Category: Ethics

√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.


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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:


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


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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.

A question on tactics

What does attacking a doctor on Facebook to the point that she deletes her account* accomplish? Yes, she’s a hypocrite for being very serious about “MY body, My choice” for women’s issues, but also performing circumcisions at the request of her patients’ parents that violates their bodies because she stupidly doesn’t believe she should have a say in what she does for the parents – and to her patients. But I’m genuinely unclear on what attacking her, calling her disgusting, and going full offensive at her achieves. Will she now see the light and stop mutilating infants? Or is this our Two Minutes Hate ritual? Since it’s a very clear either/or scenario, I want the former, not the latter, so if there’s something else I’m missing making people choose the latter, please explain it to me.

* And her Instagram account. I’m not posting the link.

“Being Targeted”, Predictably

The latest strategy to circumcise children is underway:

Over 900 boys and men in Mombasa County are being targeted for circumcision in a new drive by the government to reduce new HIV infections caused through the exercise.

The National Aids and STI Control Programme (NASCOP) said on Friday that it is targeting men aged between 10 and 50 years to undergo the cut under Voluntary Medical Male Circumcision (VMMC).

The first paragraph mentions boys. The second paragraph discusses 10-year-old men, because fewer would participate in the lie of “voluntary”. It’s always this way in advocating for circumcision, with the meaning of words being malleable to the goal. (e.g. “Medical” rather than “medicalized”) When public health officials advocate for voluntary, adult male circumcision, they never mean “voluntary” or “adult”.

The Lie Feeds Itself – PrePex Is Predictably More Unethical on Circumcision

Over the course of five years, it’s been clear where PrePex would go. Circ MedTech made it clear earlier this year that it would not be satisfied with a device aimed at voluntary, adult male circumcision. It only cares about two of those four words. Its adherence to the use of PrePex in voluntary, adult circumcision was always a delay in technology, not a wall of ethics. Now, it shares predictable evidence of its lack of ethics in developing and promoting PrePex. From its FAQ, Is PrePex available for adolescent boys?

The manufacturers of PrePex are committed to assisting males of all ages with appropriate male circumcision technology. Non-surgical circumcision using PrePex is now available for males ages 13 years and above. Devices for Infants & Children (0 days to 13 years) based on the existing PrePex technology are underway.

The only appropriate male circumcision technology appropriate for a normal, healthy male under 18 who does not – or cannot – consent is the technology that remains in the package, unused. Instead, Circ MedTech wants to assist¹ males of all ages, whether or not they want – or will ever want – to be assisted. It does not care about voluntary or adult.

Note that, despite being dated December 3, 2014, that link did not include the italicized language on April 22, 2016. It stated:

The manufacturers of PrePex are committed to assisting males of all ages with appropriate male circumcision technology. Non-surgical circumcision using PrePex is not yet available for youths under the age of 18, although it is being developed and tested.

An ethical organization would not mislead in this manner. I will not pretend to be surprised, however small the offense.

Circ MedTech’s absurdity with language continues in Who is eligible for circumcision with PrePex?:

PrePex has been proven safe and effective for adult and adolescent men over the age of 13. In studies to date, approximately 90% of men who volunteered were eligible to undergo the procedure. Men interested in medical male circumcision should consult with a trained healthcare provider to determine whether PrePex is right for them.

Every time I think circumcision advocacy can no longer shock me, something ridiculous like “adolescent men” appears. Dare I predict the eventual use of “infant men”? Surely that’s too absurd?

I have another ethics question. Did all of the “adolescent men” volunteer, or were they volunteered by their parents. And it’s disgusting² that the prospective patients in “Is PrePex available for adolescent boys” became “adolescent men” when discussing the actual circumcision of those healthy-and-unable-to-consent individuals.

On April 21st, that link stated:

PrePex has been proven safe and effective for adult men over the age of 18. In studies to date, approximately 90% of men who volunteered were eligible to undergo the procedure. Men interested in medical male circumcision should consult with a trained healthcare provider to determine whether PrePex is right for them.
Non-surgical circumcision is not yet recommended for youth under the age of 18 outside the clinical evaluation framework. Several African countries are currently investigating the safety and efficacy of the PrePex procedure for adolescent men, and study results should be available in early 2014.

“Adolescent men” was already there, but within one two-sentence paragraph, Under-18s transitioned from youths to adolescent men. That’s at least impressive in its shamelessness, I suppose.

As always, when public health officials speak of voluntary, adult male circumcision, they never mean voluntary or adult.

