Valid Dinner Table Topics: Ethics

When I listen to podcasts discussing circumcision, I’m prepared to sigh and grumble in frustration. Listening to The Dinner Table podcast: Circumcision involved a different experience. I talked pointedly at my radio as I listened, pausing every 30-45 seconds to digest my irritation. It was generally an unpleasant experience because the discussion needed much more reflection and thought in place of the talking-point regurgitation. However, I’m glad I stuck with the episode. It contains numerous succinct examples of both exactly why we shouldn’t circumcise children and how people encounter truth but manage to pick themselves up and scurry off before having to confront reality.

Note: I’ve kept the conversational tics in the transcript from the hosts, Tessa Osborne and Griffin Wiles. (I will do this for their interview with Dr. Joel Greenberg, which I’ll review in my next post). I left them in because they demonstrate the speaker working through the thought in real time, which I think is fairer than editing it. I do not interpret or intend these tics within the transcript to suggest anything else.

Here are some observations:

Wiles: Mmm hmm. And there’s, of course, there’s hygiene. People who are not circumcised as a child, and later on in life, get circumcised, it’s a hygienic reason. If they do it themselves, or if parents circumcise their kids… … or if parents circumcise their kids, it’s for hygienic reasons. Adolescents and young adults are more likely to be circumcised. Social and sexual desirability are also really big social determinants in being circumcised.

Boys should and can be taught to wash themselves. Surgery is neither a replacement for nor an ethical change to this basic life skill.

The next section in the podcast covers some of the perceived medical benefits. I’m not interested in refuting them in detail again here, so I’ll both point to my archives and reiterate that every possible benefit argued for can be achieved and/or treated with less invasive methods and with the consent of the individual himself. That’s the core of the topic, not whether or not imposing it on someone can achieve something.

Anyway, in my experience, the perceived medical benefits are the cloak of respectability placed over the real reason, which is some variation of “I like it, aesthetically”, which Wiles states directly. It’s also, “women prefer it”. Or, more crudely, “women won’t have sex with him if he’s not.” It’s the cultural lie society repeats without questioning whether or not it’s true. If it were true, as people pretend, we don’t stop to consider that maybe the individual male would rather have his foreskin than sexual attention from someone for whom he is not good enough without surgical modification.

After a bit more about the perceived benefits making risks “significantly” lower, a statement that isn’t true in the context of absolute risks (or when compared to less invasive alternatives):

Wiles: … Along with the medical aspect, a lot of people think that circumcision diminishes sexual pleasure, or that it diminishes sexual desire, and there is little evidence that supports the theory that sexual function and sexual desire is diminished. So, really,…
Osborne: Good to know.
W: … the studies are inconsistent in the results that they yield…
O: Mmm hmm.
W: … so there’s really little evidence to suggest that circumcision has an impact on sexual desire and sexual function, period.

There is ample evidence that circumcision diminishes sexual function. Even studies cited favorably by circumcision advocates demonstrate the undeniable truth that the foreskin has nerves (e.g. ridged band and frenulum) and functions (e.g. gliding mechanism). Circumcision removes both. It’s objectively incorrect to conclude anything else with regard to function¹.

Moving to the ethical question reveals a missed opportunity for contemplation on the primary question involved:

Osborne: I want to know, what do you think ethically about circumcision?
Wiles: Alright, well. Personally, I grew up circumcised, was circumcised very early on.
O: Can I go as far as to ask you, are you still circumcised to this day?
W: I am still circumcised, it did not grow back.
O: Ok.
W:
O: Just the way you had made it sound, you were like, “I *was* circumcised. I *was*.”
W: I was at a time circumcised, yeah. So I… … I thought that all penises looked like circumcised. I thought penises were, they just came circumcised, like I didn’t know it was a whole procedure until later on in life. I’m glad I was circumcised, I have to be honest, I am glad, because I think aesthetically, for one circumcision makes the penis look more attractive.
O: Mmkay. Have you ever met a guy that said that he didn’t want to be circumcised?
W: I’ve met guys who are uncircumcised but I have never asked if they want to be.

Ponder that last question more, please. It’s what matters here, as the intact guys can still choose. (If it isn’t obvious, I’m a guy who doesn’t want to be circumcised, but I had no choice in the decision.)

Osborne: Ok. How do you feel about, like, if, you know, if you gave a child that choice, like you decided not to circumcise them, and you said, like, if when they’re an adult, and they want to do it, they can do it. Do you think that’s, like, right, or do you think…
Wiles: I think that’s…
O: …….. or do you think, just do it when they can’t feel it?
W: I think that’s right, umm. I do feel like there are advantages to doing it when they are younger, especially with the disease prevention and the convenience. If you’re already in a hospital, you might as well.
O: Ok, I… I, personally, under the topic of genital… … mutilation, if we could call it that. I wouldn’t… like, if I had a son, I wouldn’t want to make that decision for him. I don’t think that’s fair for me. Umm… I think that might be violating some of his rights. And I think that he can do it when he’s older. I mean, we’ve got good medicine, he can be knocked out, get it done.

“You might as well” is not an ethical argument. It is a pithy shorthand for the abdication of parental responsibility for which so many people justify circumcision.

Last, while Osborne’s overall approach is strong, I don’t understand the assumption within “when they can’t feel it”. Babies can feel pain, including after the procedure during healing. I doubt she believes babies don’t feel it, and this was a thinking-out-loud shorthand for “can’t remember it”. If so, that has its own problems, as any thought experiment would show we can do all kinds of awful things to babies that they won’t remember. Not remembering them wouldn’t make any of them ethical to impose.

There’s still an interview to analyze, but that will get its own post.

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¹ In the linked study, Bossio found that the foreskin is the most sensitive part of the penis to light touch, which seems clearly relavant to the typical sexual experience. It’s absurd to find this objective fact and then explore subjective explanations valuing only other aspects. Some men will value other aspects more, yes, but some won’t.

