Strong and Non-Conflicting Evidence

A few days ago in the Huffington Post Canada, Sheryl Saperia defended non-therapeutic male child circumcision against the German court ruling. The title of her essay is “Male Circumcision is Not Mutilation, Period.” She is wrong.

After a bit of setup, she states:

For instance, neither the right to security of the person nor to gender equality should operate in such a way as to proscribe male circumcision on the grounds that it is comparable to the justifiably prohibited custom of female genital mutilation (FGM).

The two are ethically comparable. They are both non-therapeutic genital cutting on a non-consenting individual. That’s the comparison. It applies to every scenario.

But ignore the comparison. She’s jumping to the “FGM is worse, so male circumcision is okay” defense. Truncate her statement to the minimum necessary facts to understand male circumcision and the content of the ruling. Do male infants have the right to security of person? Assuming she answers correctly, that males possess this right, then non-therapeutic circumcision violates that. It is surgery, and without the recipient’s consent. It inflicts harm. Sometimes that harm is greater than what is expected, and in thankfully-rare instances, it can be fatally so. But it always involves harm. The right to be secure in one’s person should include protection from unnecessary, unwanted harm for all children.

She continues:

FGM is sometimes termed female circumcision, but this is a misnomer as it implies a minor operation equivalent to male circumcision. According to Doriane Coleman, a Duke University law professor whose expertise is children and the law, “This analogy can and has been rejected as specious and disingenuous, as the traditional forms of FGM are as different from male circumcision in terms of procedure, physical ramifications, and motivation as ear piercing is to a penilectomy.”

The term female circumcision is a misnomer for semantic reasons, but also because, as she indicates, it fails to fully explain what FGM does. However, semantic accuracy of male circumcision does not prove that male circumcision cannot also be mutilation. Saying it’s not FGM isn’t enough.

Contrary to Professor Coleman, the analogy is neither specious nor disingenuous. It is not based on merely the traditional forms. The traditional form of FGM differs across cultures. The question of which version we should use exposes the flaw in the tradition approach. The varying extent of damage can be reflected in the codified punishment for violations.

It makes more sense to start with the principle involved. Again, non-therapeutic genital cutting on a non-consenting individual is wrong. The principle does not require equivalent damage for both to violate the principle. Anyway, the anatomical analogy to mnale circumcision is a hoodectomy. The latter is illegal, which brings in the topic of equal rights. The law does not protect the rights of male minors that it protects for female minors.

The motivations aren’t as different as suggested, either.


The World Health Organization is also clear that:

“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.”

I prefer my fact sheet because it deals with principles and equality rather than outcomes. Still, even on the appeal to authority she begins here, she’s wrong. Within its fact sheet, WHO states:

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.

To repeat myself, would WHO rebrand female genital mutilation to “female genital cutting” and declare it an acceptable parental choice if some health benefits were found? I find the possibility doubtful, at best. So why shouldn’t we also apply the basic logic of harm as “removing and damaging healthy and normal genital tissue, and interferes with the natural functions of bodies” to males? It’s okay to do this without their consent because we’ve pursued a “health benefits” justification for enough years, even though almost every claimed benefit can be achieved with less invasive preventions and/or treatments?

Ms. Saperia quotes a 1997 joint statement from several groups declaring “FGM to be universally unacceptable, as it is an infringement on the physical and psychosexual integrity of women and girls and is a form of violence against them.” Even if we pretend that there is no psychosexual violation to males, there is the clear infringement on their physical integrity. (She returns to this point later, although she furthers her error.) Circumcision is a form of violence against males. It inflicts some level of harm in every instance.

Instead of acknowledging this connection, she quotes the WHO to push the irrelevant facts about circumcision being a long-standing practice and that many reasons exist for its imposition on healthy children. And then the predictable argument about HIV, which is easily refuted, and also countered with the truth that condoms are still necessary after circumcision.

