“…but most of them pick themselves up and hurry off as if nothing ever happened.”

Posted: July 15th, 2014 | Author: | Filed under: Ethics, FGM, Logic, Religion | No Comments »

Rebecca Steinfeld describes Elissa Strauss’ essay, How Female Circumcision Is Different From a Brit Milah, as “badly researched & poorly argued”. Ms. Steinfeld is correct.

Fighting against female circumcision, also known as female genital mutilation, is a no-brainer of an issue. Who could support the use of often unsterilized blades to slice off, in the least-invasive case, a portion of the clitoris, and, in the worst case, the whole clitoris and the labia, which are then sewn together, leaving just a small hole for the release of urine and menstrual fluid?

Obviously, but the inclusion of “often unsterilized blades” is irrelevant in the ethical analysis of FGM compared to male circumcision. Using unsterilized, non-surgical equipment is egregious, but that is a violation of medical standards within the context of a rights violation. The violation is wrong, even if it is performed using top-notch equipment with trained staff in a sterile environment. Of course, the appropriate strict standard implied is neither required nor adhered to for religious male circumcision, so the distinction hardly matters.

The degree of harm is relevant to the act. It should inform punishment. It is not relevant to the core ethical principle.

But before we Jews start fastening our anti-FGM pins to our messenger bags and sharing petition links on social media, we have to contend with the elephant in the room. You know, the one with the mohel on top.

Indeed, many fighting female genital mutilation see male circumcision in the same light, viewing both procedures as a violation of basic human rights because both are done without consent or reasonable medical justification. …

Yes. This is the place Strauss should’ve stopped. She proved the comparison. Instead, an appeal to authority:

The World Health Organization sees a big difference between the two procedures, describing female circumcision as having no health benefits and as “a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children.”

FGM may reflect deep-rooted inequality. That’s debatable, given that the common idea that it is imposed by men on women is more complicated than normally stated. The last sentence, though, applies to male circumcision. That’s the comparison. Both are non-therapeutic genital cutting. Imposing that on a non-consenting individual (e.g. a minor) violates that individual’s rights. There is no asterisk on the right to bodily integrity for whichever distinction a person needs to impose it.

The WHO casts male circumcision in a very different light, describing it as “one of the oldest and most common surgical procedures worldwide, and is undertaken for many reasons: religious, cultural, social and medical. There is conclusive evidence from observational data and three randomized controlled trials that circumcised men have a significantly lower risk of becoming infected with the human immunodeficiency virus (HIV).”

I’ll grant these unequivocally, despite potential objections. So? They do not negate the ethical objection. There are any number of non-invasive preventions and treatments available to achieve these benefits. Some of them, such as condoms, are still necessary after circumcision. The ethical issue exists in part because not everyone shares the same preferences. Some would choose their foreskin and its alleged risks over circumcision and its alleged benefits¹.

Both female and male circumcision are motivated by custom: the surreptitiously stubborn notion of “This is what we do.” But the cultural setting accommodating the customs, as well as the physical ramifications of the procedures, reveal stark differences, and to ignore them is to demean the experience of the 135 million women and girls around the world who have had their genitals mutilated.

Those stark differences are often real. But Strauss already demonstrated the valid ethical comparison, before the added question begging. Mentioning that more extreme aspects of some FGM practices exist maybe shows that one is more wrong, but it doesn’t change that both are wrong.

Opposing non-therapeutic male child circumcision does not demean the experience of any female victim. This argument is a common fallacy. It’s clear that their experience is traumatic. The violation is obvious, real, and unethical. The results are usually more extreme than the results of male circumcision. The comparison is one of ethics, not harm. It is not a competition of victimhood. As I’ve often said, a punch to the face is not the same as a knife in the stomach. Because the latter is worse, the former isn’t a violation? That’s silly.

A common trope appears in the comments that feeds directly from Strauss’ approach. Twitter user CpaHoffman posted this comment (emphasis added):

Jews circumcise their male babies because we are commanded to by the Torah; it doesn’t hurt them (if it did, we’d have died out long ago). Female genital mutilation is not a “moral equivalent” or even on the same planet. Yet the lunatic fringe needs to drag it into every discussion of circumcision and needs to compare the two as if they were different yogurt brands.

It’s not comparing “apples and oranges”; it’s comparing apples and poison oranges.

That is a convenient straw man, but the argument against violating a child’s rights isn’t that it kills. (Although it can and does.) Death is not the only form of harm from circumcision. All surgery involves harm, including circumcision, which should be apparent since a normal part of the body is removed². Imposing that harm without direct need or consent that can’t be resolved with less invasive methods is unethical. Just like non-therapeutic genital cutting on female minors.

¹ These benefits can be medical, religious, or cultural.

² This is a different analysis than whether or not a surgery is a net harm.


Human Rights as Politics rather than Principle

Posted: June 17th, 2014 | Author: | Filed under: FGM, Media Marketing, Politics | No Comments »

What is it about the basic concept of human rights that confuses so many people, such as U.N. High Commissioner for Human Rights Navi Pillay:

FGM is a form of gender-based discrimination and violence. It is a violation of the right to physical and mental integrity. It violates the right to be free from torture and other cruel, inhuman and degrading treatment. Because it is almost always practised on young children, it is also a violation of the rights of the child. FGM violates the right to the highest attainable standard of health, including sexual and reproductive health. And when it results in the death of the person who is mutilated, it violates the right to life.

I’d state it as the rights of self-ownership and bodily integrity, but still, even this way it’s easy to understand. Cutting an individual’s healthy genitals without the person’s consent violates rights. So why staple on this (emphasis added):

This harmful and degrading practice is not based on any valid premise. FGM has no health benefits. On the contrary, it generates profoundly damaging, irreversible and life-long physical damage. It also increases the risk of neonatal death for babies born to women who have survived it.