Or, as the linked article by Brian Earp explains:

So let me try another analogy. Saying that removing the foreskin “doesn’t reduce penis sensitivity” is a bit like saying that removing the pinky finger doesn’t reduce hand sensitivity. What you really mean is that removing the pinky finger (which is part of the hand) doesn’t reduce sensitivity in the remaining fingers—although, as we’ll see, it’s not even clear that this part of the analogy holds up in the actual study.

In other words, it’s an odd way to frame the hypothesis. To continue the analogy, my guess is that most people—if faced with the claim that removing the pinky finger doesn’t reduce sensitivity of the hand—would say, “But what about the pinky finger itself?!”

Review: Tom Rosenthal’s Manhood

I stood in the corner of the bar attached to a comedy club on a rainy, late September Friday night in central London, alone. I realized I was about to cry. I managed to stop myself, a decision I immediately regretted. I didn’t want to bawl in the bar. I don’t cry, which I do not admit here to brag. It’s a source of frustration rather than pride for me.

I took a deep breath, and centered myself to quickly understand why that moment almost occurred. It was an unthinking reaction sprung from my depths out of the surprise that I wasn’t alone. I’d just seen Tom Rosenthal’s Manhood, his hour-long examination of circumcision where he demonstrated that he feels about it exactly as I do.

Manhood is, first, a comedy show. “Let me lecture you for an hour on the horrors of male circumcision” is a difficult entryway to challenge someone’s preconceived ideas on the topic. I know this because I’ve wanted to give that lecture so many times and seen the glassed-over “Oh, you’re actually against circumcision” reaction from my answer to an initial question. So, I knew going in there was an hour of material. But I was skeptical because circumcision is not funny. I did not expect to be persuaded that it could be.

After the show, it’s still true that circumcision is not funny. However, Rosenthal’s examination of circumcision, the mistaken ideas around it, and how men are treated for speaking out against the practice is hilarious. He understands the humor is in the preposterous, unquestioned ways we perpetuate this violation. Humor offers a path to the necessary realization and knowledge about what is happening. Most critically, unlike much of what passes as humor about circumcision, he understands that the circumcised male and the foreskin are not the butt of the jokes.

Rosenthal’s mastery flowed through the peaks of finding humor in something as basic as the word uncircumcised to the valleys of anger resulting from the discovery of what’s been done to us. I know that feeling intimately. Seeing it expressed with Rosenthal’s talent and perspective fractured me for a moment before letting me put myself back together with more than I had before.

After pondering the show for more than a month and finally writing to this point, I found this review:

Rosenthal has an engaging, energetic manner, and all is brought together by a theatrical ending that’s memorable, silly and ridiculously over-the-top. But none of this overcomes the tonal shifts between the uncomfortable, serious side of the show and the flippant.

The tonal shifts between the uncomfortable, serious side of the show and the flippant are why Manhood works. Again, circumcision is not funny. I knew this before the show, and I know it after. Tom Rosenthal knows that, too. But I laughed and never felt an urge to stop myself because he’d crossed a line. Unlike every ridiculous joke you can find of a comedian making the man or his foreskin the target, Rosenthal hits the laughs by communicating the absurdity of doing this to normal, healthy children.

The show being in the UK added an interesting element for me, since circumcision is not common there. Most of the audience seemed predictably unfamiliar with the facts and ideas in the show. The gasps at some of Rosenthal’s more shocking revelations about circumcision were enlightening for me as an outsider. I appreciated that it’s possible to find a random group of people who don’t think cutting children is reasonable. They were learning, and in a manner conducive to that. Comedy was the perfect entryway.

I’m purposely not repeating any of the jokes, but they’re fantastic. Rosenthal just announced he’s doing more shows in 2020, so I’d much rather people who care about this topic see the show for themselves. Also, I hope one day he can bring the show to the United States. I would love to see it with Americans to discover if there are differences in the reaction among a random group likely to hold only the superficial belief that circumcision is Good(™). But mostly I trust it will get through to audiences here. That’s what we need.

Flawed Circumcision Defense: Wesley J. Smith (Again)

I expect garbage opinions on male circumcision. Too many people don’t think about it, letting the inertia of ignorance fill in the gaps in their knowledge as parents (and humans pondering anatomy). But I don’t expect such trash from a magazine like National Review that prides itself on being smart, honest, and principled. (More on that in a moment.) Here, Wesley J. Smith shows an embarrassing lack of curiosity and imagination. (Again, since Smith has shown he doesn’t understand the subject before.)

“Intactivists”–the nutty name anti-circumcision activists have given themselves–who aim to outlaw infant circumcision, claim that the procedure has no benefits and constitutes child abuse.

Baloney. There are at least mild health benefits for men, to the point that the American College of Pediatricians recommends that the choice of whether to circumcise be left to parental discretion.

He should talk to more people against non-therapeutic male child circumcision, since he doesn’t appear to have met those like me. The procedure has potential benefits. Removing a body part inherently means something that can happen to it can no longer happen. Phimosis, for example, is no longer possible. Or name any potential benefit, real or made up. It doesn’t matter. Smith cites a new rehashing of studies by Brian Morris¹ showing potential benefits to the health of female sexual partners. Fine. I’ll concede it, even though much of the context is often dropped. Male circumcision offers that benefit, whether it does or not.

Here’s the problem: so what? That something is possible does not prove it’s acceptable to do it. Acceptance of science (with disagreement on the veracity of claims) is compatible with rejecting the application of that science to the healthy, normal body of another human being without that person’s consent. Non-therapeutic male child circumcision does not meet the ethical threshold for proxy decision-making. It can be delayed until the male can consent, given that it’s non-therapeutic. There are less invasive prevention methods and treatments available for every potential issue non-therapeutic circumcision seeks to address. The child owns his body, including his foreskin. This is the same human right everyone has over their body and genitals.

That’s all before we even get to preference. What does the individual want for his body? All tastes and preferences are unique. The individual has to live with the decision. If left intact with his choice, he has to live with it for 18 years, at which time he can change it. Or not. If circumcised, he has to live with it for the rest of his life, including the decades he’ll spend as an independent adult. He can’t reject what didn’t need to be forced. The ethical difference in those two scenarios is stark.

