Posted: April 15th, 2014 | Author: Tony | Filed under: "Voluntary", Public Health | No Comments »
When public health officials advocate for voluntary adult male circumcision, they never mean voluntary or adult. From Zimbabwe:
The ministry was working together with the Population Services International (PSI) on the programme.
PSI director for voluntary medical male circumcision Ngonidzashe Madidi said for the purposes of sustainability, they were studying the early infant male circumcision (EIMC) to ensure protective effect of male circumcision is sustained.
Madidi said they wanted EIMC to run parallel with the adult Voluntary Medical Male Circumcision (VMMC) programme.
“Currently, EIMC is in a study phase and we are happy to say we managed to circumcise at least 560 babies successfully,” Madidi said.
Are the infants happy? Do they think it was successful?
Posted: April 10th, 2014 | Author: Tony | Filed under: Ethics, Media Marketing, Public Health, Science | No Comments »
It isn’t difficult to see how Brian Morris’ process works. He publishes a “new” paper making bold, biased, often-unsupported claims citing his prior work doing the same, and receives circulation for his ideas from unquestioning journalists acting as stenographers. His latest, with Stefan Bailis and Thomas Wiswell, is a good opportunity to assess the reporting within consideration of an excellent article by Ian Sample, “How to write a science news story based on a research paper“.
1. Find a good paper
That rules out anything written by Professor Morris, but I’ll grant that his focus on non-therapeutic infant male circumcision satisfies the criteria that the work be “controversial”.
2. Read it
You cannot cover a paper properly without reading it. The abstract [ed. note: Or the press release] will give the barest essentials. You need to read the introduction for context, the discussion and conclusions for take-home messages. Check the methods. Was the experiment well designed? Was it large enough to draw conclusions from? Find weaknesses and flaws. You will probably need help to work out how fatal they are. Spend time on the results. Have the authors omitted key data? Look at odds ratios, error bars, fitted curves and statistical significances. Are the results robust? Do they back up the scientists’ conclusions? …
Given that Morris’ latest paper is only 10 pages (pdf), including references, this shouldn’t be hard. Yet, I found no initial article covering it that suggested the reporter bothered to read beyond the press release, or perhaps the abstract. For example, both of these articles cite the “benefits exceed risks by at least 100 to 1″ line as truth, despite there being no support within the paper for this preposterous claim. It’s merely a statement. Where is the support for this in the paper? The questions Mr. Sample suggest provide a path for investigating this paper further. There is a table of potential benefits cited for circumcision, but no data offering how these are weighted to produce an objective mathematical conclusion.
Within the key table listing claimed benefits, Table 4, Morris cites a study by Dr. Jonathan Wright while omitting the necessary qualification that the study found a correlation, not a causal link. As Dr. Wright stated, “‘These data suggest a biologically plausible mechanism through which circumcision may decrease the risk of prostate cancer,’” said study researcher Dr. Jonathan Wright, an assistant professor of urology at the University of Washington School of Medicine. He noted that the study was observational; it did not show a cause-and-effect link.” How much does this correlation contribute to the “100 to 1″ number?
4. Get context
Science builds on science. Know the previous studies that matter so you can paint a fuller picture. …
Like Dr. Wright’s study, for example. Or the way Morris previously used a study by Dr. Kimberly Payne to support a claim that the “highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.” Yet, Dr. Payne’s study, which Morris (and Krieger) rated as the highest quality, resulted in Dr. Payne stating that “[i]t is possible that the uncircumcised penis is more sensitive due to the presence of additional sensory receptors on the prepuce and frenulum, but this cannot be compared with the absence of such structures in the circumcised penis.”
5. Interview the authors
Get them to explain their results and justify their conclusions. What do the results mean in plain English? What do they not mean? Ask your questions in simple language to get answers you can quote. Run phrases you might use past the authors, so they can warn you of howlers. Do not ask multi-part questions: you will not get full answers.
Perhaps Morris should justify making up rights when he says “[d]enial of infant male circumcision is denial of his rights to good health, something that all responsible parents should consider carefully”. Do parents who do not circumcise their healthy son violate his rights?
This is especially interesting in light of a comment in the press release. Professor Morris said (emphasis added):
“The new findings now show that infant circumcision should be regarded as equivalent to childhood vaccination and that as such it would be unethical not to routinely offer parents circumcision for their baby boy. Delay puts the child’s health at risk and will usually mean it will never happen.“
If not circumcising an infant male “will usually mean it will never happen”, that demonstrates that circumcision will usually not be necessary. Is this one surgery, and the ethical implication, somehow different than withholding from a healthy child every other surgery that will usually never be required?
This also shows the sleight-of-hand in “half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin,” which is included in the paper (and on Morris’ site). Requiring treatment is not the same as requiring circumcision.
In footnote e of Table 4, Morris cites a figure for risks associated with neonatal circumcision where “data show that risk of an easily treatable condition is approximately 1 in 200 and of a serious complication is 1 in 5000″. So, a complication is not an argument against non-therapeutic infant male circumcision because it will probably be easily treatable. And treatable medical conditions associated with the foreskin will usually not require circumcision, as Professor Morris states, but somehow also justify non-therapeutic infant male circumcision. That’s “Heads I win/Tails you lose” nonsense. Professor Morris is engaging in propaganda.
When the New York Times quoted Morris about this paper, he said: “Just as there are opponents of vaccination, there are opponents of circumcision. But their arguments are emotional and unscientific, and should be disregarded.” That is demagoguery, and should reflect on Professor Morris’ reputation. The argument against non-therapeutic infant male circumcision is rooted in ethics, but it is also rooted in the science of normal human anatomy. The foreskin is healthy, just as every other body part usually is. And opponents of non-therapeutic child circumcision support condoms, soap, and antibiotics, for example, which are all scientific inventions and discoveries.
6. Get other scientists’ opinions
Such as Professor Kevin Pringle, of New Zealand, and Dr. Russell Saunders, pen name for a New England pediatrician. While I disagree with the latter’s conclusion on parental choice, for my purpose in this post, he wrote: “Having reviewed Dr. Morris’s study, I find his statements about the benefits of circumcision as a routine procedure overblown, and the comparison with vaccination baseless.”
7. Find the top line
How about this, from page 7 of the paper:
The timing of circumcision is crucial. Medical and practical considerations strongly favor the neonatal period (Table 4).16 Surgical risk is, thereby, minimized and the accumulated health benefits are maximized.14,16 …
As Morris’ statement about the likely lack of need demonstrates, circumcising in infancy is not usually crucial for the male’s health to the point of circumcision becoming necessary. There isn’t a justification for non-therapeutic infant circumcision. It can wait until the male can choose – or reject – non-therapeutic circumcision for himself.