The answer is obvious to anyone who spends any time studying the issue of genital cutting. It’s a method that attempts to distinguish female genital cutting from male genital cutting. It shows up over and over. It’s transparent and wrong because it’s politics at the expense of human beings. The principle isn’t gendered. Non-therapeutic genital cutting on a non-consenting individual violates the individual’s human rights, full-stop. That is the human rights principle involved. The potential health benefits a child’s parents may cite can’t be a valid premise for non-therapeutic surgery without the child’s consent.

That isn’t my primary point here, though. The “FGM has no health benefits” approach is short-sighted and obtuse in the push to end FGM. It contains an implicit argument that FGC – not FGM, because unnecessary genital cutting without consent somehow can’t be mutilation – would be acceptable if some health benefit could be reasonably claimed. It’s a way of saying that human rights are important, but only to the extent that someone can’t find an excuse people are willing to accept as justification for ignoring obvious violations. It demonstrates that the person making the argument does not understand the implications of defending human rights and the courage it requires to be consistent to the principle. This tactic is not a framework for considering humans and their rights. It’s a strategy uninterested in human rights principles. It’s a strategy of manipulating emotions to achieve an ideological goal.

I’m not familiar with the source material, but I think this Friedrich Nietzsche quote I stumbled on today works well in this context (via):

“The most perfidious way of harming a cause consists of defending it deliberately with faulty arguments.”

That’s what the “FGM has no health benefits, so it’s not acceptable like male circumcision” argument is when attached to a human rights argument. If you claim to defend human rights, you have to defend human rights, not the politics of favored human rights.


The Equation Is Unnecessary Genital Cutting Minus Consent

Posted: March 23rd, 2014 | Author: | Filed under: "Voluntary", Control, Ethics, FCD, FGM, Logic, Media Marketing, Parenting, Politics | 1 Comment »

Many have heaped scorn on Mary Elizabeth Williams’ Salon piece that criticized Alan Cumming for calling male circumcision genital mutilation and comparing it to female genital mutilation. This scorn is deserved.

Alan Cumming wants to tell you about his penis. He wants it to be a shining example to the world. In a candid interview with Drew Grant this week in the New York Observer, the 49-year-old Scottish actor reveals his strong opinions on “Girls,” naughty cellphone pictures, and, most controversially, circumcision. Or as he puts it, “genital mutilation.”

“There’s a double-standard, which is that we condemn the people who cut off girls’ clitorises, but when it happens to boys,” Cumming says. “I mean, it is the most sensitive part of their bodies, it has loads of nerve endings, and it can go horribly wrong. I’m speaking out against it … I’m just so suspicious of the medical industry, which just flings pills at people to ensure everyone is reliant on things. ‘Here are some pills, Mommy. Take them, and we’ll take your baby away and hack its thing off, and then we’ll bill you for that too.’”

I don’t share Mr. Cumming’s view of the medical industry. Its complicity strikes me as cultural inertia and cowardice. My experience suggests that profit-driven focus on circumcision is limited, although it motivates some. But that’s a distraction. The key is that he is correct about the comparison.

Circumcision of a healthy male minor is mutilation of that male’s genitals. To be valid, it must involve his consent prior to the surgery, not assumed to be later granted retroactively. This is the standard inherent in 18 USCS § 116, which criminalizes all non-therapeutic genital cutting on female minors without regard for parental justifications or potential benefits. The difference we imagine is an accident in the history of Western child genital cutting.

Later in the essay:

… And earlier this week, protesters threatened to disrupt Bill and Melinda Gates’ TED Vancouver talk because of their organization’s efforts to increase the practice in Africa as a means of “limiting the spread of HIV in the parts of Sub-Saharan Africa.”

There is good reason to find the work of the Gates Foundation repugnant, as it pertains to male circumcision. It speaks in the euphemism of voluntary medical male circumcision, when it also means infant circumcision. This is unethical because it violates the principles of bodily integrity and consent. And this study, commissioned and funded by the Gates Foundation, hardly provides reassurance when examining the context of WHO and UNAIDS, who think violating this human right of male children can be legitimized through question begging. Mental gymnastics like that are not admirable.

Cumming’s equation of circumcision with female genital mutilation is an insultingly inaccurate one — boys are not circumcised as a ritualized means of suppressing their future sexual enjoyment,

Although it’s easy to find similar defenses of male circumcision, ritual or not, this implies that the critical issue is intent rather than outcome. Female genital mutilation, in all its forms, is wrong because the female is mutilated, not because she is mutilated for “bad” reasons. Some reasons given are the same as those for male circumcision. And not all females who were mutilated reject or condemn it. Yet all reasons for surgically altering the healthy genitals of a female minor are still bad. This focuses on the principles and facts involved, not our feelings.

Notice, too, how often erroneous claims like “[t]here is no evidence whatsoever to support the notion that it affects function, sensation or satisfaction” are made about male circumcision, as it’s made with that quote from Williams’ link to reader comments on an article. The statement is wrong on its face because circumcision changes the function. If you change the form, you change the function. The function of the penis, including its structure, should not be lazily defined as “to have sex” or something similarly ridiculous. The foreskin is normal anatomy with functions for the penis and belongs to its owner.

The quote is disputable on sensation, considering the (anecdotal) arguments in favor of male circumcision stating that males can “last longer“. Consider the heads I win/tails you lose efforts of Brian Morris here, as all outcomes are assumed to be favorable to overall satisfaction, even when the studies cited do not involve anything near 100% on the subjective evaluation of satisfaction.

nor does a clean male circumcision compare with the often crude, blunt and unsanitary practice of female genital mutilation.

Those qualifiers obfuscate. What about clean female genital cutting compared with crude, blunt, and unsanitary male circumcision? A sterile surgical environment does not grant legitimacy to a rights violation. Again, the act is what matters. There are degrees of harm possible, but the inevitability of harm requires first priority, whatever the degree.

The World Health Organization calls FGM “a violation of the human rights of girls and women” with consequences that include “severe pain, shock, hemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue,” while it in contrast notes, “There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%.”