Notice, too, that Smith can’t even cite the right organization, calling the American Academy of Pediatrics the American College of Pediatricians. The latter exists, but is not the source² of his link. If he can’t cite them correctly, what is the likelihood he read the AAP’s technical report that fails to support their position?.

Smith concludes:

The utter obsession some have about outlawing circumcision–whether undertaken for religious or health reasons–has always puzzled me.

But now we know that other than emotion and a bizarre belief expressed by some intactivists that sex isn’t as good for the circumcised, there appears no substantial reason to oppose the practice, much less outlaw it.

If he addressed his puzzlement with research rather than cognitive dissonance and confirmation bias, he might understand there’s more than BUT MUH BENEFITS. That Wesley J. Smith can’t think of a reason against non-therapeutic child circumcision is not proof there is no reason against it. The reasons are real and substantial.

For example, he would know the “belief” expressed that sex isn’t as good for circumcised men is an argument that sex isn’t the same, which is a fact, and that it likely isn’t as good, an educated guess based on data and anecdotal evidence. Removal of the foreskin means sex with a circumcised penis is sex without a foreskin. If you change form, you change function. The skin and nerves and functionality there at birth are no longer there. Again, that is a fact. Whether that’s good or not is a different matter. And again, all tastes and preferences are unique.

Anecdotal opinions are easy to find, but you have to be willing to search for and understand the implication of “…[n]ever felt I was too sensitive before circumcision but in retrospect I was.” Will every man think he was “too” sensitive? Does that suggest circumcision changes sex, at least?

Or do you need someone with a few more credentials, such as Dr. Laura Berman, who states “[r]emoving the foreskin also removes thousands of nerve openings that make sex more pleasurable.”

Or do you want a scientist and ethicist who studies circumcision, like Brian Earp, who reads studies rather than headlines to understand what research means. This includes when he read and analyzed³ a study by Jennifer Bossio, writing⁴, “you will be surprised to learn—I am quoting directly from the paper now—that ‘Tactile thresholds at the foreskin (intact men) were significantly lower (more sensitive) than all [other] genital testing sites’ including the sites in circumcised men (emphasis added).”

Or do you want another researcher who studies circumcision and sensitivity, like Dr. Kimberly Payne, who wrote in her study, “[i]t is possible that the uncircumcised penis is more sensitive due to the presence of additional sensory receptors on the prepuce and frenulum, but this cannot be compared with the absence of such structures in the circumcised penis.”

Yet, Brian Morris used Payne’s study, which he rated as the highest quality, in another rehash he used to conclude, “the highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.”

The people who seem to care the least about the details of circumcision generalize toward the view they already held going in. Morris is a propagandist, and presumably Smith relies on him because he wants to believe. He’s not unique in that approach, but it’s not something he should put on display as he did.

Which leads me back to National Review’s Credenda. Among their convictions:

A. It is the job of centralized government (in peacetime) to protect its citizens’ lives, liberty and property. All other activities of government tend to diminish freedom and hamper progress. …

Non-therapeutic child genital cutting, including circumcision, violates the rights of the child, who is an individual and a citizen. Removing his foreskin deprives him of his property and liberty.

It is appropriate for the government to prohibit the non-therapeutic circumcision of male minors, as it already does for female minors. Whether or not that’s the fastest path to ending the cultural abomination is worth discussing. I think it isn’t, unfortunately. But it’s an appropriate legitimate action of government, since it would protect the rights of citizens, the substantial reason government exists. The government ignoring this diminishes freedom.

Whatever your opinion of National Review, Smith’s defense of circumcision should embarrass everyone at National Review.

¹ If you want to read the Morris study, follow the link to Smith’s post. If you want to know how to analyze one of the papers Morris cites in this new rehash, which is one of his previous rehashes of prior papers, read here and here. But notice the pattern of Morris rehashing papers over and over for the casual reader like Smith to think, “ahhh, a new study, and look at the volume of past studies showing the same thing!”. Stop being a dupe for his propaganda.

² The American College of Pediatricians has an official statement on Female Genital Mutilation. Its only reference to male circumcision is when it states:

The terminology itself has generated controversy. The World Health Organization emphasizes the fact that there are no medical benefits associated with even the least invasive procedure. Therefore, the WHO uses the term ‘mutilation’ to “establish a clear linguistic distinction from male circumcision, and emphasize(s) the gravity and harm of the act. Use of the word ‘mutilation’ reinforces the fact that the practice is a violation of girls’ and women’s rights, and thereby helps to promote national and international advocacy for its abandonment.“ (source)…

That linguistic distinction is propaganda, in the definitional, non-pejorative context, which the end of the quote acknowledges. There is harm in genital cutting, regardless of the victim. The practice is a violation of the victim’s rights, regardless of the specific genitals of the victim.

Yes, FGM is usually worse than male circumcision. Not always, and the law against FGM in the United States do not permit those harms equal to or less harmful than male circumcision. We treat the issue differently depending on who the victim is, which is logically and ethically flawed. The presence or absence of potential benefits is irrelevant to both. The absence of both need and consent is all that’s relevant.

³ Predictably, Brian Morris mischaracterized this finding in another of his rants.

Earp also clarifies with an analogy:

“Saying that removing the foreskin ‘doesn’t reduce penis sensitivity’ is a bit like saying that removing the pinky finger doesn’t reduce hand sensitivity. What you really mean is that removing the pinky finger (which is part of the hand) doesn’t reduce sensitivity in the remaining fingers — although, as we’ll see, it’s not even clear that this part of the analogy holds up in the actual study.”

Lazy thinking seems to be a prerequisite for those who advocate non-therapeutic male child circumcision.

Flawed Circumcision Defense: Dr. Laura Berman

tl;dr version:

Dr. Berman writes:

… Thankfully, [male circumcision] is a choice that we do have here in America, unlike the millions of young girls across the globe who must endure genital mutilation with no option to decline.