8. Remember whom you are writing for
This is where Morris gets what he needs most. The headlines encourage readers who only skim headlines to believe that Morris has proven that the potential benefits exceed the risks 100 to 1, that circumcision is similar to a vaccine, and that there is some case for mandatory circumcision of infants. It’s all absurd and does a significant disservice to readers and truth.
9. Be right
Posted: March 23rd, 2014 | Author: Tony | Filed under: "Voluntary", Control, Ethics, FCD, FGM, Logic, Media Marketing, Parenting, Politics | No Comments »
Many have heaped scorn on Mary Elizabeth Williams’ Salon piece that criticized Alan Cumming for calling male circumcision genital mutilation and comparing it to female genital mutilation. This scorn is deserved.
Alan Cumming wants to tell you about his penis. He wants it to be a shining example to the world. In a candid interview with Drew Grant this week in the New York Observer, the 49-year-old Scottish actor reveals his strong opinions on “Girls,” naughty cellphone pictures, and, most controversially, circumcision. Or as he puts it, “genital mutilation.”
“There’s a double-standard, which is that we condemn the people who cut off girls’ clitorises, but when it happens to boys,” Cumming says. “I mean, it is the most sensitive part of their bodies, it has loads of nerve endings, and it can go horribly wrong. I’m speaking out against it … I’m just so suspicious of the medical industry, which just flings pills at people to ensure everyone is reliant on things. ‘Here are some pills, Mommy. Take them, and we’ll take your baby away and hack its thing off, and then we’ll bill you for that too.’”
I don’t share Mr. Cumming’s view of the medical industry. Its complicity strikes me as cultural inertia and cowardice. My experience suggests that profit-driven focus on circumcision is limited, although it motivates some. But that’s a distraction. The key is that he is correct about the comparison.
Circumcision of a healthy male minor is mutilation of that male’s genitals. To be valid, it must involve his consent prior to the surgery, not assumed to be later granted retroactively. This is the standard inherent in 18 USCS § 116, which criminalizes all non-therapeutic genital cutting on female minors without regard for parental justifications or potential benefits. The difference we imagine is an accident in the history of Western child genital cutting.
Later in the essay:
… And earlier this week, protesters threatened to disrupt Bill and Melinda Gates’ TED Vancouver talk because of their organization’s efforts to increase the practice in Africa as a means of “limiting the spread of HIV in the parts of Sub-Saharan Africa.”
There is good reason to find the work of the Gates Foundation repugnant, as it pertains to male circumcision. It speaks in the euphemism of voluntary medical male circumcision, when it also means infant circumcision. This is unethical because it violates the principles of bodily integrity and consent. And this study, commissioned and funded by the Gates Foundation, hardly provides reassurance when examining the context of WHO and UNAIDS, who think violating this human right of male children can be legitimized through question begging. Mental gymnastics like that are not admirable.
Cumming’s equation of circumcision with female genital mutilation is an insultingly inaccurate one — boys are not circumcised as a ritualized means of suppressing their future sexual enjoyment,
Although it’s easy to find similar defenses of male circumcision, ritual or not, this implies that the critical issue is intent rather than outcome. Female genital mutilation, in all its forms, is wrong because the female is mutilated, not because she is mutilated for “bad” reasons. Some reasons given are the same as those for male circumcision. And not all females who were mutilated reject or condemn it. Yet all reasons for surgically altering the healthy genitals of a female minor are still bad. This focuses on the principles and facts involved, not our feelings.
Notice, too, how often erroneous claims like “[t]here is no evidence whatsoever to support the notion that it affects function, sensation or satisfaction” are made about male circumcision, as it’s made with that quote from Williams’ link to reader comments on an article. The statement is wrong on its face because circumcision changes the function. If you change the form, you change the function. The function of the penis, including its structure, should not be lazily defined as “to have sex” or something similarly ridiculous. The foreskin is normal anatomy with functions for the penis and belongs to its owner.
The quote is disputable on sensation, considering the (anecdotal) arguments in favor of male circumcision stating that males can “last longer“. Consider the heads I win/tails you lose efforts of Brian Morris here, as all outcomes are assumed to be favorable to overall satisfaction, even when the studies cited do not involve anything near 100% on the subjective evaluation of satisfaction.
nor does a clean male circumcision compare with the often crude, blunt and unsanitary practice of female genital mutilation.
Those qualifiers obfuscate. What about clean female genital cutting compared with crude, blunt, and unsanitary male circumcision? A sterile surgical environment does not grant legitimacy to a rights violation. Again, the act is what matters. There are degrees of harm possible, but the inevitability of harm requires first priority, whatever the degree.
The World Health Organization calls FGM “a violation of the human rights of girls and women” with consequences that include “severe pain, shock, hemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue,” while it in contrast notes, “There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%.”
WHO also explains that female genital mutilation “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.” There is no unethical caveat for “but if we find some benefits to female health, or even male health, we’d have to weigh mutilating injury against potential benefits.” That unethical caveat is always applied to male genital mutilation, as Williams does here. An adult male volunteering is not the same as an infant male being volunteered. Consent is the issue, not how horrible female genital mutilation usually is or how innocuous and/or beneficial male circumcision appears to be. Non-therapeutic genital cutting on a healthy individual who does not consent is unethical. It involves harm. Gender is irrelevant to the principle.
One can argue, quite persuasively, about whether the practice of circumcision still has validity here in the West, especially among those who don’t have a religious directive. What’s needed, however, is education and enlightenment, so families can make the healthiest choices for their children. …
I reject the premise. This is a not a decision parents should be allowed to make for their children. The argument that parents may decide this for their healthy children requires this decision to be a parental right. If it’s a parental right, then the prohibition of non-therapeutic genital cutting on daughters is indefensible. The basis for thinking about genital cutting can’t be girls and the parents of boys. That’s absurd.
… It’s not helpful to make far-fetched comparisons, and it certainly isn’t constructive to imply that men and boys who are circumcised are somehow damaged, “mutilated” goods. That’s a shaming technique that serves no one, one that turns having a foreskin into a bragging point. …
Why are we only worried about shaming men and boys by using the term “mutilation”? Isn’t there the possibility or likelihood that women and girls will feel shamed if we describe their genitals as mutilated? Are the psyches of females more able to handle facts?
There is a difference in stating a fact and demanding a value judgment from that fact. The bodies of males who were circumcised as children were mutilated. Their rights were violated. Circumcised males are not obligated to think this is bad or shameful. The obligation (for everyone) rests in understanding that it is unacceptable to perpetuate this violation on their children or to permit its continued practice in society.
Or to put it in terms of individual autonomy, circumcision mutilated me through the deprivation of an essential¹ part of my body. Where I had a normal human foreskin, I now have only scars. My penis is mutilated. No one gets to reject that fact for me. But I do not feel shame. This sense that males might feel shame is what encourages parents to circumcise their sons for conformity. We have to stop being afraid of shame. We’ll achieve that only when we are no longer afraid to state that shame belongs with those who circumcise, not those who are circumcised.
