Flawed Circumcision Defense: Yair Rosenberg

In what appears to be an attempt at a GOTCHA! in response to the German court ruling, Yair Rosenberg offers a weak effort touting the potential benefits of non-therapeutic circumcision. He opens:

“Male circumcision is a highly significant, lifetime intervention. It is the gift that keeps on giving. It makes sense to put extraordinary resources into it.”

Who would you guess recently offered this paean to foreskin fleecing? A rabbi? An imam? Nope. Try U.S. AIDS coordinator Eric Goosby at a health convention last month for top officials from 80 countries.

This smacks down the logic of a German regional court that has banned religious circumcision, calling the practice a “serious and irreversible interference in the integrity of the human body.” …

Mr. Goosby’s statement, used as an appeal to authority, does not smack down the logic of the German court. Circumcision can impart potential benefits when it is imposed on a healthy child, while meeting the court’s statement that it is a “serious and irreversible interference in the integrity of the human body”. The imposition on a healthy child makes it unethical. There is no need for an allegedly-required belief that the science isn’t real. Mr. Rosenberg’s argument focuses on ends without a complete consideration of the means.

He next offers the inevitable appeal to a reduced risk of HIV. As almost every advocate does, he omits the relevant caveats. The risk reduction is in female-to-male HIV transmission in high-risk populations. Neither describes the HIV epidemic in any Western nation, including Germany. Even if it did, the studies involved voluntary, adult circumcision, not infant circumcision. That’s the ethical question. Infants can’t consent. They also won’t be having sex any time soon. There is no immediate need to force non-therapeutic circumcision on them for this potential benefit.

His next tactic is revealing. He quotes a story on the HIV studies. The story quoted unnamed federal health officials who declared that the studies were halted early because the findings made it “unethical to continue without offering circumcision to all 8,000 men in the trials”. Okay, fine, they offered circumcision to the control group. Mr. Rosenberg states:

Unethical not to circumcise the men.

No. Researchers deemed it unethical to not offer circumcision to the control group. That’s a huge difference. The control group men retained the right to reject circumcision. One might say this distinction is “highly significant”. Mr. Rosenberg seems to have missed the entire ethical issue. The issue is the imposition of circumcision, not whether or not someone could (or should) conclude that circumcision for himself is awesome because of various possible benefits.

He returns to an appeal to authority:

… The American Academy of Pediatrics is soon expected to come out with a new policy pushing circumcision, reversing its prior stance.

I’m not a fan of the “no medical association recommends it” argument because it’s an appeal to authority and because it could change. But the same problem applies to using a medical association’s support. In the latter case, it’s an evaluation without regard for what the individual needs or wants. It’s untethered from rights and reason.

He continues (emphasis added):

Given this impressive scientific consensus as to the medical dividends of male circumcision, the German court’s judgment—which permits circumcision for “medical reasons”—is a confused and ignorant muddle. Some have rightly criticized it as an assault on millennia of Jewish tradition and practice (not to mention Islam), something one would have thought a German court would be sensitive enough to avoid. But the ruling itself, as the research above amply demonstrates, is logically incoherent and factually wrong for a simple reason: All circumcisions are medically beneficial. Whether or not the procedure stems from religious motivations, it will have measurable health benefits. So by the court’s own reasoning, all religious circumcisions ought to be permissible as long as the parents also want the medical dividends—which effectively means that circumcision has not been banned at all. Of course, it is very unlikely that this is what the court intended and much more likely that it was entirely unaware of the scientific consensus surrounding circumcision’s advantages.

First, it seems clear that the court meant “medical reasons” to mean “medically necessary”. In saying that the court’s reasoning renders non-therapeutic circumcision valid based on merely mouthing the words “medical benefits”, he is echoing the silly argument many push that pretends prophylactic circumcision is “medical” circumcision. It is not. Non-therapeutic child circumcision involves proxy consent, not consent, so the only valid medical reason is need. As Mr. Rosenberg acknowledges, this interpretation is not likely the court’s intent. Assuming that this means the court was unaware of the science is too convenient. It begs the question. “They ruled circumcision is harm, so obviously they didn’t consider the benefits. If they had, they’d know that all circumcisions are medically beneficial and rule accordingly.”

