Swedish, Danish medical groups call for respecting rights of children

Posted: January 30th, 2015 | Author: | Filed under: Ethics, Law, Religion | No Comments »

1/31/15 Edit: This news is from last January. I first saw it in this story posted this week. I looked for other news articles and used the one in this post because the quote from Mr. Ullenhag was more complete. I noticed the date of January 26th, but missed that it was from last year, unlike the link above. My analysis is the same, obviously, but the mistake is mine.

Interesting news:

Large medical associations in Sweden and Denmark recommended banning non-medical circumcision of boys.

In Sweden, the recommendation came in a resolution that was unanimously adopted last week by the ethics council of the Sweden Medical Association — a union whose members constitute 85 percent of the country’s physicians, the Svenska Dagbladet daily reported on Saturday.

It recommended setting 12 as the minimum age for the procedure and the boy’s consent. Jewish ritual circumcision, or brit milah, is performed eight days after birth. Muslims typically circumcise boys before they turn 10.

In Denmark, the Danish College of General Practitioners — a group with 3,000 members — said in statement that non-medical circumcision of boys amounted to abuse and mutilation, the Danish BT tabloid reported Sunday.

I don’t know that 12 is the right minimum age, but I’ve long been willing to accept an age below that of majority as long as the boy can offer his informed consent. I have concerns about how informed it could be at earlier ages, but I’m willing to leave the option for consideration.

The resolution is non-binding, which is still fine for this process. Less change is needed in Scandinavia than in the United States, but change is still needed. This is a step in demonstrating that even well-intentioned non-therapeutic circumcision constitutes harm, and the boy himself has the sole right to request or reject non-therapeutic circumcision for himself.

Any effort at respecting ethics in this area always brings some variation of this quote, with little variation:

“I have never met any adult man who experienced circumcision as an assault,” [Sweden’s minister for integration, Erik] Ullenhag said. “The procedure is not very intensive and parents have the right to raise their children according to their faith and tradition. If we prohibit it, we must also address the issue of the Christian ritual of baptism.”

Mr. Ullenhag has apparently done little research on the issues of circumcision and ethics. He is ignorant of what many adult men think of their parents making this choice. He does not understand the principle against direct physical harm involved that distinguishes circumcision from baptism or virtually any other ritual of any religion in which parents may want their children to participate. His approach implies no limits on parental authority. Surely he does not believe that is valid.

These recommendations are progress. These medical authorities, unlike American medical authorities, grasp the issues involved for the child. They are taking a principled stand. It is a positive and, more importantly, necessary step in the process to achieving proper protection for the rights and bodies of all children.


“…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 | 1 Comment »

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.


America Participates in Forced Circumcision

Posted: November 2nd, 2012 | Author: | Filed under: "Voluntary", Control, Ethics, Religion | No Comments »

An article from the American Association of Clinical Urologists in Urology Times offers a frustrating introduction to the current circumcision controversy:

Legislators, researchers, imams, and rabbis argue whether male circumcision decreases certain diseases, whether a child can or should give consent, or whether religious freedom should trump all of this. Public policy discussions that are taking place throughout the Western world—specifically, the U.S.—have implications for urologists.

Americans are mostly insulated from horror stories around the globe, such as in Indonesia, where religious extremists who practice forced circumcision on men, children, and even pregnant women in attempts at forced religious conversion; or in South Africa, where certain cultures allow for the forced circumcision of boys deemed to be “past the age of initiation.” Female circumcision is now called “female genital mutilation” and is illegal in most of the Western world.

All non-therapeutic genital cutting on a non-consenting individual is “forced circumcision”. That includes every circumcision of a healthy American boy. The issue at hand is force. (e.g. force is force) All the comforting justifications offered in the West for a nonsensical exemption to basic human rights and medical ethics for male child circumcision do not change the violation of forcing this non-therapeutic surgery on those who cannot consent. The foreskin is a normal body part, not an irrelevant “extra bit of skin” that may be removed from a minor (male only, of course) because it might cause some problem some day, no matter how likely, preventable, or treatable. (Worse: the other more bizarre reasons we accept from parents for this surgery.)

The article’s conclusion is frustrating, as well. I understand not wanting to take a stance on which side is right. However, that’s the critical question, especially if more non-therapeutic child circumcisions will be pushed to doctors as law and culture changes. The focus should not be on the possibility that these changes could increase urologists’ liability premiums. It would do that because more complications would occur in doctor-performed circumcisions. That’s simple numbers. But those complications don’t have to happen. When a requested circumcision is not medically indicated and the patient can’t consent, the critical question of which side is right must be addressed. There is an ethical answer. As the article points out, “[c]omplications stemming from circumcision may have lifelong implications for the individual at the other end of the knife, no matter their age.” What does the child want in the absence of need? When he can’t consent, no one should participate in circumcising him.