… And it’s an unfair judgment coming from a man who admits, “I myself don’t have kids. I just have managers, assistants, agents and publicists.”
I feel second-hand embarrassment, so that at least someone feels what her statement deserves.
¹ Quibble with essential as something other than an obvious stand-in for normal, and I’ll roll my eyes and ask if normal parts of female genitalia are essential.
Posted: February 26th, 2014 | Author: Tony | Filed under: Control, Ethics, FGM | 1 Comment »
I’ve discussed the comparison between male circumcision and female genital cutting/mutilation in depth across various posts. In a great post, titled Female genital mutilation (FGM) and male circumcision: time to confront the double standard, Brian Earp discusses the principled comparison in a single post that should become the “Go To” link. It’s worth the read because it’s so thorough and sourced. I know there are people who will read that and remain unconvinced. That is not because the proof isn’t there. He demonstrates the complexity that dismisses the “FGM is always the worst extreme/male circumcision is always the best extreme” that perpetuates superficial thinking on the principled comparison.
Again, it’s all worth reading, but I like this the best (links in original):
So what are the implications here? Given that both male and female forms of genital cutting express different cultural norms depending upon the context, and are performed for different reasons in different cultures, and even in different communities or individual families, how are we meant to assess the permissibility of either one? Do we need to interview each set of parents to make sure that their intended act of cutting is intended as an expression of acceptable norms? If they promise that it isn’t about “sexual control” in their specific case, but rather about “hygiene” or “aesthetics” or something less symbolically problematic, should they be permitted to go ahead? But this is bound to fail. Every parent who requests a genital-altering surgery for their child – for whatever reason under the sun – thinks that they are acting in the child’s best interests; no one thinks that they are “mutilating” their own offspring. Thus it is not the reason for the intervention that determines its permissibility, but rather the consequences of the intervention for the person whose genitals are actually on the line. …
That’s the truth missing from society’s moral relativism. One is judged on outcome alone, with intent assumed from the outcome. The other is judged on intent alone, with outcome assumed from the intent¹. For female genital cutting we focus on the female. For male genital cutting we focus on the parents. That’s the mistake. Separate approaches for the same inherent violation – non-therapeutic genital cutting on a non-consenting individual – cannot hold under inspection. Earp’s post is great for revealing that error with such clarity.
¹ This is especially maddening because the intent we assume and praise is not benign.
Posted: December 30th, 2013 | Author: Tony | Filed under: "Voluntary", Ethics, FCD, Logic, Media Marketing | No Comments »
It won’t come as a surprise to read that I don’t think much of Yair Rosenberg’s lazy approach to analyzing non-therapeutic infant male circumcision. Add another example. This time he’s misreporting the findings of another meta-analysis by Brian Morris. Mr. Rosenberg quotes from a Daily Mail article that amounts to little more than a press release.
But first his introduction:
Across Europe, pushes to ban circumcision have rested on its supposedly deleterious effects on a child’s body, and lack of demonstrable benefits. Anne Lindboe, Sweden’s child welfare adviser, has gone so far as to label the practice “violence against children,” claiming that parents who perform it do so out of “ignorance.” She and her counterparts in Denmark and Finland have classified child circumcision as a “human rights violation” and called for it to be criminalized. A German court similarly banned the procedure on the grounds that it caused “bodily harm.” The only problem with these stances? They completely contradict everything science has found about circumcision’s impact on children’s health.
Findings of potential benefits from voluntary, adult male circumcision do not contradict the ethical, rights-based position against non-therapeutic infant male circumcision. Proxy consent is not the same as the consent given by adult volunteers to this permanent, irreversible surgery. Circumcising healthy minors violates their rights to bodily autonomy and integrity, just as any other permanent, non-therapeutic intervention is a violation. It’s the same principle that applies to even the tiniest, less-invasive-than-male-circumcision cut on a female minor’s genitals, which we’ve rightly criminalized. Potential benefits and human rights violation are not mutually exclusive. The presence of potential benefits does not eliminate the fatal ethical flaw. Nor does deciding that circumcision diminishing sexual function, sensitivity, or satisfaction is a “myth”, as Mr. Rosenberg claims of the new meta-analysis by Prof. Morris and Dr. John Krieger.
With that misguided frame, Mr. Rosenberg presents the study:
“The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction,” Professor Brian Morris told The Daily Mail. Morris and his co-author looked at 36 studies covering 40,473 men, half circumcised and half not. They ranked each in terms of scientific rigor and quality, according to accepted official guidelines. And they found that circumcision “had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, duration of intercourse, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration.” Indeed, after 24 months, 99.9 percent of men were satisfied with their circumcisions–and 72 percent said sensitivity had increased.
There’s a lot to unpack there. The largest point is that Mr. Rosenberg clearly didn’t read the 12 page paper because he regurgitates the results in the digestible (i.e. misleading) package given in the news article. Reading it might reduce his confirmation bias. There are enough obvious limitations, as well:
While the review considered a large body of evidence, there are some factors that may be influencing the findings.
For example, many studies were surveys, and the recruitment process for them is not described. It could be the case that men who have a satisfying sex life may be more willing to participate and answer questions on sexual performance and satisfaction that those who aren’t.
Also, most of the responses in the study are subjective, and what one person considers to be a sexual problem or sexual satisfaction, another might not. There may also be differences in the culture and ethnicity of the participants of certain studies, meaning that their findings cannot be so easily transferred elsewhere.
Beyond that, focus on the conclusion from the study. They state that their analysis suggests this conclusion. Suggests is not a synonym for proves. Yet, even though the Daily Mail article doesn’t use the word in quoting Morris, Mr. Rosenberg states:
Morris told The Daily Mail that he saw his study disproving circumcision’s adverse effects as complementary to those showing its benefits. …
He repeatedly misses the critical issue of consent versus force. In a previous article Mr. Rosenberg summarized a finding that “[i]t would have been unethical to continue without offering circumcision” to the remaining intact volunteers in a study with a simple statement that it would be “[u]nethical not to circumcise the men.” It appears that Mr. Rosenberg is not a reliable filter for news pertaining to circumcision.
There are obvious problems in the current meta-analysis. I will accept their methodology and reasoning as presented, which lead to their “suggests” conclusion. Assuming it is accurate, so what? The findings were not 100%. Of course, 99.9% is presented as essentially the same thing, which is even better than the result we’d expect from a dictator’s latest popular election. From the Krieger et al. Adult Male Circumcision study in Kenya ¹, 8.9% of circumcised men identified their penile sexual sensation as something other than “increased” or “the same” 24 months after circumcision. It’s ridiculous to pretend that these men don’t matter and that their experience should be ignored to allow a perceived universal defense for circumcising male minors.
Mr. Rosenberg concludes:
Yet the findings of science have done little thus far to deter Europeans politicians and health officials from seeking to criminalize circumcision, and labeling those who practice it “ignorant” and “barbaric.” It remains to be seen if this study will alter their course.