Within either analysis, his conclusion is still wrong. The italicized bit is Mr. Rosenberg’s personal evaluation. It is his subjective conclusion based on his preferences. (He indirectly admits this later.) It is not an objective fact. The only objective fact is that circumcision inflicts some guaranteed level of harm. There is also the possibility of unexpected harm reflected in further complications, which contradicts his “all circumcisions” insistence.

Not everyone will value the potential benefits the way he does. I don’t. The HIV benefit he cites, the one that barely applies to Western societies, is effectively moot if a male simply wears a condom when he has sex. The same ease of prevention applies to HPV, for which there is also a vaccine approved for females and males already exists. And so on. The remaining benefits are generally achievable through less invasive preventions and/or treatments. The most invasive surgical option on children as a prophylactic measure can’t be justified ethically.

Or to put it in extreme terms, is circumcision medically beneficial to the boys who will lose more than their foreskin? What about the boys who die? Is circumcision medically beneficial to them? All circumcisions are medically beneficial, right?

He also misstates the goal of activists:

But that scientific consensus reveals more than just the follies of this German court; it also exposes the deeply problematic aims of American advocacy groups which seek to outlaw circumcision for the entire United States. …

The goal is to prohibit non-therapeutic circumcision on non-consenting individuals. It is not to outlaw circumcision, full stop. That’s his meaning, but precision matters here, just as it does when discussing the reduced risk of female-to-male HIV transmission in high-risk populations.

After trotting out the tired “why do you hate the poor?” argument, he writes:

… It’s one thing to abstain from a potentially medically beneficial procedure due to personal convictions; it’s quite another to enforce those convictions coercively on others.

Children who have circumcision forced on them do not get to abstain due to personal convictions. They had someone else’s convictions enforced coercively on them. If Mr. Rosenberg understands the ethical issues involved, he hasn’t shown it yet.

Ultimately, those who seek to ban circumcision as the essential equivalent of child abuse—from this German court to activists who recently attempted to bar the practice in San Francisco—are doing so in the face of tremendous scientific evidence to the contrary. Their claims are at odds with countless studies, not to mention global health policy. The burden of proof, then, is upon these activists to defend their disregard for this science, not on the majority of Americans who choose to circumcise their children and take advantage of its documented benefits.

This isn’t how the burden of proof works, since proponents of non-therapeutic circumcision on non-consenting children are the people advocating intervention contrary to the normal, healthy body. It warrants an answer, regardless. I do not disregard this science. I accept it all. I just don’t foolishly pretend that the possibility of a benefit permits me to disregard ethics or the vast amount of science beyond claimed benefits from non-therapeutic circumcision. The normal, healthy foreskin is science. The ability of soap and water to cleanse the penis, foreskin included, is science. Condoms are science. The power of antibiotics to treat infections is science. If we are to take Mr. Rosenberg’s narrow reasoning as a valid replacement for ethics, any surgical intervention on a child becomes acceptable if some rationale about possible benefits can be found. There is no limiting principle that respects rights. It’s based on one’s preference for circumcision about one’s child, without regard for what the child needs or might (not) want.

He concludes¹ with this:

After all, individuals are free to discount scientific evidence on the basis of value considerations, even dubious ones, and base their life decisions upon that calculus. But such subjective notions should never form the basis for coercive state policy any more than, well, religion.

Individuals are free to discount scientific evidence on the basis of value considerations. I do. I accept the benefits, but I value other aspects of the issue more. Ethics, bodily integrity, and normal body parts all matter more to me than the possible benefits. Whether that’s dubious or not for me is not for anyone else to decide. Yet I don’t have any freedom on this. My parents had me circumcised. They made my decision on their subjective calculus. It was the basis of their coercive parental policy. If the issue is force, and it is, the only illegitimate force exercised here is circumcising healthy children. Prohibition is the defensible position.

If we want to discuss whether prohibition is the best approach to solving the violation of non-therapeutic circumcision on non-consenting individuals, that’s a discussion worth having. Cultural change is likely to be far more effective. Society, in general, and religions, specifically, have changed. There’s no reason to believe it can’t happen here. It should. It will. In the meantime, though, children are having their decision made with force. Agitating for change through multiple avenues, including the law, is reasonable.

¹ He actually concludes with “Your move, Foreskin Man.” That’s not an argument. I’ve written what I need to say on that topic.