WHO also explains that female genital mutilation “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.” There is no unethical caveat for “but if we find some benefits to female health, or even male health, we’d have to weigh mutilating injury against potential benefits.” That unethical caveat is always applied to male genital mutilation, as Williams does here. An adult male volunteering is not the same as an infant male being volunteered. Consent is the issue, not how horrible female genital mutilation usually is or how innocuous and/or beneficial male circumcision appears to be. Non-therapeutic genital cutting on a healthy individual who does not consent is unethical. It involves harm. Gender is irrelevant to the principle.

One can argue, quite persuasively, about whether the practice of circumcision still has validity here in the West, especially among those who don’t have a religious directive. What’s needed, however, is education and enlightenment, so families can make the healthiest choices for their children. …

I reject the premise. This is a not a decision parents should be allowed to make for their children. The argument that parents may decide this for their healthy children requires this decision to be a parental right. If it’s a parental right, then the prohibition of non-therapeutic genital cutting on daughters is indefensible. The basis for thinking about genital cutting can’t be girls and the parents of boys. That’s absurd.

… It’s not helpful to make far-fetched comparisons, and it certainly isn’t constructive to imply that men and boys who are circumcised are somehow damaged, “mutilated” goods. That’s a shaming technique that serves no one, one that turns having a foreskin into a bragging point. …

Why are we only worried about shaming men and boys by using the term “mutilation”? Isn’t there the possibility or likelihood that women and girls will feel shamed if we describe their genitals as mutilated? Are the psyches of females more able to handle facts?

There is a difference in stating a fact and demanding a value judgment from that fact. The bodies of males who were circumcised as children were mutilated. Their rights were violated. Circumcised males are not obligated to think this is bad or shameful. The obligation (for everyone) rests in understanding that it is unacceptable to perpetuate this violation on their children or to permit its continued practice in society.

Or to put it in terms of individual autonomy, circumcision mutilated me through the deprivation of an essential¹ part of my body. Where I had a normal human foreskin, I now have only scars. My penis is mutilated. No one gets to reject that fact for me. But I do not feel shame. This sense that males might feel shame is what encourages parents to circumcise their sons for conformity. We have to stop being afraid of shame. We’ll achieve that only when we are no longer afraid to state that shame belongs with those who circumcise, not those who are circumcised.

… And it’s an unfair judgment coming from a man who admits, “I myself don’t have kids. I just have managers, assistants, agents and publicists.”

I feel second-hand embarrassment, so that at least someone feels what her statement deserves.

¹ Quibble with essential as something other than an obvious stand-in for normal, and I’ll roll my eyes and ask if normal parts of female genitalia are essential.


Brian Earp Confronts the Genital Cutting Double Standard

Posted: February 26th, 2014 | Author: | Filed under: Control, Ethics, FGM | 1 Comment »

I’ve discussed the comparison between male circumcision and female genital cutting/mutilation in depth across various posts. In a great post, titled Female genital mutilation (FGM) and male circumcision: time to confront the double standard, Brian Earp discusses the principled comparison in a single post that should become the “Go To” link. It’s worth the read because it’s so thorough and sourced. I know there are people who will read that and remain unconvinced. That is not because the proof isn’t there. He demonstrates the complexity that dismisses the “FGM is always the worst extreme/male circumcision is always the best extreme” that perpetuates superficial thinking on the principled comparison.

Again, it’s all worth reading, but I like this the best (links in original):

So what are the implications here? Given that both male and female forms of genital cutting express different cultural norms depending upon the context, and are performed for different reasons in different cultures, and even in different communities or individual families, how are we meant to assess the permissibility of either one? Do we need to interview each set of parents to make sure that their intended act of cutting is intended as an expression of acceptable norms? If they promise that it isn’t about “sexual control” in their specific case, but rather about “hygiene” or “aesthetics” or something less symbolically problematic, should they be permitted to go ahead? But this is bound to fail. Every parent who requests a genital-altering surgery for their child – for whatever reason under the sun – thinks that they are acting in the child’s best interests; no one thinks that they are “mutilating” their own offspring. Thus it is not the reason for the intervention that determines its permissibility, but rather the consequences of the intervention for the person whose genitals are actually on the line. …

That’s the truth missing from society’s moral relativism. One is judged on outcome alone, with intent assumed from the outcome. The other is judged on intent alone, with outcome assumed from the intent¹. For female genital cutting we focus on the female. For male genital cutting we focus on the parents. That’s the mistake. Separate approaches for the same inherent violation – non-therapeutic genital cutting on a non-consenting individual – cannot hold under inspection. Earp’s post is great for revealing that error with such clarity.

¹ This is especially maddening because the intent we assume and praise is not benign.


Renee Lute’s Circumcision Decision Deserves No Respect

Posted: October 11th, 2013 | Author: | Filed under: "Voluntary", Control, Ethics, FCD, FGM, Logic, Media Marketing, Pain, Parenting, Science | No Comments »

At The Good Men Project Renee Lute makes a request: Please Respect Our Circum-Decision. It only requires a short response: No. Still, her essay is worth analyzing to explain why the only answer is “no”.

Circumcision on a healthy child is a permanent body alteration without the child’s consent. I’m under no obligation to respect that. I do not believe anyone should respect that. If Lute understood circumcision as well as she claims, she’d understand how absurd it is to request respect for her decision from someone who recognizes this surgical intervention as the human rights violation it is.

She is, of course, due a respectful rejection of her request. I will not engage in ad hominem, nor will I call her names as a result of what she intends to do. Anyway, facts and logic are enough to demonstrate her errors.

She begins:

… I’m apologizing to [my unborn son] for writing this piece, because now the world will know just a little bit about the future state of his penis, and most little boys don’t have to deal with that. …

This common theme is strange. Intact genitals are the human default. Unnecessary intervention is the only reason the status of a child’s genitals is considered an issue if people know, as if knowing is a Big Deal. Or, rather, unnecessary intervention is the only reason the status of a boy’s genitals is considered an issue if people know. This bizarre reality is the result of intervening, not some inherent shame in having others know we have human genitals.