Her analysis shifts depending on whether a male or female is cut without need or consent. Male circumcision is “a choice that we do have here in America”. “Thankfully”¹. Her male circumcision argument is about parents, without consideration for the child. She then compares the victims of FGM “who must endure genital mutilation with no option to decline.” When did I have the option to decline my mutilation? When did any boy circumcised without need have the option to decline? Her argument is sophistry. It’s garbage and shows why any defense of male circumcision as ethically different from female genital mutilation is mistaken. Dr. Berman should feel shame for even thinking that sentence.

**********

Dr. Laura Berman posted a question on Facebook, asking:

Men, how do you feel about your circumcision (if you were circumcised)? Do you wish you weren’t, or do you think your parents made the right choice? And women – do you have a preference when it comes to partners who are circumcised vs. uncircumcised?

The replies are roughly in line with what anyone should expect from a circumcision thread. In response to some comments asking her opinion, she followed with a blog post about it, “When You Miss Your Foreskin: The Real Deal on Male Circumcision”. Early on, she writes:

First, as a Jewish woman, I want to acknowledge that there is a cultural legacy behind circumcision which informs many people in my community and their decision to circumcise. While I appreciate and love my Jewish heritage, I realize this is not enough of a reason to perform surgery on an infant without medical cause.

That statement takes courage and is worth commending. Unfortunately, she does not let that inform enough of the rest of her post. She continues:

The pediatric community is still largely in favor of circumcision, as they say that the benefits of circumcision outweigh the risks. What are these benefits?

She links the AAP’s 2012 statement there, which I’m omitting because you can get there here or here, instead. Apart from quoting the AAP’s flawed statement, quoting the AAP as “the pediatric community” is silly. The *American* pediatric community is still largely in favor of (non-therapeutic infant) circumcision. Most of the rest of the world is not in favor, for the reason Dr. Berman touches and then skips. There is not enough of a reason to perform surgery on an infant without medical cause. (There is no reason. There is no medical cause.) That’s the ethical principle applicable here, as in non-therapeutic genital surgeries on female minors. There’s no reason to exclude male circumcision from ethics.

After reviewing some potential benefits of circumcision, including the casual sexism of “for little boys who hate to bathe”, which should be rewritten as “for parents who abdicate their responsibilities”, Dr. Berman gets to some negatives. She writes:

Loss of nerve endings. Removing the foreskin also removes thousands of nerve openings that make sex more pleasurable.

It’s beyond comprehension how someone can write that fact and not end the post there with, “Yeah, this is wrong. We must stop immediately. And we should apologize for every non-therapeutic, non-consensual circumcision performed before now, because we were wrong to perform every one of them.” But she doesn’t, because of the usual consequentialism and moral relativism involved in this debate that predictably appears in her post. She continues:

… Along with physical pain, many men later report that they feel they feel violated as their circumcision was done without their consent.

Although I feel violated, that is a direct result of being violated. My non-therapeutic circumcision occurred without my consent. My circumcision violated me. I know why we avoid acknowledging this as a society, but it’s too blatant to be defensible.

Dr. Berman shifts to something worth repeating:

Last, before I end, I want to address the issue of consent around circumcision. One man on my Facebook post compared circumcision to rape, and while I appreciate his right to anger about his circumcision, we must be very, very careful when we use the word ‘rape’ to describe anything other than rape. Words matter. They are powerful. They shape our beliefs and they inform the way we live in this world. So when we use the word ‘rape’ to talk about a medical procedure performed in good faith, this does a grave injustice to rape victims who have been abused, traumatized, penetrated and dehumanized by a sexual predator(s).

I agree with this, and stand by what I’ve written on it.

However, what is consent, if not the ability to reject something you neither need nor want? It shouldn’t be discussed in the context of calling circumcision “rape”. We must discuss consent, though,
because it’s the crux of the violation. You don’t believe in consent if you believe consent in non-therapeutic genital cutting is sometimes relevant and sometimes not.

She moves on to the comparison of female genital mutilation/cutting and male circumcision. It’s flawed:

Nor do I think it is appropriate to take over a conversation about female genital mutilation by bringing up male circumcision in the Western World. There is a giant difference between FGM which occurs across the globe in places like Africa, Indonesia, and more. There are currently 200 million women living today in 30 countries who have been victimized by female genital mutilation in which these young girls near puberty are held down while some or all of their external genitalia are cut off with a sharp blade or piece of glass or similar cutting instrument.

It’s usually not appropriate to take over a conversation about FGM. The problem arises when the writer changes the analysis used for non-therapeutic female and male genital cutting, as most writers on the comparison do, and as Dr. Berman does here. Is it wrong to alter the healthy, normal genitals of a girl in a sterile operating theatre with appropriate pain management and the best parental intentions, the context assumed for male circumcision? It is still wrong in that context because it harms the girl without her consent. “One is almost always worse” is true and irrelevant to the principled analysis of non-therapeutic genital cutting without the recipient’s consent.

The usual caveats appear to continue the false distinction:

Unlike male circumcision, there are absolutely no benefits to FGM,…

If there were potential benefits to FGM, very few would change their opinion on FGM. Rightly so, because they would look at the costs – the guaranteed harm – and judge it unethical. There is no excuse for distinguishing this violation of males from this violation of females.

… and unlike circumcision, it is not performed to protect male sexual health …

Harming an individual to protect him from harm that can be prevented with lesser interventions is an absurd justification. He may not prefer this “protection” at the expense of his foreskin.

… but in order to erase female sexual pleasure and to lay ownership to a woman’s genitals. …

What did Dr. Berman ask? “And women – do you have a preference when it comes to partners who are circumcised vs. uncircumcised?” Why is that question relevant to the discussion? Dr. Berman doesn’t use the “women prefer” argument, but enough proponents use it to make the comparison. At best, we do not discourage “you prefer circumcision, so circumcise your son”. So, is the argument that it isn’t intended to lay ownership to a man’s genitals or that it doesn’t lay ownership? Even when the former is correct, it’s irrelevant because the latter is always incorrect in non-therapeutic child circumcision. “Son, you should prefer our preference(s), so we’ll make this choice that forces you to live with our preference(s) forever” is the antithesis of self-ownership.

