Category: Parenting

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.

Self-Ownership and Parenting Coexist

Katia Hetter wrote a fantastic essay at CNN, titled “I don’t own my child’s body”. It’s in response to the Sandusky molestations, and is worth reading on its own for that reason.

It’s also impressive because it captures the spirit of genital integrity as part of the more general realm of children having rights separate from their parents. Children are individuals, too. I most respect that she explains that her child is an individual while still demonstrating that she parents her child. Recognizing and respecting a child’s individuality and self-ownership is a part of parenting, not a suggestion that, as a result, parents may not make any decisions for the child. Some ardent circumcision advocates, masquerading as advocates for “parental choice” (for sons only, somehow), trot out the latter, absurd trope whenever someone suggests that children own their healthy, normal bodies. This essay serves as an effective disinfectant for that nonsense.

My daughter occasionally goes on a hugging and kissing strike.

She’s 4. Her parents could get a hug or a kiss, but many people who know her cannot, at least right now. And I won’t make her.

“I would like you to hug Grandma, but I won’t make you do it,” I told her recently.

“I don’t have to?” she asked, cuddling up to me at bedtime, confirming the facts to be sure.

No, she doesn’t have to. And just to be clear, there is no passive-aggressive, conditional, manipulative nonsense behind my statement. I mean what I say. She doesn’t have to hug or kiss anyone just because I say so, not even me. I will not override my own child’s currently strong instincts to back off from touching someone who she chooses not to touch.

I figure her body is actually hers, not mine.

Exactly.

Link via Attorneys for the Rights of the Child (link), on Twitter.

Flawed Circumcision Defense: Dr. Ruth Westheimer

At the risk of being impolite to Dr. Ruth Westheimer on her birthday, here’s a reminder of how lacking her position on male child circumcision is. From an advice column from 1995:

Dear Dr. Ruth: There is a good deal of anti-circumcision opinion in circulation these days and I would like to get your opinion. One of the claims is that circumcision results in a reduction of sexual pleasure. The argument, which sounds logical, is that exposing the glans reduces its sensitivity and that therefore the uncircumcised penis affords more sexual pleasure than the circumcised one. Sounds plausible, but is it true?

I think that many of today’s young parents, Jewish and others, who like to do what is “politically correct” might well forgo circumcision of their sons if that condition would mean someday depriving them of a measure of sexual pleasure.

Can you suggest any kind of evidence which either supports or challenges this claim?

Dear Reader: While it is true that one of the long-term effects of circumcision is some loss of sensitivity in the glans, or head of the penis, what you must realize is that sex really takes place in the brain, and so long as the man is in a loving relationship, there will be many compensating sensations taking place in his brain to replace those he might have lost in his penis.

She answers the question correctly (with an answer contrary to the mistaken opinion many hold today, almost 17 years later). While I understand what she’s doing, using the bulk of her answer to disregard the implication of her initial statement is inexcusable. The question involved children, not how to comfort a circumcised adult sexual partner. This disregard is still all too familiar today. “It affects his sexual pleasure, but…” There is no valid defense of that “but” for non-therapeutic circumcision on a child.

On her website, she answered another circumcision question. It’s undated. I assume it’s (considerably) more recent than 1995. It doesn’t matter. (emphasis added)

[Reader:] My wife and I are expecting, and we are not finding out the sex. However, if we have a boy, she is adamant that we not circumcise him, and I am adamant that we do. I have researched article after article about the hard medical facts of circumcision and how it lowers the transmission rates of STD’s such as HIV. It also helps with penile carcinoma, UTI’s, and ulcerative STD’s.

My intelligent wife believes that we should offer our son a choice of whether he wants it or not, and is afraid our son will feel the pain if he has it.

I am circumcised, and want my son to ‘look’ like daddy, as well as not have to explain to him at a younger age as to why he is so much different than daddy.

I’m interrupting here to highlight what is obvious. The father talks about all of the benefits he has researched. Yet, his statement makes it clear that his real reasons are that he wants his son to look like him and to avoid the need to parent his child with an explanation for why his son is “different” (i.e. normal). This is even though a son won’t ‘look’ like daddy for at least a decade after circumcision, which he will still have to explain if it comes up. Better to act like a parent and explain his normal, healthy body to him than to pretend that his dad’s insecurities justify surgery. (These insecurities will appear again.)

Furthermore, if the procedure is done later, our son will be in pain for six weeks, and I just don’t want him to have to endure that torture. [ed. note: so it’s acceptable to force him to endure that as an infant?]