That gets to the reason why I won’t respect her and her husband’s decision for their unborn son. A daughter’s normal, healthy genitals are off-limits for surgical intervention, and rightly so. Those who recognize the ethics involved as gender-neutral must stand against the opinion that a son’s normal, healthy genitals can be subjected to surgical intervention. (There will be more on the valid comparison below.)

She discusses Mark Joseph Stern’s terrible Slate piece (my post) and Brian Earp’s reply at The Good Men Project. She writes:

Neither of these articles really threw me. I know the arguments against circumcision, and I know the arguments for circumcision. What did surprise me, however, was what I found in the comments section under The Good Men Project article. …

Never read the comments. We know that doesn’t mean “never read the comments”. But it’s a reminder that the Internet is a place for bad manners and emotional responses. That’s particularly true in comment sections. Discussion of circumcision is no different. I’m not excusing the behavior. The rude, hateful, and misogynistic garbage is wrong and needs to stop. But reasoned proponents of bodily integrity, as I aim to be, have our argument harmed only in the sense that someone is willing to generalize about those who disagree based on the miscreants that any group has.

… I am not a circumcision enthusiast. In fact, I could not care less whether other people circumcise their sons or not. Do it if you want! Don’t if you don’t want! But I am begging you—begging you—to not make families who choose to circumcise their sons feel like they are abusers of children, or human rights violators.

“Do it if you want! Don’t if you don’t want!” is the false argument. What does the child who will live with the circumcision want? That is the core. Without knowing what he will want, imposing it as a non-therapeutic intervention is a human rights violation. I suppose it’s unfortunate if that makes someone feel bad about circumcising their healthy son(s). But I recognize that my parents violated my rights when they circumcised me. I won’t pretend¹ that someone else circumcising their son isn’t violating his rights because stating a truth makes them feel bad about the choice they make. (I do not take a position on how individual males should feel about being circumcised.)

Why am I going to have my son circumcised? Because his father and I have done our reading. We’ve talked about it, and we’ve made our decision. There are legitimate reasons. Circumcision eliminates the risk of phimosis (in which a foreskin is tight and cannot be fully pulled back, which makes cleaning and passing urine difficult, and increases the risk of penile cancer). This affects 1 in 10 older boys and men. Circumcision reduces the risk of inflammation and infection of the head of the penis and the foreskin, and greatly reduces the risk of urinary tract infections in infants. Uncircumcised men have a 15-60% increased risk of prostate cancer (which affects 1 in 6 men). [1] We are not uneducated about circumcision. …

That last line is not necessarily true, given what comes before it in that paragraph. The sole source cited for this knowledge is a pamphlet by Brian Morris, which contains no sourcing of its own. (Some of the material in this excerpt is verbatim from Morris, without quotes to indicate as much.) It contains information that is biased and exaggerated.

To the claim that circumcision eliminates the risk of phimosis, this is incorrect. Contrary to the risk of phimosis being a “legitimate reason” to circumcise a healthy child, the ethical standard is that the risk of complications is a legitimate reason to refrain from intervening on a healthy child. Remember, too, that Brian Morris is the cited source for the 1 in 10 claim. He’s stated that all boys are born with phimosis, which is false. Even if the statistic is true, it is that phimosis will affect 1 in 10, not that it will require circumcision in 1 in 10. This mirrors his claim in the pamphlet that “the foreskin leads to 1 in 3 uncircumcised boys developing a condition requiring medical attention.” A condition requiring medical attention is not a synonym for circumcision. This is a rhetorical sleight of hand. The true incidence of medical need for circumcision within an intact male’s life is approximately 1%, which includes for phimosis.

As for the “15-60% increased risk of prostate cancer” statistic, that is a correlation, not a proven fact. “Circumcision before first sexual intercourse is associated with a reduction in the relative risk of PCa in this study population.” To quote the author, “‘These data suggest a biologically plausible mechanism through which circumcision may decrease the risk of prostate cancer,’ said study researcher Dr. Jonathan Wright, an assistant professor of urology at the University of Washington School of Medicine. He noted that the study was observational; it did not show a cause-and-effect link.”

She continues:

… One of the aforementioned commenters wrote that anyone who would have their child circumcised should have to experience it themselves, first. Well, my husband has experienced it (and remarkably, he gave me his permission to tell the world just now), …

I don’t like that pointless suggestion because it invites that pointless rebuttal.

…and while I have not gone through the completely incomparable horror of female circumcision (I am not going to detail why it’s incomparable here, but I do encourage you to research the differences if you don’t know what they are. You’ll find some information here), …

I know what the differences are. I know what the similarities are. The difference is in degree, not in kind. That difference in degree can be great, of course, but non-therapeutic genital-cutting on an individual without the individual’s consent is not a gendered principle. The WHO defines female genital mutilation as “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.” The perceived difference², including in the link Lute provides, rests on what constitutes a medical versus non-medical reason. If we assume the “no known health benefits” argument against FGM turned into “known health benefits”, would people change their mind and decide it’s no longer mutilation? Some might say “yes”. They’d be wrong. I suspect most people would not change their conclusion. As the WHO states, FGM “also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.” That would still hold true if their were potential benefits. It holds true for male circumcision, as well.

… My husband and I aren’t unfamiliar with pain, and we are willing to put our child through a moment of discomfort for the benefits this procedure provides. Kind of like we’re willing to put our child through a moment of discomfort for the benefits that vaccinations provide.

But is their child son willing to have the moment (i.e. 1+ week) of discomfort and a lifetime without his foreskin for the potential benefits this procedure provides? (Remember from above that the Lutes do not appear to understand the benefits.)

Circumcision is not like a vaccination. Vaccinations work with the body’s immune system to trigger disease resistance. Circumcision merely removes a part of the body because it might cause a problem later. The comparison needs critical thinking beyond “prevents disease”, lest we further open parental decision-making to other ridiculous interventions.