¹ The violation of rights seems to require euphemisms.

² I rewrote the euphemism I initially used. I prefer to speak truthfully.

Flawed Circumcision Defense: Barbara Kay

[10/19 Update: Edited for clarity and to reduce speculation since late night posting is imperfect and probably unwise.]

National Post columnist Barbara Kay used Brian Morris’ latest rehash on circumcision to repeat her ignorant thoughts on the subject. She begins by regurgitating claimed benefits, which can all be conceded here for the sake of time because they’re irrelevant to the only issue, ethics. Then:

… Dr. Morris and his American co-authors state, “We found that up to 65% of uncircumcised males might experience at least one of these [medical conditions] over their lifetime.” …

Until May 2015 Morris claimed the number as 33%. Since June 2015 he claims it’s 50% in a brochure on his website. And it’s apparently 65% in this new review. When will he settle on 100%? But more to the point, it’s obvious he likes whichever way he can claim this number because it’s flashy. “Ooooooh, 33/50/65 percent is high. Such danger!” But it’s a meaningless number in the context of non-therapeutic circumcision of boys. I assume Morris knows this. I assume Kay doesn’t, so a review of Morris’ history could help. Instead of those numbers, this is what is worth discussing here, from Morris:

Up to 10% of males reaching adulthood uncircumcised [sic] will later require circumcision for medical reasons.

Not only is the number only 10%, it’s only up to 10%. Medically necessary circumcision is rare, at any age. There is no ethical case for imposing the most radical solution without consent when at least 90% of males will never need it.

She continues:

… Their risk-benefit analysis of the procedure led them to conclude the benefits exceed the risks by about 100 to one. (In another study, published in the Journal of Sexual Medicine, Dr. Morris and colleagues found circumcision produced no adverse affect on sexual function or pleasure, a charge often leveled by anti-circumcision activist groups.)

Much like when Yair Rosenberg accepted Morris’ claim unexamined, Kay doesn’t appear to know the primary source.

But in a study Morris and Krieger rate as [highest quality], Payne et al [12], this:

… It 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. …

Payne’s study published in 2007. In 2011 Kay wrote:

Set aside the rights-based rhetoric. It’s about sex: Circumcised men have greater pre-orgasmic endurance; non-circumcision permits more frequent ejaculations. …

So, circumcision either delays orgasm, assumed to be positive for all men, or has no effect on sexual pleasure. Like Morris, she appears to play “heads I win, tails you lose”.

Kay goes on to write:

… The AAP states: “The new findings show that infant circumcision should be regarded as equivalent to childhood vaccination and that as such it would be unethical not to routinely offer parents circumcision for their baby boy. Delay puts the child’s health at risk and will usually mean it will never happen.”

That quote is not from the AAP. It’s from Prof. Morris. He wrote it in a press release more than 18 months after the AAP published its revised position statement. Kay doesn’t bother to fact check the most basic statement. [ed. note: Kay asked the online editor to correct her error.] Nor does she pursue how Morris’ quote undermines their case for non-therapeutic neonatal circumcision since he acknowledges that circumcision is rarely necessary.

Thus, while it’s inexcusable, it’s hardly shocking when she continues:

The CPS could not condemn the practice on grounds of increased morbidity. After thousands of years of what is essentially a controlled study with virtually all Jewish men, with a large percentage of Muslim men on one side, and uncircumcised men on the other, it has been unequivocally concluded that circumcision presents no health risks; quite the contrary, as we shall see.

Even Morris doesn’t pretend that circumcision “presents no health risks”. He understates them, and ignores the guaranteed harm from the removal of the foreskin (and possibly frenulum) in 100% of circumcisions. But he’s not so biased that he’ll posit such an obvious untruth. Yet, there’s Kay’s indifference masquerading as hyperbole for all to see.

… Morris’s team estimates the combined frequency of adverse events at 0.4% overall, arguing that “the cumulative frequency of medical conditions attributable to [having an intact foreskin] was approximately 100-fold higher” than the cumulative risk of circumcision.

Even if we accept the numbers, he’s arguing frequency of medical conditions attributable to the foreskin, not the frequency of medically necessary circumcision. It’s fascinating, perhaps, but a transparent obfuscation. The anti-science charge is often leveled at activists here, but soap, water, antibiotics, steroids, condoms, and so on are also science. To start with the most extreme solution at the tiny prospect of a problem sometime in the future is ridiculous.

