Author: Tony

“Moral Case for Circumcision” Ignores Morality

In this essay Rabbi Shmuly Yanklowitz attempts to make the moral case for infant circumcision. Rabbi Yanklowitz fails in every all seven attempts, and in the familiar ways. This is not surprising since non-therapeutic genital cutting on a non-consenting individual is immoral.

He starts with health. He makes the mistake of focusing on relative risk without concern for absolute risk or the implications of his approach. He concludes the paragraph with this:

… Is it fair to avoid giving a boy protection when it is available? It’s not only Jewish law to maintain one’s health but also Jews should serve as a model for this important health practice.

“To avoid giving a boy protection” is a weird way to frame this point. It shows the flaw because it suggests that the conclusion informs the defense rather than the reverse. It assumes parents are unreasonable if they don’t circumcise healthy boys. Is it fair to avoid giving any child any protection that might reduce the risk of something, regardless of how small that risk?

This approach to healthy children is only applied to the male foreskin. Every other possible intervention is rejected. We are not immoral when we “avoid giving” other potential protections. The moral case against infant circumcision demands its rejection as we already refuse to consider any other intervention that might reduce something at some point. Rejecting infant circumcision is the only consistent moral approach.

Next, explaining circumcision’s role in “sexual morality”, he quotes Maimonides and responds:

… Circumcised men may not have less sexual desire or more self control but teaching a value of sexual moderation may be one pedagogical goal of this ancient ritual. We have many sexual wrongs in society to be reminded of such as rape, adultery, impropriety, and molestation. Perhaps circumcision can serve as a sacred reminder for men, in our over-sexualized world, to cultivate self control.

What is this, if not a means to control male sexuality? I’ve written before about the mistaken belief that non-therapeutic male child circumcision does not involve control. It does, even if this is not consciously understood when expressing intent. So it is again with Rabbi Yanklowitz’s reasoning.

Worse, this is borderline insulting because he seems to imply that men are less likely to control themselves without some external intervention against their genitalia. If my foreskin hadn’t been removed shortly after birth, would I now be inclined to commit rape, adultery, impropriety, and molestation?

Next, Rabbi Yanklowitz offers a utilitarian approach:

If an uncircumcised man chooses to have the procedure done later in life, it will be much more painful (even with anesthesia) and dangerous than it would be for a newborn. It is the responsibility of parents to shield their children from unnecessary pain.

There is no guarantee a male left with his foreskin and choice will need or want circumcision later in life. Statistics show neither is likely. Yet, pain is guaranteed when a child is circumcised. The choice that shields the most children from unnecessary pain is to leave everyone intact until need arises or they can make the choice themselves. Instead of every child – male only – experiencing pain, only those who have the misfortune to have a malady or who decide that the potential benefits outweigh the costs (e.g. pain) for them will experience pain. From a utilitarian standpoint, the prudent (i.e. moral) position is to leave children intact with their normal genitals because this non-action causes the least amount of unnecessary pain.

It’s also questionable whether or not circumcision later in life is more painful and dangerous. If it’s more dangerous¹, the individual facing the danger can consent or reject the surgery if he doesn’t want the risk. (My assumption there is for elective, non-therapeutic circumcision, which is the issue involving infants.) And infant circumcision has its own dangers, since the foreskin is fused to the glans and it’s difficult to judge how much to take off since the child still has all of his growing remaining. Severe consequences like amputation and death can – and do – occur, as well.

The utilitarian approach is subjective and has a tendency to favor whatever argument someone is making because it assumes all people favor the same choices. Yet, each person must provide his own weighting to the relevant issues. (The typical flaw of utilitarianism is to completely ignore the value of the foreskin in the equation. Its loss somehow isn’t a cost of the surgery.) The utilitarian push for circumcision ignores that individuals are must live with the negative outcomes and/or the intended outcomes he may not want. All children together won’t share the lost glans, lost penis, or lost life in the instances of severe complications. It makes no sense to consider all children lumped together.

His fourth point is parental values and social acceptance. The topic itself demonstrates the necessary proof that this is about control. That control makes it immoral. The circumcision is unnecessary, yet the values of the parents override the child’s lack of need and possible preferences throughout his life. Making sure that others accept him via surgery elevates the opinion of others above his own about his body. It denies personal autonomy. The paragraph endorses that view, but these sentences warrant focus:

… Not circumcising a Jewish boy may hinder his social acceptance and his chances of finding a Jewish spouse. The overwhelming majority of Jewish women look for a mate who is circumcised. It would be cruel to prevent a man from potentially finding a suitable mate. …

This is a claim commonly made in defense of female genital cutting. If we reverse the genders in his position, it’s easily understandable that this is about controlling the child. There is no compelling reason why this defense is acceptable for male genital cutting while being (rightly) rejected for female genital cutting. It is immoral when imposed on either gender.

Next, he extols the virtues of modesty. I don’t have much to say on this. Parents surgically altering their son to remind him to live up to their idea of modesty is self-evidently about control, and thus, immoral.

Next, “unconscious memory”:

…We give our baby boys one token formative experience, and then we do all we can to protect and shelter the child. This experience helps to ensure that the boy can be a moral agent. However, this reasoning, of course, should not be extended beyond this minor example.

Whether this experience is “token” or not must be decided by the individual receiving it, not the individual giving it. It is a subjective judgment.