When Dr. Berman later talks about whether “circumcision is the right choice for you and your family”, she implies that the penis belongs to the family rather than the boy. The best intentions don’t change the action. It is permanent control over part of the child’s sexuality.

After more awful facts of FGM, and embedding an Instagram post from WHO (correctly) declaring FGM a violation of human rights, Dr. Berman continues:

FGM is a violation of the human rights of girls and women. There are many who feel that male circumcision is a violation of the human rights of baby boys, and for these people, deciding to keep their baby intact is the correct choice. Thankfully, it is a choice that we do have here in America, unlike the millions of young girls across the globe who must endure genital mutilation with no option to decline.

Circumcision is a violation of the human rights of boys and men. This is true for the same reason non-therapeutic, non-consensual genital cutting violates the human rights of girls and women. There is neither need nor consent. Any cutting in that context violates the individual. Any analysis beyond that is sophistry for one’s preferences and biases.

Re-read the tl;dr above if it isn’t burned into your mind.

And then:

Why am I making this distinction between FGM and circumcision? Because, again, I think it does a disservice to woman who can feel no sexual pleasure, women who endure a lifetime of pain and loss, and young girls who are held down and tortured because their bodies are viewed as dirty and sinful to a medical practice which is performed safely, hygienically and with a baby’s health in mind.

Again, what is done to the genitals of girls and women is horrific, barbaric, and indefensible. Also again, this uses a different standard for assessing what is done to girls and what is done to boys. Would she approve of FGM if it is “performed safely, hygienically and with a baby’s health in mind”? Nope, and to reiterate, correctly. Consequentialism and moral relativism have no place in the analysis of genital cutting, including male circumcision. Genital cutting is wrong for boys for the same reasons it’s wrong for girls. (Especially when we consider “their bodies are viewed as dirty” in the context of “for little boys who hate to bathe” and “I chose to circumcise because I thought it was cleaner.”)

In summary, using the last link in the previous paragraph, Dr. Berman writes:

While nothing can ever undo that man’s circumcision,…

“While nothing can ever undo that man’s *non-therapeutic, non-consensual* circumcision… That’s the whole story. Stop ignoring it.

¹ I’m not thankful male circumcision is a choice “we” have in America, because “we” decided my penis without me.

Ethics Rationalizations, applied to Genital Cutting

Jack Marshall at Ethics Alarms has maintains a list of Unethical Rationalizations and Misconceptions. It’s a wonderful list for understanding human (mis)conduct and for striving to be better. Much of it applies to the debate over non-therapeutic child genital cutting. (See below.) Recently, Mr. Marshall posted a revision to his list. He added Rationalization #23, The Dealer’s Excuse. or “I’m just giving them what they want!”. This is the rationalization “that conduct becomes justifiable and benign if there is a market for it.” He further explains:

Those who employ the Dealer’s Excuse aren’t providing a service out of altruistic motives, but out of the profit motive. They want the money they can make by doing unethical things that make society uglier, dysfunctional and dangerous, and they really don’t care if their customers come to a bad end or bring miseries to others.

This is true of a subset of practitioners who circumcise infant males, for sure. That it happens is self-perpetuating. “That doctor is doing it, and making quick money doing it, and it makes the parents happy, so there’s no reason I shouldn’t participate.” It’s ugly and harmful.

In my experience from talking to doctors who circumcise (and some who don’t), there is a related factor. They’re cowards. I perceived many of these doctors to be ambivalent or opposed to non-therapeutic infant circumcision. But they feel obligated to appease the parents at the expense of their patient. From Mr. Marshall’s list, it’s Rationalization 15, The Futility Illusion: “If I don’t do it, somebody else will.” If one individual doctor refuses, the outcome for the child is likely no different. But change doesn’t happen if we refuse to speak out and reject what we know to be wrong.

Related, this post from 2015, Ethics Quiz: “Fixing” “Elf Ears”, has relevance. A 6-year-old boy’s ears stuck out like an elf’s, basically. Dr. Tracy Pfeifer, a plastic surgeon quoted in the news article, defended it by saying, “The surgery is relatively simple and it is life-changing in a positive way for these young children.” Someone told me that about circumcision yesterday. Like Mr. Marshall, my response is essentially “so what?”. As he said in his post:

The surgery is also premature, and thus unethical from a medical ethics standpoint, because at six no child’s adult appearance can be accurately predicted. Nor can a six year old make an informed decision about surgically changing his or her appearance at that age, though The Daily News found some dubious experts—as in “flacks for the plastic surgery trade”—to claim otherwise. Except in a case of serious deformity, the choice to radically change a child’s appearance should be made after the child has gained some understanding of the issues involved.

Exactly. Protruding ears, “big” nose, or foreskin, the analysis is the same. Science is necessary and relevant, but the application of that science requires ethics. What we can do is not the same as what we should (be allowed to) do to another.

(See also: The Slippery Slopes of Religious Freedom and Female Genital Mutilation, especially on the potential outcome if Alan Dershowitz’s expected defense strategy in the Detroit FGM prosecution succeeds. I wrote indirectly about the case. The latest version of the complaint is here (pdf).)