Argument from Ignorance and/or Hatred

Posted: October 31st, 2012 | Author: | Filed under: "Voluntary", Control, FGM, Politics, Religion | 2 Comments »

In a letter to the editor of the Standard-Examiner in Ogden, Utah, a reader attempts to make a point about Sharia Law. I’m not going to wade into the political aspect of this. But the reader makes an informative error. He writes:

When girls reach age 12 to 14 they are held down, naked, by usually their mothers or as many men that it takes to hold them down, as they cut their clitoris off. They say this helps to control them. Then the girl’s legs are wrapped together for 40 days so the wound can heal.

I could quibble, but this more or less sets up the issue. FGM is evil. But the reader loses his narrative in the next paragraph. He gets basic facts wrong that contribute to a mistaken distinction that doesn’t exist within the principles he aims to establish. (emphasis added)

They tell the little girls that this will make it more pleasurable for their husband when they get married while being denied any sexual pleasure themselves. This mutilation of the genitals makes it painful to have sex and extremely painful to bare children. Everyone knows that they have to be covered up head to toe and escorted by a male wherever they go, but I wonder if the American people know that it is OK to beat their wives by hand or by stick as needed. Or that they are forced to perform oral sex with their husbands, who have not been circumcised so the penis stinks due to the buildup of urine. If the woman complains the husband cuts off her nose.

The principles he implies are the basics. Females possess the rights to their bodily integrity and autonomy. They should be free from unnecessary harm without their consent. Cutting their healthy genitals violates them. It is bodily harm. They are mutilated.

The problem here is that the same rights exist for males. Non-therapeutic genital cutting on a non-consenting individual, not just the genital mutilation of girls, violates the principles involved, regardless of the extent. The husbands of these women are almost certainly circumcised. Their genitals are not cut to the extent that their wives’ genitals are cut. They are cut, though. I’m not aware of any cultures that cut females that don’t also cut males. (Please correct me if I’m wrong.) In Egypt male circumcision is practiced as a part of Islam.

The reader’s comment that the husbands are not circumcised would be bad enough on its own because it’s inaccurate. The additional “so the penis stinks due to the buildup of urine” is projection. It strives to distinguish forms of non-therapeutic genital cutting with an ignorant dismissal of basic hygiene. It seeks to reiterate a validity and desirability for male circumcision, without regard for the male’s preference. The issue the reader raises but fails to crystallize is the use of force.

Forcing genital mutilation on girls is wrong. Forcing wives to have any form of sex is wrong. That extends to males, as well, if the desire to protect females is to carry complete moral weight. Any system – whether political, cultural, or religious – that permits or encourages the use of force by one citizen against another citizen for any reason other than self-defense is illegitimate. The reader’s core point is correct. He should apply it as a universal to all people, not selectively as an instrument endorsing his own cultural relativism. (He is not unique in this, of course. Commonality doesn’t justify it.)


Flawed Circumcision Defense: Rabbi Shmuley Boteach

Posted: August 31st, 2012 | Author: | Filed under: "Voluntary", Ethics, FCD, FGM, Law, Parenting, Religion, Science | No Comments »

Rabbi Shmuley Boteach has an opinion piece in The Wall Street Journal titled, “Germany’s Circumcision Police”. It starts off well.

There was a head-spinning moment in Germany last week: News emerged that a rabbi had been criminally charged for performing his religious duties. Rabbi David Goldberg of northern Bavaria, who shepherds a 400-member community, is the first person to run afoul of a ruling by a Cologne judge earlier this year that criminalized circumcision, a basic religious rite.

There is some precedent outside of Germany for such a ruling. …

Even though we disagree on policy, agreeing on basic facts is always good. But his essay slowly falls off the path.

… In the United States, a San Francisco ballot initiative tried last year to make circumcision an offense punishable by a $1,000 fine and up to a year in prison; it failed to get enough votes. …

That’s not an accurate summary of what happened last year. A court ruled that the local ballot initiative conflicted with an existing state law and struck it from the ballot. It had nothing to do with getting enough votes.

… But the circumcision ban deserves universal scorn.

Does the German government really want to get into a public battle over whether they are better guardians of the health and welfare of Jewish (and Muslim) children than their parents?