As circumcision requires both parents consent, this matter will not resolve itself. I feel that my wife should consent as I have more experience in this matter than she does. [ed. note: This is stupid. Would he abdicate his responsibility as a parent if his wife wanted their daughter cut?] I would also feel inferior when our son asks, ” Daddy, why did you cave in to mom’s demands?” later in life. [ed. note: Protecting your children from harm is the “manliest” thing a father can do. Don’t pretend this is about proving your power and ego.]

We are at an impass. We are both passionate about our beliefs (she would consent to having our son circumcised if I were Jewish). What can I do? Should I let this battle go?

Before getting to Dr. Ruth’s answer, I didn’t interject into this man’s question to mock him. I only seek to indicate how obvious the rebuttals are that a good advice columnist would offer about this parenting question. His approach is quite common, so it shouldn’t be unfamiliar to Dr. Ruth. She didn’t go that route, of course.

[Dr. Ruth:] While it’s OK to have differences of opinions, I would hope that you don’t have to have actual battles over these issues. Perhaps because you’re both acting so stubborn, neither one of you is willing to listen to reason. And at this point, you don’t even know if it’s going to be a boy or a girl!

While you raise good points regarding the health concerns, those risks are greatly reduced if it is a boy and you teach him to clean his penis thoroughly. [ed. note: Indeed.] I know not every young male does a good job at that, but if this is important to you, then you’d just have to make it your duty to make sure he does. [ed. note: Parenting… What a useful answer.]

Your wife’s point that the decision should be his does not sound very intelligent. It is much worse to have this procedure when you are older, so the decision must be yours when he is quite young. If that’s her only concern, then perhaps your argument that you want his penis to look like his dad’s has more weight. But in the end, this is not such an important issue and rather than fight over it, you should have some reasonable discussions, if the baby turns out to be a boy, and see what happens. But better to lose this particular debate than fight with your wife.

Dr. Ruth’s last paragraph is a complete mess devoid of ethics. The wife’s point is the only intelligent opinion uttered throughout. As Dr. Ruth answered in another question (about an adult), “[i]t’s his penis …”. Yes. In that other question, if the argument that it’s his penis weren’t the correct answer, Dr. Ruth should’ve told the woman asking that question to demand that her boyfriend get circumcised. She didn’t. Self-ownership exists from birth. It is not negated simply because a boy’s parents fear a possible future outcome.

That gets to Dr. Ruth’s next failing here. She omits the critical point. What is the risk he will need to be circumcised later? It’s quite low, of course. In addition to the more important fact that there is no decision to be made now, there will likely never be a decision that needs to be made. Whether or not he might deem the prospects of adult circumcision to be worse is irrelevant. It does not mean the decision must be his parents’. Dr. Ruth’s opinion is not intelligent. Justifying cosmetic surgery on a son to appease his father’s ego is not intelligent, either.

(Her last sentence is an accidental correct answer. She found her way to a good suggestion premised on an awful reason.)

Avoiding Circumcision Regret

Addressing parents who circumcised or intend to circumcise despite the compelling evidence against the practice remains our biggest challenge as activists for genital integrity and bodily autonomy for all. Since cultural change is the most likely (and probably most effective) route to ending non-therapeutic child circumcision, we have to confront it. Logic matters, which is my preferred route. But emotion matters, too. Kindness and decency can contribute to the discussion and sway parents into protecting their sons the way they would protect their daughters if someone suggested genital surgery on them.

In that approach, I think this post at Mothering achieves a brilliant mix of logic and emotion. A mother wrote it to her son before the circumcision, which never occurred because her son benefited from her persistence in wanting to do the right thing for him. (It also helped that the urologist selected for the possible circumcision embraced ethics¹ enough to be uncomfortable without consent from both parents.) Thus, the letter she wrote to her son to apologize for allowing him to be circumcised instead became an excellent testament to the arguments against circumcision. I strive to achieve this power in my writing.