Beyond that, empathy is a wonderful trait. There are better ways to instill this in children involving parenting rather than surgery. Are males not empathetic enough, or capable of learning through logic and example, that they require such an experience before they can practice it in their lives? This is preposterous and impossible to prove. Using it as a defense isn’t acceptable, as evidenced by the qualifications offered at the end of the paragraph. Again, they suggest that the conclusion informed the defense rather than the reverse. (Every defense of circumcision suggests this in some way.) Inflicting pain and the removal of healthy body parts to teach lessons is immoral.

The last item is that circumcision is a symbolic reminder. It focuses on religion, which I’m going to leave alone. My response is that symbolism isn’t valid if the individual doesn’t value the symbols. There seems to be a considerable chance that a child will value many of the same things his parents value. I accept that without reservations. But the focus must be on the individual. This is not guaranteed for any individual. Permanently altering a child to remind him of something he may one day reject is problematic, at best.

Rabbi Yanklowitz proved nothing he set out to prove. The moral case for infant circumcision he attempted is little more than the most common responses given. The emphasis is on the parents, not the child. The moral case for surgery with children starts and ends with their physical need. For circumcision, there is no need. There is no moral case for non-therapeutic infant circumcision.

¹ This is where I’ll invoke the articles on the PrePex as an example. My objection to the recent pieces about it centers on the poor journalism rather than the device. I expect the device will eventually be tweaked to allow for infant circumcision at some point. That would be wrong. For now it’s a device for voluntary, adult circumcision. I have no objection to that. The claimed risks involved with the device are low. The claim that adult circumcision is more dangerous than infant circumcision doesn’t appear to hold up, generally, regardless of the method. This claim is a framing device of dubious quality rather than a fact to be negate ethics.

Small Victories: The New York Times Revises

The New York Times revised its article on the PrePex circumcision device. I have no way of knowing if that change occurred because of my entry on the subject or some other source that provided some revelation to the paper’s editors. Frankly, I don’t much care who got it done. The key is that the Times changed the article to inch closer to reality. It’s not close to perfect, but compare the two. The original:

Dr. Reed said he had heard that another device, Ali’s Klamp, was being tested in Kenya under protocols that seemed to match W.H.O. requirements. According to Circlist.com, a circumcision information Web site, it is a Turkish device dating to 2007, and works on principles similar to those of the Tara Klamp and another device, the SmartKlamp, approved by the F.D.A. in 2004.

The current, revised version:

Dr. Reed said he had heard that another device, Ali’s Klamp, was being tested in Kenya under protocols that seemed to match W.H.O. requirements. According to Circlist.com, a Web site with information about circumcision and arguments favoring it, Ali’s Klamp is a Turkish device dating to 2007, and works on principles similar to those of the Tara Klamp and another device, the SmartKlamp, approved by the F.D.A. in 2004.

This is an improvement.

Now that I’ve stated that, it’s a bit silly for the revision to declare Circlist a site that contains “arguments favoring” circumcision. Circlist is a fetish site. It hosts slash fiction fantasies, pornography, and pro-female genital cutting material, among its offensive content. It pushes unprincipled half-truths and distortions, with strategic omissions, designed to make circumcision seem fantastic and without any ethical flaws or harms, real or potential. The site’s treatment of non-therapeutic child genital cutting is on par with “Teach the Controversy“. It’s propaganda unbounded by facts. The New York Times still needs to ask itself the relevant question: How reliable is Circlist’s “information about circumcision” given the ridiculous nature of its “arguments favoring it”?

Thus, the victory, such that it is, feels hollow. The paper version can’t be revised. The online version still cites the website. It needs further revision, which would hopefully lead to more accurate, ethical coverage of circumcision and its implications for healthy children.

However, that revision is something. Whatever inspired this update, it’s a small sign of progress. We need more of these.

The New York Times Links to a Fetish Site

Update: It’s been pointed out that the link within the New York Times story is broken. It’s missing the “www” from the link, an understandable mistake. So, the paper linked incorrectly to Circlist. The proper conclusion is that the editors failed to fact-check in addition to not checking source credibility rather than the pathetic implication that they didn’t link to a fetish site. I missed this because I started at Internet Archive and worked backwards.

I’ve noted it throughout, but almost every link after the first paragraph of this post is NSFW.

Last month the Washington Post ran a commercial masquerading as an editorial. Today, the New York Times follows suit, but ups the offensiveness in an unexpected – and unacceptable – manner. The article is another regurgitation for the PrePex device, so I won’t quote any of the related nonsense. The largest problem is at the end of the advertisement.

Dr. [Jason] Reed said he had heard that another device, Ali’s Klamp, was being tested in Kenya under protocols that seemed to match W.H.O. requirements. According to Circlist.com, a circumcision information Web site, it is a Turkish device dating to 2007, and works on principles similar to those of the Tara KLamp and another device, the SmartKlamp, approved by the F.D.A. in 2004.

I removed the hyperlink from the excerpt because – unlike the New York Times – I refuse to link to a pro-circumcision fetish site. But it is instructive. It demonstrates how uninterested the New York Times is in logic and ethics. The story doesn’t seem to rely on Circlist for any specific facts since, again, this piece is merely a commercial. That doesn’t make the site’s inclusion in the commercial, with a direct link in the online version, any less problematic.

With any effort, a “journalist” like Donald G. McNeil, Jr. could presumably uncover the bias of Circlist. For example, from its “Considering Circumcision” page, this Editorial Comment:

It used to be the case that the argument between the pro-circumcision and anti-circumcision lobby groups was an argument of opinion versus opinion. That is no longer the case. The pro-circ groups (CIRCLIST included) now have proven scientific fact on their side, whereas the anti-circ groups continue to rely on a less tangible line of reasoning based primarily on the morality of genital integrity – especially as regards child circumcisions. Of necessity they have, in the main, quietly dropped their assertions that the science is bunk.