When she gets to the comparison of male and female genital cutting, she ignores the principle.

The single most irrational argument one often sees is the charge of moral equivalency between circumcision and female genital mutilation. FGM is a phenomenon that is, apart from both affecting the genitals, …

Apart from both affecting the genitals, indeed. Affecting the genitals of a healthy child who does not need or consent to the permanent alteration of said healthy genitals. Non-therapeutic genital cutting on a non-consenting individual is unethical. The individual has inherent rights to bodily integrity and autonomy from birth. Non-therapeutic circumcision violates those rights.

… quite separate from circumcision. Unlike circumcision, which removes an unnecessary piece of skin, …

Unnecessary circumcision removes a piece of skin. It’s the same words, but made objective rather than subjective. It’s the fact-based opposite of “heads I win, tails you lose”.

… in no way prevents natural and satisfying sexual function, …

In addition to calling back to the Payne study and Kay’s earlier comments about delayed orgasm, circumcision removes the foreskin, a natural part of the body. That is “natural”. Its mechanism is gone, so circumcision certainly prevents that function. And “satisfying” is subjective. Would all men prefer delayed orgasm and the loss of the foreskin? (I don’t.)

… FGM is a misogynistic practice created as a means for men to control women, …

Circumcision controls men. Its imposition is another’s assessment that the male’s body should be the way someone else prefers. It is then made that way (hopefully, except when complications occur, including possible death). The male is never asked. He is to say “thank you”, praise the imposition, and impose it on his sons as soon as they’re born.

Kay’s argument rests on control as intent rather than action. I doubt she would accept that parents cutting their daughter’s genitals for the reasons we allow them to cut their son’s genitals. She assumes their intent is always evil, but is it the intent or the act that matters here? If she believes intent with FGC is only what she writes, as she appears to believe, she should read more¹ on the topic. And then extrapolate back to the disparity in the intent and the violence of male circumcision.

… meant to prevent sexual desire and gratification in women to ensure their fidelity, and which removes a portion of the genitals absolutely vital to gratification. It is the very epitome of patriarchy, whereas circumcision is a rite of passage conceived by males for other males, and for thousands of years rooted solely in spiritually contractual language and meaning. Women who have been subjected to FGM invariably come from countries in which extreme misogyny is the norm. Circumcision carries no moral or gender-injustice baggage of this kind whatsoever.

I agree that FGM is awful. But it’s silly to repeatedly claim a definitive knowledge that male circumcision does not remove of portion of the genitals absolutely vital to gratification. She ignorantly cites bad summaries of studies and only uses groups of males circumcised at birth or as young children as reference points for this opinion. She doesn’t appear interested in males as individuals with rights and preferences of their own for their foreskins. (“Conceived by males for other males”.) Preference for the foreskin or circumcision is an individual decision. What other males prefer is only valid for themselves.

She closes by misunderstanding the ethics involved one last time, in a disgusting manner:

Parents deserve to be informed of all the evidence, pro and con, when the issue of circumcision arises. It is not necessary for the CPS to actively recommend circumcision to keep to the path of ethics and professional responsibility, but given the accumulation of evidence demonstrating the positive effects of circumcision, it would be unethical of the CPS – or any pediatricians individually – not to present the science available, or worse, to recommend against the procedure.

She’s dancing close to the silly proposition that boys have a right to grow up circumcised. The only ethical position is absolute opposition to (and prohibition of) all non-therapeutic genital cutting without the patient’s consent. It’s the right she recognizes for females. Her source (inadvertently?) recognizes that circumcision is rarely needed ever and can be (but likely won’t be) chosen later. She cites evidence of males who are dissatisfied with circumcision and being circumcised. But she ignores these in favor of her own biases. Cognitive dissonance (and a non-sequitur) is the best she can offer. She is ignorant. She should aim to be less ignorant.

¹ Consider Fuambai Sia Aahmadu, and from 2008.

The Lie Feeds Itself -PrePex and Unethical Circumcision

Note: I updated the title after posting this entry.

I wrote this in December 2011:

… 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.

And this, in February 2012, in a footnote:

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 [sic] negate ethics.

I expect the device will eventually be tweaked to allow for infant circumcision at some point. And four years later, this press release, from last month (emphasis in original, footnote added):

The World Health Organization (WHO) expanded the Intended Use of the currently-prequalified PrePex device to include adolescents aged 13 years, and above. Effective immediately, the PrePex device, manufactured by Circ MedTech, can be offered for adult and adolescent males in the 14 priority countries in Southern and Eastern Africa. PrePex was the first male circumcision device to receive WHO Prequalification on 31 May 2013.