A utilitarian defense for violating human rights is ineffectual because the defense relies on using only a preferred subset of factors to reach a conclusion. “It’s mine” is a sufficient reason for a male to want his foreskin. He owns his foreskin as much as he owns any other part of his anatomy. Potential benefits valued by his parents are irrelevant while his body is healthy. Proxy consent for this non-therapeutic intervention is invalid because the net benefit or harm is subjective to the individual himself.
This is obvious if considering the question Morris and Krieger asked. Does male circumcision affect sexual function, sensitivity or satisfaction? In order, yes, maybe, and maybe. The findings suggest as much if we look at the participants in the included studies as individuals with their own unique tastes and preferences rather than as statistics. The paper’s focus is sex as a measurable number, which is an idiotic way to reach a conclusion about a subjective topic like human sexuality.
For sexual function, the foreskin is removed. That changes function. Maybe that’s “good”, maybe it’s “bad”. Each person must decide before circumcision what he thinks he wants. What his parents prefer is meaningless.
As for sensitivity, the results are equivocal. I’m willing to accept the negative findings as lower-quality studies for this purpose. But in a study Morris and Krieger rate as 2++, Payne et al , this:
… It is possible that the uncircumcised penis is more sensitive due to the presence of additional sensory receptors on the prepuce and frenulum, but this cannot be compared with the absence of such structures in the circumcised penis. …
Yet, for Morris and Krieger, this is support for their “suggests” conclusion because:
… More circumcised participants reported an increase in their level of sexual arousal, while more uncircumcised men reported being unaffected by the erotic stimulus. …
They want to believe, so they believe. That’s the only way I can reconcile the source study with their analysis.
In certain aspects sensitivity is quantifiable, but there is a an element of experience to human sexuality that a generalized “yes” or “no” here dismisses. That same element of experience, but without the ability to quantify in a utilitarian summary, exists in personal evaluations of satisfaction. This is why I don’t state that someone is wrong for preferring circumcision or believing it improves their experience of sex or life, in general. But that is also why it’s wrong for Morris, Krieger, Rosenberg, or anyone else to support parental choice (i.e. proxy consent) for non-therapeutic circumcision. Declaring one’s own preference as a truth applicable to someone else – without concern for the individual’s preference for himself – is the critical mistake inseparable from their argument.
One final point: It’s important to read the abstract and the study rather than just the abstract, even as a layman. Doing so reveals a lot of nuance, as the AAP’s revised position statement in 2012 so embarrassingly showed. It avoids the “It’s official!” conclusion too many (like Mr. Rosenberg here) want to staple to the evolving science involved in circumcision. The Payne  study is another example of the importance of this maxim, as are the remaining studies reviewed by Morris and Krieger, probably.
¹ Bracketed numbers correspond to the same-numbered footnote in the Morris/Krieger review.
Posted: October 11th, 2013 | Author: Tony | Filed under: "Voluntary", Control, Ethics, FCD, FGM, Logic, Media Marketing, Pain, Parenting, Science | No Comments »
At The Good Men Project Renee Lute makes a request: Please Respect Our Circum-Decision. It only requires a short response: No. Still, her essay is worth analyzing to explain why the only answer is “no”.
Circumcision on a healthy child is a permanent body alteration without the child’s consent. I’m under no obligation to respect that. I do not believe anyone should respect that. If Lute understood circumcision as well as she claims, she’d understand how absurd it is to request respect for her decision from someone who recognizes this surgical intervention as the human rights violation it is.
She is, of course, due a respectful rejection of her request. I will not engage in ad hominem, nor will I call her names as a result of what she intends to do. Anyway, facts and logic are enough to demonstrate her errors.
… I’m apologizing to [my unborn son] for writing this piece, because now the world will know just a little bit about the future state of his penis, and most little boys don’t have to deal with that. …
This common theme is strange. Intact genitals are the human default. Unnecessary intervention is the only reason the status of a child’s genitals is considered an issue if people know, as if knowing is a Big Deal. Or, rather, unnecessary intervention is the only reason the status of a boy’s genitals is considered an issue if people know. This bizarre reality is the result of intervening, not some inherent shame in having others know we have human genitals.
That gets to the reason why I won’t respect her and her husband’s decision for their unborn son. A daughter’s normal, healthy genitals are off-limits for surgical intervention, and rightly so. Those who recognize the ethics involved as gender-neutral must stand against the opinion that a son’s normal, healthy genitals can be subjected to surgical intervention. (There will be more on the valid comparison below.)
She discusses Mark Joseph Stern’s terrible Slate piece (my post) and Brian Earp’s reply at The Good Men Project. She writes:
Neither of these articles really threw me. I know the arguments against circumcision, and I know the arguments for circumcision. What did surprise me, however, was what I found in the comments section under The Good Men Project article. …
Never read the comments. We know that doesn’t mean “never read the comments”. But it’s a reminder that the Internet is a place for bad manners and emotional responses. That’s particularly true in comment sections. Discussion of circumcision is no different. I’m not excusing the behavior. The rude, hateful, and misogynistic garbage is wrong and needs to stop. But reasoned proponents of bodily integrity, as I aim to be, have our argument harmed only in the sense that someone is willing to generalize about those who disagree based on the miscreants that any group has.
… I am not a circumcision enthusiast. In fact, I could not care less whether other people circumcise their sons or not. Do it if you want! Don’t if you don’t want! But I am begging you—begging you—to not make families who choose to circumcise their sons feel like they are abusers of children, or human rights violators.
“Do it if you want! Don’t if you don’t want!” is the false argument. What does the child who will live with the circumcision want? That is the core. Without knowing what he will want, imposing it as a non-therapeutic intervention is a human rights violation. I suppose it’s unfortunate if that makes someone feel bad about circumcising their healthy son(s). But I recognize that my parents violated my rights when they circumcised me. I won’t pretend¹ that someone else circumcising their son isn’t violating his rights because stating a truth makes them feel bad about the choice they make. (I do not take a position on how individual males should feel about being circumcised.)
Why am I going to have my son circumcised? Because his father and I have done our reading. We’ve talked about it, and we’ve made our decision. There are legitimate reasons. Circumcision eliminates the risk of phimosis (in which a foreskin is tight and cannot be fully pulled back, which makes cleaning and passing urine difficult, and increases the risk of penile cancer). This affects 1 in 10 older boys and men. Circumcision reduces the risk of inflammation and infection of the head of the penis and the foreskin, and greatly reduces the risk of urinary tract infections in infants. Uncircumcised men have a 15-60% increased risk of prostate cancer (which affects 1 in 6 men).  We are not uneducated about circumcision. …
That last line is not necessarily true, given what comes before it in that paragraph. The sole source cited for this knowledge is a pamphlet by Brian Morris, which contains no sourcing of its own. (Some of the material in this excerpt is verbatim from Morris, without quotes to indicate as much.) It contains information that is biased and exaggerated.