The reasonable response a journalist might have is to ask what part the health of the child at the time of circumcision indicates. Whether or not the science is valid or bunk is secondary. The application of that science to a healthy (also science) child’s genitals is the ethical/moral question. In the analysis, ethics > science.

In other locations, Circlist believe[s/d] that “Parental Request” is an indicator for circumcision. (And a tight foreskin, and a long foreskin, and a loose foreskin. As long as the end result is YAY CIRCUMCISION…) But, since the child is healthy, that informs the morality involved. Circlist is like most pro-circumcision propagandists. The potential benefits supposedly demonstrate that it is ethical, as opposed to being merely a piece of information. Because it can possibly impart something does not make it ethical. If it did, prophylactic surgery of any type on children would be ethical. That’s stupid.

Any length of time spent on Circlist would reveal the depth of its bias (and kink), which at the least requires some offsetting balance if it’s going to be a source for the New York Times. The challenge is in finding out what the members of Circlist believe. Sometimes, they tell you. On the site today:

FIANCÉE GIVES HUSBAND-TO-BE AN EROTIC CIRCUMCISION

The following text is a work of fiction written by an anonymous contributor living in North America. The story involves a Do-it-Yourself circumision. CIRCLIST recommends that you do not mimic the scenes described. Circumcision should only be carried out by a qualified medical practitioner.

There are more at the link I’m not providing. Advocates who’ve been involved in this topic for more than a few years are familiar with what else the site contains and/or contained. Contained is the key I want to focus on now. The current site has been scrubbed of some material, but the Internet Archive reveals its not-lost secrets. (Remaining links are from March 25, 2008, a date picked at random.) Such as more stories and pictures that are very much NSFW, although I don’t recommend the NSFW link. The subject is “Foreskin Has Erotic Purpose For Some”. That’s a way of saying there’s still a circumcision to be done that can generate sexual excitement, not that maybe the foreskin should stay.

Next, (NSFW):

As for infant circs, I am sure, since you are circ-obsessive or you wouldn’t belong to this club, you’ve seen your share of adults circumcised as babies. Many of their scars are quite extensive and, dare I say it, ugly. From the sulcus down to the shaft skin it’s bumpy, red and sometimes looks quite sore. Whether it is sore or not, I can’t say. Also, when the frenulum has been removed, the raw area left in the wake of the surgery can look quite angry. Some guys say that this is still their most sensitive area on their penises, as is mine, even though I instructed the doc to leave mine alone. The worst consequence of these infant circs without sutures is the skin bridge (see photo at right). Sometimes the inner foreskin edge doesn’t grow to join to the shaft skin edge. It turns back on itself and joins with the corona of the glans. From all accounts this bridge can be benign or very painful in sex.

Notice that they are happy to publish that they’re circ-obsessive at the same time they publish a clear explanation that circumcision causes problems. (The corresponding picture and others show circumcision fits the definition of mutilation, especially when forced on another.) Yet, they think the moral question of imposing this on healthy children is essentially a non-issue. Why would anyone trust them to be a good judge of ethics?

Finally, if you click to Circlist today, you’ll find a very different view of female genital cutting than in the past. More on that in a moment. But what’s interesting is how they currently differentiate between female genital cutting and female genital mutilation. They don’t think the distinction is what you think it is.

Female Circumcision (“Femcirc”): Surgery that modifies the female genitalia in ways likely to be accepted by a neutral observer as enhancing the quality of a woman’s sexual experience.

Female Genital Mutilation (“FGM”): Surgery that modifies the female genitalia in ways likely to be accepted by a neutral observer as reducing the quality of a woman’s sexual experience.

The consent of the female isn’t discussed. It’s merely whether a “neutral observer” thinks the cutting “enhances” the sexual experience. They are not endorsing a view that females have a right to their bodies, just that someone else’s perceived benefits to sexuality is a valid reason to cut. They discard the moral question of non-therapeutic male genital cutting, which is unsurprising. But they discard the moral question of non-therapeutic female genital cutting, as well, in spite of its clear position within the Western world. They’re not arbiters of ethics and human rights, yet they’re quoted in the New York Times. Why?

All of that is offensive, but their past interest was more involved. (NSFW) From “Cindy (USA)”:

I recently had my clitoral hood removed (female circumcision) to improve sensitivity and cleanliness as it was such a long hood. I had some pain during healing, but that has been minimal. Healing has been rapid.

The glans clitoris has slowly increased in size since the operation. The sensitivity is also there and my ability to orgasm has increased be cause of it.

I think that all women should consider have their hoods removed as it would aid in cleanliness of the area and grreatly improving orgasm! I’m totally satisfied!
…

Next:

Photos of my girlfriend Lisa, before and after her circumcision are attached. She previously had her clitty hood circumcised, and now her lips. I think she looks much better, don’t you?

Finally, from “French Couple Advocates Both Male and Female Circumcision”:

We are a French couple , 32 years old, from Metz, in the east of France. I am Pascale (wife), my husband is Marc. We have 3 children, 2 girls, one boy.

We are strongly interested in male AND female circumcision, especially female because male circumcision is not a problem for us. My husband has been circumcised (well circumcised) for 3 years.