She proceeds into the illogical “no real harm”:

In the absence of strong and non-conflicting medical evidence that male circumcision regularly causes substantial harm to young boys, the arguments against the procedure are severely weakened. …

Substantial is a subjective word. What one person finds substantial, I might not. And vice versa. The core question is whether or not there is non-conflicting medical evidence that non-therapeutic male circumcision causes harm. There is. It causes harm, in every case. Normal, healthy tissue is removed. Nerve endings are severed. The resulting scar provides further proof, and the mechanical functioning is altered. I accept that many people think this trade-off is acceptable for the possible benefits. But only the individual male is qualified to make that evaluation for himself.

… Since male circumcision and FGM are simply incomparable, gender equality should not demand the banning of the former just because the latter is illegal. [ed. note: Again, they’re comparable in principle (and to an extent within FGM Type IV). The law should reflect that.] And while the right to security of the person is certainly implicated by circumcision, the low risk of harm (and the fact that most complications are extremely minor) means that this right should be balanced against other compelling rights, such as religious freedom.

There is not a “low risk of harm”. There is a 100% risk of harm. There is a low risk of complications, of unexpected outcomes. Those harms are not the same. There is no implication. The guaranteed harm of non-therapeutic circumcision violates the child’s right to security. That should be balanced against competing rights, but as the court found, a child’s right to physical security outweighs his parents’ supposed right to practice their religion. From an individual rights perspective, the parents’ religious freedom ends where the child’s body begins. The child also possess a right to religious freedom.

After a paragraph praising the unity the three major religions are showing in their criticism, she writes:

According to the German court, the right to religious freedom “would not be unduly impaired” because the child could later decide for himself whether to have the circumcision. Aside from the court’s interference with a religious precept that the ritual must take place long before adulthood, the judgment could ironically cause greater harm to one’s bodily integrity because circumcision for adolescents and adults, as compared to infants, is more complicated and has a higher rate of adverse effects.

First, civil law already interferes with many religious precepts because they involve harm to others. Interference is not necessarily improper.

To her point, the issue is consent to the harm inflicted. The right to bodily integrity involves the ability to consent to harm. Or not. If a male wishes to get himself circumcised, he can decide for himself that whatever benefits he values from non-therapeutic circumcision outweigh the harm and risks of further harm. Or not. The perceived increase in difficulty in adults is not an ethical argument in favor of infant circumcision.

Within the religious context, we need to evaluate the number of teens and adults who would volunteer for ritual circumcision if left intact from birth. I assume that number would be very high. I do not believe it would be 100%, at which point the implications to individual rights should become obvious. More on this in a moment.

Outside the religious context, the number of teens and adults who would volunteer for cultural circumcision if left intact at birth would be very low, as it is now. I also assume the number of medically necessary circumcisions would increase, but only on a volume basis. The percentage would likely stay low, apart from the consequences of unnecessary fiddling with the non-retractable foreskins of children by doctors and parents.

While there appears to be the difference between infant and adult circumcision Ms. Saperia cites, there are other differences. Consent is the largest, but there is also the ability to say how much skin the individual wants removed, if he consents. Does he want to keep his frenulum? As an adult, he can have greater amounts of pain management medicine, as needed. The case isn’t as convenient to their argument as proponents seem to believe.

Ms. Saperia’s conclusion calls for a recognition of community rights, within limits, to support multicultural acceptance and integration. This is lacking on medical grounds because it is objective harm for non-therapeutic reasons. It is lacking on legal grounds because analogous surgical interventions are treated unequally in law. It is lacking on moral grounds because it lacks the consent of the recipient. Every proof she attempted failed to demonstrate that non-therapeutic circumcision on non-consenting children should be permitted.

Coercion Negates Self-Determination

The German court ruling involves many issues, so I expect it to be an ongoing source for posts for the foreseeable future. I’m building my thoughts on the opposition, which is a complex issue. For this post, though, there are a few comments worth mentioning. The full article contains many quotes based on faulty logic, but this comment¹ encapsulates the problem with balancing parental religious freedom with a child’s right to be free from harm:

The Evangelical Church’s Hans Ulrich Anke said: “Religious freedom and parents’ right to choose how to educate their children have not been weighed against the fundamental right of the child to bodily integrity”.