Dear XXXX,

You’re cuddled up peacefully against me. You’re so happy and innocent and perfect. You’re four days old and you are amazing. I want to give you everything. And I’m already failing you. I’m so sorry, XXXX. I won’t ask you to forgive me because I’ll never forgive myself. I’m your mother and it’s my job to protect you. And I don’t know how to do it. This week, your dad and I will take you to a doctor’s office. They will strap you to a board and cut off a perfectly healthy part of your body. The most sensitive part of your perfect little body will be raw and sore. There is no medical reason for us to do this to you or put you through this pain. But we’re doing it anyway. I don’t know how to stop it. I am failing you. Letting this happen goes against everything I ever wanted to teach you. I don’t know how I’ll be able to look you in the eyes after I do this to you. How can I teach you to love your body when I’m showing you that your body wasn’t good enough? How can I teach you to be confident in being who you are when we’re putting you through surgery just so you’ll fit in? How can I teach you to love and accept others the way they are when we’re rejecting your perfect little brand new body the way it is? How can I teach you to believe in yourself and believe that you can do anything if we think your body needs surgery because we don’t think you’re capable of basic hygiene? And how can I teach you that God made you when I’m showing you that God made a mistake? I’m so sorry for not protecting you. I’m so sorry that I will never be able to be the mother that you deserve now. Please know that I believed in you, XXXX. I believed that you would be a strong, confident man who would love his body the way God made it, love who he was, and not give a damn about what other people thought you should look like or who you should be. I fought for you, XXXX. I just didn’t fight hard enough, and I will regret that for the rest of my life. And I will spend the rest of my life trying my best to undo the damage that I’m letting be done. I will always cherish these first few days of your life, when you were still whole and trusting and the happiest baby I’ve ever seen. The days before I failed you. I love you, XXXX. I’m so so sorry.

Love,
Mommy

This follow-up provides a nice perspective from the mother after she kept her son safe.

Via @IntactVoices.

¹ If only that urologist understood the ethics of circumcising without consent from the healthy patient…

Sexual Control: Making a Permanent, Unnecessary Decision for a Child

It’s rare to find a blatant attempt to explore justifications for the use of male circumcision as a form of sexual control. From Thursday’s debate on SB12-090 (pdf) within the Colorado House Health and Environment Committee, State Representative Sue Schafer directed a request to Dr. Jennifer Johnson. Dr. Johnson testified against the bill, specifically, and child circumcision, generally. Within Dr. Johnson’s opposition, she discussed the nerve endings in the foreskin lost to circumcision. Rep. Schafer asked (audio, excerpted from the legislature’s archive):

Rep. [Lois] Court said earlier “there are no dumb questions”, and that we will speak in a respectful manner, but I’m concerned about the rate of teen pregnancy, the rate of date rape, sexual violence, and when you talk about more nerve endings in the penis, in the foreskin, I’m just wondering if there’s any risk of more sexual activity among young men, more male irresponsibility, so if you’d be good enough to comment on that.

That question isn’t dumb. It’s offensive and insulting. Her underlying implication is that, if non-therapeutic male circumcision could be shown to lower the occurrences of what she’s concerned about, that would dismiss the ethical concerns about negatively affecting male sexuality that apply to every male child circumcision. It implies that it’s acceptable to control male sexuality (i.e. permanently reduce it) to limit sexual activity during teen years. It implies that males may inherently be incapable of controlling their own sexual behavior. There’s also the possibility that her implications are targeted only at the poor, the subject of this bill to restore Medicaid funding for non-therapeutic circumcision. I suspect her concern is for the general application of circumcision upon males, not just poor males covered by Medicaid. Regardless, Rep. Schafer’s question exposes the issue and its connection to unquestioned parental proxy consent for male circumcision, a permanent, non-therapeutic surgical intervention.

It’s useful to have this clear example because it’s a common misconception that male circumcision of minors involves no control or attempted control over male sexuality. That’s a misconception because non-therapeutic male child circumcision is always control. The patient receives only someone else’s idea of what a “normal” penis should be. He can no longer exercise control over his normal, healthy body, only his altered body. The flaw is most commonly some form of drivel about the preferences of the boy’s future sexual partners, which is speculation, but it applies to religious justifications, as well. Someone else imposes what the child “should” want. The truth is clear: all non-therapeutic child genital cutting controls sexuality.

The challenge to defeating the common misconception rests on separating parental intent from the act. The accepted argument entails the idea that male genital cutting can’t be something bad because the parents have good intentions. American parents think they’re doing what’s in the best interests of their sons, so we’re told we must accept that this negates the obvious reality of what the act is and does. That’s flawed because the act matters before we consider intent. Parents do not intend harm, but circumcision (i.e. surgery) causes harm. We can – and must – make a judgment on the act without regard to intent because it’s a non-therapeutic intervention on a non-consenting individual. It fails ethics.

Lawsuits as Strategy

I resisted commenting on this story. I don’t think it’s worth our time as activists for several reasons. One, the petitioner, Dean Cochrun, is an inmate in prison for kidnapping. He’s not exactly a sympathetic individual, even though I agree with the gist of his claim. Two, He’s representing himself. He’s going to make a mess of this, on the off chance it proceeds beyond his initial filing. I read his self-written complaint to judge it. I’m not an attorney so I’m not sufficiently qualified in much of the debate. Still, it’s clear how unfocused and emotional his claim is, when there’s a legitimate approach based on objective facts about circumcision and the unethical disparate treatment of healthy boys and girls. We can do better.

