM in every form. If guilty of the charges, the doctors should serve the maximum sentence allowed.

I noticed something both fascinating and infuriating in this USA Today version of the Detroit Free Press article on the arrest of three doctors in Michigan on charges of mutilating the genitals of female minors. Specifically, this section:

As some medical experts on the topic stated in a 2015 article by The Atlantic:

“Male circumcision does no harm. Female gender mutilation does. Male circumcision cuts the foreskin, FGM cuts the clitoris — the two things cut are not even remotely the same. For male circumcision to be equivalent to FGM, the entire tip of the male’s penis would need to be cut off … Constantly trying to claim they are equivalent practices when they are not takes away from the unique seriousness of female ‘circumcision/mutilation,’ as most cases are performed during a traumatic developmental period and remove most sexual sensation, which is not true with male circumcision.”

Two things immediately jumped out. Who are the medical experts? Where is the link to the Atlantic article? Seeing that this is the USA Today version, I investigated to determine if the link was dropped from the original Detroit Free Press version, which is here. Nope. The link isn’t there. And not only is the link not there, those two paragraphs were removed and replaced. (More on the latter in a moment.) So I checked the Wayback Machine to see if the USA Today version is different or out-of-date. Predictably, it’s out-of-date, because the first version was what USA Today still presents. My hunch was that the reporter, Tresa Baldas, (or an editor) made an inexcusable mistake, which was then erased (incompletely, because the internet is mostly forever). It’s the conclusion I draw, but I’m open to more facts.

I found the referenced Atlantic article, “How Similar Is FGM to Male Circumcision? Your Thoughts”. It contains Baldas’ paragraph from two excerpted, merged comments. The quoted “medical experts” are a commenter called Tyfereth and a commenter, Jim Eubanks, who is an MD candidate, according to his Facebook profile. Half-right, I guess, except the initial comment is the one drawing the alleged distinction. Tyfereth’s comment:

Male circumcision does no harm. FGM does. Male circumcision cuts the foreskin, FGM cuts the clitoris, the two things cut are not even remotely the same. For male circumcision to be equivalent to FGM, the entire tip of the males penis would need to be cut off. Now that would be a harm, but cutting off the foreskin isn’t harmful.

This is ridiculous logic. (It is also incomplete knowledge of the various types of FGM.) Cutting inflicts harm. This is indisputable, except for foolish attempts such as this. Declaring that cutting the body and removing a normal, healthy body part is somehow harmless, like touching a raindrop, should raise skepticism in every reporter (and editor). That it didn’t immediately demonstrates a problem Ms. Baldas (and/or her editor) should question in her continuing coverage. Instead, she quoted Tyfereth as a medical expert on nothing more than a lame “nuh-unh!”.

At least Mr. Eubanks appears to be closer to an expert. But he isn’t making the same argument, so he shouldn’t be lumped in with Tyfereth’s nonsense. In his complete comment, he’s a bit more nuanced.:

False equivalency. You can stand against both practices, but constantly trying to claim they are equivalent practices when they are not takes away from the unique seriousness of female “circumcision/mutulation” as most cases are performed during a traumatic developmental period and remove most sexual sensation, which is not true with male circumcision. We can oppose both but take them on their own terms please.

He’s still wrong, of course. There is no false equivalency in the principle. Non-therapeutic genital cutting on a non-consenting individual is unethical. The right involved is a human right based in consent, not a female right based in degree of harm¹. The cutting done on an individual is a matter for penalty, not whether both violations or just those of females should be treated as crimes. The boy who is cut has as much right to his normal, healthy body² as the girl who is cut has to hers.

This is apparent with analysis of a more recent article Ms. Baldas wrote, “Report: Girl’s genital mutilation injury worse than doctor claims”.

A doctor’s findings, however, contradict that claim. A juvenile protection petition filed on behalf of the victims in Minnesota, along with federal court documents, cite scarring, a small tear, healing lacerations and what appears to be surgical removal of a portion of her genitalia.

I have or had all four of those injuries. I can’t state they are to the same degree, of course, so I’m not declaring that here. I’m stating the comparison is valid because non-therapeutic genital cutting without consent violates the individual. There is no false equivalency in stating that everyone has the same right to be free from unneeded, unwanted harm.

————-
Here are the paragraphs that replaced the reference to the medical experts in the Atlantic.