Parents don’t have the right to educate their children with the blade of a scalpel. This is as true about male circumcision as it is for any other surgery, including religiously-argued female genital cutting. The right to be free from obvious, objective harm without one’s consent is not a right that begins upon reaching a society’s arbitrary age of majority. It’s especially fallacious to imagine that this right doesn’t exist from birth for male minors only, as laws against non-therapeutic female genital cutting imply. The fact that male circumcision is proscribed in religious texts demonstrates nothing about the legitimacy of its imposition on a healthy, non-consenting child in a civil society. There are many religious dictates that we do not allow under this expansive view of religious freedom because the actions violate the rights of others. A balancing test is necessary. Where there is a conflict, religion must change, not our protection of the rights of all citizens, equally.

This post by Iain Brassington at the Journal of Medical Ethics blog deftly addresses this conflict for what it is. (Mr. Brassington cites this news story.)

The president of Germany’s Central Council of Jews, Dieter Graumann, called it “an unprecedented and dramatic intervention in the right of religious communities to self-determination”.

That’s telling. The rights of the child give way to the right of a community to cut him. Can communities have rights anyway? I’m not at all sure. If they can, and if self-determination is one of them, does that always have to come out trumps? Again, I’m not at all sure. It’s strange to see rights-talk brought to the table in defence of unconsented, irreversible, and non-therapeutic body modification. If a boy decides that it’s important to get himself circumcised later in life, then that’s a different matter entirely: good for him. But without any choice? I may have missed something, but I don’t understand how the claim is supposed to work. Can anyone help out?

Mr. Brassington succinctly identifies the conflict. The argument is for community “rights” at the expense of individual rights. Effectively, children are property. I suspect critics of protecting a male child’s right to bodily integrity expect opponents to retreat on the basis of some form of fallacy to render reconsideration of existing norms unjustified and offensive. Unfortunately, but with reason for optimism, this is part of the path to achieving full protection of bodily integrity for all individuals.

¹ It’s possible to read that in a different context from the rest of the article. That subtlety may be what he meant, which would rather likely side closer to my view than with the other comments in the article. I will consider it in the context of the rest of the article, as criticism of the court and an attempt to support non-therapeutic child circumcision as a parental religious right.

Flawed Circumcision Defense: Yair Rosenberg

In what appears to be an attempt at a GOTCHA! in response to the German court ruling, Yair Rosenberg offers a weak effort touting the potential benefits of non-therapeutic circumcision. He opens:

“Male circumcision is a highly significant, lifetime intervention. It is the gift that keeps on giving. It makes sense to put extraordinary resources into it.”

Who would you guess recently offered this paean to foreskin fleecing? A rabbi? An imam? Nope. Try U.S. AIDS coordinator Eric Goosby at a health convention last month for top officials from 80 countries.

This smacks down the logic of a German regional court that has banned religious circumcision, calling the practice a “serious and irreversible interference in the integrity of the human body.” …

Mr. Goosby’s statement, used as an appeal to authority, does not smack down the logic of the German court. Circumcision can impart potential benefits when it is imposed on a healthy child, while meeting the court’s statement that it is a “serious and irreversible interference in the integrity of the human body”. The imposition on a healthy child makes it unethical. There is no need for an allegedly-required belief that the science isn’t real. Mr. Rosenberg’s argument focuses on ends without a complete consideration of the means.

He next offers the inevitable appeal to a reduced risk of HIV. As almost every advocate does, he omits the relevant caveats. The risk reduction is in female-to-male HIV transmission in high-risk populations. Neither describes the HIV epidemic in any Western nation, including Germany. Even if it did, the studies involved voluntary, adult circumcision, not infant circumcision. That’s the ethical question. Infants can’t consent. They also won’t be having sex any time soon. There is no immediate need to force non-therapeutic circumcision on them for this potential benefit.