There are some relevant topics to discuss, though, which are brought out in this report by Stephanie Rabiner, Esq. at FindLaw. (Again, the caveat applies that I’m addressing these concerns from a layman’s perspective.)

Can circumcision rob you of your, uh, “sexual prowess”?

A South Dakota man thinks so, which is why he has filed a federal circumcision lawsuit against the hospital where he was born. He claims he only recently learned of his missing foreskin, and that doctors misled his mother into believing the procedure was medically necessary.

This is a fair reading of the complaint, but I don’t think it’s complete to say the he claims doctors misled only his mother. Mr. Cochrun wrote “Unknown Doctor who performed this procedure had misled my mother by failing to inform her that there are no medically necessary reasons for performing this procedure and so by the Unknown Doctors acts or omissions I was permanently and irreversibly scarred and deformed.” In the next two sentences he wrote: “By doing so the Unknown Doctor infringed upon the rights of my mother, father, and self. My mother and father were unable to make an informed decision because they were not provided with the facts necessary.” He references both his parents. This speaks to my claim that his suit is unfocused and poorly structured.

His argument is also problematic because it implies that parents have a right to impose non-therapeutic genital cutting if they’re sufficiently informed. They don’t, partly because they can’t be. The only rights involved in non-therapeutic genital cutting, those that were violated, belong to Mr. Cochrun. That should be the approach for any lawsuit, even if arguing that parents are insufficiently informed of the harms and risks of circumcision is a path to the inevitable, eventual recognition of genital integrity for all children.

Ms. Rabiner’s analysis continues, after a bit of laughing because of his name (an immature aside suggesting she hasn’t quite applied a sufficient openness to the general claims represented within Mr. Cochrun’s suit):

Cochrun, 28, is currently in prison on a kidnapping conviction, according to the Associated Press. This may explain why he had both the time to file such a strange lawsuit and why he only recently became aware that he was lacking in the foreskin department.

Unnerved by this revelation, he now claims he “was robbed of sensitivity during sexual intercourse.” The circumcision lawsuit further states that he lost “the sense of security and well-being I am entitled to in my person.”

Whether or not Mr. Cochrun is truthful in his claim, I do not find it difficult to believe that someone would not know he is circumcised (or intact). It’s common, as demonstrated in studies and anecdotal reports. Culture is weird in many ways. Dismissing such a revelation because it contradicts an assumption suggests we should check the assumption.

But, to the analysis within her post (link in original):

This is all well and good — and a little sad, to be honest — but it’s almost certain that a judge will toss Dean Cochrun’s suit. Here’s why:

  1. Consent. Cochrun was an infant when he was snipped, which means his mother had the legal right to consent to the procedure. There’s no indication that doctors lied to her.
  2. Statute of limitations. Personal injury lawsuits can’t be filed 28 years after the events in question. Sure, some states may toll – or pause – the clock and only restart it when the victim first learns of the injury. But it’s highly unlikely Cochrun didn’t know he was circumcised.
  3. Lack of jurisdiction. Cochrun lives in South Dakota. The hospital he is suing is in South Dakota. He has filed a state law tort claim. He filed his circumcision lawsuit in federal court. Federal courts have no jurisdiction to hear his claim.
As to this third point, even if Dean Cochrun re-filed his circumcision lawsuit in state court, the first two points will still apply. His lawsuit will undoubtedly be cut short.

In reverse order… The last point is the key here, which I didn’t process on my first reading. (Give me an ‘F’ in Civil Procedure, I suppose.) But, yes, that’s the best defense of my request not to get behind this suit or make too much of it. But even if he refiled in a state court, my opinion doesn’t change.

On the second point, from the included link:

… A child or a person with a mental illness is regarded as being incapable of initiating a legal action on her own behalf. Therefore, the time limit will be tolled until some fixed time after the disability has been removed. For example, once a child reaches the age of majority, the counting of time will be resumed. …

If this South Dakota code is what would apply in state court and I read it correctly¹, the clock began on Mr. Cochrun’s 18th birthday and ran out on his 19th birthday. Arguing that this suit is faulty because he filed 28 years after his circumcision seems to be incorrect. It should be that he filed 9 years too late. For purposes here, I’m granting that Mr. Cochrun’s “[m]ere ignorance of the existence of a cause of action” did not toll the statute of limitations because “the facts could have been learned by inquiry or diligence”, even though I’ve already demonstrated that it’s possible he may not have known his circumcision status until recently. Whether or not it’s true, it could be. It deserves serious consideration, even if it doesn’t change the conclusion on Mr. Cochrun’s claim.