********************

From the Ethics Alarms list of Unethical Rationalizations and Misconceptions, at a minimum the following rationalizations apply to the defense of non-therapeutic genital cutting on minors. I’ve encountered each at least once in my activism, some as recently as yesterday:

1. The Golden Rationalization, or “Everybody does it”
1A. Ethics Surrender, or “We can’t stop it.”
2A. Sicilian Ethics, or “They had it coming”
3. Consequentialism, or “It Worked Out for the Best”
4. Marion Barry’s Misdirection, or “If it isn’t illegal, it’s ethical.”
6. The Biblical Rationalizations
9. The Reverse Slippery Slope
13. The Saint’s Excuse: “It’s for a good cause”
13A. The Road To Hell, or “I meant well” (“I didn’t mean any harm!”)
14. Self-validating Virtue
17. Ethical Vigilantism
22. The Comparative Virtue Excuse: “There are worse things.”
23. The Dealer’s Excuse. or “I’m just giving the people what they want!”
24. Juror 3’s Stand (“It’s My Right!”)
25. The Coercion Myth: “I have no choice!”
27. The Victim’s Distortion
29. The Altruistic Switcheroo: “It’s for his own good”
29A. The Gruber Variation, or “They are too stupid to know what’s good for them”
32A. Imaginary Consent, “He/She Would Have Wanted It This Way”
34. Success Immunity, or “They must be doing something right!”
38. The Miscreant’s Mulligan or “Give him/her/them/me a break!”
41. The Evasive Tautology, or “It is what it is.”
42. The Hillary Inoculation, or “If he/she doesn’t care, why should anyone else?”
43. Vin’s Punchline, or “We’ve never had a problem with it!”
44. The Unethical Precedent, or “It’s Not The First Time”
45. The Abuser’s License: “It’s Complicated”
46. Zola’s Rejection, or “Don’t point fingers!”
48. Ethics Jiu Jitsu, or “Haters Gonna Hate!”
49. “Convenient Futility,” or “It wouldn’t have mattered if I had done the right thing.”
50. The Apathy Defense, or “Nobody Cares.”
50A. Narcissist Ethics , or “I don’t care”
51. The Underwood Maneuver, or “That’s in the past.”
57. The Universal Trump, or “Think of the children!”
57A. The Utilitarian Cheat or “If it saves just one life”
58. The Golden Rule Mutation, or “I’m all right with it!”
59. The Ironic Rationalization, or “It’s The Right Thing To Do”
63. Yoo’s Rationalization or “It isn’t what it is”
64. Irrelevant Civility or “But I was nice about it!”
64A. Bluto’s Mistake or “I said I was sorry!”

The whole list is worth reading and understanding, in general, both to notice when you encounter them and to be diligent about not offering them.

Incomplete Progress (v2)

Two new examples of circumcision without consent that should be prosecuted, but not for a reason distinguishing it from any other non-therapeutic genital cutting on a child. First, from England.

A 61-year-old man, believed to be the doctor who carried out the procedure, has been arrested on suspicion of grievous bodily harm with intent.

The boy’s mother complained to police, saying her son was circumcised without her consent while staying with his paternal grandparents in July 2013.

If consent from one parent is permitted, it’s still a violation because the healthy¹ boy didn’t consent.

Next, from South Africa:

A police investigation is under way after a group of 27 boys were illegally circumcised in Scenery Park‚ East London‚ the Eastern Cape health department said, writes Naledi Shange.

Spokesperson Sizwe Kupelo said police‚ traditional leaders and health officials raided the initiation school on Sunday afternoon.

They were accompanied by some of the parents whose children had been circumcised without their consent.

The same point on consent applies.

As in my last post, we’ll be making real progress when the meaning of their aligns with ethical principles by referencing the boys, not their parents. Still, any pursuit that raises the issue of consent at all is almost certainly progress.

¹ This key point is why the change we need is more cultural than legal. Doctors who support non-therapeutic circumcision of children – American doctors, in particular – are inclined to believe nonsense about the foreskin, such as what Brian Morris promotes. There won’t be a change in the legal until the culture changes. But if there were somehow a legal change without cultural change, the law wouldn’t matter. The boy’s chart would read “therapeutic treatment for phimosis” or some other offensive lie. Also, having a law no prosecutor will enforce is no better.

Incomplete Progress

I don’t know if the facts mentioned here are accurate or not. I assume so. And for my inclination, obviously, it’s believable. If the facts are as reported, this is progress. But I want to be weary of first reports, always, so that’s what I want to say on the claimed facts.

My focus is the lede of the article.

A British GP is to be prosecuted by an outraged mother for assault after circumcising her baby boy without her consent.

The day that is written as, “A British GP is to be prosecuted by an outraged mother for assault after circumcising her baby boy without his consent” will be better progress.

There’s no complaint about the article for its lede. It mentions the ethical issue of the child’s consent in the next paragraph. We’re getting close to when the framing will finally be right, and people recognize the rights violation is to the child, not his mother and/or father in certain circumstances.

√erifying what you want to believe

WZZM, the ABC affiliate in Grand Rapids, Michigan, has a “verify” article purporting to address the following:

The story of a female genital mutilation case in Detroit has prompted lots of questions from our viewers on what this procedure actually is and how it compares to circumcision in males. So, we set out to Verify this issue by reaching out to the experts.

WZZM “verifies” this in a surprising and predictable manner. There’s a video associated with the article. It’s what I will use as a summary for two reasons. I assume that’s what most people who arrive at the link will use. But I’ll focus on the video because it addresses what WZZM researched, not the comparison the article said they aimed to verify. (Most of the sections of the article are rote talking points. Also, I’m unconvinced the article had an editor for content because it did not have one for grammar.)

First, the on-air reporter, Val Lego, provides a summary of the two procedures.


(Larger size here)

This is the surprising part. It’s accurate. As those of us who recognize the valid comparison have said, both inflict permanent harm for non-therapeutic reasons and without consent. This is where the discussion should end. If this were investigating the correct question, the comparison as posited in the article, Ms. Lego would say, “As you can see, they are comparable. They are both a violation of the child.”

But this wasn’t investigating the correct question. Contrary to the accompanying article, WZZM sought to “verify” the difference between female genital mutilation and male circumcision. WZZM begged the question that they’re different. So, even with the ethical comparison established, the analysis works to provide the flawed, predictable psychological comfort for the viewer. Anyone with even a basic understanding of American culture can predict the outcome:


(Larger size here)

Here’s the completed list. It’s “√erified”. You got it right, didn’t you?