This piece is both explanatory and pleading. I am pleading with you. Don’t make these perfectly well intentioned families—like us—feel like monsters because you’ve decided to go a different way with your own sons. We’re doing something different, and that’s okay. We each have our reasons. I don’t care whether you breastfeed or formula feed. I don’t care whether you co-sleep or have your babies in their own cribs, and I don’t care whether you’ve named your child something completely traditional (like Kate) or whether she’ll be answering to Zenith for the rest of her life. I’m asking for the same courtesy.

It’s okay to do something different. It is not okay to do this something different. You can’t respect one right of your son less than the same right of his sister and brush it aside as “parenting”. If someone asks me to respectfully tell them they’re wrong, I agree with that request for decency. But I will not respect what is obviously indefensible and deeply offensive to basic human rights.

¹ I don’t call circumcision “abuse”. (c.f. Truth and Loaded Words)

² The other mistake is in thinking that FGM is designed to control sexuality, but that male circumcision isn’t and doesn’t. It controls male sexuality because it forces a specific form on the child for his genitals. (e.g. It’s more aesthetically appealing to women.)

There is also a history, up to the present, in circumcision reducing sexuality. Read Moses Maimonides or this.


Mark Joseph Stern Is Mistaken On Circumcision

Posted: September 19th, 2013 | Author: | Filed under: "Voluntary", Ethics, FCD, FGM, Hygiene, Logic, Media Marketing, Parenting, Public Health, Science | 1 Comment »

It takes a special commitment to ignorance to cherry-pick evidence to prove that opponents cherry-pick evidence. Mark Joseph Stern possesses that special commitment.

There are facts about circumcision—but you won’t find them easily on the Internet. Parents looking for straightforward evidence about benefits and risks are less likely to stumble across the Centers for Disease Control and Prevention than Intact America, which confronts viewers with a screaming, bloodied infant and demands that hospitals “stop experimenting on baby boys.” Just a quick Google search away lies the Circumcision Complex, a website that speculates that circumcision leads to Oedipus and castration complexes, to say nothing of the practice’s alleged brutal physiological harms. If you do locate the rare rational and informed circumcision article, you’ll be assaulted by a vitriolic mob of commenters accusing the author of encouraging “genital mutilation.”

One paragraph in, and there’s so much to unpack. First, the obvious point is that Mr. Stern is another in a long line of lazy writers who thinks that the ability to type a word into Google proves much of anything for a story. If it’s just “a quick Google search away”, in a paragraph filled with links, it’s reasonable to expect an author to include the search he used to get to the evidence of alleged malfeasance. When I use Google to search circumcision, I get Wikiepdia, news articles, KidsHealth.org, the Mayo Clinic, the government’s Medline Plus, Intact America, Jewish Virtual Library, NOCIRC, and so on. I’ll point out that only the results for Intact America and NOCIRC are to something decidedly against non-therapeutic child circumcision, but so what? It’s a search algorithm. That’s easily gamed. It doesn’t prove Mr. Stern’s silly angle.

That “rare rational and informed circumcision article” is another in Hanna Rosin’s string of awful circumcision defenses.

As for the vitriol, this is the internet. Never read the comments. That doesn’t excuse the comments. They’re often offensive and uninformed and the people who engage in that behavior are wrong, even if they’re ostensibly on my side. But you’ll find them on both sides. It doesn’t prove anything on the argument. Using it as evidence against the argument is ad hominem.

So. There are facts about circumcision. Circumcision is the “surgical removal of the foreskin of males”. The foreskin is the “loose fold of skin that covers the glans of the penis”. Those are facts. But he’s implying the context of non-therapeutic male child circumcision. What should parents want?

Parents shouldn’t want anything, of course, because this is not their decision. Just like we don’t allow them to cut off any other normal body parts of their children, they do not possess a right to circumcise their sons for any reason other than immediate medical need that can’t be adequately resolved with less-invasive methods. Proxy consent is not sufficient for non-theratpeutic circumcision. But because our society doesn’t yet grasp the full implication of an equal right to bodily integrity, parents want information. Fortunately, there is scientific evidence against non-therapeutic circumcision!

The normal, healthy foreskin is normal and healthy. If parents leave it alone, as they should, statistics demonstrate that their son(s) will almost never need any intervention for his foreskin, and much less a medically-necessary circumcision.

Of every 1,000 boys who are circumcised:

  • 20 to 30 will have a surgical complication, such as too much bleeding or infection in the area.
  • 2 to 3 will have a more serious complication that needs more treatment. Examples include having too much skin removed or more serious bleeding.
  • 2 will be admitted to hospital for a urinary tract infection (UTI) before they are one year old.
  • About 10 babies may need to have the circumcision done again because of a poor result.

In rare cases, pain relief methods and medicines can cause side effects and complications. You should talk to your baby’s doctor about the possible risks.

Of every 1,000 boys who *are not* circumcised:

  • 7 will be admitted to hospital for a UTI before they are one year old.
  • 10 will have a circumcision later in life for medical reasons, such as a condition called phimosis. Phimosis is when the opening of the foreskin is scarred and narrow because of infections in the area that keep coming back. Older children who are circumcised may need a general anesthetic, and may have more complications than newborns.

Those numbers, from the Canadian Pediatric Society, are hardly compelling in favor of circumcising healthy children. Non-therapeutic circumcision prevents 5 boys (0.5%) from being admitted to a hospital with a UTI in the first year of life. Yet, between 20 and 30 (2-3%) boys will suffer a surgical complication, and another 2 to 3 (0.2-0.3%) will suffer a more serious complication.

The really curious statistic is the last in each group. About 10 (~1%) babies may need to have the circumcision done again due to a poor result. If normal, healthy boys are left with their normal, healthy foreskin, 10 (1%) of them will need a medically-necessary circumcision later in life. Those numbers look curiously similar.

So, to recap the facts in this context, circumcision is the permanent removal of a normal, healthy foreskin from a boy who can’t offer his consent to eliminate the 1% lifetime risk that he’ll need a circumcision.

