Framing with Reason or Emotion

Posted: December 11th, 2014 | Author: | Filed under: Media Marketing | No Comments »

Dr. Adam Aronson, for Kids First Pediatric Partners, has an explainer, “Circumcision: A Parent’s Choice”. It’s predictable rather than what it should be. But given that there are countless versions of this same refusal to take the ethical stand, I highlight this one because it’s poorly framed in an instructive way.

Reasons Parents May Choose Circumcision
There are a variety of reasons why parents choose circumcision.

Medical benefits, including:

  • A markedly lower risk of acquiring HIV, the virus that causes AIDS.
  • A significantly lower risk of acquiring a number of other sexually transmitted infections (STIs), including genital herpes (HSV), human papilloma virus (HPV), and syphilis.
  • A slightly lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised (sic) infant boy has about a 1 in 100 chance of developing a UTI in the first year of life.
  • A lower risk of getting cancer of the penis. However, this type of cancer is very rare in all males.
  • Prevention of foreskin infections.
  • Prevention of phimosis, a condition in uncircumcised (sic) that makes foreskin retraction impossible.
  • Easier genital hygiene.

These are stated as facts. I concede¹ them as facts for my purpose here, even though I think it’s critical to mention, for example, that the relative risk reduction for female-to-male HIV transmission applies to populations with high incidence of HIV and low circumcision rates, which doesn’t map to the HIV problem in the United States. Also, the absolute risk is tiny. Whatever. Yay, facts, I guess, because none of that justifies applying them to the normal, healthy foreskin of a child (i.e. parental choice).

But that isn’t the issue. This is:

Reasons Parents May Choose Not to Circumcise
The following are reasons why parents may choose NOT to have their son circumcised:

  • Fear of the risks. Complications are rare and usually minor but may include bleeding, infection, cutting the foreskin too short or too long, and improper healing.
  • Belief that the foreskin is needed. Some people feel the foreskin is needed to protect the tip of the penis. Without it, the tip of the penis may become irritated and cause the opening of the penis to become too small. This can cause urination problems that may need to be surgically corrected.
  • Belief it can affect sex. Some feel that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life.
  • Belief that proper hygiene can lower health risks. Boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis, and STIs.

Parents “fear” the rare and usually minor risks, yet the potential benefits were presented as parents’ reasoned approach to risks rather than parents circumcising because they fear statistically-unlikely problems. This is especially odd since most of the potential problems used to justify non-therapeutic infant circumcision are even less likely to occur during the years parents are responsible for their child’s health.

Parents hold a “belief” that the foreskin is needed. They “feel” the foreskin protects the tip, as if circumcision removes only the foreskin around the tip of the boy’s penis. And the transition to the facts of irritation and possible meatal stenosis holds the stigma of “belief” rather than “reasons not to remove an individual’s normal, healthy foreskin without his consent”.

Parents may have a “belief” that circumcision can affect sex, even though this is a fact once the foreskin is gone. Changing form changes function. It doesn’t have to get to a change in sensitivity.

Parents trust in “belief” that proper hygiene² can lower health risks, which we know is a fact. It’s also our default expectation that parents properly care for every normal part of a child, except a boy’s foreskin, because that has a hygiene exception where surgery is somehow justifiable as a parental choice.

This frame appears over and over again. “Reasonable” people understand that circumcision provides important benefits that are “good”, as the Los Angeles Times Shareline demanded yesterday. It appears in almost every interview Dr. Douglas Diekema gave on behalf of the AAP or CDC in the last few years, such as when he said “If you talk to reasonable people about what the data shows… it’s real. …” Circumcision is designated as the rational approach. Parents who impose it are presented as more rational because they looked at facts, at science. Parents who respect their son’s normal, healthy body as they respect their daughter’s normal, healthy body are presented as emotional, anti-science, or “foreskin fetishists”. Their argument allegedly amounts to nothing more than “don’t hurt the babies”. They “believe” in spite of facts.

Here’s the first list again, processed through the second list’s filter:

Reasons Parents May Choose Circumcision

  • Fear of HIV, even though the absolute risk of female-to-male vaginal transmission in the United States is markedly low.
  • Belief that he will be at risk of other sexually transmitted infections (STIs), including genital herpes (HSV), human papilloma virus (HPV), and syphilis. Condoms protect significantly better against STIs, and a vaccine exists for HPV that is approved for males, as well.
  • Belief that the adhered, non-retractable foreskin could trap dirt, leading to a UTI. Some research suggests that infant circumcision causes at least as many UTIs as it prevents.
  • A belief that foreskins lead to cancer of the penis. However, this type of cancer is very rare in all males.
  • A belief that the foreskin can’t be cleaned sufficiently, leading to infections.
  • Belief that phimosis is more common than it is and can only be treated with circumcision. Steroid creams and manual stretching can often resolve non-retractable foreskin issues.
  • Fear of smegma. Males and females produce smegma. Regular bathing minimizes risk.

How does it look now?

Proponents of parental choice need to reconsider their support, for they are wrong. They must prioritize the facts of the boy’s (i.e. the patient’s) present, and how there is no problem in need of the most invasive solution. Science without ethics is a monstrosity posing as a reasoned set of facts. There is no defense for prioritizing fear of a statistically-unlikely future to imagine validity for parental choice for non-therapeutic genital cutting of children (male-only, “obviously”) now.

¹ I do not concede them as valid justifications. I’ve omitted the social and religious reasons sections from discussion. Potential medical benefits are insufficient to justify non-therapeutic child genital cutting. Social and/or religious reasons should obviously be recognized as particularly insufficient to justify proxy consent for (non-therapeutic) surgery.

² I do not concede this item as a fact, even for rhetorical purposes. “Easier” caters to the ignorant and lazy. This should be clear from Dr. Aronson’s last paragraph, “What If I Choose Not to Have My Son Circumcised?”.

… Keep in mind that the foreskin will not fully retract for several years and should never be forced. When your son is old enough, he can learn how to keep his penis clean just as he will learn to keep other parts of his body clean.

So, for the bulk – or all – of the time that parents will be primarily responsible for keeping their son’s genitals clean, it requires no extra work to clean an intact penis. This excuse deserves no credibility.



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