(Larger size here)

While accurate in the merely factual sense, none of it is relevant to the question of whether child genital cutting is acceptable. The comparison established before this list demands equal protection for everyone based in the ethical principle¹, whether female or male, adult or child. Everyone has the same human rights. There are no exceptions in the right to bodily integrity for “rooted in parents’ religion”, “potential health benefits”, or “only lifelong consequences we care about”. Religious rights belong to the individual, including the choice to reject genital cutting. The potential health benefits are of subjective value² because the child is healthy. Only he may decide if he values them more than his foreskin. And permanent removal of normal body parts is harm, always. That harm occurs in varying degrees, but harm is guaranteed with every cut.

Going back to the article, it ends with this:

Dr. Megan Stubbs, sex and relationship expert, says that there is a distinct intent to curb a woman’s sexual desire when she undergoes FGM/C – women and girls may face serious, lifelong medical and sexual dysfunction.

“Men who have been circumcised typically lead happy, health lives. Circumcised men still enjoy sex, with or without a foreskin,” Dr. Stubbs states.

Again, FGM is evil in all its forms. “May face” is true here because some less-common forms of FGM do not inflict serious, lifelong harm (or inflict harm similar to circumcision). Those forms are still illegal, as they should be. Good so far.

Dr. Stubbs then counters objective harm to a female victim with “still enjoy sex” for male circumcision. It’s a ubiquitous attempt at a distinguisher, the psychological comfort to parents of boys. But Dr. Stubbs changed the criterion, going from factual statements about FGM to a subjective statement about male genital cutting. Changing form (i.e. cutting away genital parts) changes function (e.g. loss of foreskin’s gliding mechanism). Whether that’s good or not depends on the individual recipient’s opinion. Outcomes vary for every individual. Preferences for or against those outcomes differ for every individual.

The issue is proxy consent for non-therapeutic genital cutting. The first picture above makes it clear how this should be answered. It is not a separate analysis for female versus male patients. (There is perhaps a separate analysis of punishment for what is inflicted on the victim.) Without need, inflicting permanent harm on an individual via proxy consent – with unknown severity and long-term consequences – is indefensible.

No individual’s experiences (or rights) are less valid than another’s because his or her outcome isn’t typical or as severe as another’s, or because his or her parents had the perceived right intention. “Still enjoy sex” is not a Get Out of Violating Human Rights Free card. Nothing in that video or article makes me think those who oppose FGM and defend circumcision would accept FGM if potential health benefits were discovered. (It wouldn’t be ethical to research the question on children, anyway.) That’s correct because FGM/C violates the girl’s body and rights. Thinking the items in the “√erified” column excuse or differentiate male circumcision in a meaningful manner is wrong and hypocritical.

¹ Non-therapeutic genital cutting without consent of the recipient is unethical.

² Science isn’t stagnant, either. It’s realistic to imagine a future with even better ways than our existing less-invasive-than-genital-cutting options to respond to the problems prophylactic male circumcision might address.

Discomfort Them So They Won’t Be Discomforted?

In the comments to the article in yesterday’s post, Bryan Swilley wrote the following:

This article is another example of the media using sex to generate readers when no real controversy exists. Sure, a few detracters exist to circumcision but they are a small minority. In my medical career I have counseled virtually no one concerning any mishaps during the procedure or any mental anguish from having it done and can remember only 1 american parent in 30 years who was steadfast against it, but I do remember the discomfort some men faced following an elective circumcision performed when they were adults. The procedure tends to help when it comes to cleanliness and I remember senior physicians during my training discussing cancers that were hidden under a foreskin later in life when no circumcision was performed.

We could easily play a game of “Whack the Fallacy”, but there are only so many hours in each day. I want to make rhetorical points instead.

Why is it difficult for people to recognize the absurdity in citing the “discomfort” of elective adult circumcision as a justification for infant male circumcision? It’s elective, so do they value the circumcision or not being in discomfort more? Do people believe an infant doesn’t experience “discomfort” during his elective elected circumcision? Why is the issue of consent not shining in their minds?

False Distinction, Not False Equivalency

Note: I’m not going to write about the charges directly here. Anything involving a cursory glance of my work here will let you know I understand, abhor, and reject FGM in every form. If guilty of the charges, the doctors should serve the maximum sentence allowed.

I noticed something both fascinating and infuriating in this USA Today version of the Detroit Free Press article on the arrest of three doctors in Michigan on charges of mutilating the genitals of female minors. Specifically, this section:

As some medical experts on the topic stated in a 2015 article by The Atlantic:

“Male circumcision does no harm. Female gender mutilation does. Male circumcision cuts the foreskin, FGM cuts the clitoris — the two things cut are not even remotely the same. For male circumcision to be equivalent to FGM, the entire tip of the male’s penis would need to be cut off … Constantly trying to claim they are equivalent practices when they are not takes away from the unique seriousness of female ‘circumcision/mutilation,’ as most cases are performed during a traumatic developmental period and remove most sexual sensation, which is not true with male circumcision.”

Two things immediately jumped out. Who are the medical experts? Where is the link to the Atlantic article? Seeing that this is the USA Today version, I investigated to determine if the link was dropped from the original Detroit Free Press version, which is here. Nope. The link isn’t there. And not only is the link not there, those two paragraphs were removed and replaced. (More on the latter in a moment.) So I checked the Wayback Machine to see if the USA Today version is different or out-of-date. Predictably, it’s out-of-date, because the first version was what USA Today still presents. My hunch was that the reporter, Tresa Baldas, (or an editor) made an inexcusable mistake, which was then erased (incompletely, because the internet is mostly forever). It’s the conclusion I draw, but I’m open to more facts.

I found the referenced Atlantic article, “How Similar Is FGM to Male Circumcision? Your Thoughts”. It contains Baldas’ paragraph from two excerpted, merged comments. The quoted “medical experts” are a commenter called Tyfereth and a commenter, Jim Eubanks, who is an MD candidate, according to his Facebook profile. Half-right, I guess, except the initial comment is the one drawing the alleged distinction. Tyfereth’s comment:

Male circumcision does no harm. FGM does. Male circumcision cuts the foreskin, FGM cuts the clitoris, the two things cut are not even remotely the same. For male circumcision to be equivalent to FGM, the entire tip of the males penis would need to be cut off. Now that would be a harm, but cutting off the foreskin isn’t harmful.