To the claim that circumcision eliminates the risk of phimosis, this is incorrect. Contrary to the risk of phimosis being a “legitimate reason” to circumcise a healthy child, the ethical standard is that the risk of complications is a legitimate reason to refrain from intervening on a healthy child. Remember, too, that Brian Morris is the cited source for the 1 in 10 claim. He’s stated that all boys are born with phimosis, which is false. Even if the statistic is true, it is that phimosis will affect 1 in 10, not that it will require circumcision in 1 in 10. This mirrors his claim in the pamphlet that “the foreskin leads to 1 in 3 uncircumcised boys developing a condition requiring medical attention.” A condition requiring medical attention is not a synonym for circumcision. This is a rhetorical sleight of hand. The true incidence of medical need for circumcision within an intact male’s life is approximately 1%, which includes for phimosis.
As for the “15-60% increased risk of prostate cancer” statistic, that is a correlation, not a proven fact. “Circumcision before first sexual intercourse is associated with a reduction in the relative risk of PCa in this study population.” To quote the author, “‘These data suggest a biologically plausible mechanism through which circumcision may decrease the risk of prostate cancer,’ said study researcher Dr. Jonathan Wright, an assistant professor of urology at the University of Washington School of Medicine. He noted that the study was observational; it did not show a cause-and-effect link.”
… One of the aforementioned commenters wrote that anyone who would have their child circumcised should have to experience it themselves, first. Well, my husband has experienced it (and remarkably, he gave me his permission to tell the world just now), …
I don’t like that pointless suggestion because it invites that pointless rebuttal.
…and while I have not gone through the completely incomparable horror of female circumcision (I am not going to detail why it’s incomparable here, but I do encourage you to research the differences if you don’t know what they are. You’ll find some information here), …
I know what the differences are. I know what the similarities are. The difference is in degree, not in kind. That difference in degree can be great, of course, but non-therapeutic genital-cutting on an individual without the individual’s consent is not a gendered principle. The WHO defines female genital mutilation as “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.” The perceived difference², including in the link Lute provides, rests on what constitutes a medical versus non-medical reason. If we assume the “no known health benefits” argument against FGM turned into “known health benefits”, would people change their mind and decide it’s no longer mutilation? Some might say “yes”. They’d be wrong. I suspect most people would not change their conclusion. As the WHO states, FGM “also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.” That would still hold true if their were potential benefits. It holds true for male circumcision, as well.
… My husband and I aren’t unfamiliar with pain, and we are willing to put our child through a moment of discomfort for the benefits this procedure provides. Kind of like we’re willing to put our child through a moment of discomfort for the benefits that vaccinations provide.
But is their
child son willing to have the moment (i.e. 1+ week) of discomfort and a lifetime without his foreskin for the potential benefits this procedure provides? (Remember from above that the Lutes do not appear to understand the benefits.)
Circumcision is not like a vaccination. Vaccinations work with the body’s immune system to trigger disease resistance. Circumcision merely removes a part of the body because it might cause a problem later. The comparison needs critical thinking beyond “prevents disease”, lest we further open parental decision-making to other ridiculous interventions.
This piece is both explanatory and pleading. I am pleading with you. Don’t make these perfectly well intentioned families—like us—feel like monsters because you’ve decided to go a different way with your own sons. We’re doing something different, and that’s okay. We each have our reasons. I don’t care whether you breastfeed or formula feed. I don’t care whether you co-sleep or have your babies in their own cribs, and I don’t care whether you’ve named your child something completely traditional (like Kate) or whether she’ll be answering to Zenith for the rest of her life. I’m asking for the same courtesy.
It’s okay to do something different. It is not okay to do this something different. You can’t respect one right of your son less than the same right of his sister and brush it aside as “parenting”. If someone asks me to respectfully tell them they’re wrong, I agree with that request for decency. But I will not respect what is obviously indefensible and deeply offensive to basic human rights.
¹ I don’t call circumcision “abuse”. (c.f. Truth and Loaded Words)
² The other mistake is in thinking that FGM is designed to control sexuality, but that male circumcision isn’t and doesn’t. It controls male sexuality because it forces a specific form on the child for his genitals. (e.g. It’s more aesthetically appealing to women.)
There is also a history, up to the present, in circumcision reducing sexuality. Read Moses Maimonides or this.
Posted: September 20th, 2013 | Author: Tony | Filed under: Ethics, Logic, Parenting, Science | No Comments »
The provocative cliche in the title is a two-way argument. As it was in the AHA Foundation post, and as it is with the frustrating, losing argument comparing circumcision and rape, people can insist on behavior that risks their own credibility. There’s satisfaction in being right, but it’s a seductive mistake to assume that counts for anything. Advocacy is about changing minds. Advocacy requires meeting people where they are, not where one thinks they should be.
Jill Filipovic posted on Mark Joseph Stern’s smear in Slate. Her post is a mix of good and bad.
Every time female genital cutting is mentioned on Feministe — every time — someone from the “intactivist” community shows up to derail the conversation and make it all about the alleged horrors of male circumcision. Intactivists, for the unfamiliar, are men (and a few women) who oppose male circumcision. They claim it’s a violation of human rights, that’s it a physical mutilation, that it’s medically unnecessary and that it reduces sexual pleasure. They’re incredibly active online, and I was interested to see that they aren’t just trolling feminist blogs — they’re showing up in the comments of every article written on circumcision.
As I said in the AHA Foundation post, “those against forced male genital cutting need to be responsible when interjecting into a discussion on FGM/C, including by doing so less often.” Considerably less often, probably. That’s the key point in that paragraph and the one I hope people grasp first.
She leaves open the possibility that the negative behavior she mentions is limited to a few when she wrote “someone from the ‘intactivist’ community” rather than the intactivist¹ community. She makes this mistake in the comments when she writes, “Wait, you mean the intactivists come onto this thread and act like total misogynist assholes? Weird! No one could have predicated that.” A few people do not constitute “the intactivists”. This is the obvious mistake Mr. Stern made. “Never read the comments” is hyperbole, but there is truth in understanding that the comments are not the entirety of the debate. The conclusion against those who oppose non-therapeutic child circumcision is too generalized to be defensible. The way some people use an open forum irresponsibly isn’t indicative of what everyone believes or how they behave.
It’s not that intactivists are wrong about everything. There should be a debate about circumcision, and there is something to be said for the position that it’s ethically wrong to remove a piece of an infant’s body where not necessary to preserve that infant’s life or health. It’s an interesting and important bodily autonomy question. On the one hand, from the strictest perspective, it seems wrong to circumcise a child without his understanding and consent. Yes, circumcision may have some disease-prevention benefits, but it comes with risks as well. On the other hand, parents do things all the time that violate their children’s bodily autonomy; they regularly don’t get their children’s consent on issues that impact that child’s person, and they even directly override their children’s desires. That’s part of being a good parent. Your kid may not want to get a vaccine, but you should probably vaccinate your kid. Your kid doesn’t want disinfectant on that cut, but the cut should get disinfected. Your kid wants to only eat hot dogs every day for the rest of his life, but your kid should probably eat some vegetables.
