It’s frustrating to read people writing about the science of non-therapeutic infant circumcision while omitting ethics and a full consideration of what constitutes harm. Such is the case with a series of posts at SquintMom. The blogger, Kirstin, is doing a series of three posts, “What the Science Says About Circumcision”. Part 1 on the benefits is here. Part 2 on the risks is here.
I have a lot to say on the two entries posted so far, but I’d rather organize my thoughts into identifying a more generalized flaw in the series. As I said, this is primarily the ethics of applying the science. Several times in Part 1, she uses parentheticals to explain the circumcised men in the studies. “With their permission”. “With their consent”. This matters. She concludes that there aren’t enough benefits to support routine circumcision in the U.S., which is the right conclusion. But her assumption seems to be that some level of benefit could justify routine infant circumcision. That’s too utilitarian. Individuals have different levels of risk aversion. A male’s willingness to accept risk may be greater than his parents’. We can’t know. Even if our HIV problem in the U.S. matched that of sub-Saharan Africa, I wouldn’t want to be circumcised. I’m responsible. I do not need circumcision to reduce my risk beyond the trivial risk I would face. No level of benefit could justify circumcising me without my permission and consent.
A willingness to carry “I don’t know” through its implications is the better conclusion for Part 2. That’s not what she offers. It’s incorrect to say “[i]t’s fine to make a decision based upon values”, as she did in her intro to Part 1. Circumcision causes physical harm, contrary to her conclusion. That she thinks that isn’t “significant”, a subjective word in the application of the science to healthy individuals, isn’t relevant to what we should allow parents to do to their – male, only¹ – children. What does the healthy male want? She mistakenly gives this no weight in her conclusion.
On the topic of harm, it’s worth starting on the legal point. Legally, all surgery is battery. Circumcision is surgery. Therefore, circumcision is battery. It is physical harm. It removes the normal, healthy foreskin. It involves risks, however insignificant they may seem to anyone other than the patient. Someone will be the statistic. He matters, too. (Again, this omission is why utilitarianism is awful.) It leaves a scar in every case. There is objective, guaranteed physical harm. To conclude that there is no physical harm to every circumcised male rather than just those who experience complications, as she did, is factually incorrect.
The legal defense to surgery as battery is consent. But non-therapeutic infant circumcision involves proxy consent, which requires a different standard. The objective is least invasive procedure possible that preserves the patient’s choices to the greatest extent possible. Since there is no procedure indicated because the child is healthy, there is no decision to be made. Permitting non-therapeutic circumcision is unethical. To address SquintMom’s recent post, “Options, Ethics, and Moral Imperatives”, a society’s overarching social philosophy can be wrong. Here, it is because non-therapeutic (i.e. “routine”) child circumcision involves objective, permanent physical harm without objective benefit.
As an example of where SquintMom went astray, I think this is a solid example (emphasis in original):
While the foreskin has sensory function (Taylor et al), there is no scientific evidence to suggest that the loss of these receptors affects sexual satisfaction or the intensity of the sexual experience for men. One study even goes so far as to suggest that while there isn’t currently evidence to support the notion that circumcision somewhat desensitizes men, even if such evidence existed, it wouldn’t necessarily be a bad thing, given that more men (and their partners) complain of premature ejaculation than complain of inability to achieve orgasm (Burger et al). While Burger doesn’t go so far as to suggest circumcision to prevent problems with premature ejaculation, these observations do put into perspective the “intactivist” argument that circumcised men don’t enjoy sex as much as they otherwise would; clearly, for the vast majority of men, enjoying sex isn’t a problem. The scientific evidence does not support the notion that male circumcision diminishes sexual performance in men, nor sexual satisfaction in men or women.
First, note the utilitarianism again. The foreskin has sensory function, but no evidence suggests… More men complain of X than complain of Y. That doesn’t eliminate the possibility that a man will want that sensory function or the concern for Y and the individuals who experience that. (I do not assume it is a direct result of circumcision.) Apart from the obvious fact that the loss of that possibly irrelevant sensory function still constitutes harm, SquintMom’s statement implies that all men value everything in the same way, or that they “should” value X more than Y. That’s obviously false. I don’t like coffee. Therefore, you don’t like coffee. Valid?
Clearly, for the vast majority of men, enjoying sex isn’t a problem. Yep. So? The better response is to carry through the implications of “I don’t know”, since we can definitively say not all circumcised males will enjoy sex. Specifically, we need not go beyond the men who are the statistics, the ones who incur a complication that is severe. The number of males who lose their glans, their penis, or their life is small, but the number is not zero. Who is going to be that male? We don’t know. Permitting parents to cause harm by applying the science of “no scientific evidence of harm” to their healthy – male, only – children means there will be males who either don’t enjoy sex or don’t live to enjoy sex. Applying the science of “no scientific evidence of harm” also assumes we won’t find any evidence in the future. The truth is that we don’t know.
She mostly expresses this point (e.g. “untestable claim”), but it’s not complete. Even ignoring what I wrote above on harm, it’s not definitive from her case that there is no physical harm from male circumcision. There is the possibility we’ll know more. In proxy consent, it doesn’t make sense to then apply the science of today permanently to the healthy body of another person based on parental values.
¹ In her first post, she prefaced the series with “[f]emale circumcision is a completely separate practice, occurring for the express purpose of destroying sexual function.” She is wrong on both positions. (She repeats the former in the comment section of Part 2.) Female genital mutilation is usually imposed with that purpose, but not always. Cultural behaviors are complex, as she points out in her series. Why should it be different on something we (rightfully) abhor? (c.f. Consider these three posts.)
Anyway, the comparison is non-therapeutic genital cutting on a non-consenting individual. It can’t be wrong for one gender but acceptable for the other. There is no parental right to cut sons. That’s a bizarre world in which males and females have unequal rights to their own bodies. There is either a parental right to cut the genitals of healthy children, or no such right to cut healthy children. We rightly call the removal of a healthy girl’s clitoral hood “mutilation”. There is no ethical, legal, or scientific distinction to avoid protecting the analogous healthy body part in males.
This is what the World Health Organization states on FGM. It consists of four types, including type 4:
Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.
Surgical alteration of the normal human body is harm.
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.
Would WHO rebrand female genital mutilation to “female genital cutting” and declare it an acceptable parental choice if some health benefits were found? I find the possibility doubtful, at best. So why shouldn’t we also apply the basic logic of harm as “removing and damaging healthy and normal genital tissue, and interferes with the natural functions of bodies” to males? It’s okay to do this without their consent because of cultural values? That’s absurd.