Marc (my husband) has a very tight circumcision with the frenulum completely removed. It was done 3 years ago, voluntarily, and without any medical reason, only to be very clean and erotic (I write my opinion!) Marc is very happy.

Mathieu (my son) also has a very tight circumcision, frenulum completely removed. We had him circumcised completely at birth. He is now 3 years old and his circumcision looks very good.

Unhappily I am not not yet circumcised, but I WANT it. We are searching information, testimonies, addresses for my female circumcision. I think that female circumcision is analogous to male circumcision and is also necessary to the couple’s sex live. I think it should be better to allow female circumcision . I am now speaking about cutting the hood and the labia minora. I am also searching for information about the complete cutting of the clitoris.

When I was 19 y o, I had a (girl) friend that told to me that she was cut off like an African woman: She had lived in UpperVolta (now Burkina Faso), with her parents, and her mother thought it was a good practice to be cut: All the females of the family were cut in a local hospital by a nurse. She had no regrets and was not ashamed to be a White French Excised woman. She showed me the result of the operation. I thought I would like to be like her.

Last years in Cap d’Agde, a huge naturist town in the south of France , we saw a couple of smooth circumcised Dutch: They had no pubic hair (like us), and the wife had her nipples pierced with rings. Also her clitoris was pierced and had no hood and was ever protruding. She had no labia minora. I want absolutely to be cut and pierced like her.

Circlist is a fetish site. It’s present is tamer than its past, but the underpinning is still there. Yet, today they’re being quoted by the New York Times. The paper, its editors, and McNeil should be embarrassed.

“Like Mother, Like Son”

The relevance of this story to the discussion of non-therapeutic child circumcision is obvious:

A Cobb County mother was charged with misdemeanor child cruelty after she allegedly let her 10-year-old son get a tattoo in memory of his deceased brother, Channel 2 Action News reported.
…

Police now want to speak with the person who allegedly applied the tattoo to Gaquan.

In Georgia, as it is in 38 other states in the U.S., it’s illegal to tattoo a minor (O.C.G.A. § 16-5-71). I suspect the comment sections on every news outlet reporting this will be filled with outrage that a parent would do this. Surely some of those commenters, like Georgia’s elected officials, support circumcision imposed at the will of parents. The hypocrisy is frustrating because the that level of cognitive dissonance is so bizarre and the challenge to overcome it so difficult.

To be clear, of course tattooing a minor should be illegal. But I’d add the same qualification I apply to non-therapeutic circumcision. If the individual minor consents, the ethical challenge is resolved. Children are not idiots until their 18th birthday. The child in this story consented to his tattoo. Whether the age of consent should be something higher than 10 is a valid question. I side on “higher”, personally, even though I wouldn’t prosecute here. Still, consent matters.

To the extent that the mother, Chuntera Napier, is correct in this case, she is correct for the wrong reason:

“I always thought if a parent gives consent, then it’s fine,” Napier said. “How can somebody else say it’s not OK? He’s my child, and I have a right to say what I want for my child.”

She’s wrong because she implies the same level of parental ownership that society grants with respect to male circumcision. There is no absolute right to do what a parent wants.

In my legally untrained view I think of circumcision as already illegal with an excused, willful lack of enforcement. The same laws that prohibit harming a child by cutting his arm, for example, should also be sufficient to prohibit non-therapeutic genital cutting. I’m unaware of any “genital cutting (on males only)” exemption. Non-therapeutic circumcision is no more “medical” than non-therapeutic female genital cutting is or non-therapeutic child mastectomy would be.

This lack of enforcement permits parents to offer the nonsensical “like father, like son” to excuse non-therapeutic child circumcision. Many in the medical community push this. In this case, the child’s tattoo is intended to memorialize his deceased brother. Napier also has a tattoo memorializing her deceased son. Why isn’t “like mother, like son” acceptable here? Why use multiple ethical frameworks for issues relating to children, if not to cherry-pick for outcome? Because one violation is uncommon and the other is practiced more than one million times each year? I’m curious to know because the answer isn’t logical.

Flawed Circumcision Defense: Dr. Paul Rein

As activists we’ve all encountered poorly thought out, often incomprehensible arguments advocating for non-therapeutic child circumcision. In their mildest forms, these merely conclude that parents should do what “works for their family”, as if all penises in the family belong to the parents. In their worst form, they’re clueless, uninterested in learning, and offer any number of bizarre justifications that defend the decision while remaining ignorant of basic facts. This essay by Dr. Paul Rein is built on the latter foundation, with the surprise of an irrational excuse for surgically altering healthy boys that I’ve never heard before.

After an introduction and a brief, incomplete history of circumcision, Dr. Rein quotes Genesis 17, including the bit about circumcising one’s slaves. In response, he writes:

… WOW, pretty powerful stuff when taken literally. So why do you think this “law” came about? For me, like Jewish dietary laws (sic) it was all about health. In days past, before modern times, food such as a pig was not considered ok to eat by the Jews because pigs were dirty, ate garbage and carried worms. Bottom feeders in the waters fall in the same category. Circumcision was a matter of numbers of complications for not doing it. Circumcision is done on day 8 of life for what reason? Is there something magical about day 8? It turns out that on day 8 of a boy’s life his blood clotting factors are normal, such that his risk for bleeding is less. In most countries of the world where babies are delivered in the hospital a circumcision if performed is done in the first couple of days and the babies are given a shot of Vitamin K which helps the blood clot, in other words it is a convenience to be done then. Surely the Jews figured out by trial and error that day 8 was the earliest, best and safest time to perform the circumcision. Most likely their dietary laws also discovered that eating pigs caused more illness than not eating them. So lets get back to circumcision.