Circumcision is more serious than a cut and hot dogs, but the vaccination piece is perhaps comparable — it’s an irreversible medical intervention. Personally, I’m sympathetic to the arguments that circumcision is an unnecessary violation of bodily autonomy. Yet if I lived in a place with a high prevalence of HIV, I’d probably circumcise my kid, as recommended by the World Health Organization.
This is an additional reason not to be a jerk to her (or anyone). She’s got the gist. It’s still not acceptable to circumcise minors in areas with a high prevalence of HIV for all the easy reasons. The WHO recommendation is wrong and unethical. The studies only researched voluntary, adult circumcision. The existence of – and continued need for – condoms, as well as the possibility of better prevention or a cure before the child is sexually active, makes waiting for consent a basic requirement. Mr. Stern complained about intactivists not paying attention to studies. It’s not excusable that he made the same mistake by assuming that the studies are transferable to infant circumcision. But see how close Ms. Filipovic is to the complete principle. Being rude is unproductive, in addition to being impolite.
The other problem with talking about this issue with the intactivists who parachute into random comment sections to debate is their nasty habit of playing fast and loose with the facts. Mark Joseph Stern at Slate explains:
The whole piece is worth a read, because circumcision is certainly something worth discussing and debating. But all parties need to come into the conversation honestly. A philosophy or principle may be so correct that it outweighs a conclusion pointed to by the weight of scientific evidence. But then let the philosophy stand against that evidence. Twisting the facts and intentionally obscuring the truth doesn’t help in the parsing of difficult ethical issues.
That’s what I got at in my post yesterday on Mr. Stern’s piece. The observation that some people behave badly is relavent. It isn’t proof against the principle’s validity. His conclusion is too broad, and obviously so. There are honest people in the debate. If a few are to stand as the representatives for all, honest people will be smeared unfairly, as Mr. Stern did.
The debate isn’t just the philosophy standing against the weight of scientific evidence. There is scientific evidence on the side of the philosophy. The normal, healthy foreskin is normal and healthy. It doesn’t require intervention, especially not the most radical intervention. Soap is science. Condoms are science. Antibiotics are science. That isn’t twisting the facts or obscuring the truth. We must stop pretending those facts aren’t involved. We must stop pretending the burden of proof rests with those who advocate against surgery on healthy children.
Citing the HIV benefit, which I concede for the argument, involves stating the facts only if citing the rest of what WHO and the AAP say about its applicability. Ms. Filipovic did. Mr. Stern didn’t. Mr. Stern played fast and loose with the facts.
¹ I wrote this seven years ago.
I’m familiar with the term intactivist. It’s cute and descriptive, but because it’s cute, I do not like it. As the article shows, it does little more than give reporters an excuse to fill in the story with details at which typical readers will roll their eyes. That’s not helpful.
I still agree with it. I think its use here and in Mr. Stern’s essay show the danger in being able to label this way.
Posted: September 19th, 2013 | Author: Tony | Filed under: "Voluntary", Ethics, FCD, FGM, Hygiene, Logic, Media Marketing, Parenting, Public Health, Science | 1 Comment »
It takes a special commitment to ignorance to cherry-pick evidence to prove that opponents cherry-pick evidence. Mark Joseph Stern possesses that special commitment.
There are facts about circumcision—but you won’t find them easily on the Internet. Parents looking for straightforward evidence about benefits and risks are less likely to stumble across the Centers for Disease Control and Prevention than Intact America, which confronts viewers with a screaming, bloodied infant and demands that hospitals “stop experimenting on baby boys.” Just a quick Google search away lies the Circumcision Complex, a website that speculates that circumcision leads to Oedipus and castration complexes, to say nothing of the practice’s alleged brutal physiological harms. If you do locate the rare rational and informed circumcision article, you’ll be assaulted by a vitriolic mob of commenters accusing the author of encouraging “genital mutilation.”
One paragraph in, and there’s so much to unpack. First, the obvious point is that Mr. Stern is another in a long line of lazy writers who thinks that the ability to type a word into Google proves much of anything for a story. If it’s just “a quick Google search away”, in a paragraph filled with links, it’s reasonable to expect an author to include the search he used to get to the evidence of alleged malfeasance. When I use Google to search circumcision, I get Wikiepdia, news articles, KidsHealth.org, the Mayo Clinic, the government’s Medline Plus, Intact America, Jewish Virtual Library, NOCIRC, and so on. I’ll point out that only the results for Intact America and NOCIRC are to something decidedly against non-therapeutic child circumcision, but so what? It’s a search algorithm. That’s easily gamed. It doesn’t prove Mr. Stern’s silly angle.
That “rare rational and informed circumcision article” is another in Hanna Rosin’s string of awful circumcision defenses.
As for the vitriol, this is the internet. Never read the comments. That doesn’t excuse the comments. They’re often offensive and uninformed and the people who engage in that behavior are wrong, even if they’re ostensibly on my side. But you’ll find them on both sides. It doesn’t prove anything on the argument. Using it as evidence against the argument is ad hominem.
So. There are facts about circumcision. Circumcision is the “surgical removal of the foreskin of males”. The foreskin is the “loose fold of skin that covers the glans of the penis”. Those are facts. But he’s implying the context of non-therapeutic male child circumcision. What should parents want?
Parents shouldn’t want anything, of course, because this is not their decision. Just like we don’t allow them to cut off any other normal body parts of their children, they do not possess a right to circumcise their sons for any reason other than immediate medical need that can’t be adequately resolved with less-invasive methods. Proxy consent is not sufficient for non-theratpeutic circumcision. But because our society doesn’t yet grasp the full implication of an equal right to bodily integrity, parents want information. Fortunately, there is scientific evidence against non-therapeutic circumcision!
The normal, healthy foreskin is normal and healthy. If parents leave it alone, as they should, statistics demonstrate that their son(s) will almost never need any intervention for his foreskin, and much less a medically-necessary circumcision.
Of every 1,000 boys who are circumcised:
- 20 to 30 will have a surgical complication, such as too much bleeding or infection in the area.
- 2 to 3 will have a more serious complication that needs more treatment. Examples include having too much skin removed or more serious bleeding.
- 2 will be admitted to hospital for a urinary tract infection (UTI) before they are one year old.
- About 10 babies may need to have the circumcision done again because of a poor result.
In rare cases, pain relief methods and medicines can cause side effects and complications. You should talk to your baby’s doctor about the possible risks.
Of every 1,000 boys who *are not* circumcised:
- 7 will be admitted to hospital for a UTI before they are one year old.