Speaking of what deserves serious consideration, the correct consent argument relevant to non-therapeutic child circumcision is not presented in Ms. Rabiner’s analysis. I have no doubt that she’s correct that the consent involved rests on legal rather than right. It’s also probably nuanced and complicated with a long history in the common law. But that’s what needs to change. It already has with respect to female minors, so the notion that parents have a right to surgically alter (i.e. harm) a healthy child, but only a male child, is odd and needs to be relegated to the past as a relic of flawed, inexcusable human thinking. If it’s a right, it’s a right against all healthy children, not just male children. Any continued defense of a discriminatory distinction as a parental right is a problematic continuation of our shallow, uncritical thinking on the harm of circumcision. Non-therapeutic genital cutting on a non-consenting individual is either wrong or it’s not.

The best way to achieve full protection of genital integrity and bodily autonomy is through cultural change. It’ll be the most likely to last. But that’s slow, and real individuals have their rights violated while that change develops. Thus, other methods are valid to achieve the same result. Next best is to have elected officials extend the protection we provide to everyone but male minors to male minors, as well. Given how likely that is(n’t), other options are necessary. Which leaves us with lawsuits. The courts are (hopefully) an impartial place to work out these issues to respect the rights of all individuals. Punishing those who violate the rights (and bodies) of children, even if punishment occurs only in civil court, will circle back as an incentive on cultural change. The idea of Mr. Cochrun’s lawsuit is spot on, even where it’s execution is misguided and flawed.

¹ Any lawyers who may read this, please don’t be afraid to correct me on this.

“Since not all men are willing to be circumcised,…” (Part 2)

Update (5/31/2012): To the extent appropriate, my update to Part 1 applies here. I have not edited anything in this post, though. [End Update]

Note: Here is Part 1 of this series rebutting the recent meta-analysis purporting to demonstrate that infancy is the best time to impose circumcision on healthy males.

The interesting thing about the Brian Morris, Jake Waskett, et al article, “A ‘Snip’ in time: what is the best age to circumcise?”, is how reckless they are with their logic. They toss out information without regard for obvious rebuttals or how unrelated the so-called evidence is to their conclusion. If they think it might stick, they include it. One can only conclude that they started with the outcome of their analysis before gathering the supporting data.

For example, in their conclusion, they write that early circumcision “means an assurance of greatly reduced risk of penile cancer later in life, no smegma, better hygiene, and lower risk of various STIs.” They don’t include anything on why smegma is supposedly bad and thus indicates circumcision is not only good, but should be imposed on healthy infants. I’m sure they can find something, although I doubt it would be compelling. There’s also the logical question of why it’s an indication for non-therapeutic genital cutting on boys but not girls, who also develop smegma.

They continue this effort in their conclusion. In a sub-heading they write:

Some of the arguments against waiting until later to circumcise are:

• The cost (to the individual or the public purse) is much higher, and often unaffordable, for later circumcision.

The cost to the individual who doesn’t need circumcision later in life is zero. That population would be very large for males left intact. Even from the irrelevant “public purse” approach, they would need to calculate the cost of therapeutic circumcision paid for by they public later in life against the cost of non-therapeutic neonatal circumcision (cost per instance X number of instances). They don’t.

Also, the time value of money must be factored into the comparison. A dollar spent today is not the same as a dollar spent twenty, thirty, or more years from today. The number of adult circumcisions needed would have to be even greater to justify their public purse argument. It still wouldn’t be ethical to circumcise healthy infants, of course.

That’s not the worst “argument against waiting” they offer. This is:

• Educational resources for boys to make an informed decision are quite limited.

I had to read this several times to be certain it said what I read. They can’t be this ridiculous. They are.

The immediate, obvious rejection of that nonsense is that boys (and adult males) can use the same educational resources Morris, Waskett, et al suggest parents use to make an “informed” decision. Surely they exist, or else the position that parents can make an informed decision without adequate educational resources is irresponsible. What makes the male himself too stupid to understand the same materials? There’s no defense for their statement or their conclusions.

They offer a few more:

• Boys who later choose circumcision will likely wish it had been circumcised in infancy.

This is the bizarre argument I’ve encountered from Waskett, the mythical “right” to grow up circumcised. But this is the radical position. Boys who would later reject circumcision can’t undo the harm imposed on them. The authors incorrectly dismiss this. It is the center of both the physical and ethical argument against non-therapeutic child circumcision.