His next tactic is revealing. He quotes a story on the HIV studies. The story quoted unnamed federal health officials who declared that the studies were halted early because the findings made it “unethical to continue without offering circumcision to all 8,000 men in the trials”. Okay, fine, they offered circumcision to the control group. Mr. Rosenberg states:

Unethical not to circumcise the men.

No. Researchers deemed it unethical to not offer circumcision to the control group. That’s a huge difference. The control group men retained the right to reject circumcision. One might say this distinction is “highly significant”. Mr. Rosenberg seems to have missed the entire ethical issue. The issue is the imposition of circumcision, not whether or not someone could (or should) conclude that circumcision for himself is awesome because of various possible benefits.

He returns to an appeal to authority:

… The American Academy of Pediatrics is soon expected to come out with a new policy pushing circumcision, reversing its prior stance.

I’m not a fan of the “no medical association recommends it” argument because it’s an appeal to authority and because it could change. But the same problem applies to using a medical association’s support. In the latter case, it’s an evaluation without regard for what the individual needs or wants. It’s untethered from rights and reason.

He continues (emphasis added):

Given this impressive scientific consensus as to the medical dividends of male circumcision, the German court’s judgment—which permits circumcision for “medical reasons”—is a confused and ignorant muddle. Some have rightly criticized it as an assault on millennia of Jewish tradition and practice (not to mention Islam), something one would have thought a German court would be sensitive enough to avoid. But the ruling itself, as the research above amply demonstrates, is logically incoherent and factually wrong for a simple reason: All circumcisions are medically beneficial. Whether or not the procedure stems from religious motivations, it will have measurable health benefits. So by the court’s own reasoning, all religious circumcisions ought to be permissible as long as the parents also want the medical dividends—which effectively means that circumcision has not been banned at all. Of course, it is very unlikely that this is what the court intended and much more likely that it was entirely unaware of the scientific consensus surrounding circumcision’s advantages.

First, it seems clear that the court meant “medical reasons” to mean “medically necessary”. In saying that the court’s reasoning renders non-therapeutic circumcision valid based on merely mouthing the words “medical benefits”, he is echoing the silly argument many push that pretends prophylactic circumcision is “medical” circumcision. It is not. Non-therapeutic child circumcision involves proxy consent, not consent, so the only valid medical reason is need. As Mr. Rosenberg acknowledges, this interpretation is not likely the court’s intent. Assuming that this means the court was unaware of the science is too convenient. It begs the question. “They ruled circumcision is harm, so obviously they didn’t consider the benefits. If they had, they’d know that all circumcisions are medically beneficial and rule accordingly.”

Within either analysis, his conclusion is still wrong. The italicized bit is Mr. Rosenberg’s personal evaluation. It is his subjective conclusion based on his preferences. (He indirectly admits this later.) It is not an objective fact. The only objective fact is that circumcision inflicts some guaranteed level of harm. There is also the possibility of unexpected harm reflected in further complications, which contradicts his “all circumcisions” insistence.

Not everyone will value the potential benefits the way he does. I don’t. The HIV benefit he cites, the one that barely applies to Western societies, is effectively moot if a male simply wears a condom when he has sex. The same ease of prevention applies to HPV, for which there is also a vaccine approved for females and males already exists. And so on. The remaining benefits are generally achievable through less invasive preventions and/or treatments. The most invasive surgical option on children as a prophylactic measure can’t be justified ethically.

Or to put it in extreme terms, is circumcision medically beneficial to the boys who will lose more than their foreskin? What about the boys who die? Is circumcision medically beneficial to them? All circumcisions are medically beneficial, right?