Medical associations also have cited health benefits to male circumcision, but have found no such benefits to female genital mutilation, which has been condemned by medical organizations worldwide.

For example, The American Academy of Pediatrics and the U.S. Centers for Disease Control have both found that the health benefits of newborn male circumcision outweigh the risks, though both groups say the final decision should be left to the parents as it may involve religious or cultural beliefs. The benefits cited by both groups include the prevention of sexually transmitted diseases, including HIV, and a lower risk for urinary tract infections in infants.

Neither group, however, endorses female genital mutilation in any form and has cautioned physicians against practicing it. The same goes for the World Health Organization, which has condemned female genital mutilation, but has recognized health benefits to male circumcision, stating: “There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%.”

First, the “FGM has no medical benefits” argument is a false distinction. It’s true, but irrelevant in the comparison. Most, if not all, opponents do not oppose FGM because it has no medical benefits. They oppose it because it violates the girl and inflicts harm on her. It’s a “spaghetti against the wall” argument. If researchers were to find (potential) benefits, the harm would still be real. Few opponents would change their mind. Rightly, of course, but it demonstrates the argument’s irrelevance.

Next, the American Academy of Pediatrics did not “find” that the health benefits outweigh the risks. They declared it to be true in the same way Michael Scott declared bankruptcy. The ethics section (Pg. 759) of its 2012 technical report states:

… Reasonable people may disagree, however, as to what is in the best interest of any individual patient or how the potential medical benefits and potential medical harms of circumcision should be weighed against each other.

This is obviously true. The value of a potential risk reduction at the expense of risk and an objective physical cost with the lost foreskin is a subjective conclusion based on the individual’s personal preferences. Yet the Abstract misrepresents what’s in the Technical Report when it declares, “preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure”. The AAP knows this is not a factual statement. Lazy, uncritical journalism perpetuates this subjective conclusion as fact.

Even the alleged bioethicist involved in the Task Force knows the truth, despite what he signed off on with the Abstract. Dr. Douglas Diekema said, “Not everyone would trade that foreskin for that medical benefit.” All individual tastes and preferences are unique. I think the potential benefits probably have merit. I don’t care. I don’t want them in exchange for my foreskin. I’d rather have my foreskin and a (tiny) higher absolute risk of a foreskin-related problem than my circumcision. This is true in spite of my parents preferring me circumcised. The proper analysis is cost-benefit, not risk-benefit. The risks are a relevant cost, but the loss of the foreskin is the primary cost of circumcision. For indefensible reasons, most – including the AAP and CDC – ignore it completely.

The reference to the CDC is curious for another reason. Its proposed guidelines have not proceeded beyond the flawed draft recommendations from 2014. Again, uncritical journalism is probably to blame. Most treated the draft as final, despite it clearly stating “draft” and open to review. I assume this happens due to laziness and confirmation bias. Insert your own theory why. It doesn’t matter. The result is misinformation spreads further.

With respect to FGM, the AAP briefly proposed a ritual nick as an alternative, which has implications for the “false equivalency”. But it is correct they don’t endorse it today. The WHO, however, is clueless and/or hypocritical. From its FGM factsheet, it states:

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

FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls’ and women’s bodies. Generally speaking, risks increase with increasing severity of the procedure.

Everything there that isn’t the “spaghetti against the wall” argument (and “total removal” for the pedants, although it occurs) is true of male circumcision. WHO recognizes FGM as “a violation of the human rights of girls and women”. It is a violation of human rights, not female rights. Injury to the genitals without need or consent is the problem, not the form of the body part.

¹ Even though, yes, what is done to females is usually more harmful than what is done to males.

² This applies to intersex children, too. Obviously.


A question on tactics

Posted: February 19th, 2017 | Author: | Filed under: Ethics, Mission | No Comments »

What does attacking a doctor on Facebook to the point that she deletes her account* accomplish? Yes, she’s a hypocrite for being very serious about “MY body, My choice” for women’s issues, but also performing circumcisions at the request of her patients’ parents that violates their bodies because she stupidly doesn’t believe she should have a say in what she does for the parents – and to her patients. But I’m genuinely unclear on what attacking her, calling her disgusting, and going full offensive at her achieves. Will she now see the light and stop mutilating infants? Or is this our Two Minutes Hate ritual? Since it’s a very clear either/or scenario, I want the former, not the latter, so if there’s something else I’m missing making people choose the latter, please explain it to me.