As long as parents continue to circumcise their healthy sons, I hope so. Obvious physical harm for subjective non-therapeutic benefits is unacceptable without the individual’s consent. Protecting the rights of all citizens is a legitimate role of the state.

The Los Angeles Times recently cited a study predicting that as the number of circumcisions goes down in the U.S., the cost of health care will steadily climb. Eryn Brown reported that “If circumcision rates were to fall to 10% . . . lifetime health costs for all the babies born in a year would go up by $505 million. That works out to $313 in added costs for every circumcision that doesn’t happen.”

I’m not impressed by Rabbit Boteach endorsing the idea that a child’s normal body – and by extension, his rights – has a price beyond which we’ll justify non-therapeutic intervention to remove parts of it. But, more importantly, the key in that is not $313. It’s predicting. Aaron Tobian and his co-authors used a data model to make a guess. There are many factors involved. They are not constant. Cost, availability, and need could be quite different in two decades. For the potential benefits against sexually transmitted infections, circumcision can be chosen later. That would match the ethics of the studies that used adult volunteers. This study seeks to “prove” that a specific, non-urgent solution should be applied now, regardless of ethics.

Why? Because circumcision has been proven to be the second most effective means—after a condom—for stopping the transmission of HIV-AIDS, with the British Medical Journal reporting that circumcised men are eight times less likely to contract the infection.

He gets credit for mentioning condoms, which puts him ahead of the AAP. Still, condoms provide greater protection than circumcision, and remain necessary after circumcision. So, cost-wise, it’s condoms or condoms and circumcision. The former is cheaper and ethical. Infant circumcision is not ethical, including when potential benefits against STDs are cited.

While the Germans decry the barbarity of circumcision for men, they also overlook the benefit to women who are the men’s partners. Male circumcision reduces the risk of cervical cancer—caused by the human papillomavirus, which thrives under and on the foreskin—by at least 20%, according to an April 2002 article in the British Medical Journal.

They overlook the potential benefit to women? Do they? They can agree that (voluntary, adult) circumcision may confer reduced risk to female partners while also finding it unacceptable to impose circumcision on infant males (i.e. not “men”). Rabbi Boteach ignores the ethical foundation for the court’s ruling.

While some attempt to equate male circumcision with female clitoridectomy, the comparison is absurd. Female circumcision involves removing a woman’s ability to have pleasure during sexual relations. …

Not necessarily. Yet, in spite of that, it remains unethical. At some point, the human rights principle(s) involved must factor. Equal protection is a human rights principle.

… It is a barbarous act of mutilation that has no corollary to its male counterpart. …

This is also not true. Within what he wrote, it is, because he limited himself to clitoridectomy. The scope of illegal female genital cutting/mutilation is much broader than that, including any cutting that is anatomically analogous to (or less harmful than) male circumcision. That’s relevant.

… Judaism has always celebrated the sexual bond between husband and wife. Attempts to malign circumcision as a method of denying a man’s sexual pleasure are ignorant. …

Male circumcision controls male sexuality, with a long history as an attempt to limit sexual pleasure. It is still used to reduce pleasure for males.

… Judaism insists that sex be accompanied by exhilaration and enjoyment as a bonding experience that leads to sustained emotional connection.

If we ignore explicit statements in favor of circumcision as a way to diminish male sexual pleasure, Rabbi Boteach’s claim here is not mutually exclusive from reduced sexual pleasure. Intent does not guarantee outcome.

We Jews must be doing something right in the bedroom given the fact that, alone among the ancient peoples of the world, we are still here, despite countless attempts to make us a historical footnote.

This is evidence that male circumcision does not eliminate male reproductive ability. No one has claimed it does. His statement is a non-sequitor. The ability to reproduce is not proof that circumcision is acceptable or that it does not affect sexual pleasure or inflict harm.

Related: From the Cut Podcast, a debate between Rabbi Shmuley Boteach and Cut director Eliyahu Ungar-Sargon.


I Haven’t Forgotten

Posted: August 15th, 2012 | Author: | Filed under: Religion | 1 Comment »

I wrote:

… There are issues offered by proponents of ritual child circumcision that deserve to be taken seriously. Asking people to let go of something they intensely value is asking them to bear costs, even if it should be clear that avoiding objective harm to the child must be stressed more. I intend to write more on them in the near future.

I’m working on that post. I want it to be as honest and clear as it can be.

In the meantime I know of at least one response to that. Lilli at Moralogous offered a thoughtful treatment of the issue. I like it because it’s not the approach I’m writing. The different perspective is useful in encouraging debate and consideration of the many aspects involved in circumcision.

Anyway, I haven’t forgotten.