There are other potential benefits, which Mr. Stern links in great detail. I have no problem including them, regardless of how weak or stupid I think they may be. That still isn’t enough to permit non-therapeutic child circumcision. The inputs into the decision are facts, but their value is not. Each person is an individual with his own preferences that his parents can’t know. What Mr. Stern values is not automatically what I value. Or to make the more appropriate connection, what parents value is not automatically what their son will value. That is why proxy consent requires a stricter standard than consent. A surgical decision that permanently alters a healthy child’s body can’t be permitted within proxy consent.

Mr. Stern writes this curious statement among many curious statements:

… Yet in the past two decades, a fringe group of self-proclaimed “intactivists” has hijacked the conversation, dismissing science, slamming reason, and tossing splenetic accusations at anyone who dares question their conspiracy theory. …

What a specific subset of people do is hardly the entirety of the argument or proof in favor of his position. Again, this is just silly, indefensible ad hominem. But what he says is also untrue. Dismissing science? Not here. I’ll accept any claimed benefit. The argument against forcing circumcision on a child is still as powerfully conclusive. Slamming reason? Stating that normal, healthy children should not undergo surgery is the position using reason. Conspiracy theory? Nope. Parents who circumcise, and people who support that option, are generally well-intentioned. I can show examples where that isn’t true, but I’m aware that such evidence is isolated. It’s surely true that some doctors circumcise for the money. I assume most circumcise because they believe it’s acceptable or believe parents should choose, even if the doctor wouldn’t. It’s important to understand how we got here, but I don’t much care about placing blame for that. I care about moving forward. There are any number of like-minded individuals Mr. Stern could find and talk to rather than write the wrong things he wrote.

… For doctors, circumcision remains a complex, delicate issue; for researchers, it’s an effective tool in the fight for global public health. But to intactivists, none of that matters. …

All of that matters. No one I know believes that adult (or older teen) males shouldn’t be able to volunteer for non-therapeutic circumcision.

Mr. Stern’s tactic here is what he’s complaining about. It’s similar to when Dr. Amy Tuteur goes on a tedious rant about “foreskin fetishists”. Smear your opponents because they smear you. “They”, of course. Internet comments are a part of humanity, not representative of it.

… The first rule of anti-circumcision activism, for instance, is to never, ever say circumcision: The movement prefers propaganda-style terms like male genital cutting and genital mutilation, the latter meant to invoke the odious practice of female genital mutilation. (Intactivists like to claim the two are equivalent, an utter falsity that is demeaning to victims of FGM.)

I’ve written circumcision a whole bunch above. But circumcision is genital cutting, because facts. The comparison is in the principle of those facts. Non-therapeutic genital cutting on a non-consenting individual is unethical. It’s also genital mutilation if we are to accept the WHO definition of female genital mutilation:

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.

… It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.

The issue is human rights, not a specific subset of human rights from which male minors are somehow exempt.

Anti-circumcision activists then deploy a two-pronged attack on some of humanity’s most persistent weaknesses: sexual insecurity and resentment of one’s parents. Your parents, you are told by the intactivists, mutilated you when you were a defenseless child, violating your human rights and your bodily integrity. Without your consent, they destroyed the most vital component of your penis, seriously reducing your sexual pleasure and permanently hobbling you with a maimed member. Anti-circumcision activists craft an almost cultic devotion to the mythical powers of the foreskin, claiming it is responsible for the majority of pleasure derived from any sexual encounter. Your foreskin, intactivists suggest, could have provided you with a life of satisfaction and joy. Without it, you are consigned to a pleasureless, colorless, possibly sexless existence.

Some take that approach. I only speak for myself on being unhappy with circumcision. I’ll quote myself on his generalization:

… The problem is not that circumcision is bad, per se. Healthy men who choose to have themselves circumcised are correct for their bodies. Men circumcised as infants who are happy (or indifferent) about being circumcised are also correct for their bodies. …

But if you only dive into comments sections, it’s easy to believe that’s the only opinion. It’s not excusable to believe that, but it’s easy.

Intactivists gain validity and a measure of mainstream acceptance through their sheer tenacity. Their most successful strategy is pure ubiquity, causing a casual observer to assume their strange fixations are widely accepted. Just check the comment section of any article pertaining to circumcision. …

Ahem.

Take, for example, the key rallying cry of intactivists: That circumcision seriously reduces penis sensitivity and thus sexual pleasure. …

My “key rallying cry” is that circumcision is medically unnecessary and violates the child’s basic rights to bodily integrity and autonomy. That holds up even if the rest of his paragraph’s citations hold up. Sexual satisfaction is a subjective evaluation to each individual. The ability to orgasm is not the full universe of sexual satisfaction. And any change to form changes function. The individual may view that change as good. He may view it as bad. Parents can’t know. That’s the ethical flaw in circumcising healthy minors.

Study after …

Surely Mr. Stern read through the studies to understand exactly what they say. I have my doubts. I read it. That study is problematic when viewed as conclusively as Mr. Stern cites it. It requires nuance the study’s author provided. Does an appeal to authority sweep away any concerns about limitations?

study after …

Adult male circumcision does not adversely affect…” Is that proof that circumcision of male minors doesn’t affect sexual satisfaction, with the glaring caveat against surgery that such a male can’t know?

It’s also worth noting that Mr. Stern linked that same study again later in the paragraph. He also linked another study in consecutive sentences. And a third. That’s deceptive and improperly gives an impression about “an entire field of resarch”, no?

… ([No adverse effect] fits with what my colleague Emily Bazelon found when she asked readers for their circumcision stories a few years ago.) …

Ms. Bazelon’s premise and finding were ridiculous.

So much for circumcision’s supposedly crippling effect on sexual pleasure. But what about its effect on health? Intactivists like to call circumcision “medically unnecessary.” In reality, however, circumcision is an extremely effective preventive measure against global disease. …

The potential benefits don’t render non-therapeutic circumcision “medically necessary”. Earlier he complained about propaganda-style terms. Pretending that “medically unnecessary” doesn’t have an accepted, factual meaning is propaganda-style question begging.