* And her Instagram account. I’m not posting the link.


“Being Targeted”, Predictably

Posted: December 14th, 2016 | Author: | Filed under: "Voluntary", Ethics, Public Health | No Comments »

The latest strategy to circumcise children is underway:

Over 900 boys and men in Mombasa County are being targeted for circumcision in a new drive by the government to reduce new HIV infections caused through the exercise.

The National Aids and STI Control Programme (NASCOP) said on Friday that it is targeting men aged between 10 and 50 years to undergo the cut under Voluntary Medical Male Circumcision (VMMC).

The first paragraph mentions boys. The second paragraph discusses 10-year-old men, because fewer would participate in the lie of “voluntary”. It’s always this way in advocating for circumcision, with the meaning of words being malleable to the goal. (e.g. “Medical” rather than “medicalized”) When public health officials advocate for voluntary, adult male circumcision, they never mean “voluntary” or “adult”.


The Lie Feeds Itself – PrePex Is Predictably More Unethical on Circumcision

Posted: December 1st, 2016 | Author: | Filed under: "Voluntary", Ethics, Public Health | No Comments »

Over the course of five years, it’s been clear where PrePex would go. Circ MedTech made it clear earlier this year that it would not be satisfied with a device aimed at voluntary, adult male circumcision. It only cares about two of those four words. Its adherence to the use of PrePex in voluntary, adult circumcision was always a delay in technology, not a wall of ethics. Now, it shares predictable evidence of its lack of ethics in developing and promoting PrePex. From its FAQ, Is PrePex available for adolescent boys?

The manufacturers of PrePex are committed to assisting males of all ages with appropriate male circumcision technology. Non-surgical circumcision using PrePex is now available for males ages 13 years and above. Devices for Infants & Children (0 days to 13 years) based on the existing PrePex technology are underway.

The only appropriate male circumcision technology appropriate for a normal, healthy male under 18 who does not – or cannot – consent is the technology that remains in the package, unused. Instead, Circ MedTech wants to assist¹ males of all ages, whether or not they want – or will ever want – to be assisted. It does not care about voluntary or adult.

Note that, despite being dated December 3, 2014, that link did not include the italicized language on April 22, 2016. It stated:

The manufacturers of PrePex are committed to assisting males of all ages with appropriate male circumcision technology. Non-surgical circumcision using PrePex is not yet available for youths under the age of 18, although it is being developed and tested.

An ethical organization would not mislead in this manner. I will not pretend to be surprised, however small the offense.

Circ MedTech’s absurdity with language continues in Who is eligible for circumcision with PrePex?:

PrePex has been proven safe and effective for adult and adolescent men over the age of 13. In studies to date, approximately 90% of men who volunteered were eligible to undergo the procedure. Men interested in medical male circumcision should consult with a trained healthcare provider to determine whether PrePex is right for them.

Every time I think circumcision advocacy can no longer shock me, something ridiculous like “adolescent men” appears. Dare I predict the eventual use of “infant men”? Surely that’s too absurd?

I have another ethics question. Did all of the “adolescent men” volunteer, or were they volunteered by their parents. And it’s disgusting² that the prospective patients in “Is PrePex available for adolescent boys” became “adolescent men” when discussing the actual circumcision of those healthy-and-unable-to-consent individuals.

On April 21st, that link stated:

PrePex has been proven safe and effective for adult men over the age of 18. In studies to date, approximately 90% of men who volunteered were eligible to undergo the procedure. Men interested in medical male circumcision should consult with a trained healthcare provider to determine whether PrePex is right for them.
Non-surgical circumcision is not yet recommended for youth under the age of 18 outside the clinical evaluation framework. Several African countries are currently investigating the safety and efficacy of the PrePex procedure for adolescent men, and study results should be available in early 2014.

“Adolescent men” was already there, but within one two-sentence paragraph, Under-18s transitioned from youths to adolescent men. That’s at least impressive in its shamelessness, I suppose.

As always, when public health officials speak of voluntary, adult male circumcision, they never mean voluntary or adult.

¹ The violation of rights seems to require euphemisms.

² I rewrote the euphemism I initially used. I prefer to speak truthfully.