This is conjecture. It shows the logic-optional framework upon which Dr. Rein is willing to build his conclusion on non-therapeutic child circumcision. I’d like to see citations for the number of complications throughout history “for not doing it”. But I can accept that without citations because it’s irrelevant to the more immediate question: what is justified today?

For example, whether or not there’s something magical about day 8 or the availability of Vitamin K may be interesting, but neither is a valid defense for circumcising healthy infants. Being convenient doesn’t make it acceptable. Any biological magic of a healthy human’s Day 8 ability to properly clot his blood still applies to his Day 6,574¹ ability to properly clot his blood. But, ethically, only one of those is valid.

When Dr. Rein begins to discuss risks of circumcision, he fails to include a complete list of objective outcomes. Some are possible and some are guaranteed.

… The risks include, pain on performing the procedure, bleeding and infection, irritation of the glans, increased risk of meatitis- which is an inflammation to the opening of the penis, injury to the penis during the procedure, and a belief by some that removing the foreskin decreases sexual pleasure. There are also some people who believe it is a violation of the child’s human rights because they did not consent to the procedure.

He should’ve mentioned that circumcision includes the risks of amputation and death. Those are rare, but if he’s not including the absolute risk of the maladies against which non-therapeutic circumcision is a prophylaxis, a full set of known risks should be included.

He should also state that circumcision leaves a scar. That could lead into an actual discussion of whether the male himself wants that, as well as the intended cost of the surgery, the loss of his foreskin. The foreskin is not, biologically, an inert afterthought. I’m not surprised he would omit this because I don’t think he understands this. But the burden is on him to be educated, not on others to defend why healthy, normal body parts exist.

His advice focuses into one key paragraph:

What is a FAMILY to do when they have a newborn boy? …

Celebrate and not cut his healthy genitals. This is what a family does when they have a newborn girl.

… As I have mentioned in the past it is up to you to make informed choices. You as the responsible adult who has had a child should make an informed decision. Educate yourself as to the benefits and risks remembering that most of the risks are small, but when they do happen to you they are 100% in your experience. Nothing is without risk and you weigh the risk versus the benefit. …

Being the “responsible adult” does not mean that option is valid. Tradition does not justify its imposition. The possibility of benefits, the “responsible adult’s” subjective minimization of the risks involved, or the doctor’s omission of the full costs also fail as justifications. The surgical alteration is not medically indicated or necessary. That is the sole relevant information. Where circumcision is being imposed on another who can’t consent, only medical need can justify it.

… Regarding circumcision if you choose not to have your child circumcised and as an older boy or adult he needs to be circumcised the risks increase. The risk of surgery such as pain, bleeding and infection are higher for older boys and men. …

This logic could be applied to any non-therapeutic surgery one might choose to force on a healthy child, primarily with respect to pain. The claimed inability to remember the pain as an infant does not mean the infant does not experience the pain. As an adult, the individual has the choice to use sufficient pain management. It’s also worth noting that actual need for circumcision is rare. Where an adult male’s circumcision is optional, his preference for the possible benefits demonstrate that he values them more than the costs, including the pain. Infants don’t get that choice.

… If you believe that the pain of a circumcision is traumatic to the child and affects him for the rest of his life then don’t do it. To that I say, c’mon. A newborns brain is immature and the few seconds to minutes of crying is no more traumatic that a night of crying from colic. Does that baby who has colic from a formula become so traumatized that he never wants to drink from a bottle? …

Dr. Rein’s lack of concern for the child and what he may experience from unnecessary surgery is scary. Is “c’mon” the scientific term for a newborn’s pain coping mechanism?

… Arguments such as decreased sexual pleasure from a man’s point of view are pretty tough to make. Do you really know any guys who say, geez I wish ….?

Here I am: Geez, I wish I had my foreskin. I am not alone. Dr. Rein should research the topic before he mocks opinions he does not understand. Research would allow him to reject his own incorrect ideas that are easily refuted.

It gets worse:

… Another thing to think about in making your decision is are you a single mother having this child? Little boys, 5 and up are probably not inclined to have their mom making sure that they are practicing proper hygienic techniques and in light of the fact that the USA has the highest rate of single parent homes in the western world that might be something you want to consider. …

Yeah. I thought I’d heard all the dumb arguments. I’m not pleased to know that more creative stupid excuses develop. Raising children involves teaching them proper hygiene and setting expectations for maintaining that throughout childhood. Dr. Rein’s suggestion is nothing more than telling parents (i.e. the “responsible adults”) it’s okay to abdicate their parental responsibilities because that responsibility is too uncomfortable.

To put it in a different perspective, as someone stated in the comments section of the essay, would it be legitimate to suggest that single fathers have their daughters’ genitals cut because it would be too uncomfortable to monitor their hygiene? Even if I accept the incorrect suggestion that forced, non-therapeutic female and male genital cutting don’t involve the same rights (and ethical) violation, the underlying implication of Dr. Rein’s statement is that parents should act against their child if it’s more convenient for them to do so. All other considerations be damned. It’s about the parents, not the patient. That’s unethical, anti-science nonsense.

Dr. Rein addresses the human rights point, badly:

… Finally the human rights issue is in my opinion a weak argument. As parents we are making many decisions for our children. Children don’t get to make too many medical decisions including vaccinations and antibiotics that are often forced on them when they don’t need them.