Circ MedTech’s CEO, Eddy Horowitz said: “The expanded use of PrePex for younger ages will sustain Voluntary [sic] Medical Male Circumcision (VMMC) programs in the 14 Sub-Saharan Africa priority countries and will serve the new UNAIDS Sustainable Development Goal (SDG) of an additional 27 Million male circumcisions by the year 2020.”

Circ MedTech Ltd. is in the advanced stages of adapting its PrePex technology for use with infants¹ and children, thus offering safe male circumcision services to all ages, worldwide.

At least they dropped their lie about “voluntary” in the last paragraph. But they still include it in their FAQs.

Why is it called “Voluntary Medical Male Circumcision?”

“Voluntary Medical Male Circumcision” is a term used by the global health community to emphasize that circumcision is a personal choice.

“Voluntary Medical Male Circumcision” is a term used by the global health community for propaganda. The global health community (i.e. public health officials) does not care, has not cared, and apparently will not care, about “voluntary” (or even “medical”, since this surgery is “medicalized”, not medical, circumcision). The expansion of PrePex to children who can’t consent demonstrates this. Volunteer and volunteered are not synonyms here. The global health community legitimizes whoever’s choice results in a statistic, the removal of another normal, intact male’s foreskin. Remember, the measure of success in these campaigns is “male circumcisions”, not something relating² to HIV infection rates, the alleged, stated aim of “Voluntary” “Medical” Male Circumcision.

If those involved with PrePex cared about ethics, this expansion of the product line wouldn’t occur. But here we are with the above evidence and the questions raised by more from their FAQs, such as:

What is Voluntary Medical Male Circumcision? (click to read answer)

In 2007, the World Health Organization (WHO) and UNAIDS announced recommendations,based on extensive studies, to scale up Voluntary Medical Male Circumcision (VMMC) to men in areas of high risk for heterosexual HIV transmission. The studies showed that men with a circumcised penis are approximately 70 percent less likely to contract HIV from heterosexual intercourse than men with an uncircumcised penis–in addition to other health and hygiene benefits.

This finding, replicated in rigorous, repeated studies across several countries, has led doctors and public health professionals to recommend that men in high-risk areas have access to VMMC.

Imagine a person who doesn’t know what Voluntary Medical Male Circumcision is. Now imagine that person reading the answer PrePex gave to his question, “What is Voluntary Medical Male Circumcision?”. Does he now know what Voluntary Medical Male Circumcision is? Circ MedTech already showed they don’t know what “voluntary” or “medical” mean. They should be able to pretend better than the word salad they provide.

Let me try:

What is Voluntary Medical Male Circumcision?

Male circumcision is the permanent removal of the foreskin (i.e. male prepuce), the fold of skin covering the penis. This may also involve removal of the frenulum.

The procedure is voluntary and only offered to males able and willing to consent. This consent is achieved by providing a detailed explanation of the benefits, costs, and risks associated with male circumcision. The medical provider will emphasize what is guaranteed versus what is possible for the benefits, costs, and risks. With this knowledge, the individual may decide for himself if he wishes to proceed and be circumcised or not. The procedure is carried out only with his affirmative consent.

Circumcision is best carried out in a medical setting. It is recommended that, if the individual consents, this be performed in a sterile setting with trained professionals to minimize risks and negative outcomes. The risk of complications cannot be completely eliminated.

They can’t say that because it’s true and rules out the option to circumcise healthy children. Instead, they ramble about the perceived benefits. One should assign a level of trust corresponding to how forthcoming they are on the risks, so not much.

The lesson remains the same. When public health officials (i.e. the global health community) promotes “voluntary” (“adult”) male circumcision, they never mean “voluntary” (or “adult”).

¹ WHO TECHNICAL ADVISORY GROUP ON INNOVATIONS IN MALE CIRCUMCISION: “Providers must be trained to recognize when an adolescent is not eligible for the PrePexTM device due to inability to retract the foreskin or discomfort while attempting to do so, or when there are adhesions or phimosis. …” The inability to retract the foreskin is normal at birth because it adheres to the rest of the penis.

² Even where it is something related to HIV, do we have enough to determine causation rather than correlation? Possibly. I don’t know. And to repeat, I don’t care if adults choose circumcision for themselves. What each person does with his body is up to him. Nor do I state unequivocally that all potential benefits are illegitimate. The argument for imposing circumcision on a healthy child in pursuit of those potential benefits is, though. Always. The removal of his foreskin is a price the individual may not wish to pay.