• Many older boys and men may not want to face an operation even though they wish to be circumcised.

That ties to a statement earlier in their article:

Even if a man is willing to be circumcised this does not mean he will end up having the procedure done. On the other hand, a lack of willingness to be circumcised should not be interpreted as a preference to be uncircumcised. This is because a large number of obstacles have been documented, such as fear of pain or complications, embarrassment, inconvenience and cost. The obstacles are discussed in the following sections. It is reasonable to suppose that, if these barriers could be addressed through the provision of correct information and financial assistance, the fraction of men willing to be circumcised would increase significantly. Better education of parents before or soon after their baby is born about actual risks should, by helping to ensure a circumcision in infancy, avoid later deliberations and barriers to circumcision in adolescence and adulthood.

That’s very convenient for their preference. Just assume anything that helps your position and disregard anything the suggests something else. Notice the shift in that paragraph. The last sentence of that paragraph has zero relation to the rest of the paragraph. A male’s refusal to be circumcised despite a claimed desire to be circumcised demonstrates that he values avoiding the costs more than receiving the benefits. The only reasonable supposition is that the infant would likewise be unwilling to undergo circumcision if left his choice. The authors’ suggestion is nonsense.

There is at least one more installment to come.

Parental Regrets

Here’s something a little bit different that offers some insight into parental choices for children:

Picking a baby name is a difficult task for many parents.

And new research suggests that more than half (54 per cent) go on to regret their original choice.

Around 49 per cent of those surveyed said the name they originally chose for their newborn failed to reflect its personality later in life.
…

Nifa McLaughlin, editor of parenting website gurgle.com which commissioned the survey of 1,000 parents, said: ‘Choosing the right name for your children can be a tough job.

I don’t pretend that this is scientific. It is another way to look at the reality that people’s preferences are different and can change over time. If there’s a chance parents may become unhappy with a choice they made, what makes anyone arrogant enough to think it’s acceptable to force something irrevocably permanent (i.e. circumcision) onto a healthy child?

This is best expressed with this quote from McLaughlin:

‘However, there is never any way of guaranteeing your little one will like what you choose… hopefully it starts to suit them more and more as their personality develops.’

If a name doesn’t suit a child’s preference (the correct focus), the child can change his or her legal name. An individual can’t change genital cutting once it’s imposed.

Link via Family Law Prof Blog.

What Applying the Science Says About Circumcision

It’s frustrating to read people writing about the science of non-therapeutic infant circumcision while omitting ethics and a full consideration of what constitutes harm. Such is the case with a series of posts at SquintMom. The blogger, Kirstin, is doing a series of three posts, “What the Science Says About Circumcision”. Part 1 on the benefits is here. Part 2 on the risks is here.

I have a lot to say on the two entries posted so far, but I’d rather organize my thoughts into identifying a more generalized flaw in the series. As I said, this is primarily the ethics of applying the science. Several times in Part 1, she uses parentheticals to explain the circumcised men in the studies. “With their permission”. “With their consent”. This matters. She concludes that there aren’t enough benefits to support routine circumcision in the U.S., which is the right conclusion. But her assumption seems to be that some level of benefit could justify routine infant circumcision. That’s too utilitarian. Individuals have different levels of risk aversion. A male’s willingness to accept risk may be greater than his parents’. We can’t know. Even if our HIV problem in the U.S. matched that of sub-Saharan Africa, I wouldn’t want to be circumcised. I’m responsible. I do not need circumcision to reduce my risk beyond the trivial risk I would face. No level of benefit could justify circumcising me without my permission and consent.

A willingness to carry “I don’t know” through its implications is the better conclusion for Part 2. That’s not what she offers. It’s incorrect to say “[i]t’s fine to make a decision based upon values”, as she did in her intro to Part 1. Circumcision causes physical harm, contrary to her conclusion. That she thinks that isn’t “significant”, a subjective word in the application of the science to healthy individuals, isn’t relevant to what we should allow parents to do to their – male, only¹ – children. What does the healthy male want? She mistakenly gives this no weight in her conclusion.

On the topic of harm, it’s worth starting on the legal point. Legally, all surgery is battery. Circumcision is surgery. Therefore, circumcision is battery. It is physical harm. It removes the normal, healthy foreskin. It involves risks, however insignificant they may seem to anyone other than the patient. Someone will be the statistic. He matters, too. (Again, this omission is why utilitarianism is awful.) It leaves a scar in every case. There is objective, guaranteed physical harm. To conclude that there is no physical harm to every circumcised male rather than just those who experience complications, as she did, is factually incorrect.