He also misstates the goal of activists:

But that scientific consensus reveals more than just the follies of this German court; it also exposes the deeply problematic aims of American advocacy groups which seek to outlaw circumcision for the entire United States. …

The goal is to prohibit non-therapeutic circumcision on non-consenting individuals. It is not to outlaw circumcision, full stop. That’s his meaning, but precision matters here, just as it does when discussing the reduced risk of female-to-male HIV transmission in high-risk populations.

After trotting out the tired “why do you hate the poor?” argument, he writes:

… It’s one thing to abstain from a potentially medically beneficial procedure due to personal convictions; it’s quite another to enforce those convictions coercively on others.

Children who have circumcision forced on them do not get to abstain due to personal convictions. They had someone else’s convictions enforced coercively on them. If Mr. Rosenberg understands the ethical issues involved, he hasn’t shown it yet.

Ultimately, those who seek to ban circumcision as the essential equivalent of child abuse—from this German court to activists who recently attempted to bar the practice in San Francisco—are doing so in the face of tremendous scientific evidence to the contrary. Their claims are at odds with countless studies, not to mention global health policy. The burden of proof, then, is upon these activists to defend their disregard for this science, not on the majority of Americans who choose to circumcise their children and take advantage of its documented benefits.

This isn’t how the burden of proof works, since proponents of non-therapeutic circumcision on non-consenting children are the people advocating intervention contrary to the normal, healthy body. It warrants an answer, regardless. I do not disregard this science. I accept it all. I just don’t foolishly pretend that the possibility of a benefit permits me to disregard ethics or the vast amount of science beyond claimed benefits from non-therapeutic circumcision. The normal, healthy foreskin is science. The ability of soap and water to cleanse the penis, foreskin included, is science. Condoms are science. The power of antibiotics to treat infections is science. If we are to take Mr. Rosenberg’s narrow reasoning as a valid replacement for ethics, any surgical intervention on a child becomes acceptable if some rationale about possible benefits can be found. There is no limiting principle that respects rights. It’s based on one’s preference for circumcision about one’s child, without regard for what the child needs or might (not) want.

He concludes¹ with this:

After all, individuals are free to discount scientific evidence on the basis of value considerations, even dubious ones, and base their life decisions upon that calculus. But such subjective notions should never form the basis for coercive state policy any more than, well, religion.

Individuals are free to discount scientific evidence on the basis of value considerations. I do. I accept the benefits, but I value other aspects of the issue more. Ethics, bodily integrity, and normal body parts all matter more to me than the possible benefits. Whether that’s dubious or not for me is not for anyone else to decide. Yet I don’t have any freedom on this. My parents had me circumcised. They made my decision on their subjective calculus. It was the basis of their coercive parental policy. If the issue is force, and it is, the only illegitimate force exercised here is circumcising healthy children. Prohibition is the defensible position.

If we want to discuss whether prohibition is the best approach to solving the violation of non-therapeutic circumcision on non-consenting individuals, that’s a discussion worth having. Cultural change is likely to be far more effective. Society, in general, and religions, specifically, have changed. There’s no reason to believe it can’t happen here. It should. It will. In the meantime, though, children are having their decision made with force. Agitating for change through multiple avenues, including the law, is reasonable.

¹ He actually concludes with “Your move, Foreskin Man.” That’s not an argument. I’ve written what I need to say on that topic.

Tempered Hope: German Court Edition

Like every other interested activist, I’m thrilled with the ruling from the District Court of Cologne.

Non-medical circumcision is a “serious and irreversible interference in the integrity of the human body,” the Cologne district court ruled.

This criminalises religious circumcisions performed by Jews and Muslims, the Financial Times Deutschland newspaper said on Tuesday. It says circumcision should be considered a crime of bodily harm.

Basically, yes. And non-therapeutic, non-ritual circumcision on healthy children, I hope. Surgically removing a healthy, normal body part constitutes physical harm. It can’t be much clearer than that. Non-therapeutic circumcision is a “serious and irreversible interference in the integrity of the human body”. There is no parental right to inflict such harm on a healthy child.