The “Hacking Away at Perfectly Healthy Genitals is Bad” Principle

How many times have we seen a quote like this?

In Jacksonville, Dominic Morris, a 30-year-old father of two, said he did not understand what all the fuss was about. He said he was not mutilated during his circumcision, didn’t bleed at all and felt nearly no pain during or after the procedure. “Mutilation is horrible, but it’s not true that it happens here” in America, Mr. Morris said. “They cannot stop us. It’s our tradition.”

That’s said every time an activist discusses circumcision for what it is rather than what people think it is. It’s accepted thought. We’re told we owe complete deference to it. Who are we to tell people their dismissal of inconvenient facts is wrong? We’ll assume they’re informed, whatever they’ve been told or choose to believe. Parents have this absolute right to have their healthy children cut for whatever reason they desire. Sons only. Obviously.

Except, wait. I just noticed an error. I transcribed that quote wrong. Here’s the real quote from that story:

In Jakarta, Fitri Yanti, a pregnant 30-year-old mother of two, said she did not understand what all the fuss was about. She said she was not mutilated during her circumcision, didn’t bleed at all and felt nearly no pain during or after the procedure. “Mutilation is horrible, but it’s not true that it happens here” in Indonesia, Ms. Fitri said. “They cannot stop us. It’s our tradition.”

We will never accept that defense in the context of female genital cutting. Rightly so, of course. But I choose not to be a hypocrite, so I don’t accept it for male genital cutting, either. The basic fact is the same. It’s non-therapeutic genital cutting on a non-consenting individual. Therefore, the principle is the same. They are both unethical. Opposition to one necessitates¹ opposition to the other².

We should also be clear on what Ms. Fitri may be arguing.

Experts in Indonesia said the practice there had largely involved a less drastic version of cutting, usually a surface scratch or nick, as compared with more severe disfiguring. The Indonesian government’s survey asked parents if their young daughters had undergone circumcision. Ms. Cappa said it was possible that there were some more severe cases in Indonesia, but she said the official Indonesian government definition of female circumcision was “an act of scratching the skin that covers the front of clitoris without injuring the clitoris.”

That is objectively less harmful than male circumcision. Still, the official government definition could be irrelevant to the reasons parents are answering “yes”. The parents could be openly admitting something much more severe. This possible difference matters for prevention and response. In principle, it’s irrelevant. We recognize even “a surface scratch or nick” on a female minor’s genitals, which will likely heal without permanent injury or scarring, as unethical and worthy of prohibition. The WHO’s definition of FGM is effectively “any genital injury for non-medical reasons”. The universal principle is obvious and applies without regard to sex. We must all reject the silly, biased distinction the WHO and others demand. Possible health benefits are not a “medical” reason for non-therapeutic male genital cutting. (“Medicalized” is not the same as “medical”.)

What happened to Ms. Fitri is unethical. What will/did happen to Ms. Fitri’s children is unethical. For every male who was/is the hypothetical Dominic Morris as a child, what happened to them as a child is unethical.

(Title reference here.)

¹ Opposition to both does not necessitate equal activist efforts from everyone. Care more about FGC/M? Agitate for change. Care more about MGC/M? Activate for change. The cumulative effort will work itself out. Just don’t dump on those agitating more for one than the other, or for making the logical comparison of the two.

² Or it necessitates support for both, but I assume no one reading this wishes to be horribly wrong and unethical.

I Guessed What Phase Two Involves

Oh, what could this transition be?

The National Voluntary Medical Male Circumcision taskforce has rolled out the second phase of circumcision on regions with a high burden of HIV this time targeting over 1 million men.

The chairman of the Inter County Taskforce on Male Circumcision Dr Ojwang Lusi said the program is transitioning to the second phase of implementation that will run to July 2019.

We all guessed what this means.

The second phase will lower the circumcision age of boys to between 10-14 years.

I assume there’s a Phase Three – or an undocumented aspect of Phase Two – involving infant “men”. Predictably, it’s obvious why.

Lusi further noted that some challenges emerged in the first phase that they will strive to address as the second phase.

He said most of the men above 25 years declined to go for the exercise with limited number of women getting involved in the exercise with their husbands.

Men won’t volunteer, so child men get “volunteered”. As always with those who are unethical, because outcome matters instead of consent.