- 10 will have a circumcision later in life for medical reasons, such as a condition called phimosis. Phimosis is when the opening of the foreskin is scarred and narrow because of infections in the area that keep coming back. Older children who are circumcised may need a general anesthetic, and may have more complications than newborns.
Those numbers, from the Canadian Pediatric Society, are hardly compelling in favor of circumcising healthy children. Non-therapeutic circumcision prevents 5 boys (0.5%) from being admitted to a hospital with a UTI in the first year of life. Yet, between 20 and 30 (2-3%) boys will suffer a surgical complication, and another 2 to 3 (0.2-0.3%) will suffer a more serious complication.
The really curious statistic is the last in each group. About 10 (~1%) babies may need to have the circumcision done again due to a poor result. If normal, healthy boys are left with their normal, healthy foreskin, 10 (1%) of them will need a medically-necessary circumcision later in life. Those numbers look curiously similar.
So, to recap the facts in this context, circumcision is the permanent removal of a normal, healthy foreskin from a boy who can’t offer his consent to eliminate the 1% lifetime risk that he’ll need a circumcision.
There are other potential benefits, which Mr. Stern links in great detail. I have no problem including them, regardless of how weak or stupid I think they may be. That still isn’t enough to permit non-therapeutic child circumcision. The inputs into the decision are facts, but their value is not. Each person is an individual with his own preferences that his parents can’t know. What Mr. Stern values is not automatically what I value. Or to make the more appropriate connection, what parents value is not automatically what their son will value. That is why proxy consent requires a stricter standard than consent. A surgical decision that permanently alters a healthy child’s body can’t be permitted within proxy consent.
Mr. Stern writes this curious statement among many curious statements:
… Yet in the past two decades, a fringe group of self-proclaimed “intactivists” has hijacked the conversation, dismissing science, slamming reason, and tossing splenetic accusations at anyone who dares question their conspiracy theory. …
What a specific subset of people do is hardly the entirety of the argument or proof in favor of his position. Again, this is just silly, indefensible ad hominem. But what he says is also untrue. Dismissing science? Not here. I’ll accept any claimed benefit. The argument against forcing circumcision on a child is still as powerfully conclusive. Slamming reason? Stating that normal, healthy children should not undergo surgery is the position using reason. Conspiracy theory? Nope. Parents who circumcise, and people who support that option, are generally well-intentioned. I can show examples where that isn’t true, but I’m aware that such evidence is isolated. It’s surely true that some doctors circumcise for the money. I assume most circumcise because they believe it’s acceptable or believe parents should choose, even if the doctor wouldn’t. It’s important to understand how we got here, but I don’t much care about placing blame for that. I care about moving forward. There are any number of like-minded individuals Mr. Stern could find and talk to rather than write the wrong things he wrote.
… For doctors, circumcision remains a complex, delicate issue; for researchers, it’s an effective tool in the fight for global public health. But to intactivists, none of that matters. …
All of that matters. No one I know believes that adult (or older teen) males shouldn’t be able to volunteer for non-therapeutic circumcision.
Mr. Stern’s tactic here is what he’s complaining about. It’s similar to when Dr. Amy Tuteur goes on a tedious rant about “foreskin fetishists”. Smear your opponents because they smear you. “They”, of course. Internet comments are a part of humanity, not representative of it.
… The first rule of anti-circumcision activism, for instance, is to never, ever say circumcision: The movement prefers propaganda-style terms like male genital cutting and genital mutilation, the latter meant to invoke the odious practice of female genital mutilation. (Intactivists like to claim the two are equivalent, an utter falsity that is demeaning to victims of FGM.)
I’ve written circumcision a whole bunch above. But circumcision is genital cutting, because facts. The comparison is in the principle of those facts. Non-therapeutic genital cutting on a non-consenting individual is unethical. It’s also genital mutilation if we are to accept the WHO definition of female genital mutilation:
Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.
… It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.
The issue is human rights, not a specific subset of human rights from which male minors are somehow exempt.
Anti-circumcision activists then deploy a two-pronged attack on some of humanity’s most persistent weaknesses: sexual insecurity and resentment of one’s parents. Your parents, you are told by the intactivists, mutilated you when you were a defenseless child, violating your human rights and your bodily integrity. Without your consent, they destroyed the most vital component of your penis, seriously reducing your sexual pleasure and permanently hobbling you with a maimed member. Anti-circumcision activists craft an almost cultic devotion to the mythical powers of the foreskin, claiming it is responsible for the majority of pleasure derived from any sexual encounter. Your foreskin, intactivists suggest, could have provided you with a life of satisfaction and joy. Without it, you are consigned to a pleasureless, colorless, possibly sexless existence.
Some take that approach. I only speak for myself on being unhappy with circumcision. I’ll quote myself on his generalization:
… The problem is not that circumcision is bad, per se. Healthy men who choose to have themselves circumcised are correct for their bodies. Men circumcised as infants who are happy (or indifferent) about being circumcised are also correct for their bodies. …
But if you only dive into comments sections, it’s easy to believe that’s the only opinion. It’s not excusable to believe that, but it’s easy.
Intactivists gain validity and a measure of mainstream acceptance through their sheer tenacity. Their most successful strategy is pure ubiquity, causing a casual observer to assume their strange fixations are widely accepted. Just check the comment section of any article pertaining to circumcision. …
Take, for example, the key rallying cry of intactivists: That circumcision seriously reduces penis sensitivity and thus sexual pleasure. …
My “key rallying cry” is that circumcision is medically unnecessary and violates the child’s basic rights to bodily integrity and autonomy. That holds up even if the rest of his paragraph’s citations hold up. Sexual satisfaction is a subjective evaluation to each individual. The ability to orgasm is not the full universe of sexual satisfaction. And any change to form changes function. The individual may view that change as good. He may view it as bad. Parents can’t know. That’s the ethical flaw in circumcising healthy minors.
… Study after …
Surely Mr. Stern read through the studies to understand exactly what they say. I have my doubts. I read it. That study is problematic when viewed as conclusively as Mr. Stern cites it. It requires nuance the study’s author provided. Does an appeal to authority sweep away any concerns about limitations?
… study after …
“Adult male circumcision does not adversely affect…” Is that proof that circumcision of male minors doesn’t affect sexual satisfaction, with the glaring caveat against surgery that such a male can’t know?
It’s also worth noting that Mr. Stern linked that same study again later in the paragraph. He also linked another study in consecutive sentences. And a third. That’s deceptive and improperly gives an impression about “an entire field of resarch”, no?
… ([No adverse effect] fits with what my colleague Emily Bazelon found when she asked readers for their circumcision stories a few years ago.) …
Ms. Bazelon’s premise and finding were ridiculous.