This is ridiculous logic. (It is also incomplete knowledge of the various types of FGM.) Cutting inflicts harm. This is indisputable, except for foolish attempts such as this. Declaring that cutting the body and removing a normal, healthy body part is somehow harmless, like touching a raindrop, should raise skepticism in every reporter (and editor). That it didn’t immediately demonstrates a problem Ms. Baldas (and/or her editor) should question in her continuing coverage. Instead, she quoted Tyfereth as a medical expert on nothing more than a lame “nuh-unh!”.

At least Mr. Eubanks appears to be closer to an expert. But he isn’t making the same argument, so he shouldn’t be lumped in with Tyfereth’s nonsense. In his complete comment, he’s a bit more nuanced.:

False equivalency. You can stand against both practices, but constantly trying to claim they are equivalent practices when they are not takes away from the unique seriousness of female “circumcision/mutulation” as most cases are performed during a traumatic developmental period and remove most sexual sensation, which is not true with male circumcision. We can oppose both but take them on their own terms please.

He’s still wrong, of course. There is no false equivalency in the principle. Non-therapeutic genital cutting on a non-consenting individual is unethical. The right involved is a human right based in consent, not a female right based in degree of harm¹. The cutting done on an individual is a matter for penalty, not whether both violations or just those of females should be treated as crimes. The boy who is cut has as much right to his normal, healthy body² as the girl who is cut has to hers.

This is apparent with analysis of a more recent article Ms. Baldas wrote, “Report: Girl’s genital mutilation injury worse than doctor claims”.

A doctor’s findings, however, contradict that claim. A juvenile protection petition filed on behalf of the victims in Minnesota, along with federal court documents, cite scarring, a small tear, healing lacerations and what appears to be surgical removal of a portion of her genitalia.

I have or had all four of those injuries. I can’t state they are to the same degree, of course, so I’m not declaring that here. I’m stating the comparison is valid because non-therapeutic genital cutting without consent violates the individual. There is no false equivalency in stating that everyone has the same right to be free from unneeded, unwanted harm.

————-
Here are the paragraphs that replaced the reference to the medical experts in the Atlantic.

Medical associations also have cited health benefits to male circumcision, but have found no such benefits to female genital mutilation, which has been condemned by medical organizations worldwide.

For example, The American Academy of Pediatrics and the U.S. Centers for Disease Control have both found that the health benefits of newborn male circumcision outweigh the risks, though both groups say the final decision should be left to the parents as it may involve religious or cultural beliefs. The benefits cited by both groups include the prevention of sexually transmitted diseases, including HIV, and a lower risk for urinary tract infections in infants.

Neither group, however, endorses female genital mutilation in any form and has cautioned physicians against practicing it. The same goes for the World Health Organization, which has condemned female genital mutilation, but has recognized health benefits to male circumcision, stating: “There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%.”

First, the “FGM has no medical benefits” argument is a false distinction. It’s true, but irrelevant in the comparison. Most, if not all, opponents do not oppose FGM because it has no medical benefits. They oppose it because it violates the girl and inflicts harm on her. It’s a “spaghetti against the wall” argument. If researchers were to find (potential) benefits, the harm would still be real. Few opponents would change their mind. Rightly, of course, but it demonstrates the argument’s irrelevance.

Next, the American Academy of Pediatrics did not “find” that the health benefits outweigh the risks. They declared it to be true in the same way Michael Scott declared bankruptcy. The ethics section (Pg. 759) of its 2012 technical report states:

… Reasonable people may disagree, however, as to what is in the best interest of any individual patient or how the potential medical benefits and potential medical harms of circumcision should be weighed against each other.

This is obviously true. The value of a potential risk reduction at the expense of risk and an objective physical cost with the lost foreskin is a subjective conclusion based on the individual’s personal preferences. Yet the Abstract misrepresents what’s in the Technical Report when it declares, “preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure”. The AAP knows this is not a factual statement. Lazy, uncritical journalism perpetuates this subjective conclusion as fact.

Even the alleged bioethicist involved in the Task Force knows the truth, despite what he signed off on with the Abstract. Dr. Douglas Diekema said, “Not everyone would trade that foreskin for that medical benefit.” All individual tastes and preferences are unique. I think the potential benefits probably have merit. I don’t care. I don’t want them in exchange for my foreskin. I’d rather have my foreskin and a (tiny) higher absolute risk of a foreskin-related problem than my circumcision. This is true in spite of my parents preferring me circumcised. The proper analysis is cost-benefit, not risk-benefit. The risks are a relevant cost, but the loss of the foreskin is the primary cost of circumcision. For indefensible reasons, most – including the AAP and CDC – ignore it completely.

The reference to the CDC is curious for another reason. Its proposed guidelines have not proceeded beyond the flawed draft recommendations from 2014. Again, uncritical journalism is probably to blame. Most treated the draft as final, despite it clearly stating “draft” and open to review. I assume this happens due to laziness and confirmation bias. Insert your own theory why. It doesn’t matter. The result is misinformation spreads further.

With respect to FGM, the AAP briefly proposed a ritual nick as an alternative, which has implications for the “false equivalency”. But it is correct they don’t endorse it today. The WHO, however, is clueless and/or hypocritical. From its FGM factsheet, it states:

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.

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. Generally speaking, risks increase with increasing severity of the procedure.

Everything there that isn’t the “spaghetti against the wall” argument (and “total removal” for the pedants, although it occurs) is true of male circumcision. WHO recognizes FGM as “a violation of the human rights of girls and women”. It is a violation of human rights, not female rights. Injury to the genitals without need or consent is the problem, not the form of the body part.

¹ Even though, yes, what is done to females is usually more harmful than what is done to males.

² This applies to intersex children, too. Obviously.