… Circumcision lowers the risk of HIV acquisition in heterosexual men by about 60 to 70 percent. … [ed. note: (Later in this paragraph, he uses the WHO link again.]

The “60″ link states “male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence.” Not one of those three criteria matches a Western nation. Those studies also involved adult volunteers, not unconsenting minors.

As both a personal and public health matter, circumcision is clearly in men’s best interest. …

Ethically, as a personal health matter, each healthy individual should decide for himself what body alterations are in his best interest based on his own preferences.

… Anyway, to intactivists, mutilation is mutilation; what does it matter if it’s for the greater good?

“The greater good” doesn’t matter because individuals are humans with rights, not statistics to be treated without regard for what they need or want. Life is full of risks. Because we seemingly can mitigate that does not mean we may or should.


Giving Accidental Legitimacy to Flawed Terminology

Posted: August 20th, 2013 | Author: | Filed under: Ethics, FGM, Mission | 3 Comments »

This almost-good post from the AHA Foundation, FGM is Not Female Circumcision, and Other Thoughts on Terminology, is worth discussing for the reason it is not good.

The premise that female genital mutilation (FGM) is not “female circumcision” is correct. Language matters. In basic semantics, calling FGM “circumcision” is inaccurate. The etymology of the word circumcision means “to cut around”. That can be done to the female prepuce, in a sense, but that’s not how we understand it. I’m willing to grant this, and the result that the term circumcision doesn’t apply to females.

The gist of the AHA Foundation’s post is about the ethical implications from terminology:

A number of organizations and advocacy groups refer to the procedure as “female genital cutting”, or “FGM/C” to encompass both terms. The argument for “cutting” instead of “mutilation” primarily hinges on the belief that mutilation implies malicious intent on the part of parents or the community, or is otherwise demeaning or insensitive to the cultural particularities of any group that performs FGM. Some argue that referring to it as cutting is a less provocative and more balanced term. Particularly when speaking with those who have undergone the procedure themselves or in reaching out to affected communities, we do see the value in using the more neutral terminology of “cutting” rather than “mutilation”, but otherwise believe it important to state clearly that the procedure is a form of abuse.

I agree with that. What is done to the healthy genitals of females without their consent in any form of FGM/C is morally and ethically wrong. It is indefensible. We must be clear that this violence is abuse. It should never be tolerated.

The AHA Foundation’s post fails because of its next-to-last paragraph.

The argument for referring to FGM as “female circumcision” is blatantly off-base. Female circumcision was the popular term until approximately the 1980s, when FGM and FGC came into usage. As mentioned above, to perform a procedure that parallels male circumcision, one would only remove the prepuce of the clitoris, something that is hardly ever done. (The prepuce is the “hood” or fold of skin that surrounds the clitoris and has no impact on sexual arousal or pleasure.) In nearly all cases, at minimum, either part or all of the clitoris, labia minora, labia majora is removed. To use the term “circumcision” to refer to what is happening to these girls minimizes the brutality of the procedure and ignores the fact that is an act of violence.

First, the paragraph is likely factually wrong when stating the clitoral hood has no impact on sexual arousal or pleasure. It’s bizarre that this made it into the post. I suspect the connection is an implication that the male prepuce also has no impact on sexual arousal or pleasure. Whether the clitoral hood affects arousal or pleasure, its removal would alter the woman’s sexual experience. That is a reason removing it without the individual’s consent is unethical. The parenthetical makes no sense.

To my point, since the post brought it up, what parallels male circumcision is not the only consideration. There are recognized forms of FGM/C less harmful than male circumcision. Much, if not all, of Type IV is comparable to or less harmful than a typical male circumcision. The stated, correct argument against FGM/C in the post (and elsewhere) is that any genital cutting on a female without need or her consent is wrong. (Including removal of the prepuce.) Any lesser conclusion or implication for male circumcision is moral relativism.

The paragraph’s flaw is its implication that FGM/C should not be called circumcision because circumcision is not a brutal act of violence. I doubt this is what the author means. I trust that the AHA Foundation recognizes that males possess the same “basic rights and freedoms” listed on its About page, including “security and control of their own bodies”. But the argument in that paragraph is predicated on minimizing a form of genital cutting, and based solely on gender. The general thrust of the debate is that FGM/C is often done with crude instruments in unsanitary conditions. It is. However, no one suggests that FGM/C performed in a hospital setting with clean instruments is somehow acceptable. At its core, cutting healthy genitals without the person’s consent is the issue.

The accurate approach would’ve been to leave out male circumcision and focus the paragraph accordingly. It would not be difficult. For example: “The term circumcision minimizes the brutality of genital cutting without need or the individual’s consent and ignores the fact that it is an act of violence.”

I do not believe those focused on ending FGM/C are required to actively advocate against male circumcision genital cutting. I expect them not to state or imply that male genital cutting without need or consent is acceptable. I expect them not to do this, from an exchange that started with the bottom tweet¹:

They responded to me:

We’re not advocating for anyone to be cut, only trying to point out the severity and harm done with #FGM.

I recognize that, as I indicated. But the response to Mr. Cummins was incorrect. There is no excuse for saying something false. (Or following up in agreement to his ad hominem.)

An organization that carelessly ignores the broader foundational principle to its work deserves no credibility. Every point that rejects FGM/C in the post applies to male genital cutting. In the points where the severity between the two is almost always different, and radically so, that is a critical distinction I’ve highlighted before. But something that should inform punishment rather than legality should not be used so recklessly. FGM/C isn’t made less terrible just because generally less-severe male genital cutting violates the same principle. Yes, those against forced male genital cutting need to be responsible when interjecting into a discussion on FGM/C, including by doing so less often. The same need for responsibility holds true for those who advocate against FGM/C.

¹ Contrary to Mr. Cummins’ rant, the argument is that non-therapeutic genital cutting on a non-consenting individual is wrong. There is almost always a difference in the degree of harm imposed from male and female genital cutting. It is often significant. But as the information in the AHA Foundation’s post also demonstrates, there is no difference in kind.


