Flawed Circumcision Defense: Karin Klein

Posted: December 10th, 2014 | Author: | Filed under: Ethics, FCD, FGM, Science | 1 Comment »

Encouraging half-baked opinions, like this one by Los Angeles Times reporter Karin Klein, is the inevitable result of the CDC’s proposed recommendation. The opinion piece is titled, “It’s time to end inaccurate criticisms of male circumcision”, which suggests its author should not offer an incomplete analysis in defense of male circumcision. That is what Ms. Klein offers.

The recent report by the U.S. Centers for Disease Control and Prevention should quell the unfounded arguments that male circumcision is no better than or different from female circumcision, also known as female genital mutilation. According to the draft guidelines released by the CDC, the benefits of male circumcision clearly outweigh the risks, in the form of reduced risks of urinary tract infection as infants and penile cancer later in life, and lower risk of contracting HIV and other sexually transmitted diseases.

The short version of her essay is “Shut up.” It’s her introduction and conclusion. Alas¹, no.

“According to the draft guidelines released by the CDC” involves undue weight for the recommendation. The CDC’s conclusion is subjective. The equation is not merely benefits versus risks. There is a direct cost (i.e. harm) in the loss of the foreskin. That matters, yet it isn’t factored into the CDC’s analysis (or the AAP’s before it or Ms. Klein’s here). And the CDC ignores the individual foreskin owner’s preferences. Someone might value his foreskin more than reduced risks of future maladies. As I do. It isn’t defensible to declare that the potential benefits “clearly” outweigh the risks, for everyone, or that this demonstrates anything conclusive.

The comparison of male circumcision to female genital mutilation rests on the principle involved, not indifference to the disparity in recognized potential benefits. Non-therapeutic genital cutting on a non-consenting individual is unethical. Minimal or maximal cutting is relevant for punishment, but not for whether the individual’s human rights are violated. A female owns her body from birth, including her genitals. A male owns his body from birth, including his genitals.

It’s understandable that circumcision has become controversial. It’s a permanent change made to the body, usually in infancy. (It should be noted that parents make all kinds of decisions that affect their children’s lives permanently; circumcision happens to be a particularly visible one.) …

It’s a permanent change made to the healthy body. Defending this removes any limitation on what parents may do. It isn’t that it’s a particularly visible effect. It’s that circumcision alters the child’s body without need. Proxy consent requires the patient’s need, not the proxy’s preference. Non-therapeutic circumcision is still cosmetic surgery, contra the silliness Ms. Klein will shortly suggest.

Nor is non-therapeutic circumcision acceptable because parents make all kinds of decisions. This common argument rests on the flawed premise that a) Parents make decisions for their children, b) Non-therapeutic genital cutting is a decision, therefore c) Parents may cut the healthy genitals of their children sons. It’s ridiculous. Treating all decisions equally to defend an extreme, gendered decision makes no sense. It imagines a strange scope of parenting we don’t accept, as evidenced by the required strikethrough in c) to narrow the conclusion to what parents may legally decide on non-therapeutic genital cutting. It’s about parental rights only to the convenient extent that it maps to what we want to do. It’s arbitrary.

The CDC report won’t end the debate, nor should it necessarily do so. Perhaps its most important short-term good will be to increase the likelihood that the procedure will be covered by health insurance, because circumcision could not be viewed as solely a cosmetic procedure, but rather one that carried health benefits backed by the most current scientific research. That gives parents the option — either way.

It is still cosmetic surgery, even with potential health benefits backed by the most current scientific research. It is backed by an incomplete analysis of all factors involved. Arguing only from potential benefits and risks without factoring in the costs (i.e. harms), as well as preferences for how an individual weighs those three aspects for himself, is biased, inaccurate nonsense. The CDC shouldn’t peddle it. Ms. Klein shouldn’t defend it.

But it should end the scurrilous argument that male circumcision, with its very low complication rate, is mutilation on par with female circumcision. There are no known health benefits to female genital circumcision and a long list of not-uncommon consequences, including fistulas, abscesses and childbirth complications.

If Ms. Klein is going to use a word like scurrilous to criticize critics, she should first understand mutilation. Should we assume that a case of non-therapeutic female genital cutting without the girl’s consent that doesn’t result in a complication, or at least only a “very low complication rate”, isn’t actually mutilation? I assume Ms. Klein’s answer is the correct answer, which is “obviously not”. We can also search for the unifying principle that shows how weird it is to argue that parents should have the choice to surgically alter the bodies of their children, except this choice is for sons only because we’ve researched that. For example, in the WHO factsheet on Female Genital Mutilation, this:

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.

Partial removal or other injury to the genital organs for non-medical reasons? As long as you don’t foolishly suggest “reduced risk of X” is somehow a medical reason² for non-therapeutic circumcision, removing the foreskin is clearly such an injury.

And:

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.

Removing and damaging healthy and normal genital tissue, and interferes with the natural function of bodies? Male circumcision fits that, too. Without need or consent, male circumcision is indefensible genital mutilation. Awareness of potential benefits does not change the equation. It is mere question-begging.

Of course, even religious traditions shouldn’t outweigh health concerns. Just as female genital mutilation is outlawed in this country no matter what the religious beliefs of the parents, if the CDC report had found similar complications with male circumcision, then there should be serious conversations about whether the procedure should be allowed. But that’s not what the science shows; until there is solid evidence to contradict the CDC report, conversations about restricting parents’ ability to make this decision for their sons should end.

It makes sense to ask if the boys who suffer the complications, including the most serious outcomes, could be considered mutilated, or is it merely based on the intent we assume for the parents? (The simplistic, “Male genital cutting is well-intentioned. Female genital cutting is ill-intentioned.”) But complications and consequences are unique. Consequences includes the costs (e.g. loss of the foreskin). That ignored aspect is what makes non-therapeutic male circumcision an unacceptable parental choice. Again, using the subjective conclusion that the benefits outweigh the risks while excluding the factual harms and the child’s preference is an incomplete analysis. Demanding, as Ms. Klein does, that we guide policy on this subjective opinion is ludicrous.

The CDC’s recommendation and Ms. Klein’s demand aren’t made better by using SCIENCE! as an incantation. Å normal, healthy foreskin is science. The numerous methods short of circumcision to prevent and/or treat maladies are science. A condom is no less SCIENCE! than circumcision. Antibiotics are no less SCIENCE! than circumcision. Soap and water are no less SCIENCE! than circumcision. It might be interesting that parents prefer SCIENCE! to SCIENCE!, but the issue involves ethics. The ethics are the same, whether it’s daughters or sons. Non-therapeutic genital cutting on a non-consenting individual is unethical. We all have the same basic rights. Non-therapeutic genital cutting without the individual’s consent violates her – or his – basic human rights.

¹ The piece includes a “Shareline” suggestion to tweet out a link to it with propaganda, “There are reasonable debates about male circumcision — but not about its benefits vs. risks”. That’s also nothing more than “Shut up”. It poisons the conversation by setting boundaries on what’s “reasonable” to debate. It’s also incorrect.

² The factsheet makes it clear that this would not be accepted for any non-therapeutic female genital cutting, as the law against FGM in the United States also makes clear. There is a principle, and it doesn’t negate the principle of equal rights simply because we’ve agreed to study the possible benefits of cosmetic surgery.


One Comment on “Flawed Circumcision Defense: Karin Klein”

  1. 1 Choose Intact » Blog Archive » The Trauma of Small Numbers said at 4:32 pm on May 26th, 2015:

    […] critical to continue highlighting and objecting to garbage initiatives like the CDC’s recent draft proposal that focuses on infants. We’re convincing people that it’s time to stop […]


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