This decision is not like other decisions. It’s the unnecessary surgical alteration/reduction of a child’s body in pursuit of subjective outcomes based on someone else’s preferences. Parents vaccinate to protect their children, so, yes, in that limited non-useful manner, vaccinations and non-therapeutic circumcision can be viewed the same way. But the same thing could be said about comparing vaccinations to removing the healthy breast buds of a girl whose family has a history of breast cancer. There has to be more for it to be intelligent and useful. So, vaccinations work to build the body by using its natural mechanisms. Circumcision simply removes a body part that may develop a future problem. Dr. Rein’s comparison is invalid.

If Dr. Rein thinks that the irresponsible use of antibiotics by parents is a defense of the irresponsible use of circumcision, he’s more interested in establishing defenses for his pre-determined conclusion than reaching a conclusion based on facts and logic. I’m going with that because I read his essay. He didn’t provide any evidence for me to conclude otherwise.

¹ Or Day 6,575…

Donations Are Voluntary, Not Taken

Anyone who’s spent a moderate amount of time studying circumcision and the ethical lapses involved understands the vast expanse of those lapses. These are generally thoughtless rather than intentional. Cognitive dissonance has a powerful hold on human beings. Forced genital cutting of healthy children is just one of many absurd, offensive examples.

That said, it’s still disheartening to read stories like this:

… Scientists at a laboratory in Germany have begun growing human skin from the cells of infant foreskins.

According to the German Herald, the “medical breakthrough” is being used to test cosmetics and other consumer products and could someday replace all animal testing. The so-called Skin Factory, at the Fraunhofer Institute in Stuttgart, takes foreskin cells donated to the project and uses them to grow the skin, according to spokesman Andreas Traube.

This is not a “medical breakthrough”. The technique involved may be new, but the process of using infant foreskins is not. Skin cells generated from (healthy) infant foreskins have been used in cosmetics and skin grafting for many years.

The ethics of the “donation” are grotesque:

Traube said the foreskin is taken from children aged 1-4, because the younger tissue has better research applications. “The older the skin is, the worse it performs,” he said. …

“It’s logical that we’d want to take the operation to a bigger scale,” Traube said. “In the future, there are all sort of possible applications for the Skin Factory like cancer research, pigmentation diseases, and allergic reactions.”

Scaling up this operation obviously requires more healthy male children circumcised without their consent. But in pursuit of what goal?

The scientists at the Fraunhofer Institute hope the skin they’ve been able to produce will provide a humane alternative to using animals in testing of cosmetics and other products, a German news service, the Deutsche Presse Agentur, reported.

Obligatory disclosure: I’m a vegan. I understand and care about animal welfare issues. However, I do not place the welfare of animals above – or even equal to – the welfare of humans. The choice here is not to injure or not injure an animal. The choice is to injure an animal or to injure a human. The correct ethical choice is simple to understand when contemplated, however briefly. The scientists (and parents) involved should contemplate them. The sooner they’d like to start, the better.

**********

On a closing note, from the second article:

For their next project, the scientists are working on reproducing the human cornea.

Do the scientists intend to use “donated” infant male corneas?

Rwanda Imposing a Foreskin-Free Generation

On Monday the Washington Post published a propaganda piece by Rwandan Minister of Health Agnes Binagwahois. She talks writes of “an opportunity to lay the foundation for an AIDS-free generation,” which inevitably means a primary focus on “voluntary, adult” male circumcision. It’s a matter of faith that this will solve everything, and as a result, there must not be any ethical issues to discuss. Anyway, they’re only implementing “voluntary, adult” male circumcision. Just believe.

Experience demands a closer inquiry. When public health officials speak of “voluntary, adult” male circumcision, they never mean voluntary or adult. They say it, as Binagwahois does. That phrase is mandatory. They do mandatory very well.

We have the capacity to save nearly 4 million lives in sub-Saharan Africa, the hardest hit region in the world, by scaling up voluntary medical male circumcision — the best tool we have for HIV prevention. But the only method widely approved for funding is the surgical method, which is expensive and impractical for countries lacking physicians and surgical infrastructure.

She didn’t say adult yet, but that shows up. She writes that “[p]ublic health officials set a goal to reach nearly 20 million men ages 15 to 49 by 2015…”. I’d quibble over a 15-year-old being an adult, but I also think a 15-year-old is capable of informed consent. If only her statement were true.

In the essay she links to a paper outlining Rwanda’s “national goal”, which can be summed up as a willful violation of human rights. From page 61:

High coverage of male circumcision has been shown to be effective in reducing heterosexual transmission of HIV infection. Under this Outcome, circumcision will be promoted to adult males, with the aim of increasing the prevalence of circumcision. In addition, although circumcision of newborn boys will not contribute to the result of reduced sexual transmission of HIV during the period covered by this NSP, it is nonetheless an important long-term strategy for reducing susceptibility to HIV infection in the Rwandan population.

In case it isn’t quite clear enough, the report includes this table:

Figure 18

Then it’s summarized:

Output 1.1.2.1. Newborn boys, adolescents and adults have increased access to circumcision

Key strategies:

  • i. Advocacy for integration of circumcision in minimum package of health centers
  • ii. Promotion and provision of male circumcision for adolescents and adults
  • iii. Promotion and provision of male circumcision for newborn boys

She also links to the WHO’s 2011 revised report, Progress in scale-up of male circumcision for HIV prevention in Eastern and Southern Africa: Focus on service delivery. On page 14 the WHO describes Rwanda’s current “Service” delivery strategy.