So much for circumcision’s supposedly crippling effect on sexual pleasure. But what about its effect on health? Intactivists like to call circumcision “medically unnecessary.” In reality, however, circumcision is an extremely effective preventive measure against global disease. …
The potential benefits don’t render non-therapeutic circumcision “medically necessary”. Earlier he complained about propaganda-style terms. Pretending that “medically unnecessary” doesn’t have an accepted, factual meaning is propaganda-style question begging.
… Circumcision lowers the risk of HIV acquisition in heterosexual men by about 60 to 70 percent. … [ed. note: (Later in this paragraph, he uses the WHO link again.]
The “60″ link states “male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence.” Not one of those three criteria matches a Western nation. Those studies also involved adult volunteers, not unconsenting minors.
As both a personal and public health matter, circumcision is clearly in men’s best interest. …
Ethically, as a personal health matter, each healthy individual should decide for himself what body alterations are in his best interest based on his own preferences.
… Anyway, to intactivists, mutilation is mutilation; what does it matter if it’s for the greater good?
“The greater good” doesn’t matter because individuals are humans with rights, not statistics to be treated without regard for what they need or want. Life is full of risks. Because we seemingly can mitigate that does not mean we may or should.
Posted: September 5th, 2013 | Author: Tony | Filed under: Ethics, Logic, Mission, Public Health | No Comments »
Dr. Lindsey Doe, a clinical sexologist, hosts sexplanations on YouTube. It’s an excellent show that educates viewers on human sexuality. In the latest episode, “How to Deal with Sexual Injustices”, she talks about injustice with a focus on male circumcision. She is spot-on in her analysis and how to approach this injustice on a personal level. Please watch. (It’s obviously NSFW based on strong language and topics.)
The circle she created about circumcision is an excellent starting point. (Here’s a screencap of that circle.)
Posted: August 20th, 2013 | Author: Tony | Filed under: Ethics, FGM, Mission | 1 Comment »
This almost-good post from the AHA Foundation, FGM is Not Female Circumcision, and Other Thoughts on Terminology, is worth discussing for the reason it is not good.
The premise that female genital mutilation (FGM) is not “female circumcision” is correct. Language matters. In basic semantics, calling FGM “circumcision” is inaccurate. The etymology of the word circumcision means “to cut around”. That can be done to the female prepuce, in a sense, but that’s not how we understand it. I’m willing to grant this, and the result that the term circumcision doesn’t apply to females.
The gist of the AHA Foundation’s post is about the ethical implications from terminology:
A number of organizations and advocacy groups refer to the procedure as “female genital cutting”, or “FGM/C” to encompass both terms. The argument for “cutting” instead of “mutilation” primarily hinges on the belief that mutilation implies malicious intent on the part of parents or the community, or is otherwise demeaning or insensitive to the cultural particularities of any group that performs FGM. Some argue that referring to it as cutting is a less provocative and more balanced term. Particularly when speaking with those who have undergone the procedure themselves or in reaching out to affected communities, we do see the value in using the more neutral terminology of “cutting” rather than “mutilation”, but otherwise believe it important to state clearly that the procedure is a form of abuse.
I agree with that. What is done to the healthy genitals of females without their consent in any form of FGM/C is morally and ethically wrong. It is indefensible. We must be clear that this violence is abuse. It should never be tolerated.
The AHA Foundation’s post fails because of its next-to-last paragraph.
The argument for referring to FGM as “female circumcision” is blatantly off-base. Female circumcision was the popular term until approximately the 1980s, when FGM and FGC came into usage. As mentioned above, to perform a procedure that parallels male circumcision, one would only remove the prepuce of the clitoris, something that is hardly ever done. (The prepuce is the “hood” or fold of skin that surrounds the clitoris and has no impact on sexual arousal or pleasure.) In nearly all cases, at minimum, either part or all of the clitoris, labia minora, labia majora is removed. To use the term “circumcision” to refer to what is happening to these girls minimizes the brutality of the procedure and ignores the fact that is an act of violence.
First, the paragraph is likely factually wrong when stating the clitoral hood has no impact on sexual arousal or pleasure. It’s bizarre that this made it into the post. I suspect the connection is an implication that the male prepuce also has no impact on sexual arousal or pleasure. Whether the clitoral hood affects arousal or pleasure, its removal would alter the woman’s sexual experience. That is a reason removing it without the individual’s consent is unethical. The parenthetical makes no sense.
To my point, since the post brought it up, what parallels male circumcision is not the only consideration. There are recognized forms of FGM/C less harmful than male circumcision. Much, if not all, of Type IV is comparable to or less harmful than a typical male circumcision. The stated, correct argument against FGM/C in the post (and elsewhere) is that any genital cutting on a female without need or her consent is wrong. (Including removal of the prepuce.) Any lesser conclusion or implication for male circumcision is moral relativism.
The paragraph’s flaw is its implication that FGM/C should not be called circumcision because circumcision is not a brutal act of violence. I doubt this is what the author means. I trust that the AHA Foundation recognizes that males possess the same “basic rights and freedoms” listed on its About page, including “security and control of their own bodies”. But the argument in that paragraph is predicated on minimizing a form of genital cutting, and based solely on gender. The general thrust of the debate is that FGM/C is often done with crude instruments in unsanitary conditions. It is. However, no one suggests that FGM/C performed in a hospital setting with clean instruments is somehow acceptable. At its core, cutting healthy genitals without the person’s consent is the issue.
The accurate approach would’ve been to leave out male circumcision and focus the paragraph accordingly. It would not be difficult. For example: “The term circumcision minimizes the brutality of genital cutting without need or the individual’s consent and ignores the fact that it is an act of violence.”
I do not believe those focused on ending FGM/C are required to actively advocate against male
circumcision genital cutting. I expect them not to state or imply that male genital cutting without need or consent is acceptable. I expect them not to do this, from an exchange that started with the bottom tweet¹:
They responded to me:
We’re not advocating for anyone to be cut, only trying to point out the severity and harm done with #FGM.
I recognize that, as I indicated. But the response to Mr. Cummins was incorrect. There is no excuse for saying something false. (Or following up in agreement to his ad hominem.)
An organization that carelessly ignores the broader foundational principle to its work deserves no credibility. Every point that rejects FGM/C in the post applies to male genital cutting. In the points where the severity between the two is almost always different, and radically so, that is a critical distinction I’ve highlighted before. But something that should inform punishment rather than legality should not be used so recklessly. FGM/C isn’t made less terrible just because generally less-severe male genital cutting violates the same principle. Yes, those against forced male genital cutting need to be responsible when interjecting into a discussion on FGM/C, including by doing so less often. The same need for responsibility holds true for those who advocate against FGM/C.
¹ Contrary to Mr. Cummins’ rant, the argument is that non-therapeutic genital cutting on a non-consenting individual is wrong. There is almost always a difference in the degree of harm imposed from male and female genital cutting. It is often significant. But as the information in the AHA Foundation’s post also demonstrates, there is no difference in kind.