The Wisdom of a Child

Posted: August 18th, 2013 | Author: | Filed under: Ethics, FGM, Logic | No Comments »

Here’s an instructive video on UNICEF’s new report on female genital mutilation:

Kheiriya Abdi lives in Somalia. She is 10 years old. She said, “I don’t want to be circumcised because of the problems you face afterwards. I do not want any part of my body to be cut.


Genital Mutilation Is One Cause

Posted: March 17th, 2013 | Author: | Filed under: "Voluntary", Ethics, FGM | 1 Comment »

Owen at Oggy Bloggy Ogwr posted a fascinating discussion on International Women’s Day – Life, Ethics & Independence III – Circumcision. He’s thorough and makes a strong case, summarized with this:

I think the point I’m trying to make here is that perceived injustices that might be deemed “the same cause” for both sexes might not be similar at all. It’s issues like this that mean we have/need an International Women’s Day in the first place.

There are millions of women who currently have to endure some of the worst abuses humankind can throw at them for simply being born the “wrong gender”, and who don’t have much of a voice – except on days like today.

His post is strong because he addresses the issues involved rather than defending International Women’s Day with the rhetorical equivalent of “Shut up, men”. I disagree with very few of his points in the post. However, those few lead me to disagree with his defense of his conclusion, while accepting his conclusion that there is value in addressing the injustices women and girls still face and doing so on their own. Basically, his second paragraph stands without the incorrect qualification presented in the first.

My primary disagreement is here:

Is there a double standard here?

Uh….no.

If female circumcision only ever involved removing the clitoral hood – the female equivalent of a foreskin – and was still deemed “genital mutilation” then you would have a point. I doubt you can compare this with women making an informed and conscious choice to have various “body modifications” either.

The UK and US anti-FGM acts prohibit all non-therapeutic female genital cutting, including that which is analogous or less damaging than male circumcision. They prohibit “procedures that intentionally alter or injure female genital organs for non-medical reasons.” The WHO fact sheet on FGM defines it as “removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls’ and women’s bodies.” All non-therapeutic cutting on a female without her consent is (rightly) considered mutilation.

Male circumcision fits within both descriptions above, as well as the definition of mutilation. There is no valid reason to distinguish non-therapeutic genital cutting on a non-consenting individual as mutilation or somehow not. The lack of consent to any level of permanent, non-therapeutic surgical harm is the critical issue in identifying genital mutilation. Male circumcision or hoodectomy or any other non-therapeutic cutting is ethically acceptable only when voluntarily chosen by the individual receiving it. Proxy consent is still lack of consent.

I recognize the often great difference in severity from what is typically done to males and females. That matters, and should inform penalties, whether criminal or civil. This difference should not inform legality. (The challenge of enforceability can’t be ignored, of course, but that’s separate from what “should be”.) As I’ve said before, a punch to the face is still battery even though a knife to the gut generally causes more damage.

To be fair, Owen made it clear that he understands the problem inherent in male circumcision. He disagrees with imposing it on children. I am not saying anyone needs to fight male circumcision in their fight against FGM, even though they are the same cause in principle. My point is that FGM is bad enough on its own that making that case doesn’t need a separation of male circumcision from mutilation. This is also true because separating male circumcision from mutilation is counter-factual.

(Conversely, the case against male circumcision can be made without a comparison to FGM.)


International Day of Zero Tolerance to FGM, 2013

Posted: February 6th, 2013 | Author: | Filed under: Ethics, FGM, Law, Media Marketing, Public Health | No Comments »

Today is International Day of Zero Tolerance to Female Genital Mutilation. The WHO statement on this is lacking, which I don’t find surprising. (emphasis added)

The International Day of Zero Tolerance to Female Genital Mutilation is observed each year to raise awareness about this practice. Female genital mutilation of any type has been recognized as a harmful practice and violation of the human rights of girls and women. WHO is committed to the elimination of female genital mutilation within a generation and is focusing on advocacy, research and guidance for health professionals and health systems.

Female genital mutilation (FGM) refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Female genital mutilation has no known health benefits. On the contrary, it is associated with a series of short and long-term risks to both physical, mental and sexual health and well-being.

FGM is affecting about 140 million girls and women, and more than 3 million girls are at risk every year. A special focus for WHO this year, is the troubling trend of health-care providers increasingly being the ones performing female genital mutilation, and thereby contributing to legitimize and maintain the practice.

Today, I’m not going to discuss the comparison to male circumcision beyond the one inherent in this sentence. I am going to use WHO’s approach to male circumcision to compare why its last sentence shouldn’t be a surprise.

Stating that FGM has no known health benefits works from the premise that the possibility of benefits could justify FGM. No benefit could justify forced FGC (i.e. mutilation). The human rights principle is superior. WHO should state that as its foundation, and be consistent and repetitive. In reminding readers about this lack of benefits, WHO almost apologizes for being against FGM. The absence of benefits is not why this shouldn’t be done.

Think back to when the AAP issued a revised policy statement on FGC, later retracted. As I wrote here and here, I didn’t/don’t think it said what people read into it. But the reaction was universal and swift. On the idea that permitting limited forms of genital cutting could prevent greater harm to females, activists stood on the absolute principle. Whether or not this makes sense is a worthwhile discussion. (My posts linked above set out my thoughts on the issue. The principle still matters more.) Regardless, that incident demonstrates that activists would never excuse FGC/M if benefits were proposed or found. Can anyone imagine a scenario where any scientific committee allowed research into possible benefits? For those inclined to accept possible benefits as a justification, everyone else must discourage this thinking. Lazy statements that lack the courage to defends what is morally and ethically correct fail that goal.

WHO’s approach, which informs its stance on male circumcision, enables the predictable problems described in the last sentence. Because the organization refuses to stand for principle where courage is necessary, it creates the conflict of legitimizing genital cutting through “medical” male circumcision programs. I know of no populations that cut females that don’t also cut males. So, WHO drives campaigns to legitimize genital cutting while driving campaigns to delegitimize genital cutting. The flaw is obvious. The principle and consistency matter.