The legal defense to surgery as battery is consent. But non-therapeutic infant circumcision involves proxy consent, which requires a different standard. The objective is least invasive procedure possible that preserves the patient’s choices to the greatest extent possible. Since there is no procedure indicated because the child is healthy, there is no decision to be made. Permitting non-therapeutic circumcision is unethical. To address SquintMom’s recent post, “Options, Ethics, and Moral Imperatives”, a society’s overarching social philosophy can be wrong. Here, it is because non-therapeutic (i.e. “routine”) child circumcision involves objective, permanent physical harm without objective benefit.

As an example of where SquintMom went astray, I think this is a solid example (emphasis in original):

While the foreskin has sensory function (Taylor et al), there is no scientific evidence to suggest that the loss of these receptors affects sexual satisfaction or the intensity of the sexual experience for men. One study even goes so far as to suggest that while there isn’t currently evidence to support the notion that circumcision somewhat desensitizes men, even if such evidence existed, it wouldn’t necessarily be a bad thing, given that more men (and their partners) complain of premature ejaculation than complain of inability to achieve orgasm (Burger et al). While Burger doesn’t go so far as to suggest circumcision to prevent problems with premature ejaculation, these observations do put into perspective the “intactivist” argument that circumcised men don’t enjoy sex as much as they otherwise would; clearly, for the vast majority of men, enjoying sex isn’t a problem. The scientific evidence does not support the notion that male circumcision diminishes sexual performance in men, nor sexual satisfaction in men or women.

First, note the utilitarianism again. The foreskin has sensory function, but no evidence suggests… More men complain of X than complain of Y. That doesn’t eliminate the possibility that a man will want that sensory function or the concern for Y and the individuals who experience that. (I do not assume it is a direct result of circumcision.) Apart from the obvious fact that the loss of that possibly irrelevant sensory function still constitutes harm, SquintMom’s statement implies that all men value everything in the same way, or that they “should” value X more than Y. That’s obviously false. I don’t like coffee. Therefore, you don’t like coffee. Valid?

Clearly, for the vast majority of men, enjoying sex isn’t a problem. Yep. So? The better response is to carry through the implications of “I don’t know”, since we can definitively say not all circumcised males will enjoy sex. Specifically, we need not go beyond the men who are the statistics, the ones who incur a complication that is severe. The number of males who lose their glans, their penis, or their life is small, but the number is not zero. Who is going to be that male? We don’t know. Permitting parents to cause harm by applying the science of “no scientific evidence of harm” to their healthy – male, only – children means there will be males who either don’t enjoy sex or don’t live to enjoy sex. Applying the science of “no scientific evidence of harm” also assumes we won’t find any evidence in the future. The truth is that we don’t know.

She mostly expresses this point (e.g. “untestable claim”), but it’s not complete. Even ignoring what I wrote above on harm, it’s not definitive from her case that there is no physical harm from male circumcision. There is the possibility we’ll know more. In proxy consent, it doesn’t make sense to then apply the science of today permanently to the healthy body of another person based on parental values.

**********

¹ In her first post, she prefaced the series with “[f]emale circumcision is a completely separate practice, occurring for the express purpose of destroying sexual function.” She is wrong on both positions. (She repeats the former in the comment section of Part 2.) Female genital mutilation is usually imposed with that purpose, but not always. Cultural behaviors are complex, as she points out in her series. Why should it be different on something we (rightfully) abhor? (c.f. Consider these three posts.)

Anyway, the comparison is non-therapeutic genital cutting on a non-consenting individual. It can’t be wrong for one gender but acceptable for the other. There is no parental right to cut sons. That’s a bizarre world in which males and females have unequal rights to their own bodies. There is either a parental right to cut the genitals of healthy children, or no such right to cut healthy children. We rightly call the removal of a healthy girl’s clitoral hood “mutilation”. There is no ethical, legal, or scientific distinction to avoid protecting the analogous healthy body part in males.

This is what the World Health Organization states on FGM. It consists of four types, including type 4:

Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

Surgical alteration of the normal human body is harm.

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.

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 of cultural values? That’s absurd.

“Since not all men are willing to be circumcised, …” (Part 1)

Update (5/31/2012): I modified the first paragraph to focus my jabs. I should not have been as broadly rude as I was. I have great contempt for Brian Morris, but he should’ve been the only target for that contempt. The other authors merely frustrate me via either personal interactions or their public statements. In my interactions with Mr. Waskett, specifically, I haven’t experienced the contemptible behavior so easily witnessed from Morris. I regret that mistake.