Plans include the integration of MC into existing services with campaigns and mobile services to increase coverage. Service delivery has begun at selected sites, including military settings. Neonatal and adolescent MC is articulated in the longer-term plan.

About that “long-term” plan. Rwanda keeps saying “long-term”, but a close look at Figure 18 shows its definition. Rwanda’s target for 2012 is 50% of all newborn males. Rwanda is actively circumcising newborn males now. The limitation is clearly not intent. I believe they are sincere in focusing on adults, although less so on the “voluntary” aspect. But it’s obvious where the real focus is. Fear of HIV in the presence of effective-but-elective non-surgical interventions leads to a blatant disregard for the rights of children. It is disgusting.

Since there is a national plan to circumcise newborn and adolescent males without their consent, why does Binagwahois not say so explicitly? Instead, she pretends that the current focus is only on adults and limits herself to advertising for the “non-surgical” PrePex device. Since she doesn’t know the meaning of voluntary or adult, it isn’t particularly surprising that she doesn’t understand the definition of surgery. The ability to limit bleeding does not mean it is non-surgical. Condoms are non-surgical. Foreskin removal is surgical. It’s not refuted just because the device’s manufacturer says so. Regurgitating marketing material is not supposed to be the job of a public health official.

**********

For consideration relevant to the ethics and practicality of the PrePex rollout, Figure 6 in the study (NSFW) Binagwahois’ essay links suggests to me that there will be complications when use of this device is scaled to 20 million men in field settings. And to be fair to Circ MedTech, it promotes PrePex for adult male circumcision. We’ll see if their focus remains on voluntary, adult male circumcision.

Flawed Circumcision Defense: Dr. Edgar Schoen

This is more than a three months old. I never posted it because I wasn’t quite happy with it. It’s not current, but as long as Schoen is promoting circumcision or being listened to by parents, doctors, and educators, it’s relevant to publish.

Dr. Edgar Schoen wrote an essay on the end of the ballot initiative in San Francisco that would’ve extended equal protection to male minors against non-therapeutic genital cutting. Schoen, being the advocate that he is, again deals in misdirections and half-truth omissions to sell his unethical view. From the beginning, he refuses to play fair.

Fittingly, Judge Loretta Giorgi ordered the removal of the proposed San Francisco initiative to criminalize infant circumcision from the ballot. However, supporters of the measure continue to voice their undocumented and erroneous claims that circumcision has harmful emotional effects and no medical benefits.

That’s an interesting way to phrase opposition. I have no doubt he’s aware of individuals who state that circumcision has harmful physical effects in spite of the potential medical benefits. His equation is only the side he wants. If it doesn’t help his case, he ignores it and pretends that it’s a lie sold by people who don’t care about the health of children, which can only be achieved through circumcision. Somehow. He’s nothing but a propagandist.

For example:

These “intactivists” ignore the overwhelming evidence and the multiple health benefits of circumcision from infancy through old age, including a 60% protection against the heterosexual transmission of HIV/AIDS.

“Overwhelming”, being an adjective, is subjective. Declaring the potential benefits from non-therapeutic circumcision to a healthy child to be “overwhelming” is to ignore evidence in the way he mistakenly accuses others of ignoring evidence. That 60% protection against female-to-male HIV transmission also contains the caveat of high-risk population (i.e. sub-Saharan Africa rather than the United States). That 60% figure is relative risk reduction to normal genitalia (among adult volunteers in a high-risk population), not absolute risk. The absolute lifetime risk of female-to-male HIV transmission to American males is in the low single-digits, regardless of circumcision status. He’s playing loose with the facts because dealing with them honestly demonstrates how absurd it is to declare the potential benefits “overwhelming”.

Schoen continues this pattern with his standard talking points on the potential benefits, except he omits the potential aspect. Rebuking every claim he makes would be tedious rather than productive. Antibiotics, condoms, etc. His bias is decipherable (and embarrassing) once you see his only trick. Instead, it makes more sense to address his ethical and logical lapses.

The neonatal period is ideal for performing the procedure, as circumcision is quicker, less traumatic and has fewer complications than when performed on older patients. Newborns are very resilient and uniquely equipped to deal with stress, having high levels of stress hormones as well as pain-relieving hormones. The thin foreskin means that sutures are not usually needed like in older patients, and local anesthesia is effective at numbing the area to further minimize pain.

“Ideal” conditions for non-therapeutic surgery do not overcome the ethical violation inherent in imposing that non-therapeutic surgery on a non-consenting individual. He ignores the patient’s preference, the physical harm to each recipient, the implications of the complications that do occur to healthy children, and the physical differences between neonatal and adult circumcision. His approach implies that there are no trade-offs, that the potential benefits of non-therapeutic child circumcision are a surgical “free lunch”. He never acknowledges that the foreskin offers benefits, too. (He relies on the silly notion that the foreskin is an accidental leftover from evolution.) Dr. Schoen is either ignorant or dishonest.

Continuing:

Opponents of circumcision have no problem making up unintended side affects that can result from this safe and accepted procedure. …

This is ad hominem. For someone who cites women’s sexual preference for a circumcised penis as a benefit to neonatal circumcision, he should tread carefully with his ridiculous accusations. Either call out examples of lies, or don’t write the charge.

Defending circumcision as “accepted” is a logical fallacy. A popular position can be wrong. The principle matters, not the irrelevant opinion of everyone other than the male upon whom this violation is imposed.