The various stories all quote some part of a statement by Professor Holm Putzke. They need to be pieced together to get his full statement, but the good bits I’ve read are here:

“This ruling has enormous significance for doctors,” said Professor Holm Putzke, an expert on law from Passau University in Germany. “For years there has been a call to ban circumcision for religious reasons. The court, as opposed to many politicians, was not afraid of criticism that its ruling was anti-Semitic or harmful to religion.”

Passau [sic – Putzke] further stated that the decision “may not only influence future rulings, but also bring about a change in the worldview of religious people regarding basic rights of children.”

And here:

Meanwhile, Holm Putzke, a professor of criminal law at the University of Passau who has argued for several years for a ban on involuntary circumcision, told JTA he hoped the ruling would spark discussion in Germany about “what should be given more weight – religious freedom or the right of children not to have their genitals mutilated.”

It’s not that complicated. There is no right to mutilate children within the individual right to religious freedom. The right to practice religion is not a right to practice it on another’s body with a permanent, harmful act.

As you can guess, I didn’t need 24 hours to understand that. I didn’t write about this yesterday because I wanted to think on it a bit, and to wait for a little more information to flow out because I can’t translate the source material. The court’s press release (pdf) is only in German, and Google Translate offers a bizarre counter-factual translation. Now that I’ve seen a little more, the key difference between what I know now and what was in the original trickle of information is that this decision is not binding. It’s a precedent in Germany, but it doesn’t immediately outlaw non-therapeutic genital cutting on minors in Germany. It will likely reach higher courts in Germany. This ruling is a victory, but it’s not time to spike the football in the endzone. There’s a long way to go, even in Germany. But it’s a brilliant start worth celebrating. We’ve long known that history will be on our side. This is further evidence.

Where I’d rather focus after the initial high is to suggest we all acknowledge and understand the implications for our efforts, particularly in the U.S. When the San Francisco ballot initiative began last year, that was a win. It became a minor setback for other reasons, but the initiative was correct. The text of the proposed legislation clearly identified the right and why it was generally applicable rather than an attack solely on religion as some inexcusably declared.

Still, the initiative had a flaw. The opportunity was specific to California and its ballot initiative option. It was worth pursuing (if there hadn’t been a controlling law on city versus state regulations already in place). It just shouldn’t have been in San Francisco. That was a tactical error. The city has a reputation outside of its boundaries that added unnecessary baggage to the effort. It allowed people uninterested in simple critical thought to suggest and accept that the initiative was on par with banning Happy Meals. The initiative involved liberty interests (i.e. individual bodily autonomy and genital integrity) that would’ve been helped by not being associated with unrelated silly endeavors.

So it is with this ruling. There’s more than just “we’re right!”. The case involved a Muslim family, which is being lost in many of the news reports and blogs reporting it. But the connection with and implications to Jewish ritual circumcision are obvious. If the ruling sticks and applies throughout Germany, it will affect both religions. That is legitimate. Again, circumcision inflicts physical harm, as the court found. Non-therapeutic reasons can’t excuse its imposition on children. That’s the rational extension of the finding. The elephant in the courtroom is the prohibition in Germany of an act associated with Judaism.

Ridiculous people will focus on this with hysterical hyperbole, but there are also reasonable people discussing it. It can’t and shouldn’t be dismissed. We should not feel ashamed or apologize for this unfortunate connection. It’s noteworthy but far too simplistic as an attack point. We should be cognizant of history and be responsible in how we talk about the ruling and its inevitable opponents within (and beyond) religious communities. History matters, but it can’t be an excuse to avoid the present. It can’t be a defense for uncritical thinking, for the wrong idea that non-therapeutic circumcision on a minor is an extension of a parent’s religious freedom. Religious freedom for parents and bodily integrity for children are consistent within the same civil law. We have the principles on our side. Let’s be intelligent about how we focus the discussion – and refocus it, if necessary – on rights and the future rather than solely on the past.