A long list of familiar names have conducted a meta-analysis of a bunch of studies involving circumcision. The article purports to ask the question “What is the best age to circumcise?”. (Notice the implicit assumption that a male should be circumcised.) They don’t address that question, of course, instead answering “How can we encourage infant circumcision?”. They only justify it in their minds because their analysis is lacking. I didn’t expect anything better after seeing Brian Morris attached to it. (Jake Waskett, Aaron Tobian, Ronald Gray, Robert Bailey, Daniel Halperin, and Thomas Wiswell, among others, are listed as co-authors.)

I’ll probably post more extensive critiques because it all deserves as public an airing as possible. Their credibility deserves to be attached to this awful piece of scholarship. For now, I want to focus on this, from the section titled “Is infancy the best time medically?”. It offers a succinct example of their incomplete, flawed approach.

All boys are born with phimosis. This resolves by about age 3 in all but approximately 10% of males, who as a result experience problems with micturition, ballooning of the foreskin, and painful difficulties with erections (see review [9]). Paraphimosis can similarly be prevented by infant MC.

This is silly. All boys are born with phimosis? That’s a stupid way to explain normal human development. They’re pathologizing the healthy infant foreskin to justify the conclusion they want to reach. How many of those boys in the 10% will have their foreskin naturally separate (i.e. “resolve”) after age 3 and will never need any intervention to achieve this? They’re implying that an intervention is necessary for healthy, intact three-year-old boys whose foreskin hasn’t fully separated. (The whole paper is that, except stated rather than implied.)

Throughout the paper, they never consider the important question when reaching the conclusion that something can be “prevented by infant MC”: how many legitimate instances of phimosis/paraphimosis/UTI/whatever require circumcision later in life because another, less invasive intervention is insufficient. They declare that the risk in intact males “of developing a condition requiring medical attention over their lifetime = 1 in 2”. (I’ll grant that because it doesn’t alter the conclusion on non-therapeutic infant circumcision.) They never identify how many of those require circumcision. Yet they use this 50% figure as a justification for infant circumcision. The need for circumcision rather than the need for medical intervention is what’s relevant. Their focus is mistaken and leads to their incorrect conclusion.

In the “Cosmetic Outcome” section, they write:

When circumcision is performed in infancy the ability of the inner and outer foreskin layers to adhere to each other means sutures are rarely needed and the scar that results is virtually invisible [98]. Other factors include the more rapid healing at this time of life, contributed by age-associated differences in pro-inflammatory factors that might affect scar formation [145].

Once again they’re using normal human development to manipulate a path to their predetermined conclusion. They’re using a convenient aspect of the surgical procedure rather than medical need to justify imposing the surgical procedure.

The ability of an infant’s inner and outer foreskin layers to adhere to each other once cut also demonstrates that boys are not born with phimosis. This ability is evidence that the normal foreskin is not supposed to be separated from the rest of the penis at birth. Neither argument is a valid defense of infant circumcision, but the authors can’t have both in their attempt. Doing so is just a way of presenting the preferences they like as the only preferences worth considering. That’s biased by the authors’ utilitarianism. Remember when I wrote “[t]he utilitarian approach is subjective and has a tendency to favor whatever argument someone is making because it assumes all people favor the same choices”? Their article is a perfect example of that.

Since that ability is classified under “cosmetic outcome”, let’s discuss that. My circumcision healed the way they suggest. The scar did not heal “virtually invisible” for me. Any cursory review of pictures of circumcised penises will show that the scar is almost always quite visible. My complexion is very light, so I suspect my scar is less visible than what most males experience. But it’s still quite visible. They’re wrong. This error is inexcusable.

Perhaps the cosmetic outcomes of circumcision, infant or adult, are desirable to Morris, Waskett, et al. They’re entitled to their opinions about their own bodies. It does not follow that parents who share that preference may force those onto the body of a child – male only – who may not share that preference. The cosmetic outcome of circumcision is hideously ugly to me. I wouldn’t choose it for myself if I still had my choice. I am not the only one, since not all men are willing to be circumcised. The author’s opinion or statistics on female preferences about a male’s normal body are irrelevant until and unless the individual decides he wants himself circumcised.

Unsurprisingly, the authors never discuss male preference in the Ethics section. (More on that later.) The title of this post is the closest they get to mentioning the possibility. They mistakenly use that sentiment to reach the conclusion that infants should be circumcised. They endorse the view that if you can’t convince someone, promoting its imposition on them is somehow defensible. It isn’t.