The crux of his failure to address all aspects of this debate is this:

As study after study shows the benefit of circumcision throughout the male life span, one has to wonder what motivates supporters of this extreme initiative. No one is forcing them to circumcise their child, yet they will continue to take that choice away from other parents regardless of the available medical evidence.

“Throughout the male life span” includes the majority of his life when the male is an independent individual with the power to consent or refuse. Circumcising a healthy infant creates a circumcised adult, eventually. That is the ethical issue he fails to address. Yet, he only offers the irrelevant “no one is forcing them to circumcise their child” trope. True, but the actual issue is that someone is forcing another person to be circumcised forever, regardless of whether he wants to be or not, and in direct contradiction to his obvious, objective lack of any need for the intervention. That is unethical. Non-therapeutic genital cutting on a non-consenting individual is wrong.

Fear Still Exists in the Modern World

When discussing circumcision, it’s vital that activists speak openly and honestly about all relevant facets of sexuality. That includes snicker-inducing topics like masturbation, which is why it’s wonderful that Cracked included a critical, almost scathing examination of male circumcision in its article, “5 Insane Ways Fear of Masturbation Shaped the Modern World”. The entire circumcision section is worth reading, but I want to quibble on one point.

Second, many doctors thought that removing the foreskin made masturbation much more difficult (which, as about half of our readers know, it totally doesn’t). By the way, that 1895 medical journal suggests that another way to prevent boys from masturbating is to sever the fucking nerves to the penis, so there just wouldn’t be any feeling there at all.

Removing the foreskin makes masturbation more difficult, even though evidence suggests that circumcised males masturbate at least as much as intact males. (Much is too subjective with regard to difficulty, and unnecessary to prove my point here.) With a normal, intact penis, a male is generally able to masturbate without additional lubrication or concern. He may use additional lubrication, but it isn’t necessary, as his foreskin provides all the mobility he needs.

Circumcision changes the form of the penis, thereby changing its function. The male no longer has his foreskin to provide lubrication and mobility. His sexual experience changes from one based on pressure to one based on friction. He generally must use some form of lubrication to make masturbation comfortable. Without it he can easily chafe his penis. He may also experience pain from masturbation (and other sexual activities) if too much of his foreskin was removed, for example.

Some have speculated, reasonably, that circumcised males engage in a wider variety of sexual activities because it takes more to achieve satisfaction. Even if the opposite were true, it’s clear that circumcision alters the penis and makes sex different, if not obviously more difficult.

Flawed Circumcision Defense: California Assemblyman Mike Gatto

California Assemblyman Mike Gatto is an authoritarian. He believes that male children do not have human rights equal to the rights of their fellow citizens. Mike Gatto believes that freedom and liberty involve parental ownership of the genitals of their male children. He believes that the individual right involved in child genital cutting is exclusively the right to cut a male child without medical need. He believes that subjective, non-medical “affiliative benefits” are enough to justify surgery on a child, even if the child does not or might not want to be forcibly affiliated. California Assemblyman Mike Gatto prefers mindless, unquestioned deference to parental choices about non-therapeutic male child genital cutting.

Thankfully for Mike Gatto, his colleagues in the lesiglature and California Governor Jerry Brown share his authoritarianism. Gov. Brown signed Assembly Bill 768, which prevents local governments within California from prohibiting non-therapeutic circumcision on male minors. Now history may know that these individuals supported genital mutilation after the point at which sufficient evidence existed to understand the correct position that respects individual rights, science, and morality.

To understand what these politicians have failed to grasp, imagine a male. He is an adult. He is intact. He is healthy. He tells his parents that he has unprotected sex with HIV-positive women. What rights do his parents have to deal with this? Under the illogic of Assemblyman Gatto and his colleagues, his parents may force him to be circumcised.

But he’s an adult, so they don’t have that right, correct? Of course. Yet Mike Gatto has accepted a delineator based on age to define when the child receives his right to decide which permanent, non-therapeutic alterations he wants or does not want inflicted on his body. By legislating an endorsement of non-therapeutic genital cutting against healthy male children, Mike Gatto endorsed a form of permant parental control over a male’s genitals. Circumcising an infant creates a circumcised adult, without regard for the adult’s opinion.

Legally there’s no reason to distinguish between a healthy newborn and a healthy teen one day shy of his 18th birthday. His penis belongs to his parents, according to the worldview of Mike Gatto. We understand that there is a difference and most (probably, hopefully) think that forcibly circumcising the latter male is offensive and shouldn’t be done. But that requires us to backtrack to the age where it becomes acceptable to circumcise a healthy child for no reason. We must ask why that age and not a later age. So, what is that age? Is it 17? 13? 10? 6? 3? 1? When does it become unacceptable to cut the healthy genitals of a male, because that distinction is arbitrary? What will it require to make Mike Gatto understand that the correct age is upon birth?

California already established that there is no arbitrary, unspecified age before which parents own the genitals of their female children. They may not allow someone to take a scalpel to the genitals of their daughters for non-therapeutic reasons, even if those reasons include a parental preference for forced “affiliative benefits.” The only factor involved in any decision to cut female minors is the presence or lack of medical need. That is the ethical, scientific view, which succinctly demonstrates that genital integrity exists within human rights. Mike Gatto believes that male children have only a mere subset of human rights, a subset that does not include genital integrity. It is a flaw in his character that Mike Gatto believes the full range of human rights only belong to male adults, female adults, and female children.